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Poetry forces a writer to condense and crystallise his thoughts and often represents a short cut to truths unsuspected by the author himself.
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Author: StJohn Piano
Published: 2020-04-26
Datafeed Article 141
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3684 words - 642 lines - 17 pages




In this article, I'm going to do my best to answer the following questions:

1) How does coronavirus kill you?

2) What can be done at home to treat it?

3) How can you tell if it's bad enough that you should go to hospital?


Disclaimer: I am not a medical professional.


I have preserved copies of the source material I used for this article here:
Source material for Home treatments for coronavirus








1) How does coronavirus kill you?





Short answer:

Coronavirus (COVID-19) can cause pneumonia, a serious infection or inflammation of the lungs. Pneumonia can cause several secondary problems, any of which can kill you.

These secondary problems include:
- Respiratory failure
- Immune system overreaction
- Secondary infection
- Sepsis
- Acute respiratory distress syndrome (ARDS)

Most people (about 80%) recover from COVID-19 without needing special treatment. [0]

15% will develop a severe infection, requiring oxygen. [1]

5% of cases will develop a critical infection, requiring ventilation.

The crude mortality rate (reported deaths divided by reported cases) is 3-4%. The actual mortality rate (reported deaths divided by actual cases) will be lower but is currently unknown. This is because it is likely that many people catch the virus, experience mild / medium symptoms, don't report it, and are therefore not counted in the statistics. [2] The paper from Niall M Ferguson et al in the UK estimates an overall infection fatality ratio of 0.9%.

For comparison, the mortality rate for seasonal influenza is usually below 0.1%.




Long answer:

The virus is called "severe acute respiratory syndrome coronavirus 2" or SARS-CoV-2. This virus causes a disease, which is called "coronavirus disease 2019" or COVID-19.

Main symptoms of COVID-19:
- fever
- dry cough
- shortness of breath

Other symptoms can include:
- tiredness
- nasal congestion
- aches and pains
- sore throat
- loss of smell or taste
- gastrointestinal problems

Symptoms that mean you should call for medical intervention:
- difficulty breathing
- chest pain or pressure
- confusion
- blue lips or face

Most infected people will develop mild to moderate symptoms. People who have underlying medical conditions and those over 60 years old have a higher risk of developing severe disease and death. This is similar to what is seen with other respiratory illnesses, such as influenza.

Most people (about 80%) recover from the disease without needing special treatment. Around 15% of people who get COVID-19 become seriously ill and develop difficulty breathing.

Complications can include:
- Pneumonia in both lungs
- Organ failure in several organs

Given the similarities between influenza and COVID-19, I have decided to use influenza as my primary point of reference.

Influenza and COVID-19:
- are viruses
- spread in a similar fashion
- cause similar symptoms (although COVID-19 is much more serious)
- can cause pneumonia, organ failure, and/or death

Pneumonia is a serious infection or inflammation of the lungs. The air sacs fill with pus and other liquid, blocking oxygen from reaching the bloodstream. If there is too little oxygen in the blood, the body's cells cannot work properly, which can lead to death.

Symptoms of pneumonia:
- difficulty breathing
- a bluish color in your lips and fingertips
- chest pain
- high fever
- a cough with mucus that is severe or is getting worse

Possible complications of pneumonia include:
- Respiratory failure: Not enough oxygen is passing from your lungs into your blood.
- Immune system overreaction: The immune system normally seeks out and destroys lung tissue containing the virus. In this case it overreacts and destroys too much, causing respiratory failure.
- Secondary infection: Something else (typically bacteria) takes advantage of a taxed immune system and infects the lungs, perhaps also spreading into other areas of the body. This can cause an immune system overreaction, both in the lungs and elsewhere, which can lead to sepsis.
- Sepsis: Uncontrolled inflammation in the body, which may lead to widespread organ failure, thereby causing death.
- Acute respiratory distress syndrome (ARDS): A severe form of respiratory failure.
- Lung abscesses, which are infrequent, but serious complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.

So, to summarise: A virus (COVID-19 or influenza) can cause pneumonia, which can cause several secondary problems, any of which can kill you.

Let's look at chance of death.

From the WHO (source):
- For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than what is observed for influenza infection.
- The crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%.
- The infection mortality rate (the number of reported deaths divided by the number of infections) will be lower.
- For seasonal influenza, mortality is usually well below 0.1%.

From the Chinese CDC (source):
- A study of 44,672 confirmed COVID-19 cases in China showed that 1,023 deaths occurred. The case mortality rate is therefore 2.3%.
- The >= 80 age group had the highest case fatality rate of all age groups at 14.8%.
- For critical cases, case mortality rate was 49.0%. Critical cases were those that exhibited respiratory failure, septic shock, and/or multiple organ dysfunction/failure.
- Patients who reported no comorbid conditions had a case fatality rate of 0.9%.
- Patients with cardiovascular disease had a case fatality rate of 10.5%.
- COVID-19 is less severe than SARS or MERS but is more contagious.


From the Imperial College COVID-19 Response Team (Niall M Ferguson et al) (source):
- Estimated overall infection fatality ratio = 0.9%.








2) What can be done at home to treat it?





Things that don't work:
- There isn't a vaccine.
- Antibiotics are ineffective because COVID-19 is a viral infection, not a bacterial one.
- No antiviral medication is recommended for treating COVID-19.


Additionally:
- Don't take ibuprofen or aspirin, not because they are dangerous, but because it is not known if they can make COVID-19 worse. [3] Use paracetamol instead.


Basic home-based treatments:

Note: It is not necessary to do all of these treatments. This is simply a list of things that will probably be helpful.

- Paracetamol
- Deep breathing exercises and lying prone (on your front) for a while may help.
- Drink plenty of fluids to avoid dehydration. This also helps to loosen secretions and bring up phlegm.
- Coughing is one way your body works to get rid of an infection (i.e. by expelling mucus). Take cough medicine if you're in discomfort, but don't try to avoid coughing entirely.
- Some sort of expectorant cough medicine may help. This is a medication that thins and loosens mucus, allowing you to cough it up, thereby reducing discomfort from chest congestion.
- I have been told that milk and dairy products will cause your body to produce more mucus. Some reading suggests (source) that it actually causes a perceptual change (your mucus and saliva feel thicker) but does not actually cause more mucus production. My conclusion: Avoid it if it makes you feel worse.
- To soothe a sort throat: Gargle with warm salt water.
- Drink warm beverages, take steamy baths and use a humidifier to help open your airways and ease your breathing. You could choose to keep the humidifier on in your bedroom all night while you sleep. You can also just turn the shower on hot and sit in the bathroom breathing in the steam.
-- Caveat: Anecdotally, I have heard that controlling the fever caused by COVID-19 can be difficult, so if your fever is particularly high, then change this to: Drink lukewarm beverages, have lukewarm baths, and use a humidifier to help open the airways.
- Tea containing honey, lemon, and ginger.
- To clear a blocked nose, you may want to set up a bowl of hot water, put some Vicks Vaporub in it, and inhale the resulting steam. You can put a towl over your head to trap the steam more effectively. Note: Please be very careful to use a solid bowl that is difficult to knock over. Anecdotally, I have heard that this is a fairly common occurrence, and people turn up at hospital with burns because of it. Perhaps use a small / medium size bowl instead of a large one.
- Stay away from smoke to let your lungs heal. This includes smoking, secondhand smoke and wood smoke. This would be a good time to think about quitting, at least for the duration of the pandemic.
- Get lots of rest. You may need to stay in bed for a while. It is important not to overdo daily activities until you are fully recovered.
- It may take time to recover from pneumonia. Some people feel better and are able to return to their normal routines within a week. For other people, it can take a month or more. Most people continue to feel tired for about a month.
- Good health habits (a healthy diet, rest, regular exercise, etc) help you to avoid getting sick from viruses and respiratory illnesses. They also help promote fast recovery when you do get a cold, the flu, or other respiratory illness.




Further home-based treatment:

- Supplemental oxygen, produced with an oxygen concentrator, and delivered via nasal tubes and/or a face mask. Don't try to purchase a non-rebreathing mask - they are only for short-term use and can cause other problems. If your lungs are less functional due to the COVID-19 infection, and cannot process their normal volume of air, this treatment will help by increasing the oxygen level in the air that you can still process. Note: Be careful not to have any fire risks near the oxygen supply. [4]

- Non-invasive ventilation can help if your physical ability to breathe is reduced. Examples: CPAP (Continuous Positive Airway Pressure) or BIPAP (Bilevel Positive Airway Pressure).

- If you can, think about implementing a home isolation plan (e.g. a specific bedroom and bathroom), so that if one person in the household falls ill with COVID-19, they do not pass it on to the others. The isolation may not be 100% successful, but at least this might stagger the infections, so that not everyone is sick at the same time.




Experimental home-based treatments:

- Taking Vitamin D may lower the risk of an immune system overreaction (i.e. a "cytokine storm") during a COVID-19 infection. UK recommended daily amount (RDA) is 10 micrograms (Note: USA RDA = 25 micrograms). To overdose on vitamin D (which would cause vitamin D toxicity), you would need to take 100x the RDA for several months (= 1000 micrograms = 1 milligram). Taking 25-100 micrograms daily is associated with reduced heart disease risk. My conclusion: If you take heavier doses (e.g. 100-200 micrograms / day) of vitamin D during a COVID-19 infection, it won't be dangerous, and might help a lot. Taking 10 micrograms / day by default will also help your body in general.

- Taking Vitamin C may help the body recover from sepsis caused by a COVID-19 infection. The New York Post reports (source) that Dr Andrew G Weber says that vitamin C levels in coronavirus patients drop dramatically when they suffer sepsis, and that he is dosing all his intensive-care coronavirus patients with 1500 milligrams of Vitamin C, 3-4 times a day. So: Total daily dose = 6000 milligrams. For comparison, the recommended daily amount of vitamin C for adult men is 90 milligrams and for adult women is 75 milligrams. Note: Long-term use of oral vitamin C supplements over 2000 milligrams a day increases the risk of significant side effects (e.g. nausea, vomiting, heartburn). My conclusion: If you take heavy doses (e.g. 6000 micrograms / day) of vitamin C during a COVID-19 infection, it won't be too dangerous, and might help a lot.

- Supplementing with zinc may help protect against respiratory tract infections (e.g. COVID-19) and reduce the duration of these infections. Note: Taking high doses of zinc reduces the amount of copper the body can absorb. This can lead to anaemia and weakening of the bones. Normal daily dose: 7 milligrams (women), 10 milligrams (men). Upper limit: 40 mg.

- Albuterol (a.k.a. Salbutamol / Ventolin) delivered by MDI (metered dose inhaler). Use only if wheezing. Albuterol is used to relieve symptoms of asthma and COPD such as coughing, wheezing and feeling breathless. It works by relaxing the muscles of the airways into the lungs, which makes it easier to breathe. Normal use: 1-2 puffs when needed, up to 4 times in 24 hours. Wait 30 seconds and always shake the inhaler between doses. Emergency use due to COVID-19: Up to 8-10 puffs at a time. The COVID-19 emergency use idea comes from a detailed post (source) on a forum for Coronavirus/COVID-19 News & Information on TexAgs (a Texas A&M University fan website). The author claims to be an ER MD in New Orleans. Note: The NHS recommends up to 10 puffs in the event of a sudden asthma attack (source). Side effects of too much albuterol: Your heart beats more quickly than normal and you feel shaky. Serious side effects (call a doctor): muscle pain, abnormal heart beat, severe dizziness, chest pain, severe headache.




Hospital-based treatments:

- Supplemental oxygen, produced with oxygen tanks or an oxygen concentrator, and delivered via nasal tubes and/or a face mask.

- Antibiotics to combat bacterial pneumonia caused by secondary infection.

- Non-invasive ventilation can help if your physical ability to breathe is reduced. Examples: CPAP (Continuous Positive Airway Pressure) or BIPAP (Bilevel Positive Airway Pressure).

- A ventilator, also known as a breathing machine or (incorrectly) as a respirator. This is a medical device that supports breathing via invasive ventilation. It gently blows air - or air with increased amounts of oxygen - into your airways and then your lungs. In critical COVID-19 cases, in which the lung functionality is heavily damaged, a ventilator can be used to supply air with a high concentration of oxygen, helping the relatively small amount of working lung tissue to process as much oxygen as possible. As the lung tissue is fixed / rebuilt, the patient can be weaned off the ventilator.

Notes on ventilators:
- In order to be placed on a ventilator, the patient must be intubated. This means having an endotracheal tube placed in the mouth or nose and threaded down into the airway. This tube has a small inflatable gasket which is inflated to hold the tube in place. Having a tube placed into your throat can be upsetting / unpleasant / irritating. Patients are therefore often sedated. The endotracheal tube can also cause further health problems: Dry mouth, skin irritation, throat irritation, and oral secretions that could drain into the lungs. Any of these can cause damage and/or infection.

Unfortunately, the death rate for critical COVID-19 cases on ventilators is still 50% (greater in some cities). Dying in a hospital (especially during a pandemic, in which everything is more chaotic), with a tube running down your throat, unable to leave the bed (e.g. to go to the bathroom), unable to speak properly, unable to see anyone you know, with hospital lights / equipment / noise around you, is not a great way to die. If you have many risk factors for death from COVID-19, you may prefer instead to arrange your affairs, set up the various home-based treatments, make general preparations for a severe illness (food supplies etc), pray to whichever god or gods you follow, and take your chances at home, in your own bed.

I think it better that someone consider how they might die prior to an emergency, rather than during one. The emphatic language used in the preceding paragraph is intended to jolt the reader a little, and get them to think about how they might actually wish to die, and what preparations they might ideally make. This is always a good exercise in any case.

I am not saying that a hospital would forcibly or unreasonably put you on an invasive ventilator. I am however suggesting that the goal of a hospital is to offer treatment if at all possible, and in an emergency you may not be thinking too clearly about the possible downsides of accepting a particular treatment.

Risk factors for COVID-19: Age (65+), heart conditions, obesity, diabetes, chronic respiratory disease, hypertension, cancer, poor immune system, smoking, chronic kidney disease, liver disease.

Counterpoint in favour of hospitals: Hospitals are able to provide palliative care that can exceed what can be provided at home (e.g. painkillers and cough medicines that are more powerful than those available over the counter).




Experimental hospital-based treatments:

- There is some evidence that hydroxychloroquine may help to prevent and treat SARS-CoV-2 infection. Source:
www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30114-5/fulltext
Organisation: The Lancet
Title: Use of antiviral drugs to reduce COVID-19 transmission
Authors: Oriol Mitja, Bonaventura Clotet
Date: March 19, 2020

- There is some evidence that remdesivir may help to treat SARS-CoV-2. Source:
www.nejm.org/doi/full/10.1056/NEJMoa2007016
Organisation: New England Journal of Medicine
Title: Compassionate Use of Remdesivir for Patients with Severe Covid-19
Authors: Jonathan Grein, M.D., Norio Ohmagari, M.D., Ph.D., Daniel Shin, M.D., George Diaz, M.D., Erika Asperges, M.D., Antonella Castagna, M.D., Torsten Feldt, M.D., Gary Green, M.D., Margaret L. Green, M.D., M.P.H., Francois-Xavier Lescure, M.D., Ph.D., Emanuele Nicastri, M.D., Rentaro Oda, M.D., et al.
Date: April 10, 2020

These treatments are not standard or well-tested, but, in a practical sense, if you are in the "severe" or "critical" categories of COVID-19 cases, you haven't got a lot to lose by trying the experimental drugs. Waiting until the evidence is stronger might not help you personally very much.








3) How can you tell if it's bad enough that you should go to hospital?





WHO recommendation (source): People with fever, cough or difficulty breathing should call their doctor and seek medical attention.

Mayo Clinic recommendation (source): If you have emergency COVID-19 signs and symptoms, such as trouble breathing, chest pain or pressure, confusion, or blue lips or face, seek care immediately.

A medical professional who is an acquaintance of mine, who does not wish to be named for medical liability reasons, was kind enough to send me the following notes on measuring blood oxygen saturation:

- It seems that when people get COVID-19 seriously, their blood oxygen saturation gradually decreases over a number of days (not exact, but correct order of magnitude: from around ~98% to ~90% over ~10 days, again, not exact).
- Then, as the infection worsens, people can suddenly become very ill, collapse when they were otherwise feeling alright, and the oxygen saturation graph starts to decrease very quickly (like, tens of percent over hours). The NHS guidelines are that if you start having difficulty breathing, wait 24 hours then phone again, but this may in fact be too late, as it turns out.
- Oxygen saturation in an otherwise healthy person is around 98%/99%. Respiratory physicians say that a saturation below 96% is abnormal, and that a saturation below 92% means that that person requires additional oxygen (like a CPAP or something). This is the case anyway, independent of COVID-19.
- Your oxygen saturation can be measured with a pulse oximeter, which shines light through a finger to measure it to within ~1%. A reasonable one may cost around 60 pounds.
- Please note that none of the above constitutes medical advice, but it does give people something useful to measure.


My conclusion: Purchasing a pulse oximeter is a good move for measuring your health in general and for early detection of a possible COVID-19 infection.

I think that it is a good idea to go to hospital for supplemental oxygen, for antibiotics to treat a secondary infection, for non-invasive ventilation, and perhaps for experimental treatments e.g. hydroxychloroquine (bearing in mind of course that they are still experimental i.e. they are not miracle cures).










[start of footnotes]


[0]
These statistics concern cases admitted to hospital, not all people who have caught the virus. Some countries have done large-scale testing, without waiting for people to come to hospital, and their statistics look rather better.

[return to main text]

[1]
Note: It would be good to find out what percentage of this group would die without oxygen therapy. Is it 100%? 50% 25%?

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[2]
Counterpoint: I have heard / read that there have been an unusual number of deaths in care homes in several countries, which have not been tested for COVID-19, and which, if counted as COVID-19 deaths, would push the mortality rate up.

[return to main text]

[3]
Excerpt from:
www.nhs.uk/medicines/ibuprofen-for-adults
Title: Ibuprofen for adults (including Nurofen)
Date: 7 December 2018

NHS coronavirus advice

There is currently no strong evidence that non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen can make coronavirus (COVID-19) worse.

But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.

If you have no coronavirus symptoms and regularly take ibuprofen for pain relief, carry on taking it as usual. If you develop coronavirus symptoms, ask your doctor about changing to paracetamol instead.

Updated: 20 March 2020


Excerpt from:
www.nhs.uk/medicines/aspirin-for-pain-relief
Title: Aspirin for pain relief
Date: 15 November 2018

NHS coronavirus advice

There is currently no strong evidence that non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or aspirin for pain relief can make coronavirus (COVID-19) worse.

But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.

If you have no coronavirus symptoms and regularly take aspirin for pain relief, carry on taking it as usual. If you develop coronavirus symptoms, ask your doctor about changing to paracetamol instead.

Updated: 20 March 2020


[return to main text]

[4]
Also note that giving too much oxygen to people with COPD (Chronic Obstructive Pulmonary Disease) can cause them to retain too much carbon dioxide.

[return to main text]

[end of footnotes]