Thursday, April 02, 2020

Don't intubate

Well, what should a doctor do instead?  Just watch people die?

I'm here studying some of the ways the conditions around treatment might be creating greater coronavirus/covid-19 burden.  So far, there is no cure for the disease, just handling the symptoms to hopefully keep patients alive.  So let's keep patients alive.

Steps One, Two, Three:
Don't get the virus, or don't get very sick.
Follow the GREAT PUBLIC HEALTH MESSAGING to wash your hands with soap frequently like a psycho, and to observe social distancing as much as possible staying away from people who may be infected and staying away from people because of course you yourself may be infected and with covid-19 you're spreading the virus even before you develop the symptoms like fever and coughs.  Read about viral shedding, I don't understand it but it is gross.  :-)  Now, the germs are out there, and if you encounter the virus you want to be in the majority that gets away with mild or moderate disease, so throughout this crazy pandemic period you should really take care of yourself, eat well, sleep and rest more than ever, enjoy that hot chicken soup or lemon honey tea, or even do the steam inhale things, stay hydrated, gargle salt, clean your nostrils with soap etc etc.  Oh Lord, it's exhausting.  Glad it's not forever.

It's not forever, in part because in some months or years there will hopefully be a vaccine.  Also because there are experiments (known as trials) going on with existing medicines (the malarial ones, the one from ebola, etc etc) to understand their effect on this disease - no they are not very effective or you would have been informed by the health authorities to use them.  Scientists are are welcome to join the various efforts. 

Steps Four, Five, Six:
But in the meantime, the coronavirus disease is a killer that has caused quick respiratory-related death for some people, just like that.  And so there must be a medical response.  But the people around all these sick people then get sick, and it seems they get it worse than other people too.  Basically, doctors are at risk.  Then you start to try to understand why doctors are at increased risk, and you also try to understand how these viruses are finding lungs to infect and all that...let's try to shorten the story by quoting:

from, a picture in The Washington Post, March 23, 2020: What the structure of the coronavirus can tell us.  (I didn't include the copy-paste the actual picture because it's probably a copyright violation to do so.)  Washing our hands is good advice.  But it's not the only weapon we have...

2. This paper that says up the temperature, dump the cool air-conditioning, and raise the humidity.  A more detailed discussion of the question is here (BBC: Will warm weather really kill off covid-19?).  Short answer, not really, not sure, or not as much as social distancing will. 
In Lagos, we've had roughly these conditions, naturally, and one prays that we will therefore be spared a great coronavirus outbreak.  Can we replicate this "weather" in the hospitals of New York and Barcelona?  Yes, we must try.
(It just occured to me to say: please don't use the heater in your building to a very high level in an effort to dry yourself into a prune - you'll make yourself ill and lower your immunity.  Please don't do stupid things.  Natural heat with humidity and ventilation is a different thing than using your HVAC as a dryer.)  Ask an air-conditioning professional, HVAC engineer, and facilities manager to help.

Please click on each of these to learn more.
Building managers, especially for hotels and hospitals, please click for technical information

More great tips from

3. But also, we must find where we're actively multiplying infection rates and stop doing that or even start cleaning the air, a keyword I've seen is aerosolization, which causes more spread and more disease.  WHO is looking into understanding this.  Engineers can help.

This is very important to consider: How to END coronavirus spread by cleaning the air coming out of hospitals.  There may be multiple ways to do that - like specifically disinfecting areas around isolation centers? 
Like I said, people are studying the situation and evolving strategies:

This thing is highly infectious.  Dealing with it may seem frustrating.  Don't be frustrated.  We'll figure it out.

4. Don't intubate.  Now here I sort of don't know what I'm talking about.  But it's invasive, with risks to the carer and the patient.  Just as the system for giving supportive oxygen produces aerosols that make more patients. 

That is why I'm suggesting a pause here to consider:  Can we avoid getting to the point where we need a wild number of these extreme procedures?    (Oh yeah, isn't that what everybody has been trying to do?)
Don't let the viruses live.  
Don't let the virus find your face.  
Don't let the virus get cosy inside you.  
Don't let the virus end you.  
Don't let the viruses spread.  
Working together, we can achieve our aim.

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