Covid-19 it's here in New Zealand, what can you do about it?

Covid-19 it's here in New Zealand, what can you do about it?

We've been watching the development of Covid-19 since it first emerged out of Wuhan China, as have most people.

Given what we do and how involved in claims we are, we're getting lots of questions on what people can do.

So let's talk about what that might be and what it might look like. (First published 28 Feb 2020, last updated 24 March 2020)

Be Informed:

Keep up to date with what's going on and how things are being managed.

24/3/2020, With the world going to hell in a handbasket, things have got very serious. We now have a full country shut down implemented for Wednesday the 25th by Midnight. This is 4-weeks in enforced isolation with only essential businesses operating. More detail on the current alert level here. Australia is heading in the same direction with all travel by non-citizens and non-residents banned.

Much of the green text in this article has links that will open in a new tab with more detail and the source research we have found.

Our local Ministry of Health website is a starting point

  • Ministry of Health website - This site does appear to be updating the main page reasonably quickly, though the supporting pages may not be as up to date.
  • If you have developed symptoms of fever, cough or shortness of breath you should seek medical advice by first phoning Healthline's dedicated COVID-19 number 0800 358 5453 or contacting your GP by phone.
  • We now have testign centres, these are facilities where you will be tested in your car.
  • Please respect and protect the health of your medical support by providing them the ability to implement containment procedures before you arrive. Do not arrive unannounced!

The New Zealand Government Response:

The response from the NZ government on this has been from the front foot, with travel bans and contact tracing that has meant we have had a significant lead on infection growth. I expect we will see most of the updates in this section for a little while.

  • The Coronavirus Finance Package is significant and one of the largest per head of population to date, at $12.1bil it is a massive injection of support for New Zealand businesses and the people they employ.
  • The support package has now been increased with the move to Level-4, it now applies to a wider range of businesses and the self-employed.
  • The support for businesses has been announced at $5.1bil, with a process for businesses to work through to apply for it with WINZ on this link.

Johns Hopkins University Team

7/3/2020, this briefing by the Johns Hopkins University Team to Capitol Hill in the US is a good snapshot of everything. It is pleasing to see this clinical briefing from a source that had credibility without the political interference we have seen confirms much of what external medical commentators have been saying for 6-8 weeks.

  • Dr Farley’s comments are very helpful on what to do and not do. 

Two excellent information sources to keep an eye on as they have watched and commented on the international experience we are about to see

Chris Martenson's Peak Prosperity updates.

  • Chris Martenson's Peak Prosperity updates.
  • Chris has trained as a pathologist, so while not being a practising clinician, he has an in-depth medical insight from the perspective of why things happen in the human body.
  • Useful information without being overly alarming.

Dr John Campbell

  • Dr John Campbell
  • As you can see is a Doctor, a clinical medicine one with a background in nurse training and research into physiology and disease pathology.
  • He has the grey hair to back up an excellent insight into this situation with the clinical aspects people have questions of.

Both of these guys have excellent information on what's going on and what you can do about it.

Understanding your anxiety and panic response:

It is called the Adjustment Reaction.

While the world may be losing its mind, this is driven from a natural anxiety reaction. This reaction is both useful and necessary to prepare people for risks. In this case, it is creating all manner of issues, Aussies #ToiletPaperGate being one of them. This discussion document on this is useful to help understand what is going on from Peter Sandman - Adjustment Reaction

What is it? What do we know?

  • This is not the flu, and it is not SARS either.
  • We know it is very virulent at least as bad as the flu and potentially more transmissible as it has an asymptomatic aspect that authorities are denying or ignoring.
  • The most concerning aspect of this virus is the impact it has on hospitals and medical systems. Unlike the flu, Johns Hopkins University (JHU) team have confirmed 20%of cases need hospital support, with this split into 15% hospital and 5% ICU/HD support need. This is the real issue overseas as case numbers overwhelm the available medical support.
  • South Korea is the country to watch and model our response on, they are doing an excellent job. Singapore has had an excellent outcome to date as well, though they have purpose built facilities for this that we don't have.
  • Did I say it is not the flu? Because it is not the flu!
  • While the science is struggling to keep up with the virus in confirming things, there are self-evident aspects of the virus that we can assume that will keep us safer even if they turn out not to be quite so accurate:
    • The first, it is airborne, not only aerosolised thorough sneezes and coughs, but it is also able to hang around in the air as flu and measles can. There have been a number of statements and articles saying it is not, followed by the virus being found in airconditioning filters. JHU appears to confirm the airborne aspect of this virus. You make up your mind, we’ll take the cautious approach until this is over thanks.
    • Infections can be caught from the usual sneezes and coughs, but also other bodily fluids, waste.
    • Toilets and bathrooms need additional attention from a hygiene perspective.
  • While the headlines with death rates are concerning, they do appear to focus on people who are older and have health conditions, more the issue is protecting our health system so it can respond and treat everyone. The consistent theme overseas has been an outbreak of stupid, with no consideration for those that are susceptible to this. The actions of those at lower risk not isolating and taking infection precautions will increase the infection risk for those at higher risk.
  • What is consistently appearing in medical reports is the comorbid factor that increases risk.
    • Those who are overweight are having a tougher time with this, which ties into diabetes and other associated diabetes conditions that are being reported.
    • We're starting to get reasonable clinical data from the CDC, this helps identify those that need to take additional precautions.
    • JAMA published a paper that has additional information with a breakdown on comorbid factors on those that died. Of the deaths these conditions were represented 10.5% cardiovascular disease, 7.3% diabetes, 6.3% chronic respiratory disease, 6.0% hypertension, and 5.6% cancer.
    • With diabetes, heart and kidney problems can be present but not at a level people are aware of, which raises the question on unknown comorbid issues with those that have died. 
    • There is a dramatic headline about a 21-year-old sportsperson who died floating around, this is less dramatic as they discovered this poor chap also had unknown leukemia which meant age wasn't a factor.
    • Up until 29/2/2020, Lung conditions, smokers and asthmatics, didn't seem to be predetermined conditions. Nothing we had seen had mentioned these as contributing issues until the JAMA report.
  • The kids and children are under-represented in the severity stats, they get it but aren't getting it as severely as the adults are.
    • Which makes some sense, when adults and older people are struggling the most with this, and the ones with heart and kidney conditions are most affected.
    • Kids and children typically don't have heart and kidney conditions.
    • We have started to see teens impacted to the point they have needed ICU support in the US. This may be related to underlying health as teen obesity is a problem in the US.
    • There are reports that up to half of ICU patients in the Netherlands are under the age of 50, so there may be an evolution of this, or it may be a reflection of a population that doesn't have as many older people as Italy and Japan have. Possibly more demonstrating that every country is going to have its own unique experience.

The not so short shortcut; what can you do about it?

  • Prepare and prevent in the first instance.

    • Gather together an appropriate kit of things you may need, food, medical supplies. We’ve developed an article with what you should consider in your list of things to get sorted.
    • We had suggested enough for up to a month. Some are suggesting longer, and some have gone a bit crazy on it, that now needs to stop.

    • With the current challenges with supply in the supermarkets, it is now too late to stock up. You need to plan on how you will manage this as it is presently and give the supply system a break to catch up.
    • We had suggested this longer period as a 14 day isolation period with an infection and recovery is going to need longer than 14 days. If you're feeling like rubbish, you're not going to want to shop or cook, so having things on hand is going to make this easier for you.
    • The panicking shoppers have focused on toilet paper but not canned food early on. This is a respiratory virus, not a gastro bug.
    • Plan appropriately, anti-bacterial products aren't going to help any better than standard products, this is a virus. Cleaning out Protex soap isn't going to go any better than normal soap.
    • Be reasonable; everyone needs to have enough too. Yes, be reasonable!
    • The behaviour in stores by people has been appalling. Stripping shelves of everything and abusing staff is not on. There is plenty of supplies it is just a matter of patience while maintaining your calm.
  • Prevent

    • Stop touching your face! Everyone touches their face 2-3 times per minute. Stop it!
    • Better still wear a mask. If you are not at home you now should be wearing a Mask, Glasses, and Hand sanitiser or gloves. (MGH) 
    • People are idiots, and we are seeing it every day in the supermarkets and other supply stores, expect it and wear your PPE -> MGH!
    • Avoid any unnecessary travel, use of technology to reduce physical contact and staying away from obviously sick people.
    • Dr John Campbells comment, in one of his updates, suggesting the use of tissues when touching public surfaces is an excellent one. This is using the tissue as a barrier for the contact and then carefully disposing of it to not contaminate yourself afterwards.
    • Increased hygiene, washing hands, limiting the use of public facilities and other precautions associated with hygiene. This is the link to the WHO video on how to wash your hands properly to prevent infection 2/3/2020. 7/3/2020, reiterated by JHU in their briefing. 
    • Do not use air drying hand dryers!
      • If you hear one, stay the hell away. These have the potential to blow this virus everywhere from someone contaminated with it on their clothing. Think coughing and sneezing into their arm... Hear a dryer, be like Forest, run!

You do not need to use hand sanitizer in addition to soap and water if you wash your hands well. Soap has been shown to be the best option to break down the virus if it is present, save the hand sanitiser for when you don't have soap and water.

  • Masks

    • These have been discussed at length, given we have a short supply of these, this may be a moot point.

    • If you see people racketeering and profiting from this, I.e. Trademe and other selling platforms, report them! They are putting everyone at risk for the benefit of their pocket. 17/3/2020, Trademe are responding to reports and are actively taking down listings that break the rules, so this is an effective response to those that wish to profit from this crisis.
    • Surgical masks like doctors and medical staff wear are good for containing infection, they stop spittle, cough and sneeze particles from escaping.
      • Good if you have an infection, not so good if you are trying to prevent it.
      • The challenge with these masks is once they are damp, about 20 minutes of use, they allow the transfer of the pathogen from the outside in.
      • One use for the additional toilet paper that has been hoarded, has been to line masks to increase their useful life.
      • Still ok if infected, but not effective if used to prevent infection.
    • N95/P2 masks, these two standards are considered suitable for preventing infection on the most part.
      • The P2 standard is typically for larger particles, some makers manufacture to the same standard as the N95, others you will need a P3 mask to be equivalent to the N95. I say this as N95 masks are hard to find and something is likely better than nothing.
      • These masks typically have an exhale vent, meaning that they are pretty useless with someone infected to stop the spread.
      • If infected use a surgical mask or a P2 mask without a vent as these are more effective at catching particles from coughs and sneezes.
      • There is some evidence that masks used by the population aren't as effective as they could be, this comes back to fitting and size. Something many people have demonstrated they struggle with. Many of the early evacuees from Whuan had incorrectly fitted masks and some were even upside down.
      • In saying that there is evidence that a lower grade infection gives your body more time to build an immune response and a mask will help reduce some of the viral particles getting to you.
      • The SARS-COV-II virus has been published as being 0.125 microns in size. The N95 mask filters out 0.3 microns and larger particles. Which suggests the N95 mask is only going to protect you if the virus is combined with mucus and gets stuck in the weave of the mask.
      • Several points that have been made by medical people:
        • N95 Masks are called 95's because they filter out 95% of the stuff down to 0.3 microns. So there is a 5% risk that larger particles can pass through any particular mask.
        • The use of masks for infectious diseases need specific procedures for fitting and removing, especially removing to prevent contamination.
        • Mask fitting is very important and medical use involves specific fitting and testing to ensure they are fitted correctly and working. The size of the mask is very important. JHU also confirmed the fitting need for these to be effective.
        • Beards and other skin impairments can break the mask seal, causing the mask to be ineffective.
        • Many people are using masks when they don't need to, and this is creating additional pressure on what is presently a scarce resource. If there is a clear risk with close contact, then there is justification. Riding in your car with the filtering modern cars have is just a waste of time.
        • And this link from Dr Siouxsie Wiles speaking to the NZ Herald is also a good reference.
  • Personal air-purifying respirators, PAPRs, discussed with the JHU briefing, these are a step up from masks, as they cover the face and shield mucus membranes from contamination. This is the physical barrier for the eyes and face. Giving an additional layer of protection. 17/3/2020, we have seen reports about covering ears as well. No this is not a pathway for the disease in healthy normal people. If you have grommets or an eardrum perforation, then you may need to take additional precautions, talk to your doctor about this.
  • JHU comments cleaning and hygiene procedures are just as important as PPE. Which we are finding most people are not great with. Frequent hand hygiene is the recommend most effective approach to minimising contamination due to the multiple contacts you have with your hands. As we said earlier, don't touch your face! 
  • And the CDC has published a cleaning and hygiene guideline for dealing with this

Right now:

  • We have over 100 cases confirmed. We are also getting a number of spreading risks which mean that the virus could be active but not yet detected in our community.
  • Though it seems our summer sun, heat and UV, may have been helping us keep numbers down until now, the recent cold snap and wet weather may not be so useful.
  • Our high UV summer may have been helping us, now that is waining it may explain why cases in NZ are starting to grow.
  • Most people are not aware that UV is used for sterilisation, it works very well on viruses. Many commercial pools in New Zealand use UV to help manage water quality and kills bugs. Wikipedia article on UV Sterilisation
  • These UV devices, if you can locate one, may be useful in helping to decontaminate things.
  • The restriction of close contact is the key measure for limiting the spread of this virus.

What are the possible vectors to catch this?

  • Clearly being around sick people. It is more than that as many that do have it don't show symptoms.
  • We have reported that the virus is able to survive on hard surfaces between 12 hours and 9 days, which is a very large window and one that still needs clear verified testing and evidence. The 9 days comment was from a case in China where the authorities tested a patient's home 9 days after they were taken to hospital and there was still active virus found, as has been identified elsewhere. Testing is showing that in less than ideal situations for the virus, higher temperatures and lower humidity, it doesn't last as long on surfaces. There is no truth to the often common assertion that it only survives for a few minutes or hours, the medical research is showing that it is potentially days. Assume it is days and treat surfaces appropriately.
  • Surface cleaning and disinfectant are going to be a key aspect of minimising transfer. Most viruses don't do well when they are dried out, so porous drying surfaces are likely to be safer than hard cold surfaces like stainless steel. Testing is suggesting it is susceptible to similar controls for other viruses.
  • Wiping surfaces down on a regular basis is likely to help with containment, a product that has a chlorine bleach or alcohol base to it are likely to be the most effective. Read the packaging and look for products that assist in killing viruses. (Also read the NCBI Link below)
  • So what surfaces do you need to focus on for cleaning:
    • Doors, door handles & knobs. Locks and fitting that require contact. Keyless entry and no contact doors are clearly going to be at an advantage.
    • Light switches and other contact plates.
    • Lift buttons both inside and outside.
    • Doors themselves, where people push or pull the door, again contact points.
    • Handrails, on stairs, escalators and lifts.
    • Public surfaces, benches, desks, and railings.
    • Your computer, screen, keyboard and mouse. Testing has shown the average computer is worse than the bathroom for pathogens. Disinfectant wipes are likely to be the approach, either alcohol or bleach-based. However, be careful and take adequate protective precautions from the chemicals.
  • Toilets/bathrooms:
    • Covid-19 is reported to infect the gastrointestinal tract and kidneys, so your waste products will be infectious if you catch this. However, that's not to say you will have gastro bug like symptoms, it does happen, but not in most cases.
    • This is one area that is a little more insidious. We know from TV reports over the years that toilets have a habit of spraying stuff everywhere when they are flushed.
    • First off, close the lid when you flush, it will limit the spray around the room.
    • The toilet, seat, pan, lid, cistern, floor, and walls will carry a level of contamination. Which is why I said earlier to avoid public toilets and bathrooms.
    • Additionally, other fixtures and fittings will also have potential contamination, basins and sinks, baths, and anything else stored in the area.
    • Anything that can't be washed should be relocated outside the bathroom now.
    • Cleaning of the bathroom needs to be with a suitable antiviral product, and all surfaces need to be done over on a regular basis.
    • If this is going to spread around your family members and housemates, the bathroom and toilet areas are where it will be the most likely.
    • Do not use air drying hand dryers!
      • If you hear one, stay the hell away. These have the potential to blow this virus everywhere from someone contaminated with it on their clothing. Think coughing and sneezing into their arm... Hear a dryer, be like Forest, run!

  • What else is a possible vector for transmission:
    • More personal items, where you have touched something and then you touch it in the normal course of your movement.
    • Glasses, prescription, safety, and sunglasses, on and off in and out of buildings and vehicles.
    • Your keys.
    • Your car, door handles, steering wheel, hand brake, and other controls.
    • Cash, this is an easy contamination path from someone sick to the cashier, and then to you.
    • There is an argument that card and contactless payment options will reduce your risk.
    • Your wallet and your phone.
    • ATM machines and self-service kiosks, people touch these all the time and no one cleans them between uses.
    • The products you buy that the cashier touches, potentially like the cash issue, they can transfer it here too.
    • And the receipts they give you...
    • Your shoes. take them off and leave them at the door, or better still, leave them in the sun. The UV will help sterilise them.
    • From a question asked 1/3/2020, fresh fruit and veggies from the store.
      • There is a risk here that infected people could contaminate the surface of the food from breathing, coughing, sneezing, and touching.
      • As to how long that would be, or what impact this would have, I don’t know.
      • However, now the question has been asked, is this how it is spreading everywhere else? Even with lockdowns, are shoppers transferring it by food?
      • How can you manage this?
        • You could try the bleach solution suggested elsewhere here, though that will impact some foods, so shop accordingly. Baking soda and white vinegar solutions have also been discussed in many forums, how effective I don't know, but maybe useful.
        • I would suggest ensuring that it is cooked through fully, high temperatures usually kill these sorts of bugs. Haven’t seen exactly what temperature requirements kill Covid-19 virus but medical people are commenting that cooking kills the virus.
        • Leaving it to sit isolated for 9 days sort of defeats the point of fresh veggies.
        • The latent risk is the virus could penetrate the food, which would mean the cooking approach is likely the most effective way to approach this. More research on this is needed.
        • Basically, avoid raw foods for the immediate future.
      • Foods like broccoli are likely to be harder to manage this sort of risk with, as they have crevices and are somewhat waterproof. 
  • This list may sound a little paranoid and extreme, but we need to be vigilant on what could track this thing back home where we are more relaxed and less vigilant.
    • With many items, isolating them for the day or putting them in the sun will likely limit any transfer. The 9 day bit is a concern and this needs consideration for each thing if not using UV as a method of decontamination.
    • For non-perishables and items that getting wet or damaged is not an issue, a bleach spray with a 1:100 dilution of 5% sodium hypochlorite is the usual recommendation for 10-60 minutes. Use 1 part bleach to 99 parts cold tap water (1:100 dilution) for disinfection of surfaces. More on this on the NCBI site

The not so good:

  • With the cases overseas out of control, and the UK and the US failing to implement effective testing, there is a distinct risk their health systems will fail. This is the one thing we can't afford to have happen. An overwhelmed health system is a recipe for increased deaths, which we want to avoid. Both the UK and the US seem to have woken up to the issue and are now responding with restriction of travel and contact
  • There are two information campaigns underway, one is "flatten the curve", and the other is "stamp it out". The later is the approach for NZ, don't let it get established here, which appears to be struggling.
  • In January and early February, there was a rush on masks, gloves, and hand sanitisers which we have assumed has been either shipped to China or hoarded for exorbitant prices at a later date.
    • Out and about masks continue to be cleaned out. The stores are getting stock, but the cretins that are trying to profit from this are making it difficult for everyone. This reflects our comment earlier.
    • Gloves do seem to be in ready supply in most places.
    • Hand sanitisers are available in limited supply, usually 1 bottle per person, and they are restricting the predictable buying 1 and coming back behaviour
  • We are having conflicting reports from the authorities about the risk. The NZ MoH, the WHO, and the American CDC are all saying there's no risk with no symptoms, yet we have well-documented cases out of China where people have been asymptomatic and have infected people around them.
    • This was one of the first examples documented. This one has increased weight as the likely source given the ability to move around, i.e. before lockdown. There is the risk that family members caught the virus from other people, but the 19 days positive but asymptomatic aspect of her presentation is the most likely cause of infection in her family.
    • To balance that, a statement in this report from the WHO-China joint mission downplays the asymptomatic risk.
    • This is in contrast to the early reporting that 1:2 cases reported in China could not be traced to a known cause or case at the time. The statement from the WHO link suggests that while asymptomatic people did develop symptoms, there is the distinct possibility that those who are asymptomatic may well have symptoms but they are not bothered by them or notice them, which is what we see with many other conditions. Some people go down like a feather, others don't appear to be affected, this is more likely to be the asymptomatic story which still poses a public health hazard.
    • 10/3/2020, Dr John Campbell highlighted that 20% of cases may be asymptomatic and infectious. So this view of potential hidden risk continues to persist.
    • More data and commentary is suggesting this is a more significant issue than authorities have disclosed to date. We need more data, which comes with more testing. All western countries need to step up the pace on this as they are in the dark presently.
  • The update to this 6/3/2020 is a statement from the WHO that all countries should roll out testing and screening to quantify the outbreak with all people showing symptoms and those that are requesting from possible exposure.
  • One thing that is becoming clear, those over the age of 60 are significantly more susceptible to this virus with the mortality rate climbing significantly the older people are. The published statistics today are suggesting that 14% of those over 80 contracting this are not surviving. The WHO official mortality rate has been lifted to 3.4% which is about 26 times the worst season for the flu, or around 50 times worse than what we would call a normal flu season. These reported numbers are the reason we need to ensure containment and access to our health system is managed.

Travel:

We had a section for travel, short-lived and moot now that the world has effectively advised do not travel.

The Safe Travel Page has the statement:

Do Not Travel Overseas At This Time

We now advise that all New Zealanders do not travel overseas at this time due to the outbreak of COVID-19, associated health risks and travel restrictions.

If you have a need to understand the travel status of a destination check out the MFAT SafeTravel page

So what if you get this thing?

  • First off isolate yourself.
    • Someone said 14 days for isolation and the authorities around the world have run with that.
    • The reality is while the known average incubation period around five days, cases showing up after 27-28 days after exposure are also happening.
    • So the number here probably should be double the current 14 days.
  • Look after yourself. Sleep is being shown as a significant factor in helping peoples immune system respond and recover.
  • Scarily, some countries are only applying a 5-7 day isolation period, this is not long enough.

So what medications do we need?

The usual for the flu. Yes, I know I said it's not the flu. But it is a respiratory virus, you treat the symptoms in the same way.

As someone who has managed pneumonia most of my life, I've learnt a few things along the way that help with deep chest infections.

Before infection:

  • Hydrate
  • Sleep well
  • Vitamin C - supports your immune system, normal levels not extreme levels as is being suggested.
  • Zinc - supports your immune system, again normal levels.
  • Oregano Oil, now, excellent support for lung function and should be started now. This is a supplement you take that primarily helps your system respond to bacterial infection of the lungs, something that follows with viral infections. This will not prevent or cure Covid-19, but it may help lighten the load on your immune system while you fight it off. I have personally found the Solgar product quite effective. This link talks about this and other herbal supplements that can help support lung function
  • It would appear adding a vitamin D supplement to your routine is recommended. Not high doses but a regular low to medium dose which assists in reducing the incidence of respiratory infection. This link has the BMJ study. Vitamin D is suggestive of being deficient in the majority of people, with the increased use of sunscreen even in the summer you can still have less Vitamin D than is needed. Sufficient to cause deficiency diseases, no, but lower than optimal is what has been said

Once infected and developing a chest infection:

  • Call HealthLine first before you call your Doctor!
    • You need to ensure that you haven't got something that needs more than management at home

    • Additionally, if you have flu-like symptoms call HealthLine first and talk to them about screening at one of the drive-in facilities. Showing up unannounced and having this virus is going to put your medical centre into quarantine. Don't do that, we need all of our medical people on deck!
  • If you are manging this at home then this list of supplementary medications is potentially useful to have on hand.
    • Paracetamol - This is anti temperature and pain
    • Sudafed PE the standard one. There are alternatives to this, I've found this works best for me while the others don't work as well. This is for decongestion reasons, to reduce the production of additional mucus that can clog airways.
    • Mucinex, this is good for thinning mucus and making expelling sputum easier.
    • Water, lots of water. 3-4 litres per day per person
    • And other things that can help you feel better like lemon, ginger and honey drinks
    • Elderberry syrup has had excellent clinical research on reducing the duration of a cold when travelling and it is also suggested as a method to reduce viruses. replicating This from Science Daily and this from NCBI/PubMed, Elderberry could be useful, not explicitly tested on Covid-19 though. (Surprisingly this isn't a whole lot of woo, which is the usual attitude to anyone saying Elderberry)
    • Olive leaf extract has been shown to assist with viral infections too.
    • We had previously mentioned having ibuprofen on hand. We have removed this as it is appearing to be problematic when used with Covid-19. The medical advice on this is conflicted, so talk to your doctor about this before taking it. Also, further reading in the comments below on temperature management that we have stated from the beginning.
  • Did we say Talk to Your Doctor? If you are sick you need to seek medical attention and guidance from Healthline and your medical specialist.
Pain medication, use it or lose it?
  • There is some argument that not taking paracetamol and ibuprofen is more beneficial as lowering your temperature could be decreasing your immune response.
  • You have a temperature for a reason. So be careful with this aspect you may feel better but it may slow your recovery down.
  • There is evidence suggesting that the high-temperature response is assisting with bringing the virus under control quicker, so forgoing the pain meds might be the best thing you can do to help your recovery.
  • However, this needs to be taken into account with your medical specialist as very high temperatures can also be very dangerous. It has also been suggested that cooling the head helps, this cools the brain which doesn't like being too hot, while leaving your body to do what it needs with the higher temperatures. A fan or cold iceblock may be sufficient to manage this for you.  
  • Did we say Talk to Your Doctor?

When do you push the Big Red Button?

What I mean by this is when do you contact the hospital or call an ambulance?

  • When you are unwell, not getting medical treatment and you don't know where this is leading. Hopefully, you followed my first comment, contact Healthline and your doctor first!
  • If you are experiencing shortness of breath, severe chest pain, severe coughing, or difficulty breathing, just like any other situation, call for an ambulance. At worst a call out will cost you $80 (NZ Cost). Cheap in comparison to your life, so call them.
  • If you are in the space between talking to your doctor and not quite at the point of calling an ambulance, call the Covid-19 hotline on 0800 358 5453 and talk to them about what you are going through. They will have good advice on what you need to do, or where you need to go. We are hearing that the helpline is having some reasonable delays, so be prepared to wait. If it is an emergency, then call 111.
  • If in doubt, don't mess about!

The most significant advantage for you with pneumonia:

The most significant advantage you can give yourself with managing a deep lung infection is sleep on your front.

I figured this out years ago; medicine seems to have only figured this out in the last few months...

  • Sleep on several pillows to elevate yourself, but still, be comfortable while sleeping face down.
  • This will assist in not having gunk from your sinuses end up in your lungs and larynx.
  • We have seen from the Covid-19 medical response that they increased recoveries of those on ventilators when they turned them onto their front. If you have a lung infection or pneumonia, do your system a favour and do this to help. Better at home and a little uncomfortable than in the ICU on a ventilator.

There is a lot here, stay informed, stay safe and take it easy, don't panic!

  • 80% of people are experiencing mild symptoms and don't need hospital support, and the overall survival rate in a working health system is above 96%. South Korea's death rate is as low as 0.9% which is still way higher than the flu, at the same time it is magnitudes below that of Italy and other countries.
  • Yes, it will impact people significantly, that's not to be downplayed, at the same time this isn't causing death at the levels of other infections we have seen.
  • If we can calmly manage things and keep the load off our health system as much as possible, we have the best chance of ensuring that everyone that needs hospital and ICU treatment gets it.
  • We are all in this together, we all need to work together to get everyone through.

As we get firm information we will update this page to assist. In the first instance check out the MoH page on the first link above or call your doctor.

If it is an emergency call 111 and ask for an ambulance

 

What about the insurance response?

A good question and one that does need some consideration. Given that this is a different subject to what is intended here in this article, we have prepared an article specifically to address this question.

Insurance will respond where it needs to, however, the initial response to an epidemic or pandemic is something the public health system is in the best place to manage this.

Glossary
  • 111 is the New Zealand Emergency Number and may not work if you are elsewhere in the world!
  • Date format used is the NZ format DD/MM/YYYY
  • Original publishing date is 28/2/2020 at 8pm.
  • JAMA Journal of the American Medical Association
  • The Lancet - the premier medical journal for publications. The gold standard of medical journals. (Yes, they do make occasional mistakes and they are active with retractions when they do)
  • The WHO - The World Health Organisation
  • BMJ - British Medical Journal
Sources & Resources
Difficult Questions & Less Than Helpful Comments

Me being me I have a tendency to ask questions no one else asks, be it social convention or just my brand of logic. So before proceeding further, be aware of this and no this isn't about getting the tin hat out. I will add and remove comments and questions once they have been addressed and we have better information.

  • If we have nothing to worry about with asymptomatic cases, why is there medical evidence of asymptomatic transfer being reported? 5/3/2020
  • What is the government doing to ensure supply of things like hand sanitizer and masks for the public when we have not seen these products on shelves for weeks? 5/3/2020
  • Today I have found that some pharmacies are getting limited stock of hand sanitizer, and it is both expensive and restricted to 1 per person. Though observing one person in a queue, they were buying one, then leaving the store, to return not long after to buy another. So hoarding is still going on with limits on purchasing numbers. What was pleasing to see was staff refusing to serve people when they had done this a couple of times. 6/3/2020 
  • 7/3/2020 JHU Q&A:
    • Testing is not at scale enough to address this. It is improving but not nearly at the levels we need. (20/3/2020 The US appears to be finally addressing this and moving with more testing)
    • Messaging, calm and informed, more testing will help public calm. This we know and have been asking for around the world. (20/3/2020 as above)
    • Public health experts need to have clear and calm messaging, including being upfront. (20/3/2020 Our PM has been excellent at communicating what is going on and taking action, the US is starting to get the message)
    • No one has immunity, but some will have more severe symptoms with those older, more susceptible to underlying conditions, and immune system compromise. Extreme caution with the most vulnerable is needed.
    • Covid-19 survival on surfaces. Parameters make firm answers difficult. Standard cleaning tools will reduce risks. Surface risks with transmission we're highlighted by JHU. See our examples above.
    • Restricting gatherings and isolation is a valid approach. (20/3/2020 Reduce numbers for gatherings are now in force in NZ)
    • Hand sanitizer alternatives, soap and water is an effective alternative. Preserve hand sanitizer for times when you don't have soap and water available. You don't need to use hand sanitizer in addition to soap and water if you wash your hands well.
    • The JHU dashboard is a well-regulated source of information that has crowd influenced the identification of data discrepancies.
    • The incubation period is a wide range, 1-14 days has been repeated again. 5-6 days from initial symptoms to progression.
    • Testing, false-negative testing is possible, reports of positive, negative, positive testing. This is seen as test challenges not so much re-infection. We don't have an antibody test yet to tell us about immune response, and past infection that has recovered. (20/3/2020 There is increased talk of having an antibody test in development)
    • Elbow bump vs sneezing into elbows... Cultural practices need to be reviewed. The Indian approach of the palm prayer greeting is likely the most useful approach. Keeps your hands engaged and reduces contacts.
    • Travel; consideration on travel needs to be thought about. We don't have new travel insurance options in NZ, so overseas is very much a case of at your risk. Many countries are saying they will cover the costs associated with Covid-19, however, the US is still unclear on this with reports that people are being charged for testing, or for negative tests. (20/3/2020 With the NZ decision to close the border for non-residents, we also now have a do not travel MFAT warning in place, which means there is no travel insurance response for new outbound travel from NZ.)

 

Jon-Paul Hale

Written by : Jon-Paul Hale

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