COVID-19 Medical Update
Dear patients:
The scope and reach of the COVID-19 virus pandemic is unprecedented in modern times. As I wrote two weeks ago, we are learning as we go along. I did want to provide you with additional information as the virus begins to be more prevalent in Portland.
Social distancing of everyone is crucial as is frequent hand washing. That is common knowledge, difficult for us to do, but important.
My current medical message is this:
1-Often one of the first signs is sore throat. At that point, gargle 5-6 times a day with warm salt water (1 tsp in 8 oz). That helps to reduce viral burden in your throat and therefore the burden being inspired into the lungs.
2-For fever, use acetaminophen, not aspirin or ibuprofen since NSAIDs up regulate ACE2, a chemical in the lungs that facilitates the transmission of the virus into type II pneumocytes. ACE2 grabs the spike protein on the covid-19 and helps transport the Covid-19 virus into the cell.
3-There is ongoing medical controversy of the role of ACE inhibitors (like lisinopril and other -prils) and ARBs(like Losartan). Both of these up-regulate ACE2 in cell systems, so logically you would not want them on board. As I suggested in my 3/16/20 letter, I recommend discontinuing these medications and using alternatives if necessary. The conventional recommendation is not to do that...but that is based on clinical data of which we have none since this is a new disease. My cardiologist friend mentioned that recommendation to me...then he sheepishly admitted he stopped his Losartan. Please contact us if you have questions about your medications.
4-Dry cough is the symptom of the virus getting into the pneumocyte (lung cell). Your immune system is working to counter the infection. Wear a mask to prevent transmission. It does not need to be an N-95, that is only for the providers to protect themselves. You want to minimize the aerosol generated by the cough. The virus travels on the aerosol, it does not free float in the air like measles or smallpox. Gravity works to have the aerosol fall within 6 feet, thus the recommendation for 6 foot distancing between individuals. Also the reason for frequent sanitation of surfaces. Switching shoes when you go inside is wise as well. Self-quarantine protects your loved ones from excess exposure to the virus and is recommended.
5-Shortness of breath occurs when there is leakage of fluid into the alveoli. To counter this, I recommend blowing up balloons during the cough phase to provide counter-pressure to the tendency of the alveoli to leak. If it progresses, then evaluation in the ER may be necessary. Mild symptoms should not precipitate ER visit as they are already overwhelmed.
6-Course of the disease: Initially sore throat, fever, headache, fatigue. The symptoms seem to percolate along for 4-5 days then on day 6 or 7, the shortness of breath and severe symptoms occur in some people. Fortunately, it seems like a minority, but that is the time that we worry the most.
I hope this gives you a bit more information to help. I am available to address queries if you would like. I am afraid this is a 3 month problem at the least and may extend, depending on the course of the disease.
My best,
Bert Berney MD