Merged 2019-nCoV / Corona virus

[dudalb]

I don't think things get that specific in Japan. If you ask most Japanese people about the intricacies of the theology of Shinto, they won't have a clue. You just go to the shrine, buy a fortune slip, throw a coin in the box, ring the bell, clap your hands, put your left leg in, your left leg out, do the Hokey Kokey, and that's what it's all about.

I love the way Shinto has made itself over almost completely since 1945......

 

[pipelineaudio]

Shouldn't the cleanliness campaign and less international and domestic travel result in less flu this coming season?

If the SanFran/Portland/Seattle anti-science/anti-vax crowd is less able to fly to the pacific islands this could be our best flu/measles season ever. We're actually somewhat fortunate that the deaths of the kids in samoa has turned some public worship of the northwesterners around a bit and people are a little more receptive to vaccinations here now

 

[Skeptic Ginger]

Here's the question I'd like to see the answer to. If anyone finds something like an answer, or an ongoing effort to find the answer, or knows the answer, please clue me in. The question is, if you get sick, and corona virus 2019 seems a likely cause, what home care should be applied to minimize the chance that the illness will become a severe case that requires hospitalization?

Specifically:

Should the patient lie down for maximum rest, or (if capable) sit up for more effective coughing?

Sit up to cough, sleep sitting up if you're having any trouble breathing.

Should over the counter decongestants (e.g. Sudafed) or expectorants (e.g. Mucinex) be taken or avoided?

My philosophy as an NP is to tell patients to treat the symptoms they can't handle. Is it keeping you awake? In normal times, if you are well enough to work, is it interfering with work? Avoid products that have multiple ingredients you don't need all of.

If you have thick mucus, an expectorant is useful to loosen it up so you can cough it out.

Should a fever (assuming it's below a temperature that would be dangerous in and of itself) be reduced with NSAIDs or other means, or should it be left alone?

See my answer above. With fever and body aches, take meds if it makes you comfortable. There's no evidence suffering makes you well faster.

If no appetite, should taking in calories be encouraged anyhow?

Liquids and calories, yes. Don't eat if you are vomiting or nauseated. For serious vomiting and/or diarrhea there are good guidelines easily found online. The answer is about a page long.

 

[Skeptic Ginger]

Shaking hands is silly habit, time to finally get rid of it ..

YES!!!!

 

[Trebuchet]

Up to nine deaths in the Seattle area now. Or eight, depending on which local TV station. One was at Harborview six days ago but the diagnosis hadn't been made. Most still associated with the same nursing home.

 

[Skeptic Ginger]

I did not know that. Is that true for most or all virions?

All of them, AFAIK. Capsid might know of some exceptions. They don't have cell walls, some have protein capsules around the genetic material but it doesn't function like a cell wall.

 

[Trebuchet]

Delete, misread something.

 

[The Atheist]

Fever can indeed kill you when it gets much over 103-104 F. It interferes with a lot of your body chemistry such as nerve impulses. That's why people have seizures with high fever.

Once again I'm faced with the choice of believing someone on the internet or a body of peer-reviewed science.

I know which one I'm going to believe, and here's another paper on the subject here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145646/

Note:

Within this upper range, 40 °C to 42 °C, there is no evidence that the fever is injurious to tissue.

Furthermore: Fever exerts an overall adverse effect on the growth of bacteria and on replication of viruses...

I think the real danger is you pushing wives' tales as science, when it seems to me the science is abundantly clear.

Do not treat the fever - it is slowing the infection and helping you overcome it.

Hope our lot are doing more than being "positive" and "inspirational".

Kee-rist, if I see that stupid, simpering woman telling everyone how wonderful and prepared the health system is I'm probably going to have a seizure myself. She is full of crap and out of touch with reality. It's bloody galling to see the Aussie idiot being much further ahead of the game than us on this one.

But hey, she'll be great at showing empathy for the victims!

Shouldn't the cleanliness campaign and less international and domestic travel result in less flu this coming season?

That would be logical, yes.

I also think the 'flu is going to be largely irrelevant this year. I see they brought in extra vaccine for it.

I'll be interested to see if it's already impacting crowd sizes at sport events come tomorrow night when the Super-Duper-Rugger round kicks off. We definitely have parents keeping kids out of school already.

 

[Myriad]

I'll leave the first couple for Ginger, but the latest evidence seems to point to not trying to reducing fever, because the fever may actually be helping defend against infection. I would therefore let it run - I haven't seen any evidence that fevers have been high enough to cause harm on their own.

https://www.aappublications.org/news/2019/05/03/idsnapshot050319



Food is unlikely to matter, but drink is essential. It doesn't appear to cause vomiting, so I'd say drinking water, clear fluids and electrolytes might be the best defence. The fact that people with poor kidney function are dying faster suggests that getting the little bastards out of your system might be part of the issue.

In general lungs work better in an upright position. So if breathless sitting up helps.


Decongestants probably irrelevant as not much in the way of runny nose or blocked nose expected. Coughing up phlegm will reduce risk of secondary infections and improve breathing so expectorants good.


Debatable. High fevers make you feel bad, but some argue they may be important in clearing infection. Use paracetamol (acetaminophen if you are in the USA), especially if high temperature >39C (no idea what that is in US units, but for traditionalists >13 Newton). If possible avoid NSAID as they may cause gastritis and increase risk of renal damage if dehydrated. Traditional damp sheets may also be helpful with high fever. Remember you feel cold as the temperature rises and hot as it comes back down, you need to give the paracetamol* when the shivering is happening not the sweating.


Probably more important to maintain fluid intake as you may lose a lot in sweating and heavy breathing with pneumonia. But yes, you can lose a lot of body mass with a fever, you burn body mass to make heat, so trying to maintain some calorie intake is good. Chicken soup seems traditional and not a bad idea.

ETA * not more than 4g a day for normal adults or whatever that is in US units (Ounces / week?).

Thanks for this.

Yeah, I didn't ask about hydration because I figured I already knew the answer to that one. And anyhow, I'm kind of a hydration fanatic. Which is odd because my mother can make a 12-oz can of Coke last three days, her mother seemed to live on 2 cups of tea a day for her latter two decades, my disabled twin brother doesn't drink at all—and then gets headaches from dehydration—unless someone else puts beverages in front of him regularly, my sibs and I all grew up with no drinking glasses bigger than 6 oz. (<180 ml) in the house (as kids on family travel rest stops the four of us would all share a single can of soda or small fountain beverage, poured into separate little paper cups), and even my wife doesn't take water breaks during her work day. I know more people who never drink plain water (only coffee, soda, juice, etc.) than who do. So, I'm the oddball who uses vase-sized drinking glasses at home and gets four water-glass refills from the waitstaff during a restaurant meal. But it does keep gout flare-ups and kidney stones at bay. Mostly.

 

[Myriad]

Sit up to cough, sleep sitting up if you're having any trouble breathing.

That one's good to know.

My philosophy as an NP is to tell patients to treat the symptoms they can't handle. Is it keeping you awake? In normal times, if you are well enough to work, is it interfering with work? Avoid products that have multiple ingredients you don't need all of.

Good. I usually keep all the active ingredients of the OTC "multi-symptom cold and flu relief" capsules, on hand as separate single-active-ingredient pills. (The exception is cough suppressant/dextromethorphan which I regard as a funny way to spell 'placebo' and don't bother with.) It costs about a tenth as much that way too.

If you have thick mucus, an expectorant is useful to loosen it up so you can cough it out.

No increase of risk of pneumonia from aspirating the thinner mucus? That seemed one of the trickier questions.

See my answer above. With fever and body aches, take meds if it makes you comfortable. There's no evidence suffering makes you well faster.

Makes sense. I wasn't sure whether the 'fever helps fight the virus' idea had been shown to be relevant for clinical practice. Apparently not.

Liquids and calories, yes. Don't eat if you are vomiting or nauseated. For serious vomiting and/or diarrhea there are good guidelines easily found online. The answer is about a page long.

Thank you very much for all that, SG!

 

[Capsid]

All of them, AFAIK. Capsid might know of some exceptions. They don't have cell walls, some have protein capsules around the genetic material but it doesn't function like a cell wall.

Viruses are usually frozen down in culture supernatant at low temperatures preferably -80C and are stable for a long time like this. I don’t know of exceptions. All have protein capsules ( they are called capsids!) and some also have lipid envelopes. The main aim is to protect the delicate RNA or DNA inside.


Sent from my iPhone using Tapatalk

 

[Planigale]

Thank you very much for all that, SG!

Originally Posted by Skeptic Ginger View Post
Sit up to cough, sleep sitting up if you're having any trouble breathing.

That one's good to know.

My philosophy as an NP is to tell patients to treat the symptoms they can't handle. Is it keeping you awake? In normal times, if you are well enough to work, is it interfering with work? Avoid products that have multiple ingredients you don't need all of.

Good. I usually keep all the active ingredients of the OTC "multi-symptom cold and flu relief" capsules, on hand as separate single-active-ingredient pills. (The exception is cough suppressant/dextromethorphan which I regard as a funny way to spell 'placebo' and don't bother with.) It costs about a tenth as much that way too.

If you have thick mucus, an expectorant is useful to loosen it up so you can cough it out.

No increase of risk of pneumonia from aspirating the thinner mucus? That seemed one of the trickier questions. See my answer above. With fever and body aches, take meds if it makes you comfortable. There's no evidence suffering makes you well faster.

Makes sense. I wasn't sure whether the 'fever helps fight the virus' idea had been shown to be relevant for clinical practice. Apparently not.

Liquids and calories, yes. Don't eat if you are vomiting or nauseated. For serious vomiting and/or diarrhea there are good guidelines easily found online. The answer is about a page long.

In answer to the highlighted. No. You naturally produce about 4 pints of mucus a day in the lungs. This normally flows up to your throat, is swallowed and any germs digested. The GI tract has an active immune system that processes swallowed germs and helps develop an immune response. Thin mucus will be coughed up or naturally flow up. The problem is the thick mucus that plugs up the lungs. So things that loosen up mucus, e.g. expectorants or steam are good.

PS dextromethorphan is not a placebo but is a real cough suppressant and so in this situation is a 'bad thing'.

 

[Ulf Nereng]

YES!!!!

But what should we do instead then? I'll suggest saluting! Or, if that is too militaristic for some, we could all start wearing hats again and lift that at each other!

 

[ynot]

But what should we do instead then? I'll suggest saluting! Or, if that is too militaristic for some, we could all start wearing hats again and lift that at each other!

Bow/nod the head as Asians do? (without the prayer hands of course)

 

[pipelineaudio]

Trying to come up with a hashtag to stop the honi/hongi besides "here grandma, have some breath of death"

Doesn't quite fit the length limit

 

[Skeptic Ginger]

Once again I'm faced with the choice of believing someone on the internet or a body of peer-reviewed science.

I know which one I'm going to believe, and here's another paper on the subject here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145646/

Note:

I think the real danger is you pushing wives' tales as science, when it seems to me the science is abundantly clear.

Stop insulting me. It's not called for. And it's going to get my evidence based reply sent to AAH.

That paper is speculative hypothesis, it's not a definitive study. From your link:

More recent evidence
It was Wagner von Jauregg in 1917 who gave an enormous impetus to the research with his work that fever was an effective treatment of neurosyphilis with malarial fever[37]. One of the most important outcomes of this research in recent years has been the discovery of a single mononuclear cell product, (IL-1, whose effects include induction of fever and activation of T-lymphocytes. Numerous substances from outside the body, exogenous pyrogens (ExPs), initiate the fever cycle. Endotoxin of Gram-negative bacteria is the most potent ExPs. The ExPs stimulate monocytes, fixed-tissue macrophages and reticuloendothelial cells to produce and release endogenous pyrogens, of which IL-1 is the most important. IL-1 acts on the hypothalamic thermoregulatory center through mediators, particularly PGE2, to raise the thermostatic set-point. The hypothalamic center accomplishes heat production by inducing shivering and heat conservation through vaso-constriction. At an established degree, fever is regulated by this centre (even at a temperature of over 41.0 °C) and heat production approximates loss, as in health, though at a higher level of the set-point. Therefore fever does not climb up relentlessly. IL-1 has other functions, including: Playing a primary role in the induction of inflammatory responses, such as neutrophil accumulation and adherence, and vascular changes. Stimulating the liver to synthesis certain proteins, acute-phase proteins, such as fibrinogen, haptoglobin, ceruloplasmin and CRP. T-cell and B-cell proliferation and activation, IL-1 activates T-lymphocytes to produce various factors, such as INF and IL-2, which are vital for immune response.

The production of fever simultaneously with lymphocyte activation constitutes the clearest and strongest evidence in favour of the role of fever.

Interesting hypothesis. If only someone has tested it.

Childhood febrile seizures are generally thought to not have any lasting damage other than freaking parents out. And a few cases of febrile seizures in adults without encephalitis have shown no sequelae. But the seizure represents the effects of hyperthermia on brain activity.

In addition your source mentioned the problem with acetaminophen. That is a well known issue that has been addressed at length in the medical community I interact with. It is a separate issue and one prevents overuse, one doesn't simply ignore it as a tool.


Based on evidence and not just hypothetical musing:The neurological and cognitive consequences of hyperthermia

...while the fever of sepsis probably confers benefit, there is increasing evidence that the central nervous system is particularly vulnerable to damage from hyperthermia. A single episode of hyperthermia may cause short-term neurological and cognitive dysfunction, which may be prolonged or become permanent. The cerebellum is particularly intolerant to the effects of heat. Hyperthermia in the presence of acute brain injury worsens outcome. The thermotoxicity involved occurs via cellular, local, and systemic mechanisms. This article reviews both the cognitive and neurological consequences and examines the mechanisms of cerebral damage caused by high temperature. ...

A temperature of 37.5 °C or greater at any point during an admission to the intensive care unit (ICU) trends towards a worse outcome, and becomes significant at temperatures greater than 38.5 °C [1]. There is emerging evidence that the central nervous system is especially vulnerable to hyperthermia, particularly if prolonged or excessive. Only in sepsis is there a likelihood that some levels of temperature elevation may afford teleological benefits leading to a survival benefit, but once the temperature rises above 40 °C it is once again associated with a worse outcome [1]....

The paper is an extensive review of a significant amount of research, unlike your source.

References
1. Lee BH, Inui D, Suh GY, et al. Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study. Crit Care. 2012;16(1):R33. doi: 10.1186/cc11211. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
2. Pease S, Bouadma L, Kermarrec N, et al. Early organ dysfunction course, cooling time and outcome in classic heatstroke. Intens Care Med. 2009;35(8):1454–8. doi: 10.1007/s00134-009-1500-x. [PubMed] [CrossRef] [Google Scholar]
3. Vicario SJ, Okabajue R, Haltom T. Rapid cooling in classic heatstroke: effect on mortality rates. Am J Emerg Med. 1986;4:394–8. doi: 10.1016/0735-6757(86)90185-3. [PubMed] [CrossRef] [Google Scholar]

Edited by Darat: 

Breach of Rule 4.

Only in sepsis was fever found to have any benefit in fighting the pathogen.

Do not treat the fever - it is slowing the infection and helping you overcome it.

You want to re-examine that recommendation?

 

[Dr.Sid]

Shouldn't the cleanliness campaign and less international and domestic travel result in less flu this coming season?

It's already happenning: http://www.newsonjapan.com/html/newsdesk/article/126425.php

 

[alfaniner]

Shaking hands is silly habit, time to finally get rid of it ..

Yeah, maybe now I won't get such offended or surprise looks when I say to the doctors at the VA "No handshakes, please" every time they thrust their open hand into my space as a greeting. You think they'd be the first to avoid stuff like that.

But what should we do instead then? I'll suggest saluting! Or, if that is too militaristic for some, we could all start wearing hats again and lift that at each other!

I'd like something like crossing one arm across the chest, with a slight head nod. In fact, I might start that -- a sign that "I'll keep my hands to myself, please."

 

[Skeptic Ginger]

Thank you very much for all that, SG!

You're most welcome.

Re this:

If you have thick mucus, an expectorant is useful to loosen it up so you can cough it out.

No increase of risk of pneumonia from aspirating the thinner mucus? That seemed one of the trickier questions.

No, it's the other way around. Your cilia in the bronchi and trachea are constantly trying to move debris away from the alveoli. When your bronchi are making a lot of mucus it's beneficial if it can be moved out as it carries the microorganisms with it. But when it's thick and sticky, cilia and coughing are less effective moving the debris out. More gets down into the lung.

You want an expectorant, not a decongestant. Decongestants dry up your runny nose. I only use decongestants when it is necessary to control the symptom.

Drugs.com: Expectorants

 

[Skeptical Greg]

....

Only in sepsis was fever found to have any benefit in fighting the pathogen.


You want to re-examine that recommendation?

I'll see your study and raise you one.

Fever: suppress or let it ride?

Is fever good or bad? Scientifically, we just do not know. However, if we take the evolutionary perspective, then blunting of the adaptive febrile response must be maladaptive. Fever is estimated to be more than 4 million years old and has been documented in the phyla Vertebrata, Arthropoda, and Annelida (7). Despite its long history of study, the exact mechanism of fever and its potentially protective effect is not fully delineated. One could hypothesize that treatment of fever compromises immune competence and renders patients more susceptible to infection.

( There's a lot more. I spared you the wall-o-text. )

Skin that one, and I'll go get another one.