Covid Daily Updates

Coronavirus: What Every Pulmonary Patient Needs to Know!

NOAH GREENSPAN, DPT, CCS, EMT-B

Pulmonary Wellness Foundation

10 East 38^th Street, NYC 10018

212.921.0214   noah@pulmonarywellness.org

You literally can’t miss it in the news these days – millions (if not billions) of people all over the world are talking about the increasing spread of “the new (novel) Coronavirus.” According to the Center for Disease Control (CDC), the earliest cases of COVID-19 began in the city of Wuhan, China, and have since spread to 40 known locations internationally.

On January 30, 2020, the World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC) and the next day, the U.S Secretary of Health and Human Services would declare it a national public health emergency (PHE) in order to better assist the U.S healthcare system in its management.  To date there have still been very few cases in the U.S. However, it’s worth mentioning that person-to-person spread is currently being reported both at the source and in many other locations including the US.

What, me worry? – Alfred E. Neuman

So, should we panic?  Absolutely not!  Should we take precautions? Absolutely!  I always tell people that “panic rarely, if ever, helps almost any situation.”  But there are understandably reasons to be concerned about the coronavirus, especially if your immune system is already compromised, as is often the case in people living with a respiratory condition.  For that reason, I have decided to try to help you lessen your anxiety while at the same time, taking reasonable precautions.

In my opinion, an educated patient is always our greatest ally in the fight against respiratory disease, the coronavirus and actually most things in life. So, you’ll definitely want to do your homework and stay informed as the situation continues to evolve.  As always, I will try to provide you with all of the important information, while leaving out many of the extras, currently fanning the flames of fear and misinformation.

What is the Coronavirus?

Viruses are microscopic, infectious agents that enter and reproduce within a host organism.  They are parasites, which means that they need a host in order to replicate or reproduce.  Viruses exist in almost every environment on earth and can infect animals, people, plants, fungi and bacteria. 

It is important to know that the term “coronavirus” is not new. Coronavirus describes a large family of viruses found in nature, mostly in various cattle and other animals that humans regularly come into direct contact with like cats, camels and bats (depending of course, on your culture and geography). 

Though usually rare, coronaviruses can spread through human contact with these animals and then from human to human.  This was the case with Middle East Respiratory Syndrome (MERS or MERS-CoV), Severe Acute Respiratory Syndrome (SARS or SARS-CoV) and most recently, SARS-CoV-2 which causes the Coronavirus Disease 2019 (COVID-19).  All three of these viruses are called betacoronavirus and have their origins in bats.  This most recent outbreak is simply a new strain.

How is the Coronavirus transmitted?

Although officials believe the initial outbreak was caused by contact with some kind of “animal reservoir,” according to the CDC, human-to-human contact is likely the most common medium.  Coronaviruses have historically spread between people who are in close contact with one another, typically within about 6 feet or so. This could include loved ones, roommates, co-workers, or anyone else you’re closely in contact with on a regular basis.

These viruses commonly spread through “droplets” of saliva or mucus when coughing or sneezing. However, the CDC believes it may also spread by other means before patients display symptoms. Officials also say that it is possible to contract the disease through physical contact with infected objects and surfaces that an infected person may have recently touched.

What are the symptoms of the Coronavirus?

Symptoms are not obviously distinguishable from similar respiratory diseases. The disease itself can cause flu-like symptoms (fever, headache) as well as those that attack the respiratory system directly, such as coughing and shortness of breath.  Many patients develop pneumonia in both lungs, and while the severity can vary from patient to patient, the most severe cases have led to death.  Currently, the CDC believes that symptoms can appear anywhere between 2 to 14 days after exposure, although the incubation period can be longer so as always, if in doubt, err on the side of caution.

Who is at risk of contracting the Coronavirus?

As more cases are reported across the globe, this quickly begins to meet the criteria for a worldwide health crisis. Both the international community and the United States as a country remain at high risk. However, individual citizens across the United States currently have little reason to worry.  So far, only 14 cases have been reported as of February 25, 2020, out of the 445 tested in the U.S. While some person-to-person spread has been reported, there has been only one case of community spread (in California), in which the suspected cause is unknown.

What should you do if you think you may be infected by the Coronavirus?

There are currently no vaccinations or antiviral treatments known to be effective against the spread of COVID-19.  If you are experiencing symptoms and have traveled from or had close contact with someone who has traveled from China in the last 14 days, the CDC recommends you contact your healthcare provider immediately. Your provider will work with your state’s health department to determine if you’ve been infected or need further treatment or testing.  For severe cases, treatment should include supportive care to the affected organs.  This is particularly important for pulmonary patients since the respiratory system seems the most vulnerable to coronavirus infection.

What can we do to prevent the Coronavirus?

Living with a chronic illness, particularly a respiratory condition can significantly compromise your immune system, making you more susceptible to picking up any bug, catching a cold, flu, or developing an infection or exacerbation of your existing pulmonary condition. Frequent illnesses or exacerbations, or even one bad one, can impact the progression of your disease and its associated symptoms. For this reason, it is crucial not only to take care of yourself when you get sick, but also, that you take specific measures to PREVENT yourself from getting sick in the first place.  The good news is that the tried and true methods of preventing colds, flus, pneumoniae or exacerbations of your existing pulmonary condition also apply to prevention of the coronavirus as well.

How We Get Sick

At the most basic level, disease is caused by pathogens. The most commonly encountered pathogens are bacterial, viral, fungal or parasitic in origin. The most common routes of transmission include: airborne or inhaled, direct contact, indirect contact or contact with a contaminated surface, sexual contact, contact with infected blood or body fluids, and the fecal-oral route.

Viruses and bacteria cause the majority of respiratory infections and unless you are living in a bubble, you will likely come in contact with one (or a million) of these on a daily basis. They are introduced to our bodies, through the mucus membranes of the eyes, nose, and mouth, either by inhaling them or by touching or coming into contact with a contaminated surface, and then touching your face.

We are also exposed to, and come into contact with spaces, surfaces and objects that are exposed to and contacted by many people on a daily basis. Anything that is touched by many people, many times each day has a greater chance of being contaminated with bacteria, viruses and other pathogens.

Depending upon the type of organism and the surface on which they are found, some viruses and bacteria can live outside the body for up to 24 hours. Whether or not you actually get sick depends upon the specific virus or bacteria and the status of your own immune system.

Please understand that I am not trying to scare you into hermetically sealing yourself in plastic bubble wrap. What I am trying to do is raise your awareness of everyday potential exposures so you can better protect yourself against them. Here are some suggestions on how to do that:

“Don’t Patchke Your Face”

My Grandma Peppie used to say: “don’t patchke your face.” Patchke is a Yiddish word that means to play around or fiddle with. It was good advice then and it’s good advice now. As I mentioned previously, pathogens are introduced to our bodies, through the mucus membranes of the eyes, nose, and mouth. So, don’t fiddle.

Wash your Hands (a lot)!

This goes hand in hand (pun intended) with “don’t patchke your face.” Frequent hand washing is your single best defense against introducing viruses or bacteria into your system. Most of us know (or should know) that we’re supposed to wash our hands before we eat, or after we use the bathroom. However, that’s not adequate, particularly for someone living with a pulmonary disease. You really need to be washing your hands each and every time you come in contact with a potential source of infection.

Also, to be clear, when we talk about hand washing that does not just mean a quick rinse.   Effective hand washing means using soap and water, and rubbing your hands together vigorously, for at least 30 seconds. Keeping in mind that you initially turned the water on with dirty hands, turn it off using a paper towel so that you don’t contact those germs again. The same goes for the bathroom door.

Antibacterial Gels/Creams/Lotions

If you don’t have access to soap and water, carrying a small bottle of anti-bacterial gel, cream, or lotion can come in “handy”. Some people may argue against using anti-bacterial products, on the grounds that they kill the good bacteria along with the bad. While this may be true to some degree, I would still choose using an anti-bacterial gel over walking around with the coronavirus on my hands, just waiting for an opportunity to enter my mucus membranes.

Antibacterial Sprays and Wipes

Remember also that objects or surfaces that you come in contact with may not be cleaned frequently (or ever), and therefore, may be contaminated with a whole host of pathogens. For this reason, it is well worth your time and effort to spray or wipe them with disinfectant before you use them.   As just one example, when you go to the supermarket, wipe down the shopping cart before leaning all over it or putting your food inside.  This is even more true for public transportation and airplanes.

At the Pulmonary Wellness & Rehabilitation Center, we have dispensers with anti-bacterial foam for our patients and staff. We also wipe down every machine in between each and every patient. The last thing we want is for people to get sick at a wellness center.

Protect Your Home

When you return home after a day out, you carry with you all of those nasty ‘bugs’ (bacteria and viruses) that have latched onto you and your belongings over the course of your day. You can help minimize their impact and reduce the likelihood of contaminating your home by taking a few precautionary measures.

First, as previously mentioned, wash your hands as soon as you walk in the door, and even better, take a shower. Change out of your dirty “outside clothes”, and into your clean “inside clothes”, and swap outside shoes for inside shoes or slippers.

When visitors enter your home, ask them to take similar precautions. Well, maybe not the shower part, but they can certainly take off their coats in the hallway, remove their shoes at the door, and wash their hands when they arrive. This is even more important when children are visiting. Since children are much more likely to come in contact with dirt, viruses and bacteria, it would be to everyone’s advantage if they have an extra set of clothes to change into and immediately wash up, especially after they’ve been playing outside.

Be Aware of Your Surroundings

Equally important to being vigilant at home is minimizing your risk of exposure when you are out. As mentioned previously, this is particularly important when you are in public places that are regularly frequented by a lot of people.

Again, think about how many people’s hands touch the handrails on escalators or stairs, equipment at the gym, door handles or push buttons. I’ll give you a hint. It’s a lot. And the poles on buses and subways are virtual petri dishes for every disease known to man and probably a few yet-undiscovered ones as well.

As both a gambling man (and a health-care professional), I’m particularly aware of the “disgusting factor” at a casino. How many hands have touched those slot machine arms, the chips or the huge stack of cash you’re hoping to put in your pocket?

And then…there’s the doctor’s office. Now, that’s a whole ‘nother ball of bacteria (and viruses). Besides the obvious, coming-in-contact-with-a-high concentration-of-sick-people-in-one-place, how often do they clean the tables and chairs? And what about that annoying pen on a chain? Or even the magazines? If in doubt, don’t be afraid to confirm that the area and equipment have been disinfected. While this may seem like an imposition on the staff, as healthcare professionals they should appreciate your concern and understand that it’s better to be safe than sorry (or sick). As Ronald Reagan said: “Trust, but verify.”

Stay Away from Sick People

That may sound overly simplistic, or even harsh in some cases, but it is both completely true and very important. Of course, we understand that you want to see your friends and family, but trust me, if your children are sick (or even your grandchildren), it is much better to take a rain check—for everyone. As someone with a chronic pulmonary disease, a cold for you is not the same as a cold for someone with a healthy immune system, and as heartbreaking as it might be to skip the visit; you really have to look at the big picture. If that visit lands you in the hospital, it doesn’t do anyone any good.

Stay at Home When You’re Sick

Rule Number One: if you are sick, just stay home! We are conditioned to believe that we should never, ever, ever miss a day of work. However, that is a surefire way to prolong your illness and maximize its spread to as many people…and places…and surfaces as possible.

At the Center, our policy is if you are sick, you stay home, no if’s, and’s or but’s. This applies to patients and staff alike, even if you feel well enough to exercise or come to work. Again, the last thing we want is for you to get sick at a wellness center or for you to get someone else sick at a wellness center (or anywhere else).

Get Enough Rest

Sleep affects every system of the body, from the immune to the endocrine, to the cardiovascular and pulmonary, and every other system in between, to some degree or another. Lack of sleep or not getting enough overall rest can have a negative impact on your body’s immune system, lowering your body’s resistance and its ability to defend itself against bacteria and viruses. While most guidelines recommend between 7 and 9 hours, the exact amount of sleep we need varies from individual to individual.

Don’t Smoke!

Cigarette smoking is one of the worst possible things you can do to your body. As if causing heart disease, lung disease, cancer and complications during pregnancy weren’t enough, smoking cigarettes also lowers your body’s immune function and increases your chances of developing an infection or exacerbation. So just don’t do it.

Don’t Shake Hands or Kiss Hello and Goodbye

While it may be customary to shake hands when you meet someone, it is definitely not in your best interest. Now, I’m not trying to be gross, but in most cases, you really have no idea when that person last washed their hands. In this situation, social mores have to take a back seat to your health. The same goes for the hello and goodbye kiss and doubly so for the double kisses. You get the idea.

You can try using an alternative greeting: say “Namaste”, bow, wave, or salute each other. Hell, throwing up a gang sign (joke). Or, you can simply let people know that you don’t shake hands. Whether or not you tell them the reason is up to you, but it could be a good teaching opportunity and a chance to educate others about your condition. The choice is yours. No pressure.

Throw Tissues Away Immediately After Use

This one may seem obvious, but I can’t tell you how many people I see blowing their nose and then putting the dirty tissue back in their pocket, purse, up their sleeve, or in their bra (or what I like to call: “Grandma’s tissue box”) … and, don’t even get me started on the handkerchief!  I don’t know who thought of this brilliant idea, but do you really want to save that stuff for later? Besides being a treasure trove of bacteria, they’re just gross. So, don’t use one.

Avoid Confined Spaces

Whenever possible, avoid spending prolonged periods of time in small, enclosed spaces with poor ventilation. Try to stay in large, open, well-ventilated areas with lots of fresh air and where close contact with others is less intense.

As an example, airplanes are one of the worst possible places when it comes to the transmission of illnesses for a whole host of reasons. There are lots of people, in close proximity to each other. The air is re-circulated around the cabin and the surfaces are rarely disinfected. This makes it very easy for bacteria or viruses to travel from person to person, on surfaces or through the air. Although not quite as bad, the situation is similar in small offices, elevators, or other enclosed areas.

Suit Up

Let’s face it. Regardless of how well we attempt to prepare ourselves for every possible condition, we are all going to encounter situations in which we have no control over our environment. When all else fails and you find that you cannot control the environment or those around you, more extreme measures must be taken. Suit up. When we know we are going to be in a hostile environment, wearing a mask and/or gloves can be an effective last-ditch effort to avoid exposure.

Seek Medical Attention Sooner Rather Than Later

By now, you should realize that I believe in the “better safe than sorry”, “err on the side of caution,” and “an ounce of prevention…” schools of thought. When in doubt, seek medical attention sooner rather than later. As I have mentioned on many occasions, a cold is not the same for me as it is for you or someone with a respiratory disease; and a day or two, and sometimes even a few hours, can be the difference between preventing and minimizing the impact of a problem versus really getting in trouble. Many doctors will give their patients a prescription for antibiotics and/or steroids to keep on hand for if and when they do get sick.

Living with a chronic illness, particularly a respiratory condition can significantly compromise your immune system, making you more susceptible to picking up a bug, catching a cold or developing an infection or exacerbation. Patients often report getting sick once, twice, three times or more over the course of a given year and whether it is a cold, the flu, pneumonia, or an exacerbation, it always seems to settle in the chest. 

To learn more about how you can prevent infection, check out Chapter 11 of my book, Ultimate Pulmonary Wellness, Prevention of Infection!