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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread


No one knows 'cacat' like cacatman!!
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Coronavirus COVID-19/novel SARS-CoV-2

I wrote this for friends/fellow medicos in Jordan (where I live, but applicable where you are, if there is the threat of coronavirus).

Feel free to make serious comments. Other comments will be removed.

Guidelines - Coronavirus Disease 2019 (COVID-19): Practice Essentials, Background, Route of Transmission

Best Practice Guidelines - 🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

Info about COVID Vaccines - Questions & Answers About COVID-19 Vaccines

How To Use
Use the search button and click "this thread" to do a keyword search for a topic of interest related to COVID-19 that is limited to only this thread.

Original Post Here - Facebook

Contains historical information that I personally gathered over the past 10 months re: COVID-19. Some information has been superseded, but most is referenced with article links for dates. This thread contains my opinion, unless referenced.

What to do if you are NOT Sick

  1. Wash your hands for at least 20 secs with SOAP and water frequently (particularly after touching door handles/after going to the toilet/physical contact with others)[1]
  2. I’d personally suggest that you take off your outside shoes at the door and use specific indoor shoes/slippers. Leave keys near door, wash hands and then or handles and keys.
  3. Only use hand sanitiser (>60% alcohol) IF you have no access to #1 (not as effective)
  4. Touch your face as little as possible (most people touch their face once every 2 minutes)[1.5]
  5. Cough/sneeze into a throwaway tissue or the crook of your arm. Don’t use a handkerchief that you keep using!!
  6. If needing to touch something, use something else e.g. your elbow or knuckle (e.g. lift buttons/door handles)
  7. Disinfect all commonly touched areas frequently e.g. phones (Apple recommends non-chlorox wipes and avoid moisture getting into the phone), wallets, door handles, tables/desks, light switches, bathroom taps.[2] Virus is thought to live up to 17 days on surfaces depending on conditions[3]
  8. Stock up on at least a month of food & water (if you run out of water, boil tap water for 10 mins before drinking), panadol, money for emergencies, hand sanitiser, a thermometer for your household, surface disinfectant and at least twice the amount of normal medications you would keep.[4]
  9. Avoid unnecessary meetings with groups of people, particularly the elderly
  10. I would advise complete social isolation with your family, but if you must let people into your house, sensitively screen your visitors for symptoms before they come to your home!!
  11. Avoid unnecessary travel[5]
  12. Avoid physically greeting people ie. no shaking hands, hugging or kissing
  13. Maintain at least a 2 metre social distancing. Keep in mind that respiratory droplets from a sneeze can travel up to 4 metres
  14. Try to avoid buses/going to malls/cinemas ie avoid high density areas. It reduces spread [5.5]
  15. re: Masks - I’d advise wearing some sort of mask whenever in public to prevent spread/protect yourself. Studies have shown that coronavirus can be aerosolised and can be transmitted in this state general consensus is changing re: use of masks (n95 is best). Paper masks are almost useless (you can purchase an N95 mask for 18 JOD from Cozmo). These are washable. Masks can be homemade. See note [5.8] for more information as to how to do this.

What to do if you have ANY FLU symptoms
  1. CALL your local doctor/health care provider for advice
  2. Quarantine yourself AND your household for a minimum of 14 days[7]
  3. Wear a mask (prevents respiratory droplets from spreading from YOU)[7.5]
  4. If you develop worsening cough/breathing, contact your local health provider/call 911
  5. You may/may not need a coronavirus test[8].
What are the symptoms of coronavirus Infection?[9]
  1. Fever, tiredness and dry cough are the most common symptoms
  2. Muscle aches/pains, nasal congestion, runny nose, sore throat or diarrhoea
  3. Symptoms are mild and begin gradually ie. just like the common flu
  4. (loss of smell or taste has been reported in up to 30% of cases, WHO is investigating now. It can last from 5-10 days)[9.5]
N.B. Sneezing and phlegm is not a common feature

Does Smoking Increase Risk?[26]
Yes. The act of smoking increases risk of transmission due to the proximity of hands to the face. Smokers also have weakened immune systems with damaged lungs which increases susceptibility and decreases their ability to combat coronavirus.

Are Pregnant Women at More Risk? [27]
Unknown, but unlikely. Vertical transmission (from mother to child via breast feeding) is also unlikely but precautions are recommended.
Good resource for pregnant women during this time of COVID-19 - https://evidencebasedbirth.com/birthing-in-the-time-of-covid-19/

For More Information
For the numbers - https://ncov2019.live/data, https://www.worldometers.info/coronavirus/
re: Testing - https://www.tga.gov.au/covid-19-testing-australia-information-health-professionals
A Christian’s perspective on the Pandemic by James Krieg and Kurt Mahlburg. Well worth following their blogs

References for the geeks (/beavers) amongst you…
[1] Here’s how to do it properly!!! https://www.cdc.gov/handwashing/
[1.5] Studies like this show people touch their face about once every 2 minutes https://www.ncbi.nlm.nih.gov/pubmed/25637115
[3] It is thought to live between 2 hours -> 9 days depending on weather conditions. It is thought to not thrive in hot (>25 degrees Celsius) and humid conditions (but it is not really proven yet). It is killed within minutes using detergents on surfaces. https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
On the Diamond Princess, virus was found 17 days later - https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm
The efficacy of various disinfectants was examined both on viruses in liquid suspension and on viruses dried on surfaces [94]. Human coronaviruses, including CoV-229E and SARS-CoV, as well as several animal coronaviruses (eg, mouse hepatitis virus and transmissible gastroenteritis virus of pigs), were studied. These viruses (both in suspension and dried on surfaces) were very susceptible to 70% ethanol, with reduction of viability by greater than 3 log within seconds [95-97]. Likewise, hexachlorophene [98], 2% glutaraldehyde [95] and 1% povidone-iodine [95,97] each produced satisfactory killing. It appears that susceptibility of coronaviruses to 6% sodium hypochlorite (the active agent in bleach)
Most of the spread occurs from asymptomatic carriers/carriers with few symptoms https://science.sciencemag.org/content/early/2020/03/13/science.abb3221?rss=1
[5.7] https://www.medscape.com/viewarticle/928149 (registration needed)
[5.8] [5.8] How to Make Your Own Mask
Material - Pillow case or cotton t-shirt is the best compromise. It is the best compromise between comfort, breathability and washability. Double layers don’t help. It’s not as good as N95 masks, but it will confer some protection.
Use this site to print out exact shape -https://www.nytimes.com/2020/03/31/opinion/coronavirus-n95-mask.html
[7] Incubation period of the coronavirus is 14 days, but usually, people get symptoms at 5 dayshttps://www.who.int/news-room/q-a-detail/q-a-coronaviruses
[7.5] A respiratory droplet is anything large than 5 microns in diameter and can land within about 2 metres from the infected person
[8] You may not need a test. Even if you do, it is best to stay at home in quarantine. Biolab can test you for 70 JD – but they will come to you, don’t go to them…call 0795907000 or 06 5907000 ext2
[10] COVID-19 is the disease caused by the novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
[11] 6 tourists were affectedhttps://en.royanews.tv/news/20230/2020-03-15
[12] 90 people are in quarantine officiallyhttps://www.aljazeera.com/news/2020/03/coronavirus-cases-jordan-fear-uncertainty-loom-200312183546081.html
[13] I think it makes sense that under-reporting and under testing will distort the numbers in Jordan due to the relative cost of testing, the economic impact on individuals who are found to have the virus, and the social stigma.
[14] 312,786 infected world wide with 13,234 deaths (22nd March, 2020)https://www.worldometers.info/coronavirus/?zarsrc=130
[15] 11th Marchhttps://time.com/5791661/who-coronavirus-pandemic-declaration/
[17] The government announces new measures to deal with the CORONA virus that includes the disruption of schools and universities.
Prime Minister Dr. Omar Al-Razaz announced saturday in a press release a series of new measures and decisions taken by the government to deal with the new coronavirus in light of the rapid global developments and in order to protect the homeland and citizens. These measures are as follows:
Education sector
• Suspension of educational institutions (kindergartens, nurseries, schools, universities, colleges, institutions and training institutes) from Sunday morning, March 15, 2020 and for two weeks.
• The education managers organize the administrative hours in the Ministry of Education, as instructed.
• The Ministry of Education will begin implementing the distance education plan through the Ministry's e-learning website from next week and national television channels from this week.
• In addition to the previously announced suspension of flights to and from certain countries from Monday, March 16, 2020, all flights to and from the Kingdom will be suspended from Tuesday, March 17, 2020.Travel• In addition to the previously announced suspension of flights to and from certain countries from Monday, March 16, 2020, all flights to and from the Kingdom will be suspended from Tuesday, March 17, 2020, until further notice, excluding commercial freight traffic.
• Staff from diplomatic missions and international organizations are excluded, provided that the ministry of health's instructions, including self-quarantine, are adhered to for 14 days. Diplomatic missions and international organizations inform the Ministry of Health through the Ministry of Foreign Affairs in case of any symptoms on the staff of diplomatic missions requiring medical examinations.
• Accordingly, all land and sea crossings and airports are closed to passenger traffic, with the exception of commercial freight.
• Direct Jordanians abroad to stay in place.
• Jordanians in neighbouring countries who are obliged to return can enter through land and sea border crossings and are subject to the procedures of the Ministry of Health.Public events, religious services and tourism
• Stop all public events and gatherings. Citizens are advised not to gather at social events, including funeral homes and weddings.
• Stress the importance of citizens' commitment as much as possible to stay in their homes, and to avoid going out unless necessary.
• Under the guidance of the Fatwa Council and the Council of Churches, stop prayers in all mosques and churches of the Kingdom, as a precautionary and preventive measure, with a commitment to raise the adhan in its time and to broadcast a unified Friday sermon on television stations.
• Suspend visits to hospitals and prisons from Sunday until further notice.
• Closure of archaeological tourist sites for one week, to carry out sterilization campaigns at these sites.
• Suspend sports events, close cinemas, swimming pools, sports clubs and youth centres, until further notice.
• Prohibit the provision of argilla and its services and smoking in cafes and restaurants. The official authorities responsible for the closure of any café or restaurant do not comply with these instructions.
• Cafés and restaurants must maintain spaces between seating areas, as instructed by the Ministry of Health.
[19] Italy has a first world health system and is overwhelmed. Cases jumped from 320 infected to 21,157 infected in just 3 weeks, with over 900 deaths. This is in a country of 60 million people with a first world health system. They are now refusing to intubate people > 60 yo due to lack of resources.https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy
[20]COVID-19 has infected 153,523 cases worldwide with 5,789 deaths (as of 14th March). The flu affects 1 billion people worldwide and kills up to 646,000 per year.https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu
[21] Trials have started, but it could take about a year before a vaccine is commercially availablehttps://www.statnews.com/2020/03/11/researchers-rush-to-start-moderna-coronavirus-vaccine-trial-without-usual-animal-testing/
[24] Al Bashir Hospital 06 479 1000, the University of Jordan 06 535 5000, and the new Zarqa Government Hospital 05 375 8200 have been designated as centres for the central region, while King Abdullah University Hospital 02 720 0600 was designated to handle suspected cases for the northern region and Al Karak Hospital 03 238 6191 and Prince Hashem Military Hospital 03 209 2030 for the southern region.https://www.jordantimes.com/news/local/five-hospitals-designated-quarantine-covid-19-testing
[25] 120-180 JOD/day in a hotel. Prince Hamzah Hospital is 1,200 JOD/day
[26] https://www.who.int/news-room/q-a-detail/q-a-on-smoking-and-covid-19
[27] https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/

@cacatman is a registered Australian General Practitioner (M.B.,B.S (Adel), FRACGP) currently living in Amman, Jordan. He obtained his degree from Adelaide University, and amongst other things, served as a doctor on board a passenger ship for 2 years, worked as a cardiac surgical assistant (for >10 years), practised general/emergency medicine in rural South Australia at Whyalla Hospital/General Practice for a number of years before moving to Amman, Jordan with his family. He works as a general practitioner in both Zarqa and Amman.
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This list came via an Australian doctor working with patients living in quarantine. I tried to adapt it for Jordan.
Other resources here - https://www.cvt.org/COVID-19-resources
1. Stick to a routine. Go to sleep and wake up at a reasonable time, write a schedule that is varied and includes time for work as well as self-care.
2. Dress for the social life you want, not the social life you have. Get showered and dressed in comfortable clothes, wash your face, brush your teeth. Take the time to do a bath or a facial. Put on some bright colors. It is amazing how our dress can impact our mood.
3. Get out at least once a day, for at least thirty minutes. Try first thing in the morning, or later in the evening. Get out onto your balcony or onto the roof of your amara (the stairs will do you good!). If you don’t want to leave the apartment, open the windows and blast the fan. It is amazing how much fresh air can do for spirits.
4. Find some time to move each day, again daily for at least thirty minutes. If you don’t feel comfortable going outside, there are many YouTube videos that offer free movement classes, and if all else fails, turn on the music and have a dance party!
Excellent exercise app - https://apps.apple.com/dk/app/nike-training-club/id301521403
5. Reach out to others, you guessed it, at least once daily for thirty minutes. Try to do FaceTime, Skype, Zoom, Microsoft Teams, Signal, Telegram, WhatsApp (need VPN for calls/video to work), phone calls, texting - connect with other people to seek and provide support (don’t forget to do this for your children as well. Set up virtual playdates with friends daily via FaceTime, Facebook Messenger Kids, Zoom, etc—your kids miss their friends, too!). We have time now to encourage one another, without feeling that we’re “biting” into their time.
6. Stay hydrated and eat well. This one may seem obvious, but stress and eating often don’t mix well, and we find ourselves over-indulging, forgetting to eat, and avoiding food. Drink plenty of water, eat some good and nutritious foods, and challenge yourself to learn how to cook something new! Personally, I use an app called “Supercook” where you record what you have in your pantry and then press a button to display what you can cook with the food items you have! It’s fantastic!!
iPhone - https://apps.apple.com/…/supercook-recipe-by-i…/id1477747816
Android - https://play.google.com/store/apps/details…
7. Develop a self-care toolkit. This can look different for everyone. A lot of successful self-care strategies involve a sensory component (seven senses: touch, taste, sight, hearing, smell, vestibular (movement) and proprioceptive (comforting pressure). An idea for each: a soft blanket or stuffed animal, a hot chocolate, photos of vacations, comforting music, lavender or eucalyptus oil, a small swing or rocking chair, a weighted blanket. A journal, an inspirational book, or a mandala coloring book is wonderful, bubbles to blow or blowing watercolor on paper through a straw are visually appealing as well as work on controlled breath. Mint gum, Listerine strips, ginger ale, frozen Starburst, ice packs, and cold are also good for anxiety regulation. For children, it is great to help them create a self-regulation comfort box (often a shoe-box or bin they can decorate) that they can use on the ready for first-aid when overwhelmed.
8. Spend extra time playing with your own children. Children will rarely communicate how they are feeling, but will often make a bid for attention and communication through play. Don’t be surprised to see therapeutic themes of illness, doctor visits, and isolation play through. Understand that play is cathartic and helpful for children—it is how they process their world and problem solve, and there’s a lot they are seeing and experiencing in the now.
9. Give everyone the benefit of the doubt, and a wide berth. A lot of cooped up time can bring out the worst in everyone. Each person will have moments when they will not be at their best. It is important to move with grace through blowups, to not show up to every argument you are invited to, and to not hold grudges and continue disagreements. Everyone is doing the best they can to make it through this.
10. Everyone find their own retreat space. Space is at a premium, particularly during the lockdown. It is important that people think through their own separate space for work and for relaxation. For children, help them identify a place where they can go to retreat when stressed. You can make this place cozy by using blankets, pillows, cushions, scarves, beanbags, tents, and “forts”. It is good to know that even when we are on top of each other, we have our own special place to go to be alone.
11. Expect behavioral issues in children, and respond gently. We are all struggling with disruption in routine, none more than children, who rely on routines constructed by others to make them feel safe and to know what comes next. Expect increased anxiety, worries and fears, nightmares, difficulty separating or sleeping, testing limits, and meltdowns. Do not introduce major behavioral plans or consequences at this time - hold stable and focus on emotional connection.
More tips - https://www.theguardian.com/…/the-family-lockdown-guide-how…
12. Focus on safety and attachment. We are going to be living for a bit with the demand of school work, Arabic lessons or official duties, homeschooling children, running a sterile household, and making a whole lot of entertainment in confinement. We can get wrapped up in meeting expectations in all domains, but we must remember that these are scary and unpredictable times for children. Focus on strengthening the connection through time spent following their lead, through physical touch, through play, through therapeutic books, and via verbal reassurances that you will be there for them in this time.
13. Lower expectations and practice radical self-acceptance. This idea is connected with #12. We may be doing too many things in this moment, under fear and stress. This does not make a formula for excellence. Instead, give yourself what psychologists call “radical self acceptance”: accepting everything about yourself, your current situation, and your life without question, blame, or pushback. You cannot fail at this—there is no roadmap, no precedent for this, and we are all truly doing the best we can in an impossible situation.
14. Limit social media and COVID conversation, especially around children. One can find tons of information on COVID-19 to consume, and it changes minute to minute. The information is often sensationalized, negatively skewed, and alarmist. Or, you could do your own research and find a few trusted sources that you can check in with consistently, limit it to a few times a day, and set a time limit for yourself on how much you consume (again 30 minutes tops, 2-3 times daily).
15. Notice the good in the world, the helpers. There is a lot of scary, negative, and overwhelming information to take in regarding this pandemic. There are also a ton of stories of people sacrificing, donating, and supporting one another in miraculous ways. It is important to counter-balance the heavy helpless information with the hopeful information.
16. Help others. Find ways, big and small, to give back to others. Support delivery businesses, offer to grocery shop, check in with elderly neighbours, write psychological wellness tips for others - helping others gives us a sense of agency when things seem out of control.
www.mouneh.jo - which is a directory of companies and licensed applications that provide goods delivery services to homes in all governorates of the Kingdom
Mujeb Organic Farm (for ordering fresh vegetables) - Android - https://play.google.com/store/apps/details…
iPhone - https://apps.apple.com/…/app/mujeb-organic-farm/id1451399537
Hammoudeh Dairy (order between 9 am-12 pm) - https://onlineorders.hammoudehdairy.com/web/
Hasam - Home delivery for eggs - 079 500 1425
Poultry delivery - 079 560 6268, 079 560 6267
Alfareed Android Application:
Alfareed IPhone Application: https://apps.apple.com/…/alfarid%D8%A7%D9%84%D…/id1452075889
Carrefour Android Application:
Carrefour IPhone Application:
Carrefour Website:
Cozmo Android Application:
Cozmo IPhone Application:
Cozmo Website:
Safeway Website:
Sameh Mall Android Application:
Sameh Mall IPhone Application:
Sameh Mall Website:
Scappery Android Application:
Scappery IPhone Application:
Zait & Zatar Android Application:
Zait & Zatar IPhone Application:
Basket Android Application:
Basket IPhone Application:
Basket Website:
Bilforon Android Application:
Bilforon IPhone Application:
Dokanti Android Application:
Dokanti IPhone Application:
Dumyah Website:
Garson Android Application:
Garson IPhone Application:
JB Mall Android Application:
JB Mall IPhone Application:
Matrix Android Application:
Matrix IPhone Application:
Matrix Website:
Talabat Android Application:
Talabat IPhone Application:
Talabat Website:
Utrac Android Application:
Utrac IPhone Application:
17. Find something you can control, and control the heck out of it. In moments of big uncertainty and overwhelm, control your little corner of the world. Organise your bookshelf, purge your closet, put together that furniture, sort out your shrinking pantry. It helps to anchor and ground us when the bigger things are chaotic.
18. Find a long-term project to dive into. Now is the time to learn how to play the keyboard, put together a huge jigsaw puzzle, start a 15 hour game of Risk, paint a picture, read the Harry Potter series, binge watch a Netflix series (like Jinn, Peasants' Rebellion), crochet a blanket, solve a Rubix cube, or develop a new town in Animal Crossing. Find something that will keep you busy, distracted, and engaged to take breaks from what is going on in the outside world.
Try the free courses here from Open University
19. Engage in repetitive movements and left-right movements. Research has shown that repetitive movement (knitting, coloring, painting, clay sculpting, skipping etc) especially left-right movement (running, drumming, hopping) can be effective at self-soothing and maintaining self-regulation in moments of distress.
20. Find an expressive art and go for it. Our emotional brain is very receptive to the creative arts, and it is a direct portal for release of feeling. Find something that is creative (sculpting, drawing, dancing, music, singing, playing) and give it your all. See how relieved you can feel. It is a very effective way of helping kids to emote and communicate as well!
21. Find lightness and humour in each day. If you have trouble finding something funny, take a look in the mirror….or call me….I’ll tell you something funny that happened to him. There is a lot to be worried about, and with good reason. Counterbalance this heaviness with something funny each day: cat videos on YouTube, a stand-up show on Netflix, a funny movie—we all need a little comedic relief in our day, every day.
22. Reach out for help - If you have a therapist or psychiatrist or team leader at work, they are available to you, even at a distance. Keep up your medications and your therapy sessions the best you can. If you are having difficulty coping, seek out help for the first time. There are mental health people on the ready to help you through this crisis. Your children’s teachers and related service providers will do anything within their power to help, especially for those parents tasked with the difficult task of being a whole treatment team to their child with special challenges. Seek support groups of fellow home-schoolers, parents, and neighbors to feel connected. There is help and support out there, any time of the day—although we are physically distant, we can always connect virtually.
23. “Chunk” your quarantine, take it moment by moment. We have no road map for this. We don’t know what this will look like in 1 day, 1 week, or 1 month from now. Often, when I work with patients who have anxiety around overwhelming issues, I suggest that they engage in a strategy called “chunking”—focusing on whatever bite-sized piece of a challenge that feels manageable. Whether that be 5 minutes, a day, or a week at a time—find what feels doable for you, and set a time stamp for how far ahead in the future you will let yourself worry. Take each chunk one at a time, and move through stress in pieces.
24. Remind yourself daily that this is temporary. It seems in the midst of this quarantine that it will never end. It is terrifying to think of the road stretching ahead of us. Please take time to remind yourself that although this is very scary and difficult, and will go on for an undetermined amount of time, it is a season of life and it will pass. We will return to feeing free, safe, busy, and connected in the days ahead.
25. Find the lesson. This whole crisis can seem sad, senseless, and at times, avoidable. When psychologists work with trauma, a key feature to helping someone work through said trauma is to help them find their agency, the potential positive outcomes they can effect, the meaning and construction that can come out of destruction. What can each of us learn here, in big and small ways, from this crisis? What needs to change in ourselves, our homes, our communities, our nation, and our world?
Hydroxychloroquine with or without azithromycin in mild-moderate covid-19 not useful
No benefit of hydroxychloroquine in patients with severe Covid and a slight increase in mortality and risk of need for mechanical ventilation.

This controlled trial enrolled 85 patients hospitalized with COVID-19 infection and randomized them to receive either hydroxychloroquine or azithromycin for 5 days. The trial was terminated early due to external data suggesting no benefit with hydroxychloroquine treatment. Outcomes in this study also failed to show clinical improvement with the use of hydroxychloroquine as compared with azithromycin. The investigators found a trend toward increased acute kidney injury in patients who received hydroxychloroquine.

Although this study was terminated early and compared hydroxychloroquine with azithromycin rather than placebo as a control, the findings do not suggest clinical efficacy of using hydroxychloroquine to treat patients with COVID-19 infection.

An increase in QTc was seen in hospitalized COVID-19 patients treated with HCQ/AZM. Changes in QTc were not associated with increased risk of death.
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Extensive resource on coronavirus - technical info + latest treatments. I haven't read it all, but seems credible. References are mainly CDC China. Use at own risk.
Incubation period compared to other coronaviruses/other viruses
Symptoms of fever, cough, shortness of breath - supplementary O2, intubation. Use of non-invasive positive pressure can spread it due to it’s presence in the the upper airways (therefore ensure correct diagnosis is central and that it isn’t flu/community acquired pneumonia)

Early Therapies (may be different now):-
1. Antiviral agents - lopinovir, ritonovir unclear efficacy, but fewer people died, but it didn’t decrease the viral load.
2. Virus receptor modulators (e.g. ACE Inhibitors/ARBs (angiotensin receptor blockers)) - Not clear either way. Could be beneficial by blocking the receptor OR it may increase sensitivity to stimulation of the pathway!!
3. NSAIDS - If using prior to infection, no difference to outcomes - DEFINE_ME
4. Corticosteroids/other anti-inflammatories - Aberrant inflammatory response plays a role in the second half of illness with significant resp failure. Corticosteroids cause other unwanted side effects with limited benefits currently (in SARS 1, may have caused harm) ie. increase the amount of viral replication (as patients aren’t treated with specific anti SARS CoV-2 drugs). Possible blockade of IL6 receptors to dampen aberrant immune response may work, but hasn’t been studied
5. Hydroxychloroquine could reduce uptake of virus into the cell but not enough clear data at the moment.

The overall feeling I get from these doctors are that they are understandably cautious in providing any hooks which may lead to false optimism. However, re: hydroxychloroquine, in Australia, I think it's been shipped out to 50 hospitals based on some Brisbane study, for further evaluation. But it does make sense that there would be some effect as it apparently did help with the sister virus SARS 1/animal studies. SARS 1 is very similar to SARS CoV-2. It shares about 80% the same genome (.....but then again, you share about 50% with a banana too!!!)

ACE inhibitors and ARBs appear safe in the context of SARS-CoV-2 infection and should not be discontinued.
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High Risk Patients
People who are at higher risk for severe illness
Group of people at higher risk
COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Based upon available information to date, those at high-risk for severe illness from COVID-19 include:

- People aged 65 years and older
-People who live in a nursing home or long-term care facility
- Other high-risk conditions could include:
- People with chronic lung disease or moderate to severe asthma
- People who have serious heart conditions
-People who are immunocompromised including cancer treatment
- People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
- People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk
- Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

Biochemical risk factors in COVID-19 - LDH Durant panel lectures 20/3/20 - Older age, co morbidiy - CV disease, HT, low neutrophil count, elevated LDH, elevater d-dimer > 1 ug/mL, elevate CRP
It lasts up to 17 days on surfaces. N.B. This does NOT mean you can actually get infected by it at this time. Just shows that it's possible for the virus to not degrade during this time
What Coronavirus in lungs sounds like
It lasts up to 17 days on surfaces (thanks for the link Dawn McCordic)
Best practice - in LOW resource settings
CDC recommends. OK to wear same facemask where seeing several COVID patients. Use caregivers who have recovered from Covid, or use a mask. Safety glasses and not normal glasses are recommended (due to no side protection).

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