Friends,
Probably most members of our Meeting Community don’t know that I am a
pulmonologist with over 40 years of teaching pulmonary physiology at GW,
running a physiology lab at VA, and managing patients with respiratory failure
on ventilators in the ICU- retired for past 4 years.
So let me provide some perspective on the question of how we should take care
of ourselves if we become infected with SARS-covid 19.
Though not still in the thick of things, I’ve been following the medical
literature on covid.
And it’s now clear that there are two kinds of respiratory failure. Both are
associated with a drop in blood oxygen, measured by the pulse oximeter (SpO2).
The angiotensin receptors by which this virus attaches to human cells are most
abundant in heart and lungs, which explains why pulmonary blood vessels, heart,
and pulmonary tissues are so susceptible.
The first Pattern of respiratory failure is primarily a problem of impairment
in the pulmonary blood vessels with reduced blood flow to the lungs but the
lung tissue itself is open and normally elastic. This is associated with
increased clotting in the inflamed blood vessels, which further blocks flow in
these pulmonary arteries. This may contribute to sudden death episodes in
people without severe symptoms.
This pulmonary blood flow pattern of covid disease can be managed at first with
oxygen and positive airway pressure (including CPAP or BIPAP). Usefulness of
anticoagulation is still unclear. But it may be helpful to take one daily
aspirin to reduce clotting. This has NOT BEEN TESTED. (Aspirin effect on
platelets lasts days- would not be needed if other blood thinning med is on
board)
HOWEVER, as this pattern of disease worsens, often high flow oxygen and large
inflation volumes are needed to get enough oxygen into the reduced blood
flowing through the lung. IV anticoagulants May be needed. This technology
isn’t readily available at home- it requires a lot of oxygen, much more than a
home oxygen generator can extract from room air and more than O2 tanks can
provide for long. So hospital care may be needed. Still it’s worth a try at
first, while waiting for the infection to subside.
This form was not originally recognized at the outset of this pandemic, and
these people were placed on ventilators and managed inappropriately, as if they
had the usual respiratory failure with stiff fluid-filled lungs, associated
with influenza, which treatment can injure relatively normal lungs with bad
outcomes. This is one reason why the original ICU and ventilator outcomes were
so dreadful.
But the second pattern of respiratory failure that can occur, is the classic
ARDS, adult respiratory distress syndrome, with stiff lungs full of
inflammatory and heart failure fluid. For these people, sophisticated ICU
monitoring with IV meds and ventilator management is crucial to get oxygen into
the blood and maintain blood flow to the vital organs, supporting the whole
individual while waiting for spontaneous immune or pharmacological control of
the virus.
So, how to manage at home:
Most of us have an oxygen saturation (SpO2) in the 95-97% range.
If you test positive for covid, of course it’s crucial to quarantine, notify
your primary physician, measure your temp 2-3 times a day, rest and drink lots
of fluids, and take Tylenol 3-4 times a day if you have a fever of 101 or
higher (avoiding all alcohol intake). If you have respiratory symptoms, It’s
also reasonable to check SpO2 carefully 3 times a day. Carefully means sitting,
probe on second or middle finger, hand warm (under a blanket or wrap), and
waiting for at least 1-2 minutes for a stable reading. This measurement is
helpful because many things can make you feel short of breath in this
situation- especially anxiety and asthma as we enter allergy season. But these
do not drop SpO2, and usually don’t need oxygen. (If you are wheezing, use
your asthma inhaler, of course.)
Establish your baseline SpO2.
If you are short of breath and it drops below 94 or 2 points below your
baseline on two measurements in a row (at least 3-4 hours apart), notify your
primary physician, and it’s reasonable to consider using CPAP and/or oxygen at
home. Then recheck your SpO2 at 1-2 hour intervals. (Borrowing pulse oximeters,
wiped with 60% alcohol is fine. But COAP machines can’t be shared without
professional cleaning)
BUT, if you’re short of breath and SpO2 is less than 92% on 2 sequential
measurements, you need to notify your primary physician and make arrangements
to go to hospital. There they can determine what’s going on in your lungs
-whether you simply need high flow oxygen (likely what happened to Boris
Johnson, Britain’s prime minister) or need more intensive treatment.
I hope this helps orient our community.
Yours in the light,
Ann
Sent from my iPhone
On Apr 22, 2020, at 10:50 AM, Paul Werbos <werbos@xxxxxxxx> wrote:
Thank you, Naomi.
This is interesting.
Last week, people from Brazil told me "It's NOT lung function directly but
what happens to blood that kills people.
We have an ozone technology which purifies blood, and works well treating
people."
I wonder. Your axiometer story does fit that story. But of course, I do not
know.
On Wed, Apr 22, 2020 at 8:24 AM NAOMI THIERS <naomihope@xxxxxxxxxxx> wrote:Friends (& Dona)-- as we hold Paul M & others in the light, I wanted to let
folks know I've bought 2 "pulse oxiometers" (coming from Amazon any day) &
would be glad to loan one to someone who's sick/worried & wants to closely
monitor their blood oxygen level.
This device let's you check how much oxygen's in yr blood, so it's good for
seeing if your lung function is in trouble (as I understand it)**. It seems
at times people w/ COVID can't tell how badly their lungs are doing until
lungs are suddenly doing VERy bad & they get to the hospital/on breathing
support later than they should have.
These devices are (for now) easily ordered online--they seem out of stock in
most drugstores. I went ahead & ordered 2 in case they end up being hard to
find-- one seems a good idea for someone w/ the virus at home who wants to
monitor themself closely. As I said, I don't have mine yet, but just let me
know if you'd like to borrow it once I get it.
In the light
Naomi
**Medical Friends correct me if I'm wrong☺️
On April 21, 2020 at 9:58 PM Paul Werbos <werbos@xxxxxxxx> wrote:
Hi, Dona!
Again and again, I find that the risks and opportunities/hopes are much
bigger than people tend to assume. So I would try to do some worst case
planning, EVEN when I dont believe that the worst will happen, and think of
positive possibilities more.
But... in the worst case.. I am impressed by the growing stories saying not
to go to the hospital even in worst case. In the very worst case, when
people think they need ventilators, it sounds to me as if they do more harm
than good! Someone spoke of staying home with a CPAP machine (and oxygen
tanks?), and that working much better than ventilators. I have at times
discussed with Doug Neal: should Meeting buy a CPAP machine to have handy
to loan out for times of need (or rather relatively high but brief risk,
no more than two weeks)?
Just think. In two weeks, if the new Abbott test certifies that Paul is now
immune, he will be free of so many constraints the rest of us need to stick
with...
Best of luck,
Paul
On Tue, Apr 21, 2020 at 9:23 PM Dona Boyce-Manoukian < donabman@xxxxxxxxx>
wrote:
Friends:
Just thought I would let you know as a follow up to my announcement after
Meeting on First Day asking for Holding in the Light for my husband, Paul.
We were tested yesterday for Covid-19 and he is positive. (I am
negative--so far).
He had a bad day yesterday but today is much better. He simply feels
sick and has some body aches. Today he does not have any elevated
temperature and he has no problem breathing. We are in contact with the GP
and taking all the precautions possible plus good nutrition and pushing
fluids. Now, he just sleeps and rests most of the time.
We have many friends, including this LHMM community for which I am
extremely thankful and grateful.
I am still active and attempt to take care of myself in this
contaminated environment. I get outside a lot and leave the windows and
doors open when weather permits. I don't need anything crucial. Two of
our children live nearby and do shopping for us. Our third child who
lives in Columbus is head of the IT for a law firm and he has been working
overtime. He took a break yesterday and went on a bike ride. He had a one
person accident which resulted in a fall and a fractured acetabelum. He
had surgery this morning and is doing as expected. Lots of pain... He
expects to be discharged tomorrow or Thursday which is a good move to get
him out of the hospital as soon as possible.
Be well,
Dona M.
