I would welcome a handbook like this for individual or family use at home if hospitals become overwelmed and can no longer accommodate even seriously ill patients. The featured handbook looks very useful, but it's written for medical professionals in a hospital setting. I'm thinking about a handbook with instructions on how to do life critical procedures as best as possible with the resources one might have at home. Off the top of my head, one topic could be about the use of a bag valve mask[1] (as a "ventilator"), how to make one at home, when should it be used, things like that.
While not exactly what you're after re: DYI, the WHO has published guidance on home care for patients presenting while mild symptoms in addition to their clinical care guidelines:
- Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts [1]
- Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected [2]
I'm sorry if it's slightly off topic, but could we 3D print plastic masks? It seems they could at least protect from the biggest droplets. Better than nothing, I would say. Even we could create a transparent full facial mask, protecting the eyes.
Somewhat related, Chinese CDC posted their official guidance on mask usage. Google translate:
I. The general public
(1) Home and outdoor, no people gathered, well ventilated. It is not recommended to wear a mask.
(2) Being in a crowded place, such as office, shopping, restaurant, conference room, workshop, etc .; or taking a box elevator or public transportation. In low- and medium-risk areas, it is recommended that you wear spare masks (disposable medical masks or medical surgical masks) with you, and wear them when in close contact with other people (less than or equal to 1 meter). In high-risk areas, disposable medical masks are recommended.
(3) For those with cold symptoms such as coughing or sneezing. It is recommended to wear disposable medical or surgical masks.
(4) For those who live together with those who are separated from home and discharged from rehabilitation. It is recommended to wear disposable medical or surgical masks.
2. Personnel in specific places
(1) It is located in densely populated hospitals, bus stations, railway stations, subway stations, airports, supermarkets, restaurants, public transportation, and community and unit import and export places. In medium and low risk areas, it is recommended that workers wear disposable medical masks or surgical surgical masks. In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above.
(2) In prisons, nursing homes, welfare homes, mental health medical institutions, school classrooms, construction site dormitories and other densely populated places. In medium and low-risk areas, it is recommended that you always wear spare masks (disposable medical masks or surgical surgical masks) with you daily, and wear masks when people gather or come into close contact with one another (less than or equal to 1 meter). In high-risk areas, it is recommended that workers wear medical surgical masks or protective masks that comply with KN95 / N95 and above; other personnel wear disposable medical masks.
Key personnel
Suspected cases, confirmed cases, and asymptomatic infections of new coronavirus pneumonia; close contacts of new coronavirus pneumonia; immigrants (from entry to end of quarantine). It is recommended to wear medical surgical masks or protective masks without exhalation valve that conform to KN95 / N95 and above.
Occupational exposure
(1) Medical personnel such as general outpatient clinics and wards; emergency medical personnel in medical institutions in low-risk areas; administrative personnel, police, security, cleaning, etc. engaged in epidemic prevention and control. Medical surgical masks are recommended.
(2) Personnel working in the ward and ICU of patients diagnosed with a new type of coronavirus pneumonia, suspected case patients; medical staff at designated medical institutions for fever clinics; medical staff in emergency departments of medical institutions in middle and high risk areas; epidemiological investigations and experiments Room testing, environmental disinfection personnel; transfer of confirmed and suspected cases. Medical protective masks are recommended.
(3) Operators engaged in the collection of respiratory specimens; staff who perform tracheotomy, tracheal intubation, bronchoscopy, sputum suction, cardiopulmonary resuscitation, or lung transplantation, pathological anatomy in patients with new-type coronavirus pneumonia. Suggestion: hood-type (or full-type) powered air-supply filter respirator, or half-plane power-supply air-filter respirator with goggles or full screen; P100 anti-particulate filter should be used for both types of respiratory protection Elements and filter elements should not be reused. Use protective equipment after disinfection.
This blog has interesting information, like how to properly remove a mask to avoid infecting yourself @ 14:59, and to not contaminate your house with outdoor clothing by leaving it outside: https://youtu.be/yyucJekT87E (turn on subtitles)
I still do think hospitals can benefit from this material. The issue I'm having right now is relaying this information to the right people. Also, living in a non-English speaking country, I have no idea if health professionals are having problems with the language barrier regarding getting themselves informed with the latest insights about covid-19. Plus, a great deal of people are playing it off.
I skimmed the home care thing posted by someone else. It said to use paper towels instead of towels to dry your hands.
I almost never use towels to dry my hands. If you use paper towels, flush them down the toilet. (Assuming it won't be a plumbing problem. I can't do this currently because I live in a hundred year old building and my lease forbids it because the plumbing can't handle it.)
But you can also just let your hands air dry. You don't have to dry them at all.
From what I gather, they resort to ventilators with Coronavirus not due to paralysis of the lungs but due to inflammation and pneumonia (aka fluid in the lungs).
Here are some ventilator substitutes in such cases:
If you have fluid in your lungs and can't adequately clear it doing lung clearance in the shower, sleep propped up. A recliner is one option or prop yourself up on pillows against the headboard.
If you are having breathing issues, absolutely do not lay flat on your back. It can cause half your lung surface to be blocked by fluid and this is a good way to basically drown. Instead, lay on your side or prop yourself up. It will reduce the amount of lung surface blocked by fluid.
Ideally, have some caffeine, fluids and salt to help open up the airways and support mucus production and then go do lung clearance before trying to sleep. Then lay down on your side or prop yourself up somehow.
(Yes, I'm aware: Ideally, you should be hospitalized at that point. I didn't want my child hospitalized when he was an infant and had pneumonia, so I laid him on my chest and slept sitting up for three nights after he started antibiotics so he could breathe. I've got an incurable lung condition. I routinely deal with fluid in my lungs without seeing a doctor. It can be done.)
Obviously, ideally, see a doctor and all that. I'm only leaving this comment because the medical system is overwhelmed and that's not always going to be an option. There are going to be people in this crisis who can get info off the internet or have basically nothing because there aren't enough doctors, ventilators, etc to go around.
> If you use paper towels, flush them down the toilet
Please don't do this. They don't break down in water. Even if your personal house plumbing could handle it, the main sewage will not if everyone starts doing this, leading to serious blockages.
Then I suggest you just air dry your hands as much as possible, which is what I typically do. Or install a hot air hand dryer at home.
I'm pretty appalled at the official recommendation to basically create a trash can full of damp paper products in an area with a deathly ill patient and didn't want to outright say that because people give me so much shit for expressing opinions of that sort.
Paper is nasty stuff to begin with. Wet paper is a horrifying breeding ground of horribleness. Especially if it is just going to sit there for hours and possibly have other nasty stuff added to the mix.
I cannot possibly overstate how strongly I feel that the official recommendation to create a trash can full of damp paper in an area with a sick person in the name of good hygiene falls under the category of "Are you insane and trying to kill people?"
Against covid-19 and human viruses in general, as a means to limit spread, a trashcan full of damp paper is likely safer than a trashcan full of dry paper, dry snot in your pocket or similar alternatives.
A virus needs living human/animal cells to procreate, (I guess) it's less likely to spread from a damp vs. dry and dusty material, and is likely to decontaminate much sooner - even the mentioned nastiness could be decomposing the virus.
Whether the sick person is likely to get a secondary infection is another issue, though I'm not sure why you consider wet paper a horrible breeding ground.
I will suggest you spend a little time looking up articles about how hospitals actively breed antibiotic resistant infections. They are a primary source of such infections.
I think I've already reached my limit for the night for trying to politely discuss this with people in this thread.
I took her point to mean bacterial and fungal (mould) grot rather than viral. Given sufficient time that could become a problem, but you'd have to leave it a few weeks I'd have thought. Still, it's a valid consideration for immune-compromised people.
I really don't want to stay in this discussion, but did want to suggest to you in specific that you might find it interesting to look up articles about stunting and the role of chronic low grade infection due to poor hygiene. The term that gets used is "enteric" something or other.
I googled "stunting enteric infections" and came up with these two articles, for example:
The TLDR: Lack of adequate food is not the full explanation for stunting. Poor hygiene in the general environment plays a significant role.
General cleanliness of your general environment has significant health impacts. We know this in the abstract. We know Sick Building Syndrome exists and we know entire neighborhoods have worse health because they have all the things the NIMBYs kept out of their neighborhood.
But people get bizarrely dismissive of the idea when it's a specific instance involving them in specific. Then it's all "Nuh-uh!" And "Do you have clinical studies?" And "That article you posted is orthogonal..."
It seems to me, you are outright dismissing paper-towels-in-trash-can approach, in both home and hospital use, no matter how it's managed, while recommending not drying or hot air dryers as a less bad substitute.
Do you have any references linking paper towel (disposal) in particular, as an added risk for drug-resistant bacteria, stunting enteric infections, sick building syndrome or your other claims?
> Wet paper is a horrifying breeding ground of horribleness.
I would especially be interested in this claim, as I would intuitively expect paper to be a worse environment for dangerous organisms than most other damp indoor locations.
First link on "hot air hand drying" shows bacterial spreading a breading[1], and a search on "paper towels" yields a paper[2] says paper drying is more sanitary than not drying or hot air drying.
I'm extremely uncomfortable with where this conversation has gone.
The official medically recommended method is dry your hands with paper towels.
If you are taking care of a sick person who could die on you, following recommended procedures is the most legally defensible thing to do. If they die, you are less likely to be charged with neglect and found guilty if you can honestly say "I followed medically recommended procedures."
It's probably a super bad idea to go into a court of law and say "I took the advice of some random internet stranger over medically recommended procedures." You should only take the advice of a random internet stranger in cases where you can't do what the medical establishment suggests because there's a shortage of medical supplies and they don't have answers for you etc.
When the medical establishment is giving you an emoji shrug and you could seriously die because of it, then it makes sense to listen to people with serious health problems who are saying "Well, I don't have a study, but this is what I do." and do a few of the things they suggest, but only those you can adequately wrap your brain around.
Based on a track record of getting healthier for nearly two decades, I'm confident that what I do is effective and is a superior approach to standard recommendations. I'm far less confident that I can adequately convey all the details in an internet discussion so as to make it work for other people.
I've made a few comments trying to be helpful because the medical establishment doesn't have adequate solutions and neither does the government. I've tried to be careful, but this discussion is getting into territory I actually was trying to avoid because it's overly personal, I can't prove it, it opens me up to personal attacks, etc.
As stated previously, I only commented at all because they are rationing medical care. So some people will be dependent on doing their best at home, in spite of being so sick that they should be hospitalized, but there just aren't hospital beds available for everyone in some places.
So, having said that, I'm going to try to reply in a conversational fashion to some of what you have asked. Please do not mistake this for medical advice or even for me trying to win some internet argument.
Do you have any references linking paper towel (disposal) in particular, as an added risk for drug-resistant bacteria, stunting enteric infections, sick building syndrome or your other claims?
To be clear: I am not making claims that paper towels are a source of sick building syndrome, etc. I'm saying we know that an unclean environment makes people sick. We even have words for it, like Sick Building Syndrome. This is not a new concept.
I've taken a quick look at your links. I'm not going to try to Google up citations of my own.
I'm speaking from first-hand experience as someone immunocompromised who has gotten off all drugs. I've certainly read up on studies about various things over the years, but trying to find you a study to support the opinions I've expressed here would be somewhat disingenuous.
I'm also really tired of trying to play that game. It's not a good game to play.
I've been attacked and harassed online for a lot of years by people who have a huge issue with the idea that I know anything medical in nature. No amount of trying to find citations to defend myself ever gets me anywhere at all.
So I'm speaking from first-hand experience and telling you this is my opinion and I stated up front that I'm not a doctor. I'm a former homemaker who spent years homeless and I have zero credibility in the eyes of a whole lot of people.
From your first link:
air from real-world bathrooms may contain fewer bacteria than the bathrooms in the study. The sampled restrooms were located in a university health sciences building, and at least some of the bacteria came from experiments going on in laboratories within the building.
So your study doesn't really say what your comment suggests it says.
Some general and rambling thoughts on hand dryers and semi related topics:
Most residential bathrooms will have fewer people using them than most public bathrooms. So they will typically have less variety of microbes.
It's absolutely possible for a hot air device to get contaminated and be a source of problems. But in my experience, when they are clean, properly located away from toilets and motion activated, they are better than paper towels.
I tend to hate the big commercial blowers used to dry out carpeting. They tend to be nasty and are sometimes visibly covered in lint.
You can Google up studies on how vacuum cleaners actively spread around infection. So it's certainly not unprecedented that some mechanical system nominally intended to improve hygiene actively spreads infection.
(I have no carpeting. It's nasty stuff. I have wood and tile floors.)
I also generally dislike forced air HVAC systems and stopped using the forced air heat in the last apartment I had that had such. I began buying space heaters rather than run the central heat in that apartment. I currently have radiant heat.
I most often use hot air hand dryers in Walmart bathrooms. Walmart bathrooms are unusually well designed. They are generally better than most other public restrooms and I wish Walmart would write the handbook for how to do a public bathroom right.
I don't like using hand dryers that aren't motion activated. The need to touch a button with wet hands degrades the cleanliness of the experience.
My dream home would include a motion activated hot air hand dryer because it's my preferred method of drying my hands when it's done right. It's certainly not always done right.
Your second link says:
The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care.
To me, this in no way suggests air drying your hands is a problem. To me, it suggests you should let them air dry thoroughly before touching stuff, not that you must use a quicker method.
I would especially be interested in this claim, as I would intuitively expect paper to be a worse environment for dangerous organisms than most other damp indoor locations.
Again, I'm absolutely not going to try to Google up some source to cite. I'm speaking from first-hand experience.
I do not own a trash can. Dry, non germy trash accumulates on the table between trash runs. Any damp or germy trash gets fairly promptly run down to the dumpster.
I will reiterate that I think it's a bad practice to let trash accumulate in an area with a sick person. My opinion that this is a super bad idea inspired my suggestion that if you use paper towels, you should flush them.
People have since provided a compelling argument that flushing them is a bad idea. Some have even done so without snark or personal attacks.
As someone with an incurable medical condition who has spent time on email support lists for people with chronic health issues, I can tell you that, in practice, when everyone at home is sick or when one person at home is extremely sick, it's very hard to stay on top of normal household chores. It's often just not realistic to add yet more chores, such as taking out the trash several times per day.
So in practice, not creating big piles of wet, germy trash is superior to finding ways to deal with the trash created by a lot of recommended best practices. Because in practice, you will probably find it sits there a lot longer than you thought it would while everyone is overwhelmed by events and struggling to come up with the energy to even put together a meal.
The combination of germiness, lack of energy and other constraints that come together during a health crisis create a perfect storm where there often seem to be no actual good answers and I think this very much contributes to fatalities.
Anything you can do to reduce the work load instead of adding to it while meeting a high standard for germ control is nothing short of a godsend in a situation like that.
It's why I usually air dry my hands. It's the only solution that I know will be actually clean and will not have knock on effects like creating piles of damp trash.
This is not medical advice. This is the ramblings of a chronically ill person currently running a fever, as I often do, who maybe should just not reply to you at all.
I said I was trying to leave this particular discussion. I would still like to do that. I don't at all like where it went.
I wonder how many people that have vague issues with "germs" are really allergic to mold. Which is everywhere and especially stimulated by anything damp.
Many years ago, I had a reaction to penicillin, but only recently someone said to me (not a doctor) hey, if you're allergic to penicillin, you're most likely allergic to mold.
So, a lot of what you say reminds me of my own experiences, but it may be a point of view of someone who has a sensitivity that isn't actually universal.
I definitely empathize with the sense that moisture and carpeting and stuff are toxic, and that all trash must be sealed off from living areas. But I also have lived with people who didn't follow the same rules, and they didn't have the same problems, which points to the issue not being living style alone.
I have a genetic disorder. So, yes, I'm unusually sensitive to a lot of things.
I used to know a guy online who swore he had zero allergies. He started every day with boatloads of coffee and ended everyday with boatloads of wine.
Uppers in the morning -- like caffeine -- and downers at night so they can sleep -- like alcohol -- is a standard treatment for allergies. I suspect he had undiagnosed allergies and maybe could have acted like less of an alcoholic if the allergies were identified and properly treated, starting with the standard practice of trying to avoid triggers as much as possible.
The older I get, the more skeptical I am that other people are as different from me as they claim and as the world claims. I don't think it's actually good for anyone to be around rotting trash, etc.
But, certainly, when someone is especially vulnerable, we should make an effort to be more careful about such things. As I get healthier, I'm more able to tolerate "normal" things.
Meanwhile, the entire world is very suddenly embracing practices I have long pursued while everyone pointed and laughed and called me crazy. It seems the world's cavalier attitude about how such things don't matter if you aren't defective like me is catching up to it and there's hell to pay.
9. Lung clearance is a standard means to treat serious lung conditions and keep airways open. A simple means to do this is stand in the shower with your feet about shoulder width apart, bend over as far as you can and cough hard.
In other words, anything that helps get phlegm and fluid out of the lungs. If you are doing lung clearance at home, you don't want to, say, mechanically suction out the lungs because you probably don't have the means to properly sterilize the equipment. Non invasive methods that don't require equipment are best for home care. Lots of people with lung issues end up very sick or dead because their home care equipment is not adequately maintained and grows nasty stuff which then gets delivered directly into the lungs.
"9. Lung clearance is a standard means to treat serious lung conditions and keep airways open. A simple means to do this is stand in the shower with your feet about shoulder width apart, bend over as far as you can and cough hard."
Regarding the self-care document, I'd never heard of acetaminophen before so had to look it up but perhaps medical people know the term? I'd half guesses by seeing the precautions though.
In the UK it's generally called Paracetamol and is in a lot of over-the-counter medicine.
Not sure why you're getting downvoted. Philanthropy is philanthropy, and i don't see anything wrong with appreciating when someone does something good.
The philanthropy is certainly admirable and appreciated, though, it shouldn't immediately discount intent for those whose job it is to worry about stuff like that.
But personally, I do think it's pretty clearly well intentioned on it's face. And I'm very thankful this is out and I hope it saves lives.
It’s not that it’s against the rules. It’s just that you’ll be downvoted by those that hate billionaires and that will impact your ability to comment. I’m glad I accumulated enough karma from before HN became like this that I can handle losing some karma to say what others have been silenced from saying by downvoters.
Looks good. I question the survivorship bias from the "0% fatality". They could have had no bad cases or just got lucky. Wouldn't a measurement of how many people it spread to at the hospital be better? The guide seems pretty legitimate though.
I'm glad info from China is filtering over onto the rest of the internet. So much vital information, especially about how to keep safe as an individual, is only available on WeChat in Mandarin.
That's a serious handbook about prevention and treatment, whoever to medical professionals or normal people. And it's more valuable to those medical in the fire line now, You still can watch the news about doctors or nurses treating potential patients without masks or any protect suit. It is a high risk to anyone, Once hospitals been infected even overwhelmed, We will be a very dangerous situation.
Perhaps People panic at the beginning in a piece of uncertain information about diseases, but now there is a handbook or practices something and some people have already experienced this and sum up some experiences, It deserved be paid attention to.
Yes. This is seriously useful information. This is how supportive treatment to get patients though the illness is done, from people who have done it. It's a very complex process. There are drugs and treatments which help, but only when accompanied by elaborate testing and monitoring. This hospital has worked out how to do this for a large number of patients. They have a dedicated facility that does only this. That's needed.
I wonder if the U.S is going to use these drugs or if most docs will be too conventional to use these drugs off label.
"Antiviral Treatment...
lopinavir/ritonavir (2 capsules, po q12h} combined with arbidol (200 mg po ql 2h)...chloroquine phosphate can be used on adults...
Interferon nebulization
Darunavir/cobicistat hdarunavir/ cobicistat (1 tablet qd) or favipiravir (starting dose of 1600 mg followed by 600 mg tid) is an
alternative option after the ethical review. Simultaneous use of three or more antiviral
drugs is not recommended. "
>I wonder if the U.S is going to use these drugs or if most docs will be too conventional to use these drugs off label.
Domestic therapeutic recommendations from a number of European countries (e.g. France, Italy, Switzerland, Belgium) includes use of these medications, so I think it likely they will.
Yeah I heard that too. It's at most an HA protein inhibitor, while the SARS-CoV-2 likely to bind with ACE2 receptor. Also it requires high concentration of the drug.
While posting this link was thinking, if this book can be done in restructured text with pdf generated using sphinx and subsequently extend it for country specific conditions and language with the help of local medical staff. It can become a very helpful knowledge base which can be referred to by practitioners and will be very useful for developing countries and clinics in remote areas.
Why does everyone want to reduce the fever with pills?
The immune system works best when there is a fever and if you suppress it you are just trading long term complications for short term relief. In the Covid-19 case it would IMO be much better to drink lots of fluids and just let the fever run its course.
>> Editor's note (19 March 2020): Since the publication of this article, the World Health Organization has updated its advice on the official Twitter account: "Based on currently available information, WHO does not recommend against the use of ibuprofen."
Yeah, messy situation, but I'll take their word and the Chinese doctors for it whom have been administering ibuprofen to measure success
Note that even if the WHO changed its recommendation, french doctors still recommend to _not_ take anti-inflammatory. Use paracetamol instead (but not more than usual). Maybe they didn't get the memo yet, I can't tell.
It's probably wise to take survivorship bias into account here. Also, I think the focus is on the wrong data point. Wouldn't it be better to look at hospitals with the best/fastest recovery rate? Or look at hospitals with the highest fatality rates to understand what specifically is causing that?
I wonder what the handbook for the billions of people in hundreds of countries without adequate health care infrastructure is. Our data points so far has been from mostly dismal first world responses with capability to report skewed statistics due to system under testing. But the reality is, most of the world will respond to this outbreak the same way they did the Spanish Flu. It would be interesting to see outcome of the first post herd-immunity country.
Vnzla has got strategically ties with Cuba, whom have already been exporting antivirals in great amounts to China, they will be fine, tho their prisons might suffer, just like most of latam prison population
If you want to worry worry about the US homeless population and those poor people on Mexican us sponsored migratory concentration camps and us Ice concentration camps as well
[1] https://en.wikipedia.org/wiki/Bag_valve_mask