Coronavirus COVID-19 - Global Health Pandemic #44

[MajorHoople]

I read an interesting article that stated there are 2 kinds of toilet paper made, one for home use and one for restaurants, office buildings, etc. Different manufacturers make different kinds of toilet paper. The commercial rolls of toilet paper are the thin, one ply type, and is packaged individually wrapped. There apparently is no shortage of that type of toilet paper. The TP for home use is in short supply because most people are at home now all day and night so use toilet paper exclusively at home instead of at work, restaurants, clubs, etc.

Some of the commercial rolls are 2 ply. If you need 96 rolls give them a call.

Toilet Paper | KaTom Restaurant Supply

 

[Curious Me]

I have been disturbed by the idea that a ventilator is "magical" and once a person is off one, they are alive and good to go. I have worked with children who were on ventilators, many recovered, with brain damage, vision loss, significant gross and find motor delays.

People should be informed that maybe, they don't want to be on a ventilator.

Opinion | What You Should Know Before You Need a Ventilator

It's just something we all have to think about.​

Here’s part of it. Eye opening for sure:

Doctors are left with impossible choices. Too much oxygen poisons the air sacs, worsening the lung damage, but too little damages the brain and kidneys. Too much air pressure damages the lung, but too little means the oxygen can’t get in. Doctors try to optimize, to tweak.

Nobody can tolerate being ventilated like this without sedation. Covid-19 patients are put into a medically induced coma before being placed on a ventilator. They do not suffer, but they cannot talk to us and they cannot tell us how much of this care they want.

Eventually, all the efforts of health care workers may not be enough, and the body begins to collapse. No matter how loved, how vital or how needed a person is, even the most modern technology isn’t always enough. Death, while typically painless, is no less final.

Even among the Covid-19 patients who are ventilated and then discharged from the intensive care unit, some have died within days from heart damage.

Even before Covid-19, for those lucky enough to leave the hospital alive after suffering acute respiratory distress syndrome, recovery can take months or years. The amount of sedation needed for Covid 19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.

All this does not mean we shouldn’t use ventilators to try to save people. It just means we have to ask ourselves some serious questions: What do I value about my life? If I will die if I am not put in a medical coma and placed on a ventilator, do I want that life support? If I do choose to be placed on a ventilator, how far do I want to go? Do I want to continue on the machine if my kidneys shut down? Do I want tubes feeding me so I can stay on the ventilator for weeks?

Right now, all over the country, patients and their families are being asked to make these difficult decisions at a moment’s notice, while they are on the verge of dying, breathless and terrified.

Thanks MassGuy for sharing some of what it says. I've been collecting some of these articles trying to make my informed choices. Boy, it sure is a depressing subject!

My awe and deep gratitude goes out to every single health care provider and caretaker. Saints and angels, IMO.

The article we were discussing.
Opinion | What You Should Know Before You Need a Ventilator

 

[JRWoodwardMSW]

Ok, allow me to share my lateral thinking here...
Rubbing alcohol and hand sanitizer are not available in Tallahassee, Florida right now. The Home Depot website said our store was out of institutional sanitizer, too. However, I found out about an alcohol spray call EcoLogic Bedbug Spray. It’s a 70% alcohol spray with two special ingredients to make it more powerful against bedbugs: essential oils of lemongrass and comint. It’s a sanitizer spray! Just ignore the essential oils, which are harmless and often used in special herbal soaps. They were $10 each for a 14oz spray.
Suggestion two: check the websites of local craft brewers/distillers. Here in Tallahassee, we have a lively craft brewing scene, and two of our brewers, Proof and Ology, are now making and selling sanitizer and rubbing alcohol. Doing well by doing good, eh? Proof was even giving away a small sanitizer with every beer order for awhile.
Stay safe!

 

[Deleted member 158085]

I think you can put them in boiling water and boil them (after you wash them) to kill off any virus.

I thought soap and water kills this virus. If it does it for our hands in 20 seconds, surely a 40 minute wash cycle would do it.

 

[The•Qwill•Pen]

Couple things I've been wanting to mention, but between the fast-moving threads and fairly significant personal struggles, I haven't had a chance before now. I'm referencing items from previous posts, but they're buried, so I do apologize in advance for not being able to assign proper credit.

Re: High-dose vitamin C as treatment for Covid19:
This is actually a treatment, developed several years ago by an MD here in VA, as a last resort treatment for sepsis/septic shock/MSOF (multi-systems organ failure) due to sepsis. It still continues to be highly controversial, with results varying from study to study. People (general public) mistakenly believe that these patients are being given OTC vit C tabs. But--that isn't the case at all. First, they're being given high doses of ascorbic acid (aka vit C) IV (intra-venously). Second, vit C is being given in conjunction with 2 other medications, and the theory is that one enables the other to work. Just to give a visual on the complexity, this is the protocol from 2017:
https://www.evms.edu/uploads/magazine/9-4/downloads/Dosing_strategy.pdf

Vitamin C, Hydrocortisone and Thiamine For the treatment of Severe Sepsis and Septic Shock Vitamin C, Hydrocortisone and Thiamine dosing protocol

Vitamin C: 1.5 g IV q 6 hourly for 4 days or until discharge from the ICU.
Hydrocortisone: 50mg IV q 6 hourly for 4 days or until discharge from the ICU. Taper is not required.
Thiamine: 200mg IV q 12 hourly for 4 days or until discharge from the ICU. Alternative dosing: 100mg IV q 6 hourly for 4 days.

Vitamin C: Vitamin C is provided by the manufacturer as a 50 ml vial at a concentration of 500mg/ml. Three (3) ml of vitamin C will be placed in a 100ml bag of either dextrose 5% in water (D5W) or normal saline and infused over 30-60 minutes. The Vitamin C min-bag solution is stable for in excess of 24 hours (should be protected from light).
Hydrocortisone: Hydrocortisone 50 mg bolus q 6 hourly
Thiamine: Intravenous thiamine (200 mg) is placed in a piggyback in 50 ml of either D5W or normal saline and administered as a 30-minute infusion. NOTE: The Vitamin C and Thiamine can both be mixed in the same mini-bag.

And some other reference articles:
Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. - PubMed - NCBI
A cure for sepsis? | EVMS Magazine 9.4
EVMS Pulse Newsroom | Eastern Virginia Medical School | Media | Press

https://www.facebook.com/video.php?v=10156743855497095

As far as this protocol being beneficial in the setting of Covid19, I have absolutely no clue, as I don't believe there's anything more than anecdotal or theoretical evidence at this point, although I don't think it should be totally discounted, as I believe CV19 can lead to sepsis/MSOF (MOO)

Hand Sanitizer:
I don't understand the public's infatuation with this. It's harsh on your hands, has who-knows-what chemicals in it that aren't listed, and it doesn't even kill some particularly nasty bugs. Not to mention it does nothing for visible dirt. I was ridiculed years ago by med school friends of mine when I adamantly stated that hand sanitizer was inferior to hand-washing (I'm a lowly non-doctor). This isn't to say there's no use for hand sanitizer. There is good evidence to show its utility in certain circumstances (e.g. when soap/water isn't available). It's the over-reliance on this stuff that bugs me to no end.

You have naturally occurring oils on your skin, which trap dirt and microbes. Soap and water work by breaking up the oils on the surface of your skin and surrounding them. Then the running water washes it off. PS, don't forget that you have beneficial flora that lives on your skin too!
https://chem.ku.edu/sites/chem.ku.edu/files/docs/CHEM190/soap.pdf (how soap/water work)

I used to scrub in for sterile procedures at my old job, and there was a certain way and order to scrub our hands/forearms in order to reduce the bio-burden as much as possible. I still do the mechanics of it out of habit, but also because it's beneficial. If you're interested in an aseptic way of washing your hands, check out this training video on scrubbing in:

Obviously, no need to be this militaristic, as you're most likely not performing surgery , but applying the basic idea/principles are useful.

Ventilators:
Someone posted this interesting podcast: REBEL Cast Ep79: COVID-19 - Trying Not to Intubate Early & Why ARDSnet may be the Wrong Ventilator Paradigm - REBEL EM - Emergency Medicine Blog
Some of its topics are whether the ARDSnet protocol is doing more harm than good, whether intubation/ventilation is leading to poorer outcomes in some cases, and questioning the pathophysiology of Covid19. I had actually had the thought that perhaps using a device that increases positive end-expiratory pressure (PEEP) might not be the best thing in these cases. I've treated lots of patients with fluid in their lungs, mostly from CHF, certain types of MIs (heart attacks), and skipping dialysis treatments. PEEP in the form of CPAP, BiPAP, manual or mechanical ventilation can be a great way to get that fluid back where it belongs. Generally, the fluid is plasma that has leaked into the lungs from the vasculature that surrounds the alveoli. But in a pneumonia, if I understand it correctly, you've also got pus and other products of the immune response. So a) does that "gook" transition back into the vasculature with positive pressure ventilation (i.e. is it too thick/viscous), and b) if it could be absorbed back into the vasculature, aren't you just sending some nasty gunk straight into the circulatory system, and could that be a pathway for sepsis? I'm not entirely sure I'm making sense here, and I could very well be completely wrong, but I'm curious what others with medical expertise might think.
Pulmonary Edema - Cardiovascular Disorders - Merck Manuals Professional Edition

They also mention proning the patient, which I remember seeing in videos at the Italian hospitals. This is quite interesting to me, and I'll have to dig into this more to figure out why/how it works.

One thing I found odd, is why they don't mention EtCO2 (end-title carbon dioxide) monitoring--at all. That's become the gold standard in the EMS system I used to work in. Odder still, I was visiting a friend in the ICU a couple months ago at a major university hospital here, and they said they didn't use it outside of resuscitation. So who knows if they know something I don't know? Anyway, in short, it's very useful as a confirmatory and diagnostic tool, including telling you how well your tissues are being perfused. There are many limitations to the pulse ox/O2 sat monitoring. On the podcast, they talk a lot about being baffled regarding the seemingly high tolerance of very low O2 sats in some patients, but I'd like to know how their EtCO2 compares. Maybe nothing, but still curious.
A Systematic Approach to Capnography Waveforms - JEMS

Re: NY EMS changing protocols of when they take a cardiac arrest (aka a code) to the hospital:
This doesn't seem too weird, although I may have worked in a more progressive EMS system. Our medical director allowed us to call TOD in the field, at which point the scene was turned over to PD. The circumstances were outlined in our protocols, but one option was to work the patient at the scene. If we didn't get a pulse back (ROSC) after a certain amount of time, we could call the attending at the local hospital to obtain orders to cease resuscitation in the field. If we got ROSC, or felt they were viable (very case-by-case), we took them to the ED. I'm not intimately familiar with the NY EMS system, but from what I read about what they were being asked to do, it didn't seem like a big deal, but they also might not be used to it.

Getting a successful outcome (meaning, they achieve ROSC and go on to walk out of the hospital neurologically intact) in an out-of-hospital cardiac arrest is something crazy low, like 1-2%. If you aren't getting any ROSC in a certain amount of time, and don't suspect it's because of something you can't fix in the field, then there is almost no chance of meaningful survival, if at all.

I sure hope I've been making sense--my brain turned off for the night about an hour ago. I'll try to come back with some better facts tomorrow when I'm not as delirious from exhaustion

Obligatory disclaimer: If I haven't supported it with science or data, then it's MOO MOO MOO

 

[Curious Me]

I think you can put them in boiling water and boil them (after you wash them) to kill off any virus.

What about my Louis Vuitton mask? Boiling water?

Instagram stars don coronavirus face masks without sacrificing on style | Daily Mail Online

 

[JRWoodwardMSW]

I’ve seen a lot of adds for sanitizer on the web lately, some of them from companies I’ve never hear of, who have no Internet footprints older than a few weeks. Some of them use packaging designs that closely match that of Purcell. What concerns me is that they don’t say “70% alcohol” and in fact never mention alcohol at all. Someone I know bought a pack of this stuff. She opened it and sniffed. The ingredient is definitely no alcohol. She thought it smelled like Bactine and other wound-care disinfectants. They contain. anti-bacterial ingredients that do not work on viruses. If a sanitizer doesn’t say “alcohol” and doesn’t list its active ingredients at all, it’s a ripoff and a fraud. DONT BUY.
BTW, Popsmart, which advertises on WS, sells legit alcohol based sanitizers. They’re a bit pricey, but legit.

 

[MassGuy]

I’ve seen a lot of adds for sanitizer on the web lately, some of them from companies I’ve never hear of, who have no Internet footprints older than a few weeks. Some of them use packaging designs that closely match that of Purcell. What concerns me is that they don’t say “70% alcohol” and in fact never mention alcohol at all. Someone I know bought a pack of this stuff. She opened it and sniffed. The ingredient is definitely no alcohol. She thought it smelled like Bactine and other wound-care disinfectants. They contain. anti-bacterial ingredients that do not work on viruses. If a sanitizer doesn’t say “alcohol” and doesn’t list its active ingredients at all, it’s a ripoff and a fraud. DONT BUY.
BTW, Popsmart, which advertises on WS, sells legit alcohol based sanitizers. They’re a bit pricey, but legit.

Yeah, there’s this ad that keeps airing touting a hand sanitizer that contains no alcohol whatsoever. As far as I can tell, it’s a new company trying to cash in.

They also advertise a low price, but you have to buy in quantity to get that “value.” They also nail you on S&H charges. They proudly advertise that their product is “not on Amazon.”

Panicked people who can’t find the good stuff are an easy mark, and think they are getting something to prevent contracting this virus.

It’s gross.

 

[mickey2942]

@Curious Me I called the Hospice center here a few weeks ago. If my husband gets sick, he isn't going to get a test, or go to the hospital. He is over age 80, and not in the best health.

The pallative care nurse told me that they would give him morphine if he was struggling to breathe. He doesn't have to go to the hospital or anything.

So, we know what the plan is for him. Hopefully not needed. But I already filled out the paperwork needed with them. All I have to do is call.

 

[The•Qwill•Pen]

tysm!
yeah no rubbing alcohol but you're right I haven't checked the variety stores
we just have hand sanitizer in the car and I do already use cetaphil
I'll research further re: vitamin C

No problem! Just trying to do my part to prevent someone else from having to take
300 pointless trips to the stores with empty shelves

Isn't cetaphil the best? Took care of some nasty eczema when all the (very expensive!) topical steroids/meds failed.

Good luck in your search!

 

[cass523]

If you call the cable company, and explain your issues, they may be able to guide you through it. I had internet issues a week ago, and didn't want anyone in my home either. I called Spectrum after trying to reset modem, and they sent a guy out whom left the new modem in our garage. They said they would contact me when all of this was over, to pick up the old one. The problem continued, and they came back and gave us new cables, and a new splitter. The issue was resolved, and I was so happy they didn't want to come in either. MOO

Mine kept cutting out because the router was too far away from me on another floor. Dead Zones
I purchased aWi-Fi extender, plugged it in around the center point of the house I have not had a problem since.
Just wanted to let @NuttMegg know in case her computer is cutting out and this could be the issue

Does it matter which Wi-Fi range extender you use? Turns out yes

 

[JRWoodwardMSW]

Yeah, there’s this ad that keeps airing touting a hand sanitizer that contains no alcohol whatsoever. As far as I can tell, it’s a new company trying to cash in.

They also advertise a low price, but you have to buy in quantity to get that “value.” They also nail you on S&H charges. They proudly advertise that their product is “not on Amazon.”

Panicked people who can’t find the good stuff are an easy mark, and think they are getting something to prevent contracting this virus.

It’s gross.

As a retired medical social worker, ESPECIALLY a guy who worked dialysis, this infuriates me.

 

[JRWoodwardMSW]

@Curious Me I called the Hospice center here a few weeks ago. If my husband gets sick, he isn't going to get a test, or go to the hospital. He is over age 80, and not in the best health.

The pallative care nurse told me that they would give him morphine if he was struggling to breathe. He doesn't have to go to the hospital or anything.

So, we know what the plan is for him. Hopefully not needed. But I already filled out the paperwork needed with them. All I have to do is call.

What’s your husbands first name? I would like my Quaker Meeting to hold him in the Light.

 

[Curious Me]

@Curious Me I called the Hospice center here a few weeks ago. If my husband gets sick, he isn't going to get a test, or go to the hospital. He is over age 80, and not in the best health.

The pallative care nurse told me that they would give him morphine if he was struggling to breathe. He doesn't have to go to the hospital or anything.

So, we know what the plan is for him. Hopefully not needed. But I already filled out the paperwork needed with them. All I have to do is call.

It sounds like a comfort knowing he will be in the care of people who respect his, and your, wishes. Thank You for sharing that. It can be so distressing and not easy to linger in the hospital. My father was given morphine and we surrounded him in prayer the entire night until morning. He sang a Frank Sinatra song when he first started to sleep. I went down to the cafeteria in the a.m., but some loud voice in my head told me to go back upstairs now. No sooner did I get back to the room that he died in my arms peacefully. Peacefully is a blessing.

 

[neesaki]

I have been disturbed by the idea that a ventilator is "magical" and once a person is off one, they are alive and good to go. I have worked with children who were on ventilators, many recovered, with brain damage, vision loss, significant gross and find motor delays.

People should be informed that maybe, they don't want to be on a ventilator.

Opinion | What You Should Know Before You Need a Ventilator

Thank you for bringing this up as I’ve had the same concerns. Ventilator associated complications are often very serious and life threatening with septic shock being a serious concern. I just looked for a link, for the moment this all I’ve come up with for the moment.
Host immune response in sepsis due to ventilator-associated pneumonia: how is it different?

Ventilator-associated pneumonia (VAP) develops commonly in mechanically ventilated patients and is a major cause of morbidity and mortality in the intensive care unit.

 

[Rocco]

Some of the commercial rolls are 2 ply. If you need 96 rolls give them a call.

Toilet Paper | KaTom Restaurant Supply

Thanks for the info but I'm actually one of the lucky ones who hasn't had any trouble buying it at the grocery store. Everyone must be stocked up by now.

 

[JRWoodwardMSW]

Thanks for the info but I'm actually one of the lucky ones who hasn't had any trouble buying it at the grocery store. Everyone must be stocked up by now.

In the Good Old Days (12/19), I bought a 96-roll individually-wrapped package from Office Depot for our local Christmas Connection to add packages to their distributions for poor families.
Just try to find such a thing now.

 

[MassGuy]

As a retired medical social worker, ESPECIALLY a guy who worked dialysis, this infuriates me.

So this is what happened. A company that owns the trademark to “Healthvana,” (the product I was referencing), has no affiliation with this company that was using their name to sell this junk.

They have been ordered to stop using that name, and now go by “Handvana.”

So not only are they selling a useless product to people trying to keep themselves (and their families safe), but they stole a name in order to do it.

They aren’t explicitly claiming that this will kill Corona, but they know exactly what they are doing.

Let no crisis go to waste, or something.

Healthvana on Twitter

 

[pocketaccent]

pocketaccent's quote said, "On day seven of their investigation, the virus was still present on the outward facing side of the mask."


That is shocking. Throwing away the surgical mask I saved. I was trying to be ecology-minded, but forget that.

Many of the big food stores in So. California, since we banned light weight plastic bags, now give us these super strong, indestructible, plastic, reusable bags. I was washing them to reuse...being ecology-minded. I feel I'm drowning in plastic, and worry about the oceans. Well, now, with the virus, the Grocery Outlet nearby no longer allows you to bring in any reusable bag, but sells large paper bags for 10 cents. Truthfully, I wish all the stores would just go to paper bags then, instead of giving me indestructible plastic I can't even reuse anymore.

No wonder surgical masks have been called disposable masks. They should be carefully thrown away without touching the outside after each use.

But since the masks are more precious than gold these days, let's hang them in a remote corner of house for 7 days, then reuse. Frankly I'm tired of new studies after new studies giving us more bad news.

 

[Jessthinkin]

Here’s part of it. Eye opening for sure:

Doctors are left with impossible choices. Too much oxygen poisons the air sacs, worsening the lung damage, but too little damages the brain and kidneys. Too much air pressure damages the lung, but too little means the oxygen can’t get in. Doctors try to optimize, to tweak.

Nobody can tolerate being ventilated like this without sedation. Covid-19 patients are put into a medically induced coma before being placed on a ventilator. They do not suffer, but they cannot talk to us and they cannot tell us how much of this care they want.

Eventually, all the efforts of health care workers may not be enough, and the body begins to collapse. No matter how loved, how vital or how needed a person is, even the most modern technology isn’t always enough. Death, while typically painless, is no less final.

Even among the Covid-19 patients who are ventilated and then discharged from the intensive care unit, some have died within days from heart damage.

Even before Covid-19, for those lucky enough to leave the hospital alive after suffering acute respiratory distress syndrome, recovery can take months or years. The amount of sedation needed for Covid 19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.

All this does not mean we shouldn’t use ventilators to try to save people. It just means we have to ask ourselves some serious questions: What do I value about my life? If I will die if I am not put in a medical coma and placed on a ventilator, do I want that life support? If I do choose to be placed on a ventilator, how far do I want to go? Do I want to continue on the machine if my kidneys shut down? Do I want tubes feeding me so I can stay on the ventilator for weeks?

Right now, all over the country, patients and their families are being asked to make these difficult decisions at a moment’s notice, while they are on the verge of dying, breathless and terrified.

This is sobering, for sure. My 84 year-old mother had a heart attack and was put in a medically-induced coma and on a ventilator in August, and suffered a pretty steep and quick decline following that, eventually dying in December. The decisions and balancing of pros and cons and "least bad" outcomes was exactly as described above, but at least she had led a full life up until then. The fact that these same painful choices and difficult outcomes are happening to relatively young and previously healthy people is really something terrible to see...