Novel Coronavirus - What Patients Should Know

I have been getting a lot of messages and emails from my patients asking me about COVID-19, the novel coronavirus.

First, I want to assure you that this is NOT the “zombie apocalypse.” The worst thing that we can all do is to panic. Frankly, I’m far more afraid of media fearmongering and the mob mentality it can cause - like the kind we see right before hurricanes - than I am of the actual virus.

The reason that this particular virus is an issue is that it’s a new strain, which means that none of us have previously developed immunity to it. We have all been exposed to other kinds of coronaviruses – for example, the “common cold” is a type of coronavirus.

The big problem is that if 300 million people in the US all get exposed to this new virus, then a lot of people are going to get sick at the same time. MOST of those people are either going to have 1) no symptoms 2) very mild symptoms 3) severe cold or flu-like symptoms.

If all these people go flooding into emergency rooms and doctor’s offices, then the infection will spread even more and the health care system will be mobbed and not able to take care of the normal health problems that happen every day.

A small percentage of people are at higher risk. Up to this point, about 2% of people who get sick have died, but it is thought that since the US will have a lower mortality rate because we have better resources than China,

Mortality is highest in patients over 80 and so far, negligible in those under 50. People at increased risk are those with weakened immune systems – older people, pregnant women, patients with heart or lung problems, etc. Death usually comes from other infections like pneumonia because of a weakened system. The rest of us need to protect these people by taking certain precautions.

New estimates indicate that COVID-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively. Also, these viruses usually burn out when winter is over, so it should taper off naturally.

Step ONE:

Your best protection against any virus including flu is hand washing. Soap and water is best; hand sanitizer is a back-up. Avoid touching your face.

Step TWO:

Avoid crowds/ non-essential travel if you are worried or you are a high-risk patient. Wearing a mask is NOT likely to help you – I would not waste my money and save these for people working in close contact with ill patients, or for ill-patients to wear themselves.

Step THREE: Think of a potential pandemic the way you would about preparing for a hurricane, but not as bad because we will still have power, water, and cable/ internet. Make sure you have 2-weeks’ worth of food and medication so you don’t have to go to the store when you’re sick. Keepi n mind that these viruses usually burn out when winter is over, so it should taper off naturally.

Step FOUR:

If you get sick, STAY HOME. This is especially important if you have a fever. I will give you a doctor’s note for your work/ school – no problem. If you are NOT severely ill, DO NOT go to urgent care, ERs, etc. You can call, text, or email me for advice. Here is my basic advice for managing respiratory infections:

Dr. Bernard’s Recommended Treatments for Upper Respiratory Infections (URIs)

Most URIs are viral in nature which means that antibiotics are not useful and can sometimes even cause harm, such as rash, severe diarrhea, or allergic reactions. Instead, we focus on reducing your symptoms so your immune system can do its job and take care of the infection on its own.

Signs you may need prescription medication:

o Symptoms last more than 10-14 days

o You get “second sickening” which means you start to get

better and then all of a sudden get a lot worse

o Strep throat – normally seen with high fever, pus pockets on the tonsils, and swollen glands in the neck. There is NO cough, congestion, or runny nose. Presence of these makes it much more likely to be viral.

o If you are wheezing, you may need inhalers or steroids

Treatment based on symptoms:

- Congestion

o Sudafed (30 mg - the TINY red tablets - every 6-8 hours) is a decongestant. You must show your ID at the pharmacy counter. It

can increase your blood pressure so check with your doctor if you have high blood pressure before you take this.

o Afrin (one spray per nostril twice daily for NO MORE THAN 3-5 days) is a decongestant that can help with a severely stuffy nose, especially at night.

o Antihistamines: Zyrtec (10 mg once daily; non-sedating) and Benadryl (25-50 mg every 6 hours as needed; sedating). These work best for those that also have allergies

o Nasal Sinus Rinse: Neti pots are sold over the counter and can help greatly with congestion. Make sure you use boiled or bottled water ONLY in these pots and wash them thoroughly after each use.

o For children: NO DECONGESTANTS. Vaporub can be helpful on the chest or feet, nasal saline (Little Noses) and suctioning with a bulb suction or “Nosefrida” is best for infants, especially before each feeding

- Cough

o Honey reduces both cough and sore throat. It is also helpful in warm drinks like tea. For kids over 1 year of age: 1 tsp of honey before bed-time or a honey-containing cough medication like Zarbees or Chestal Honey works well

o Tessalon Perles (200 mg every 8 hours) reduces the cough reflex by anesthetizing the lung and trachea

- Pain/Aches/Chills – ask your doctor about children’s dosing

o Anti-inflammatories: Ibuprofen (600-800 mg every 8 hours) You can take this as long as you are not on any other anti-inflammatory medications and don’t have liver or kidney disease

o Acetaminophen: Tylenol (1000 mg every 6-8 hours). You can take this as long as you are not taking combination medications that contain Tylenol

- Sore Throat

o Chloraseptic spray or cepacol lozenges numb the back of the throat

o Warm Salt Water gargles: mix one teaspoon of table salt in warm water and gargle for 30 seconds 3 times per day

o Vaporub on the neck, covered loosely with a bandana or scarf overnight

Most importantly:

· GET PLENTY OF SLEEP and drink lots of fluids – I like Trop-50 low calorie orange juice and chicken soup

· Stay home and rest – don’t force yourself to go to school or work if you are feeling unwell

· Wash your hands frequently and use hand sanitizer to prevent spreading the virus