News — At The Edge — 3/21
A collaborative guide to COVID-19 care
Emerging Symptoms
Notice if you suffer from any of the following first symptoms:
· Fever
· Fatigue
· Sore throat
· Dry (unproductive) cough
· Coughing up slime
· Joint / muscle pain
· Shortness of breath
· Lack of hunger
Initial symptoms may also include headache, chills, dizziness, nasal congestion, abdominal pain, diarrhea, nausea, and vomiting. Later in the infection, symptoms may include loss of smell and taste lasting for several days.
Note: Fever is not subjective. You will need a thermometer (or two), and to keep track in a log of at least daily temperature. If you choose to take temperature internally (i.e., in the bottom / rectum), it will be more precise. Be sure you have enough wipes and alcohol to clean the thermometer after each use. If taking temperature orally, don’t eat or drink for 20 minutes beforehand. Either way, note the method in your log so healthcare personnel know which it is. (Around .7 degrees Celsius is often added to oral temperatures.) Here are some good instructions for how to take an oral temperature.
Diagnosis
There will be different policies surrounding testing for COVID-19 based on where you are and what stage of the pandemic your area is in. Check online, call official hotline numbers, follow official guidelines, and consider driving to a drive-through testing center if your area has one and the patient qualifies for testing. You should not just show up at a doctor’s office or a hospital unannounced if you just experience the first symptoms.
Remember: Hospitals are bad places to be until you absolutely have to be there: You and / or the patient run the risk of getting additional infections that, when bacterial or fungal, are much more likely to be resistant to standard treatments due to the nature of the hospital environment. Also: Many hospitals are going to be overloaded.
Diary
Now is the right time to start an illness diary.
A few times a day, preferably at somewhat regular hours or points in your normal routines or rhythms (e.g., every morning before making coffee or tea), measure temperature, even if you don’t feel like you have a fever (yet). Weigh once a day if possible. Also note respiratory and heart rates in breaths and beats per minute. It will get you used to doing these things, give you practise, and (if you start early) give you some idea what (more or less) healthy values for you look like. Not necessary, but extra points for blood pressure and oxygenation.
Then write down any symptoms the patient has. If he or she is in pain, where and when is the pain, and how bad on a scale of 0 (no pain) to 10 (worst pain imaginable)? How bad is the cough? What color if there is mucus being produced? Be sure to note what medication, if any, the patient takes.
Paracetamol (also known as acetaminophen) is a good choice for fever and pain suppression. Keeping an illness diary will also help you to keep track of how much you’ve taken, when, to ensure you treat fever adequately without taking more than the recommended amount in a 24-hour period.
Get healthy again
Treat pain and fever with over-the-counter medication at the recommended safe dosages. Use paracetamol (also known as acetaminophen) if you can. Questions are emerging surrounding the safety of ibuprofen / non-steroidal anti-inflammatory medications as well as corticosteroids / steroidal anti-inflammatory medications, in case of coronavirus. If possible, avoid their use if you have symptoms. An additional safe way to treat fever is to take a bath or shower. The water temperature should be comfortable, not cold, because shivering can raise your core body temperature — and the idea is to lower it. When you get out of the bath or shower, the leftover water evaporating like sweat from your skin can help lower your temperature.
Try to keep eating nutritious food. Nothing too heavy, not too much at the same time. Lots of vitamins and fresh produce. Adequate carbohydrates (potatoes, rice, pasta, etc). Inhale steam 3+ times a day. Go for a daily walk when possible, while keeping distance from other people. If your throat is irritated, avoid acidic drinks (such as soda and juice) as they can be further irritating; water and teas are better choices then.
Notice the color and amount of your urine. If it is dark (more colored than clear), or there is not a lot, drink more water. It is very important to avoid and treat dehydration by drinking enough, even though it can be hard to drink enough when you have a fever / are sweating a lot, and are suffering from fatigue and discomfort due to illness. If you are struggling to drink enough and beginning to show signs of dehydration like darker urine, you might also try eating foods containing more water (e.g., cucumber, oranges, apples), sipping on boullion or soup, or setting a small goal for yourself (e.g., every time you get up, drink a glass of water).
Coughing can be an important, healthy effort on the part of the body to clear the lungs of fluid so you can breathe easier. Do not suppress a productive cough all the time / just because you don’t want to be coughing. However, if you want to try to suppress your cough enough to get a good night’s sleep so your body can better heal itself, then over-the-counter cough medications, herbal teas such as anise / chamomile, cocoa, and lozenges can help. Some over-the-counter cough medications contain ingredients like guaifenesin or NAC, generally considered safe mucolytics that relieve coughing by helping your body get rid of mucus (usually by making it thinner and so easier to cough up); your pharmacist can help you find one that’s right for you.
Feeling better?
Before you break your quarantine, health authorities may want to (re)test you to see you are really not contagious anymore. But maybe the number of cases is already so high that people will have to make their own decisions. Err on the side of safety and try to stay home for a little longer than officially indicated.
Bedridden
All the good care has not worked and things are getting worse. He or she is often too weak to get out of bed and may need extra encouragement to eat and drink. Otherwise try to judge what is wisest in your circumstances. By all means do not wait with this until the very last moment, because if the disease progresses, you will get short of breath which inevitably will also affect your ability to talk and to think clearly.
In any case
· Stay in bed. At this point rest is very important. The patient should sleep as much as possible. At least in the beginning, patients will still be able to get out of bed for limited amounts of time.
· Toilet, a quick rinse-off shower, weighing once a day (note in diary). Put new sheets on the bed as often as possible and wash the old sheets at 60 degrees Celsius or warmer.
· Ventilate the room as often as possible.
· Drink more water! (more than 2 liters and less then 5 liters a day).
· Try to eat vitamin-rich foods, but multi-vitamin drink is also ok.
· Inhale more often.
At this point, monitor the patient more and more closely so as to catch early any signs that the patient is in trouble. For instance: If the patient is not able to drink at least 2 liters of fluids per day, you should (kindly) insist. Dehydration is a medical condition, and without this daily bare minimum you’re quickly in trouble.
In most cases, however, the patient will improve after a few days or at most a week. Just stay with it. Once the patient gets a little better, care may be done by the patient him- or herself again. Make sure the illness diary and quarantine are kept up until the patient has been completely well for a while. If you have been caring for the patient, your own two-week self-quarantine period now begins.
At this stage, watch out especially for and note symptoms that might suggest worsening. Read the next section for more detail, but these include dizziness or rapid heart rate (drink more and eat something if you can), rapid breathing (elevate head while lying down or lower it to the table while sitting up for easier breathing), and a blue tint to fingertips or lips (cyanosis — get fresh air, get warm, and check blood oxygenation if possible). Also consider using relaxation techniques to slow a rapid respiration or heart rate that may be partially due to anxiety: Listen to soothing music, check in with a friend electronically, or see if you can slow your breathing and bring down your heart rate by counting longer for forceful exhaling than for gentle inhaling. (Some people use 4–7–8 and others prefer 5–2–5 to try slowing down their inhale-hold-exhale patterns.)
If you think the patient’s condition might be worsening, your illness diary might expand to include the following:
· more frequent temperature readings
· respiration rate (breaths per minute)
· heart rate
· onset of new confusion
Professionals Take Over
As symptoms get worse and the patient deteriorates, the frequency with which measurements are taken should go up. At this point, your log should contain temperature, respiration, and heart rate every few hours.
You should interpret any of the following as a medical emergency:
* Loss of consciousness
There’s different levels. When patient loses consciousness, make a note of whether the patient responds when you call their name (Voice), when you pinch the shoulder forcefully (Pain) or whether he/she does not respond at all (Unresponsive)
If loss of consciousness is brief, home care may include encouraging the patient to eat and drink, and freshly ventilating the room. But if this persists, get help.
* Cognitive problems / confusion
You probably know the patient, so you should be able to tell without any fancy tests if / when they are not with it anymore. But here’s the Abbreviated Mental Test Score (the AMTS) sometimes used to assess for cognitive problems. Compile the score by asking the following questions, giving one point for each correct answer. A score of less than or equal to 8 suggests cognitive problems may be present.
· What is your age?
· What is the time to the nearest hour?
· (Give the patient an address, and ask him or her to repeat it at the end of the test. For example, 42 Hacker Way.)
· What year is it?
· What is the name of the person you are seeing today?
· (Can the patient recognize two persons (e.g., friends or medical practitioners)?)
· What is your date of birth?
· In what year did World War II end?
· Name the current President / Prime Minister.
· Count backwards from 10 down to 1.
Immediate home care for cognitive problems / confusion may include encouraging the patient to eat and drink, being sure appropriate fever medication has been taken on schedule, and freshly ventilating the room. But really, again, new and persistent confusion is a bad sign. Time to get help.
* Too high or too low respiration rate
Count respirations per minute by holding your hand close enough to feel the patient’s breath, watching his or her chest, and / or watching his or her abdomen, while holding a clock with a second hand or a digital watch / phone stopwatch. Respiration rate (RR) should be between 12 and 20 breaths per minute.
Immediate home care for respiratory problems may include ventilating the patient’s room and propping him or her up so that he or she can be in an upright but comfortably resting position. It is also a good idea to elevate the head of the bed for sleeping if possible, and there are some sleeping positions that can make breathing easier, too (see Level 3, Care work).
If you or the patient are experiencing shortness of breath / labored breathing, seek medical advice.
* Low oxygen saturation
If you have an oxymeter (see shopping page), any oxygen saturation lower than 95% may indicate a respiratory problem. If at any stage the patient’s lips or fingertips turn blue (or even mildly blue) (called cyanosis), call an ambulance! Anything less than 96%, get fresh air into the patient’s room, and get him or her warm.
If the patient’s skin gets a lacy purple overlay (also called livedo reticularis) like below (and that’s not normal for the patient), that is also a reason to call for help.
* Very low blood pressure
Blood pressure lower than the bottom of the normal range (90 mmHg systolic, 60 mmHg diastolic) is cause for concern.
Dehydration is a common cause of low blood pressure, so immediate home care may include encouraging the patient to eat and drink, especially foods or beverages containing essential electrolytes like potassium and sodium. Dizziness is a common symptom of low blood pressure, so the dizzy patient will want to be careful while changing positions (laying to sitting up, sitting to standing); fainting may occur. But really, once again, if things do not look right somehow — if blood pressure is very low, or if the patient normally has high blood pressure and it’s looking much lower than their normal — again, get help.
* Too high or too low heart rate
Heart rate is easier to measure than blood pressure, and usually high heart rate (above 100–110 beats per minute for an adult) goes with low blood pressure. Smaller people and children often have normally higher heart rates. High heart rate alone may not be cause for alarm, as it may indicate anxiety or dehydration. Relaxation techniques and drinking / eating something might be appropriate. But once again, values outside the normal range here should cue you to seek medical help immediately. This is especially true if you see rapid breathing along with low blood pressure or high heart rate and / or confusion.
* Very high fever that comes (back) suddenly
If you check temperatures regularly, you will want to be aware that the trend can reverse suddenly, even when the patient seemed to be doing better earlier. Regular measurements are important. A fever that is very high (> 39° Celsius) is a cue to seek medical help. So is a fever that goes away and then comes back suddenly.
Call for help
When any of the above symptoms occur, things are serious! If at all possible, this is the point where you should not be taking any decisions based on a guide from the internet anymore. Do not wait for things to get worse. Call a doctor, or call the emergency number and get the patient in an ambulance pronto. Stay calm and report the situation as it is.
System Overload
What if the official channels are overloaded?
What we’re unfortunately seeing in some areas is that the system becomes stressed to a breaking point if too many people become sick at the same time. Either you cannot get through, you are told the ambulance is going to take a while, hospitals are not taking new patients
In the event that official means of getting medical help are unavailable, you might want to try to get hold of that doctor you know, the nurse down the street, anyone with medical training and / or experience. If that doesn’t work, depending on the urgency, you might want to mobilize your and the patient’s wider circle know you have a patient who is not doing well and that you cannot get help. Ask around for doctors or nurses.
If you do get through (by phone?) try to stay calm and help the doctor / hospital assess the situation quickly.
In cases where ambulances are the bottleneck and you feel you need one, you will have to make your own judgement whether you want to try and drive to the emergency room or wait and hope to get through. Plan which hospital you go to first and maybe have someone who is not driving with access to the internet, either in the car or on the speakerphone. https://covid-at-home.info/
*****
Coronavirus will linger after the pandemic ends. But it won’t be as bad. —
“[Virus] probably infecting between 40 and 70 percent of the global population during its first wave…over a painful six to 12 months…[but] once the first wave is done, the virus is probably here to stay…[and] the age distribution of infection changes….
[If] it confers long-lasting immunity…[most] adults will be immune, and new infections will be [children]….Still, subsequent infections…[will] be less severe…[like] when the flu vaccine is an imperfect match…[so] you can still be infected, but the resulting illness is far less harsh….
But a long and painful process may be in store…[as] first pandemic wave [hits U.S.]…[expect] more than 1.7 million hospitalizations and 170,000 deaths over the course of the first wave. That is five to ten times as many deaths as we see from the flu in a year….
[If] occurred over six to 12 months…[will] overwhelm the U.S. health-care system, which has only around 1 million beds across the country…[with] little left…to properly care for people with other conditions such as cancer, heart disease or serious injury….
An infection rate of 50 percent would leave half of adults at risk in the next wave. But a reduction in susceptible individuals would weaken subsequent waves….
Eventually, we will reach a point where…deaths in the elderly are virtually unheard of — but this could take a decade or more….
[A] vaccine would vastly accelerate this process…[and] significantly cut its mortality rate in one to two years….
While a death rate of 1 in 1,000 is plausible…it could be 10 times as high. If this is correct, the path to the post-pandemic period becomes much harder.” https://www.washingtonpost.com/outlook/coronavirus-pandemic-immunity-vaccine/2020/03/12/bbf10996-6485-11ea-acca-80c22bbee96f_story.html
*****
Our infected machine —
“[U.S.] handling the first real global crisis since the Cold War with staggering incompetence…[and] if we wait until those who can’t do math see the awful consequences…things will get colossally worse.
It is already later than you think…[because] chose to spend the last twenty years squandering…[money] on gaudy decorations…rather than fixing its decrepit roof.
Now a storm is hammering down…[and] easy to imagine this crisis marking its official decline into former-hyperpower status….[This] is likely to affect our collective way of life, and our economy, for a long time.
For most people, ‘the economy’ is a giant treadmill of rent, bills, and paychecks…lest they be flung into an abyss. Social distancing right now is [saying]…’[S]top running, right now, but of course we’re not turning that treadmill off for you’….
[But] treadmill starts breaking down if enough of us stop running.
So what would turning that treadmill off, or slowing it down, look like?….[It] starts with universal healthcare…[maybe] six-month rent jubilee, on the grounds that property owners are more able than suddenly self-isolating renters to deal with the financial repercussions, and also better positioned to negotiate with governments for a subsequent bailout….
We can’t fix the treadmill after the fire is out, and…grim nature of fire is that if we wait…until we feel ourselves burning, it will…be too late.” https://techcrunch.com/2020/03/15/our-infected-machine/
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May you live long and prosper!
Doc Huston
