COVID-19

Introduction

This page is updated regularly. It contains information from several sources across the globe, including Newpaper reports, Medical journals, Ted talks, Youtube videos posted by patients, cases reported by patients on twitter and so on. I have tried to gather information here that seems to be genuine, and which may prove to be useful in dealing with the Covid-19 pandemic. There are recommendations made by the WHO in terms of prevention. I have created a questionnaire for patients, which will help delineate the course of the disease in a patient. Feel free to circulate the questionnaire, and I would be glad if people sent me information received from patients.

Overview

Please read the various cases and watch the videos carefully. I have written down the points that struck me, but there may be things I have missed. You can make your own notes. So far, what I understand of this disease (coronavirus disease 2019) is:

The onset, duration, progress, symptomatology and severity is very variable in individuals. Some people seem to be very susceptible to severe outcomes, others not at all. You could have a positive case and a negative case in the same house. Of a husband-wife couple in the same room of a ship, one tested positive and was taken to hospital, and the other was negative after quite a few days of the infection having spread. Old people are more likely to die. Young people are less likely to die, but may still have extremely severe breathlessness etc needing ICU treatment. About 40% of hospitalized cases in the USA are people between the ages 20 to 54, with 12% of these even going to the ICU. Even if they have very mild symptoms, people are advised to stay at home if they have any of the symptoms below - as they may be ok, and still infect others leading to very unfortunate outcomes.

In most cases, a dry, persistent cough and fever with chills is present. Loss of smell and taste is reported in 30% of the patients. Just on the basis of recent onset loss of taste and smell, people are often advised to self-quarantine. In many cases, there is a GI component - diarrhea or vomiting, and stomach cramps. A lot of people report severe muscle aches and body pains, as also headaches. The person is often unable to even turn in bed, or go to the bathroom. In addition to pain, fatigue is a big component. Easy exhaustion and breathlessness. The cough is painful, with streaming of tears at times. Unrefreshing sleep. Many of the symptoms as well as laboratory findings seem to mimic Acute mountain sickness (HAPE). Another interesting feature reported in a few patients with Covid-19 are purple skin lesions like chickenpox on the feet, seen especially in younger age groups that heal without leaving a mark. It is now being called the covid toe - and several toes might be affected, and could be sore and painful, like chilblains. Conjunctivitis may be a sign, including unilateral conjunctivitis, but more reports are required for this to be an important indicator. Another unusual sensation reported by several people is a buzzing or fizzing sensation in different parts of the body, in the skin etc...like bees buzzing or an electric feeling or like bubbles fizzing - and this may sometimes be when they are recovering. Some have described a burning in the skin. One other sensation described by a few is a sharp, stabbing pain, like an ice-pick or needles. Burning and tightness in the chest is common.

Patients are most infectious in the first week, when viral load is maximum. Especially, when fever starts, or sneezing or cough. Immediately self-isolate in a room, and take extra care with hand-washing etc. All other family members should also take extreme care. Stop sharing cutlery, pillows and all things.

A very important feature to note is that many patients feel terrible one day, but quite fine the next day. The complaints seem to ease up in between. As a result, they attribute their complaints to something or the other - "maybe it's the stress at work, or maybe bec of something I ate yesterday, or I slept in the wrong position, or it must be all the dusting I did a few days back". Then they go for a run, or go to the gym etc. But then the complaints return with a bang sometimes. "It's as if I fell off a cliff" or "As if I was in a car crash". Many people report going to sleep just fine, and waking up feeling terrible the next morning. The onset might be pretty sudden in some cases. Breathlessness is described as "suffocation in slow motion....as if the air in the room was slowly sucked out" or "as if I am breathing through a straw" or "someone switched off the oxygen tank while I was under water". Difficulty in taking a deep breath. Once the condition is a bit advanced, the breathing is labored and can be heard from a distance. What is puzzling is that at times the blood oxygen is very low, but the patient is not gasping for breath as might be expected and may even be speaking normally. They are being called the "happy hypoxics". In fact, by the time the patient is slightly breathless, they may actually have pneumonia with very low oxygen levels - and actually in a serious condition.

There are mental effects such as fogginess, anxiety which can be quite marked, esp combined with breathlessness. There is a feeling as if the disease is taking over you, or that you might go insane. Some people get delirious, or have hallucinations. Phrases like - "this thing wants to kill you" Or "it will get you" are common, as is advice to "stay calm and fight it". Two patients (p42, 43) reported the same hallucination - seeing dead people. Hallucinations accompanied by confusion and much fear. Others have described a slowing down - as if everything was happening in slow motion. Fogginess, haziness is prominent. People may be disoriented, and not be able to express themselves properly. There is confusion, and one may make mistakes - putting the wrong ingredients in food etc. Some people completely have no memory of what happened for a couple of days. These are considered to be neurological effects, and may occur even in the absence of a low blood oxygen level, and are considered serious. Sleepiness with the fatigue is a common finding in this infection, including difficulty in rising out of sleep. This, along with disorientation, is a dangerous sign, and even coma might occur.

Very interestingly, after a variable period of time - ranging from 10 days to 18 days, many patients who seemed to even be sinking or dying suddenly feel better, and everything turns around. This is seen in mild, moderate and severe cases too. Thus, a lot of patients are suddenly ill on waking one morning, and suddenly well one morning on waking. Some who are religious attribute it to the presence of God.

In severe cases, complications involve the lungs (bilateral pneumonia, pulmonary hypertension), heart (failure, CHF, pulmonary hypertension) - and later kidney failure and then multi-organ failure. While hospitals are preparing for respiratory emergencies in the form of ventilators, there is now a recognized critical need in hospitals for dialysis machines too. Clyde Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine says that the best available data indicates that about one-third of patients who have Covid-19 infections have evidence of thrombotic disease. Pulmonary embolism was found in some of the patients who died.

Children may present with somewhat different signs, such as severe abdominal cramps or testicular pain in teenagers.

Some doctors have cautioned against use of 1) Steroids 2) NSAIDs and 3) Even advise against early intubation 4) People taking some BP medicines like ACE inhibitors etc seem to be at higher risk of a severe outcome. However, people are not advised to stop their medicines without consulting a physician. see RelatedInfo (7). 5) Self-medication with chloroquine is strictly not advised. It has serious side-effects, and is not of proven benefit.

Post-hospitalization recovery might take a considerable time, esp if intubated (which in itself has a very poor prognosis). See Doctor 13. One doctor suggests earplugs while in the ICU, because of the noise in the ICU etc, which is all heard by the patient and adds to confusion and disturbance. Upon discharge after the prolonged ICU hospitalization, because of high infectivity, these patients often don't even get physical therapy, which adds to the delay in recovery.

Standard precautions like hand-washing, staying at home etc are vital. Avoid touching nose, face and eyes often, esp rubbing eyes. Wear glasses instead of contact lens. Any essentials purchased must be carefully sanitized. Once infected, the following seem helpful:
Drinking lots of warm fluids and a combination of resting + intermittent movement is most beneficial. Do deep breathing exercises and simple stretches. Do salt water gargling. It is (at the time of writing) almost impossible to get tested - hospitals are not accepting test requests unless the patient is already in a very severe condition. If you have access to a homoeopathic physician, consult as soon as possible. Taking multivitamins regularly, esp with Vit D, B-complex and alpha-lipoic acid may be a good idea. Ensure that your Hb levels are normal, and if needed, taken an iron + folic acid supplement. Only take Paracetamol/ Tylenol at home. Baby aspirin may also be of some benefit in adults (not children or teens), as it might reduce the thrombotic episodes too. Some patients have used asthma inhalers for the first time, with relief. It might be a very good idea to buy a pulse oximeter and use it at home to measure oxygen levels. Anything below 95% requires a visit to a hospital.

One very important recommendation if you fall sick is that you don't keep lying on your back for prolonged periods - however fatigued or exhausted you feel. Even if it seems impossible due to pain or weakness, try to sit up for some time, or even move a little. Lie on the side or abdomen for a bit. Stretch arms over the head. Do deep breathing, even if you are feeling only slightly breathless. It seems as though the brain centers that control breathing and should activate in case of low oxygen are not so responsive. In fact, it may be a good idea to practice slow, deep breathing now, even if you are well and healthy. For some very useful breathing exercises, see Doctor 10


Doctors Case Experiences

https://www.youtube.com/watch?v=w-2GK7DDeB4

clinical

slow recovery after illness - weakness. bodyaches. cough, breathless.

actionable

cough may persist for 2 weeks after recovery. about one week after fever is gone, even if cough is there, you can go out (wear a mask). sickle cell anemia, organ donors etc - absolute lockdown.

https://www.youtube.com/watch?v=WV6-qaNn1to

clinical

lost taste and smell. could feel the heat of the cayenne pepper, but not taste it. fever.
diarrhea as a prodrome - few days before the sickness.
Acc to a report in Science Direct the loss of smell or taste is marked, not mild, and when present, indicates a 10 times increased likelihood of a covid-19 infection as opposed to some other infection.

actionable

if you lose sense of taste and smell, self-quarantine for a few days and see if anything develops.
if cough, breathless and feeling lousy - consult the doctor.
as the smell returns, there is often a general overall improvement too.

https://youtu.be/BqrSBczC8rM

clinical

there may be no fever, just gastrointestinal tract issues and fatigue

actionable

if you don't well in any way, just stay at home.

https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html

clinical

Loss of taste and smell might be very significant symptoms of covid-19. Upto 30% of the patients might have it.

actionable

Self-isolate if you develop recent onset of loss of smell. ENT doctors should not do any procedures on patients with recent onset loss of smell/taste, as any sneezing etc might infect the doctor. ENT and Eye doctors died in large numbers in Wuhan.

https://thinkingcriticalcare.com/2020/03/28/covid-clinical-discussion-w-cameron-kyle-sidell-nyc-ed-icu-doc-in-the-trenches-foamed/

clinical

the effects of a covid-19 infection may present with a lot of different symptoms, but the pathologic and lab findings seem to be fairly consistent. the main feature is hypoxemia and the doctor compares it to high altitude sickness. "it is as if they are being taken slowly up into the sky in an elevator". and at some point it stops, and they start getting better.
this has a striking similarity to a patient who described it as the room slowly getting drained out of air. the patient (see cross-ref) says it is like suffocating in slow motion. (in high altitudes, the air very rare).
"this is a high compliance, hypoxemic condition predominantly defined by pulmonary hypertension". shift of o2 dissociation curve to the right. it seems to be some kind hemoglobinopathy along with an attack on the alveolar-capillary interface.
the patients get very suddenly better after a period of time - the time period is variable. so time is a very important component. if a patient is well oxygenated for sometime, they are very likely to recover, unless already sick with other conditions.

actionable

This article and the related audio is for intensive care unit doctors.
New York City ED/ICU doc Cameron-Kyle-Sidell advises not to intubate early for hypoxemia. what patients need is hi flo oxygen, or maybe even hyperbaric chambers, or something that allows blood to absorb more oxygen.
he says rather than starting intubation early, give hi-flo oxygen and only intubate later if o2 sats show it is really required, esp with tachypnea (which may not be present earlier).
it is possible also that high ventilation settings may even damage the lungs.
see 6

https://youtu.be/eFb6kuqRqI0

clinical

double pneumonia. breathless. can hardly speak
some people are on ventilator even after 20 days.
you don't get to see your family once you leave in the ambulance ...surely for a while.

actionable

in a situation of scarcity, difficult decisions like not putting those over 70 on ventilator.
consider making a will and signing it with witnesses, esp if you are above 65 yrs of age and live in an epidemic zone.

https://youtu.be/yszwydLrnPY

clinical

shows patients on ventilators, close to death.
doctors are exhausted - physically and mentally.
difficult decisions need to be taken. further, in Italy, families are informed reg death of person over the phone. this is extremely difficult for the doctors.
supplies are dwindling and doctors have to make do - and they warn that this will be the case in every hospital in the world.
even their colleagues are in a bad emotional condition, and you need to support them.
doctors are breaking down, weeping. unable to meet their families, children etc.

actionable

doctors must be prepared for extreme mental stress. take one day at a time. understand that deaths will be inevitable, and that they need to continue doing what is needed without getting too involved.
people should absolutely stay at home and avoid spread of the virus. if hospitalized and you feel not attended to, understand that for the doctors it is far worse - it is completely crazy. be patient and calm.

https://youtu.be/5qTwevBGDuU

clinical

approximately two weeks after contact, patients develop symptoms.
the first week is really when viral levels are the highest.
so as soon as you have any symptoms, such as a runny nose, fever etc, act immediately.
the viral levels drop after the first week.

actionable

the person who has symptoms should self-isolate and take full care esp hygiene - washing hands, not sharing cutlery etc.

https://youtu.be/gAk7aX5hksU

clinical

Korean hospital guro hospital, infectious disease specialist with 30 yrs experience speaks on 24 march.
it began with pneumonia of unknown origin in patients. traced a virus from bats that has passed through intermediate animals like pangolin or a snake, and then to humans, resulting in severe pneumonia.
the death rate varies depending on country. each country has different quarantine plans, different age group demographics, diff health facilities.
we do a lot of testing in korea. 20% of those positive show no symptoms. bec of the tests, we have a better grasp of the infection than other countries.
young people may be asymptomatic, or have a mild cold for 2 weeks. those who are asymptomatic can still spread the infection.
in old people, there is immunosenescence, the immune system becomes weak. they are unable to fight the virus.
even those under 60, if they have heart disease, respiratory diaease, diabetes or smokers, or using immunosuppressants, or taking cancer meds....they may have severe illness.
people who are discharged after getting well seem to develop re-activation sometimes.
the main symptoms are cough, fever, breathing difficulties.
one droplet from a patient contains a lot of virus, and when they cough or sneeze, it lands 3 to 7 feet away, like a rainbow. and it can infect.
if we sneeze and we wipe our nose (10 mins) almost subconsciously...and then shake hands, we have transmitted the virus directly.
also, if we sneeze, and the virus lands on the keyboard, or on a door etc, or any surface, it may last up to 5-7 days. so if you touch a surface after a few hours, the virus is still alive, imagine you then touch your face, you can infect yourself. (11 mins)
it may last on paper or cloth for a day.
under certain circumstances, it can be transmitted through the air. for example, in a big congregation, with windows closed, and people close to each other, praying and singing for hours. if one infected person is present, imagine the number of droplets produced. we spit even when we speak normally. but if you are singing and shouting, you produce a lot of droplets. also in this situation, the droplets don't fall down, they go farther, and bec of the air movement, they dry and shrink a bit, and can go further ....almost 2 meters, or 6.5 feet. it becomes an aerosol, which is not so much affected by gravity. and someone far away can also be infected.
churches, call centers, or densely packed places where people are shouting or eating, are at risk.
in s.korea, you can get a private test at $140 and if it is positive, the money would be returned.
the virus can enter through the eyes, nose or mouth. masks can protect the nose or mouth. the virus attaches to ace2 receptors present in mucous membranes. skin does not have these.
16.30 in europe and usa, people don't wear masks. i find that odd. even now in wuhan and italy, people don't wear a mask. the US surgeon general says not to wear masks, and WHO too. it may be to prevent hoarding, bec the medical profession will run out of masks. but if available, everybody should wear.
korea has less infections because everyone wears masks and wash their hands regularly. masks have been proven to be very effective.
korea has already been through swine flu and MERS, so people were educated, and the country was ready to make kits. we realized we could not develop medicines or a vaccine, but we knew we could make PCR testing kits - so we focused on doing that - how to rapidly develop kits, test people and quarantine them. since the MERS outbreak, the korean govt started focusing on testing. but companies also knew there was lots of money in making these test kits, and so went into that business.
MERS was endemic to the middle east, and korea was one of the few countries that got badly hit by MERS. so we went through that hell already back then. now we know that if there is an outbreak, it will affect the country and citizens badly. so also countries like hong kong, japan etc.
south korea is handling the situation must better than any other country. but it is still not over. people are coming from other countries, bring the virus back from there, like europe etc.
people in quarantine are given an app, if they step out of their house area, an alarm rings. they also input their symptoms twice a day. if they don't enter, the govt checks on them. countries which don't want this invasion of privacy deal with it differently.
in korea, places where people gather - indoor gyms, churches, bars, dance pubs etc are strongly recommended to shut down. but it is not mandatory. older people follow the protocols well. but youngsters do not. they want to go to school or tuitions etc, as this determines their future. they also go to karaoke, pubs etc and chat and dance etc.
the coronavirus pandemic will not get over quickly. best case scenario would be - based on nov 2002 sars epidemic infecting 8000 people around the world - ended in july 2003. the coronavirus is similar to sars, so if all countries work together, it may end by july or august this year. this is the best case scenario. another possible scenario is that it could have a regular cycle moving from place to place. we might then develop a very effective vaccine eventually, but this is very difficult to achieve.
(at 30 mins) inventing a vaccine for a new virus normally takes 10-15 years and costs millions of dollars. this virus is not even a 100 days old (at time of interview). if everything goes extremely fast, it will take 18 months - if everything goes perfectly. but even if the usa or china develop a vaccine, it is not certain if they would share it. or if the entire population could be able to get the vaccine. so as vaccine is difficult, we are looking at drug repurposing. to see if a drug meant for some other condition could be used in treating coronavirus....like meds used for AIDS or malaria. these are being tried on critical patients. also meds used in past for Ebola are being tried.
another method is to use plasms of convalescent
patients and transfuse it to
critical patients. but it is difficult to look after patients and do research at the same time.

actionable

people who are discharged after getting well seem to develop re-activation sometimes.
closed places are much worse then open places....eg gyms, prayer halls etc.
young people should understand that older people might die if they are careless. they must realize the importance of social distancing, washing hands and taking care of themselves and thus of others.
get tested: if you get a fever or sore-throat, or cough or breathless...in the elderly or hifh risk groups, even if they are experiencing fatigue, mild body aches or loss in appetite. or lose sense of smell or taste, which can last for 5-10 days. that's 30% of the people.
masks are definitely helpful, useful. everyone should wear.
we must be humble at all times. the minute we get arrogant, we are finished. maybe europe and usa were overconfident. they felt masks were not needed.
it is not the end till it is over.

https://youtu.be/EQlFeBLrbS0

clinical

Dr Sarfaraz Munshi of Queen's Hospital, UK describes breathing techniques.
Lying on the bed for prolonged periods on your back will close off your smaller airways and result in secondary pneumonia.

actionable

Useful breathing techniques!
take a deep breath, hold it for 5 seconds. do this 5 times. on the sixth deep breath, give out a loud cough (covering your mouth). Repeat this again one more time. Then lie down on your abdomen/ front on a pillow and breathe just a little deeper breaths than normal for the next 10 mins.

https://7news.com.au/lifestyle/health-wellbeing/how-an-early-symptom-of-coronavirus-could-show-up-on-your-feet-c-973110.amp

clinical

A team of Spanish experts is investigating after cases showed COVID-19 sufferers could be identified early through lesions to their feet "similar to chickenpox.
One of the first cases of the symptom after the lesions appeared on the foot of a 13-year-old boy on 8th March, were initially thought to be caused by a brown recluse spider bite.

actionable

Be aware of all such latest findings and consolidate them - these might be the earliest ways to pick up a covid-19 infection. Things like this skin lesion, loss of smell and taste, exhaustion as if you have run a mile etc.

https://jamanetwork.com/journals/jama/fullarticle/2761044

clinical

More male than female patients. Common symptoms included fever, fatigue and dry cough.
Lymphopenia in 97 patients, prolonged prothrombin time in 80 patients (58%)
CT scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients.
In some cases, there were complications, which included acute respiratory distress syndrome, arrhythmia, and shock.
The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to Respiratory distress was 8.0 days.
Median hospital stay of those who came out alive was 10 days.

actionable

Blood tests like lymphocyte count and PT are useful indicators. Interesting to see lymphopenia and another study (https://www.researchsquare.com/article/rs-18079/v1) showed neutrophilia - these could be indicative of a secondary bacterial infection. S.Ferritin and procalcitonin also go up significantly in case of very severe infections, and indicate a poor clinical prognosis.

https://www.sciencemag.org/news/2020/04/survivors-severe-covid-19-beating-virus-just-beginning

clinical

Because of the massive overloads in hospitals, certain procedures followed commonly in hospital ICUs are being bypassed. This is also bec of the infectiousness of the Covid-19 virus.
For example, patients in ICUs are normally allowed family and friends in limited numbers to come and visit. Even the doctors and nurses speak to the patient. In Covid-19, everything is done from outside - through tubes etc. Doctors who go in are wearing maskes, googles, gowns and hardly speak. They do procedures.
Next - Drugs with serious side-effects are given to sedate the patient, and these need to be weaned off - but in these times, the individual assessment needed to tweak the drug and respirator settings are an additional burden for the doctors. As a result, patients are just continued on same dosage beyong need. Or efforts to try and take the patient off the ventilator - and see if they can breathe on their own - are not made.
Another example - The prolonged being in bed has serious effects, but physical therapy rehab is not easy with such an "infected" patient - even after discharge. So it is not done, resulting in loss of muscle mass etc.
This article details also some of the long-term effects of an ICU admission for covid-19. It seems that patients' overall health declines after an ICU admission. Including a much higher chance of heart attacks later in life.
Some guidenlines on ICU Mental Care - Interview with Dr. Wesley Ely, MD, MPH

actionable

Hospitals need to follow standard policies even in times of overload stress. and Doctors need to learn or not-forget these basics of ICU care, and work out ways of implementing them.


Patients Case Experiences

https://www.youtube.com/watch?v=uzJgPvukzTE

clinical

You feel a bit ill, then seem to get better, and then get worse again. Initially, cough, headache, runny nose in first 36 hrs. but on day 5, fever, muscle aches, pains everywhere. symptoms are highly variable - from patient to patient. even young people are getting severe complaints.

actionable

stay at home. only leave the house if absolutely essential. keeping a distance is not as good as staying away from people.

https://www.youtube.com/watch?v=WV6-qaNn1to

clinical

lost taste and smell. could feel the heat of the cayenne pepper, but not taste it. fever.
diarrhea as a prodrome - few days before the sickness.
Acc to a report in Science Direct the loss of smell or taste is marked, not mild, and when present, indicates a 10 times increased likelihood of a covid-19 infection as opposed to some other infection.

actionable

if you lose sense of taste and smell, self-quarantine for a few days and see if anything develops.
if cough, breathless and feeling lousy - consult the doctor.
as the smell returns, there is often a general overall improvement too.

https://www.youtube.com/watch?v=w-2GK7DDeB4

clinical

slow recovery after illness - weakness. bodyaches. cough, breathless.

actionable

cough may persist for 2 weeks after recovery. about one week after fever is gone, even if cough is there, you can go out (wear a mask). sickle cell anemia, organ donors etc - absolute lockdown.

https://youtu.be/PU2ut5Ark3Q

clinical

it comes in stages. feel better, then worse, then better, then worse. achy. i just wanted to curl up into a ball. felt like there was a balloon blown up in front of my face. the pneumonia came suddenly. went to sleep and i woke up unable to breathe. it progresses from a common cold and suddenly changes.

actionable

if you have any symptoms, even if you start feeling better, just watch and don't go out.

https://youtu.be/61z2k26_JG4

clinical

did not have fever and cough. excruciating pain all over my body. felt like limbs were made of wood. could not even roll over in bed, let alone stand up. was told not to go to the hospital, till he suddenly had to go to the emergency room.

actionable

the range of symptoms is very wide. even without fever or cough, it could be covid-19. while thinking of corona as possible diagnosis, don't miss other complaints like regular pneumonia or appendicitis etc.

https://youtu.be/CxQPCfeywXQ

clinical

very variable. felt i was recovering, and then suddenly i felt i had fallen off a cliff. first symptoms was a mild, but persistent headache. thought it was stress bec of worry about family, work etc. next day, felt weak and just wanted to rest. weak, grippe feeling. cough. i was feeling fine, but one afternoon, i felt i could not breathe. even after taking a breath, you feel as if you have not. it's as if you are suffocating in slow motion. as if slowly the air in the room has been drained out. it is not sudden, but slowly creeps up on you. felt sick. out of breath, light-headed, unable to take a deep breath. deep coughs. sinus pain, pain behind the eyes. loss of sense of smell and taste. then slowly start recovering after about 12 days. but still find breathing difficult. or take a deep breath. was unable to get out of bed for 12 days - and this was a mild case.

actionable

don't go out if not feeling well. the doctors may tell you unless you cannot speak, you won't be tested or get admitted. you may not be tested unless you are in an emergency. even if you have even mild symptoms, absolutely stay away from people.
see 3

https://youtu.be/uffhl72b-wA

clinical

30 yr old. no other underlying conditions. began with a sore-throat. felt a bit dizzy. then headache and fever. began slowly, and took about 3 hrs to feel quite ill. the fever went down a bit. then for a while symptoms went away. felt very chilly at night. back aching, maybe bec of lying in bed. fever was high. deep swab taken from nose - not painful, just uncomfortable. in this case - felt just like a flu. slight heavy breathing.

actionable

some people don't even feel they are really sick. but they could spread it to friends.

https://youtu.be/NLGX2L9JLa8

clinical

from the diamond princess ship. woke up with a high fever, 103 deg. was fine for several days, and suddenly had fever. dry cough. no runny nose, body ache etc. the fever lasted 8 hrs. felt exhausted, dehydrated. drank lots of fluids.

actionable

your wife might test negative, but you might still have it.

https://youtu.be/Wak8UQebNDs

clinical

the presentations are very different in people.
- fever can be so high that one might hallucinate. felt relieved when diagnosed with corona - at least i'm not insane.
- cannot get your breath
- feeling of isolation.

actionable

sometimes doctors may not know what to do.
look at the long-term when you are isolated, that things will get better.

https://youtu.be/nmKSmWrJbI4

clinical

- felt feverish in the afternoon. about 6p.m., fever of 99. woke up at night with chest pains about 3 a.m. and fever, and distress. progressed rapidly, was admitted. it was like a battle in my body. i couldn't do anything. slept a lot, took fluids, then back to sleep.
- other patient, no fever at all. had been to spain. dry cough. next day, cough disappeared. but got it tested. since the beginning, only cough. slight increase in heart rate.

actionable

86% of patients might be mildly symptomatic, and spread it very widely. others have serious complaints. many people are not tested. so absolute quarantine is essential.

https://youtu.be/iQ9Su-TO3Sw

clinical

in florida. 3 days after a visitor came over. had stomach cramps and diarrhea and felt bad. a day or two later, woke up very lethargic, and as if whole body had crashed. the next day, lot of body pains. next day, sore throat, irritated ears. next day felt much better. went to the gym and worked out nicely. felt good that day after the gym. next day, crashed again. then came to know that the visitor had tested covid positive. fever 99.2 initially. then went up to 102. you think you're feeling better, but the slightest physical or mental exertion drains you out. many people seem to start with diarrhea. chills and body pain, intermittent sore-throat and ear irritation. any pre-existing condition i had, felt much worse while having the corona. feels like someone is sitting on my chest. dry persistent, annoying cough. loss of weight. it takes a long time to recover from.

actionable

it is not easy to get tested for covid-19 even in the usa. when you go for testing, there may be a long wait while you are in a mask and stuff, then lots of tests are done. high nasal swabs taken then quarantined. rest is very important. he took tylenol xtra strength. lot of liquids. hot tea helps. it also calms you. isolation is tough. live it one day at a time. treat corona patients humanely. many more people probably have it than diagnosed.

cross-ref

see 14

https://youtu.be/9wzc6nFKimI

clinical

high fever. persistent dry cough and a bit of a sore-throat. like a bad cold or flu. mild symptoms. bodyache, COULD NOT MOVE. very tight chest, and difficulty breathing.

actionable

was taking paracetamol - was unable to find enough of it!! helplines extremely slow in replying. used asthma inhaler.

https://youtu.be/hoTpRQtfnII

clinical

patients feel they will almost die. shallow, dry cough....recorded in the video. patient was very sick two weeks after feeling ill. suffocation. breathing can be very labored, audible.

actionable

even doctors might reassure and send you back. you need to be alert and aware of the different presentations. now it might be less puzzling - it would be the first diagnosis. so be alert to other diagnoses!! everything is not covid.

https://youtu.be/cFmsFHKl9g8

clinical

first had complaints on 2nd march. diagnosed on march 10th. began with diarrhea, stomachache for few days., then really bad 'migraines', eye pressure. chills. body pains. fever 102, lasted several days. the cough makes the chest and head hurt.
existing symptoms seem to get much worse.
when lying down, had to lie with head elevated. lying flat made complaints much worse. lot of postnasal drip (patient had sinusitis from long).

actionable

ibuprofen should be avoided. patient's experience with meds: used phenargan for his cough etc with good relief. flushed nose with saline and felt better (others have reported the same relief with neti pot). used nebulizer with much relief. advises not to use albuterol as it can make heart race. salt water gargling. if you have postnasal drip, do salt water gargling. warm liquids help more than cold liquids. he took multivitamins.
even if you feel very well, don't exercise. because then you "crash". rest for 10 days after all is well. just walk slowly.
Don't go out till you get two negative test results.
KEEP HYDRATED!

cross-ref

see 11

https://youtu.be/h6z7nrcjv0A

clinical

video shows how the swab is taken. main symptoms at start...lower abdominal cramps. massive, unrelenting headache. day 7 tired. appetite poor. day 8 - feeling much better. looks so much better too! little lingering stomach, slight headache - but feeling much better. sudden improvement!

actionable

stay in quarantine for 14 days after positive test.

https://youtu.be/3eBA10pS9fM

clinical

40 yr old male in icu. can hardly speak. it wants to take all the life out of your lungs. i'm grateful i am alive today. don't think for one moment it won't touch you.

actionable

stay at home! the doctors treating patients are at high risk of getting infected...don't increase the burden on the hospital systems.

https://youtu.be/w9YwDoDRIHs

clinical

several patients
can't move, can't breathe, cannot catch breath. was in a bad shape, and then felt better. "felt the presence of the lord - he was blowing air into my lungs".
chest tightness. can't get breath all the way into chest. dizziness and fatigue. just kept mind strong
old patient with several underlying conditions - emphysema, valve incontinence, irregular heartbeat. felt better immediately after being given antibiotics and oxygen.

actionable

in hospital for 12 days. expect and be ready for a long stay if admitted. keep hopes up - all kinds of patients survive. it might seem like you will die. but overnight at times there is recovery.

https://youtu.be/6NwLWgOgjfA

clinical

shows how life is in a locked down city....Wuhan.
when one person in a house tests positive, and there are no hospital beds. the rest of the family has to be kept safe.
the toll mentally is tough, esp for children - if one parent is hospitalized. no certainty of when he/she will return. even after discharge, there might be some time before family gets together.
priorities change for the patient - completely....just being alive seems like a big gift.

actionable

little children learn not to touch door knobs, watch video, how to wash hands really well etc. wear a mask.
things should be explained carefully to children, in advance. what to expect, how long it might take, and that things will be ok. children grow up and mature soon.

https://youtu.be/xwEMIk8X5MU

clinical

this illness helps me appreciate the simple things in life. to live, breathe, go for a walk, hug someone - a glass of wine. the freedom. you don't know what is happening outside in the world. you cannot have your family. it is lonely. had to wear a breathing helmet for six days - difficult to even sleep in any position.

actionable

patience is the most important thing. you must learn to wait.
coronavirus is transmitted very often by people with no symptoms at all. therefore after going out into the public or anywhere, wear a mask, and wash thoroughly with soap etc.

https://youtu.be/_KfilpOdRYc

clinical

patient didn't follow any precautions. was severely infected, admiteted to hospital and ICU. "people say it's like the flu, but i can tell you it is not. it gets inside you and takes hold of you, and it takes your lungs". his father was also infected, and died.
he says - this may look like a horror movie, but it is real.
all other units in hospitals treating other conditions are now being dedicated to covid cases.
in some cities the obituaries fill 10 pages of the newspaper. there is a waiting list for funeral services though the crematoriums are running 24/7.
this is not a normal flu.

actionable

DON'T GO OUT to avoid infection. don't overburden the hospitals.
partial lockdowns are followed by more and more desperate measures to curb spread.
young people should be clearly educated about the danger of going out.

https://youtu.be/12ZhdYCpJ90

clinical

51 yr old, regular gym goer. h/o asthma, uses pump. breathless, cannot speak freely. starts with a dry cough, which makes the throat dry. lungs feel tight. did not have fever at that time. went to sleep. woke up few hours later, unable to breathe properly. fever, sweaty, clammy, but freezing. could not get warm. had a raging thirst. neck spine and back hurts. don't want to talk. get shortness of breath on moving around. don't want to raise head off pillow. it comes in waves. you feel slight relief at times and then it goes back. the asthalin pump does not help too much. if you get the cough, it is very painful. if you feel the need to laugh, don't....it is really painful. it is not like anythign ive ever had before.

actionable

stay away from each other.
stay away from old people - they will not be able to withstand a severe infection like this.

https://youtu.be/7FysPaF-XKw

clinical

doctor who recovered. woman. still extremely tired, exhausted as if i have run a marathon. sore-throat. headache. climbing a flight of stairs is like climbing Everest.
the first two days are pretty grim. very high temp, sore-throat headache, feeling like flu, but much worse. then gentle recovery.

actionable

complaints may linger on after recovery. take rest a week longer even if you know you have come out of it.

https://youtu.be/1bftPgeqIGM

clinical

priest from washington dc.
it is very restrictive, being in a small room. you wait for your body to get better or worse. uncertain. felt like a long time. there could be feelings of guilt, anxiety etc upon diagnosis.
he says he feels mentally and spiritually 100 times better, come out of hospital. on seeing the flowers etc..it was like stepping out of a black and white movie into a full color one.
i could not control many things, but the few things i could - like saying my prayers, shaving, etc.

actionable

while in hospital, there will many things that are not in your control. just do the things you can do, and do them systematically.

https://youtu.be/yrMtUQahptY

clinical

several patients
female
fever is so high that you hallucinate. after some day, fever is coming down, in the 100s. when diagnosed, it was like a weight off her shoulders - that she was not crazy. she found the medical staff anxious, and that scared her.
male
symptoms developed a day after singing at a choir. got pneumonia. cannot move, cannot breathe. many people from the choir were admitted.
female
feels great once recovered and meet people.

actionable

people who sing together are at high risk
look at the long term.

https://youtu.be/BzUwEYX5gaE

clinical

40 yrs old female. traveled from doha to gatwick airport. first got anxious bec she was self-isolating. began with a sore-throat and worsening cough. heavy chest and cough. tired. has not had fever. patient seems slightly dazed. cannot recall things too clearly.
when the doctors came in hazmat suits, it was very scary.
can hear a dry, hacking cough
need to sleep a lot.

actionable

if you need to be hospitalized, be prepared to see people in hazmat suits, anxious doctors and nurses. also be prepared not see family or anyone for a while - almost a month.
carry a hand sanitizer when you go out.
don't criticize patients -unless there is proof they were very careless, they did not want to get it.

https://youtu.be/GwFmk6PgmqI

clinical

several patients
during one of those episodes, you feel - you know - you're gonna die. but you don't. once you throw up, you can breathe a bit better.
my muscles and joints ached. as if someone was stabbing me with an ice-pick.
you can't see the doctors - they wear full masks, suits etc. you feel you are cut off from the whole world.

actionable

if you have trouble breathing or chest pain or pressure, new confusion, intense fatigue or blue lips.
you don't go to the hospital - you call your physician immediately.

https://youtu.be/4uInE0P4Io0

clinical

several patients
female
it attacks your respiratory system and hits you hard. i woke up in the middle of the night and was disoriented and unable to breathe.
it is difficult to get medical care, and you feel you might not make it.
has lost 15 lbs.
feel very distanced from family. not seen children in a while
male
fever and dry cough. the doctors who come in were fully suited up...it felt like neil armstrong on the moon.
nothing is in your control, so stress is the biggest issue.

actionable

family will also be on quarantine for 14 days.
time heals. rest. try to eat healthy.
people may treat you badly, and not want you to come back home bec they are afraid you might infect others.
stress affects your immune system, so take care of the stress.

https://youtu.be/9td3ASzuwsI

clinical

doctor recovering from covid. he got infected when a patient he tried to help get up coughed at him.
on knowing he had tested positive, his wife became extremely anxious....if she and her mo-in-law were also infected, who would take care of their baby?
it is a life-changing experience.

actionable

doctors must take every care in seeing patients, even those who have come for some other complaint.
you can donate your blood plasma for other patients, once recovered.

https://youtu.be/y37hBLd3E8s

clinical

my arms and legs were feeling weak. i thought it was bec i was wearing a suit. my colleague suggested a ct scan...and it showed a pneumonia. then the test came positive.
i was worried that my ct scan would turn white overnight. but it did not...my ct scans were not so bad.
as i staying alone, i quarantined myself.
good sleep. good food. positive mindset. open the windows. have some routine.
felt so glad when ct scan came clear. i felt i had been given a new chance at life.

actionable

have a positive mindset! sleep and eat well. rest enough.

https://youtu.be/4vZJcnPUhjY

clinical

32 yr old physician's assistant, healthy with no underlying condition
had attended a medical conference.
the infection can happen very fast esp in closed places.

actionable

wear masks
avoid any conference or gathering

https://youtu.be/pAItDHU7Et4

clinical

the fever was slowly getting higher. it was 39 to 39.4 degrees c.
patient was given anti-viral and put on a ventilator immediately.
one day at midnight i got very scared. the wind from the ventilator was so strong - it was like a typhoon.
was initially afraid, then as the fever went down, less so. fear is not good for the immunity.

actionable

manage your fear and anxiety - try to stay calm.
for a while after recovery stay alone, wear a mask etc.

https://youtu.be/wPM8v1z2xtg

clinical

marathon runner, female, 42 years old. no underlying health conditions.
went for a dinner party with 50 people. started with fever. thought maybe flu, took advil. then next day fever came back and was relentless. then developed shallowness of breath. could not breathe deeply. later had GI complaints. coughed on taking a deep breath. was vomiting a lot. lost taste, smell. migraine. developed hepatitis. it was terrifying. felt the disease was taking over my body. there was a rash all of the body. was given hydroxychloroquine. the fever stopped and the migraine started.

actionable

if unable to take a deep breath without coughing, esp when there is fever.

https://youtu.be/Hfl1oqaJL_M

clinical

26 yr, healthy female
felt ill about 8-9 p.m. with headache, feverish. next day had cough. then next day no fever, felt fine. was planning to do stuff. but next night woke up in the middle of the night with chills, vomiting and shortness of breath. could not walk more than a few steps. could not eat bec of shortness of breath. the short walk from the lift door to the emergency room door was almost impossible, had to sit down. was taken to the hospital by partner. waited 4 hrs before being seen by a doctor at 11 p.m. the doctors said that many young people were coming in as patients. total confusion in the hospital about protocols, and also doctors had no protective equipment. doctors were themselves in a state of distress. at first, patient was told she was not eligible for testing bec she had no contact with a known patient. the first swab test was lost. she was informed also that there is no point in informing her contacts bec the number of cases were so many that it didn't matter!

actionable

crazy confusion at hospitals. be extremely patient. be organized with written instructions and make it easier for the doctors.
very difficult to get tests even when you are in a critical condition.

https://youtu.be/2fLTVOxFlHo

clinical

female, ER doctor.
interview was on day 13, with the patient feeling much better overall. still coughing.
had gone to a snow resort. next day got a sore-throat, and felt something not right. next day, got a dry cough along with sore-throat, and got nasal congestion. no fever. a few days later, lots of bodyache, neck, back, headache. malaise and continued dry cough.
would get out of breath going up a flight of stairs...minimal activity. heart rate would shoot up. but not breathless at rest.
no energy at all, even after sleeping 10-11 hours at night. overwhelming fatigue. the cough was not so bad.

actionable

rest - sleep 10-11 hours! drink plenty of fluids. self-quarantine.
week to week, the situation in the world outside can change dramatically - in terms of number of cases etc.
getting a test is very difficult, even for a doctor.
how a swab is taken (>>among other things) might result in a false-negative. so positive is significant, but maybe not a negative result. check with a doctor again if needed.

https://www.nbcphiladelphia.com/news/local/a-survivors-story-how-it-really-feels-to-have-coronavirus/2346340/

clinical

48 yr old male recovered fast and well.
it was scary and draining. i was not able to get out of bed. i felt like i had the flu on steroids. it hit me like a hurricane.
it comes on so suddenly.
i woke up one day, felt good the whole day. i got home at 730 p.m., and i developed a cough, which i felt was odd. within 90 mins, everything hit me at once. i really did drop me. developed a harsh cough, fever 102, nausea, dizziness - everything hit me really quickly. could not sleep well. next morning, called the doctor, and was able to get the test very next day. results were to come after 4-5 days.
the first 5-6 days were the toughest, scariest. it comes in a hurry and drops you. cough was very persistent. fever was between 100-103. had nausea, dizziness. the bodyache was severe, the worst symptoms. the fever comes and goes - you feel you are getting better, but it comes back. at night i'd wake up drenched in sweat. then after 5-6 days i started improving. the cough persists.
there is exhaustion, really tired, brain fog. did not have breathlessness.
the cough is brutal. took a cough syrup with codeine. the cough is every minute or two. was also using an albuterol inhaler, but it did not help. hot tea with honey was helping, as also cough drops.

actionable

start planning while you are still well
have a support network of people who can help you, and can check on you. friends and family members who can bring things to you. also how to isolate yourself from the rest of your family. do this before the first symptoms. stay positive - your body will probably respond in a positive way.
you can keep the microwave and have things that can be cooked by just heating.
stay calm...tests may take time. there will be lots of guessing and double-guessing. talk to people. have people who are checking up on you. there are scary moments.

https://youtu.be/H2E1t3yMXgE

clinical

an old couple, off a cruise ship
developed a dry cough - one person's was deep, the other just a short cough. later the man has small spikes of fever on and off, nothing very high. there was some breathlessness. coldness at night at times. neither of them had very high fever. the man was diabetic, on insulin. he got very breathless after some days, could not even walk on level ground. in the ambulance, could not bear to keep on the mask, bec of the breathlessness. at one point, felt he would pass out. needed a wheelchair. it was terrible. felt as if every pore in the body had opened up. could hardly talk. got very emotional, tearful. investigations - xrays, ct scan, ecg, loads of blood tests.

actionable

practice deep breathing techniques and keep doing it when well and esp when unwell, all the time.
if you have not been tested, but have the symptoms, a quarantine of 2 weeks may not be sufficient. maybe a month is needed. or if you have tested positive, 2 consecutive negative tests.
gargle with salt water.
soap and water is much better than a hand sanitizer.

https://youtu.be/L1j1VDCei6k

clinical

had a dry persistent cough. next day, loss of appetite. sense of taste changed, everything tasted contaminated, like saw dust or black mold, and then started having a dry crackling sound in the chest. diagnosed pneumonia. oxygen levels were very low already. was admitted in the emergency room. i was so weak that i went into the slow motion, casual observor mode. i was so tired that i was not scared or alarmed. but i did think i was going to die. i just focused on breathing as much as my crackly lungs, and as fast. the o2 was given at 15 liters/min.
i was so tired i was sleeping a lot.
on the third day of hospitalization, started feeling better and self-sufficient.

actionable

focus on breathing deeply, make the effort.
cooperate the staff, go with the flow. be an enthusiastic participant and be part of the team.

https://youtu.be/b74d6NVTJ6s

clinical

was in a pool of sweat, soaked and scared. could not move. the pains and lack of energy make you want to just lie down.

actionable

was advised by pulmonologist to sit up and stretch, raise hands above head. walk a bit, move. breathe deeply when it hurts.
bring fever down and drink lots of water.
don't lie in one position, on your back. lie on different sides, or on belly. just change position.
lie down propped up if possible.
see the cross ref below for breathing exercises

cross-ref

see 10

https://ksltv.com/435377/23-year-old-survivor-has-message-about-covid-19-seriousness/

clinical

23 yr old male. healthy and athletic, but some exercise-induced asthma
came from a ski trip, felt tired and achy. all four of his friends also got the infection.
during the infection, he had headache, bodyache, chills, fever, sore-throat. he also got hives.
no motivation to get out of bed.
felt super dizzy on standing up, almost passed out.
on the third day, had sore-throat, and lungs felt tight and dry. it felt like an asthma attack.
i'd just be so winded. it was as though i'd run a mile in the cold and couldn't catch my breath. sinuses were burning like crazy. felt as if he was breathing through a straw.
every morning was a new experience.
eyes turned red, burned like crazy, tears down cheeks.
could not taste an entire lemon. also lost all sense of smell.
coughs and rubs chest.
on the 7th day i was hit with a cough. it made my head spin, and kept me up all night.
lungs still feel tight after recovering from the illness. also still not got back his sense of taste.
his friends also lost sense of smell and taste, but did not suffer as much, overall.

actionable

be careful getting up from bed, esp after a bout of coughing. hold on to something and get up after sitting in bed for a bit. you might be dizzy.
those with allergic tendencies might also have these exacerbate during the covid-19 infection.

https://youtu.be/lQhVzwlEx-Y

clinical

high fever and persistent cough.
symptoms just kept getting worse.
shortness of breath. and within a matter of two days, i could not breathe at all. it was as if someone took a scuba diving tank, and while i was underwater, and just turned it off.
was hospitalized, given iv fluids and antibiotics and oxygen.
took quite a few days to get the strength and energy to feel positive, and to fight the virus.

actionable

it seems as if you are going to die, and then things turn around, and you realize that you are going to come out of it. so stay positive - the darkest hour might be just before dawn.

https://www.washingtonpost.com/health/what-its-like-to-be-infected-with-coronavirus/2020/03/21/92794f4c-6953-11ea-9923-57073adce27c_story.html

clinical

several cases
M, 32, first had nothing more than a “general sickly feeling.” Then came a bad headache. He felt terrible. But for Torres, the worst effects of covid-19 so far have been mental: “It is psychologically unsettling to know I am carrying a virus that could harm my loved ones. The virus preys upon our need to be human, our need for social and physical affection. I struggle with depression, and the virus has left me struggling even more so.”
M, 42, an Episcopal priest in Washington, D.C., felt drained after a Sunday service on Feb. 23. He took a nap. No big deal — the service can be tiring. The next day at the gym, his muscles ached. He became fatigued, feverish, slightly dizzy. “I kept telling people I felt spongy,” he recalls. “Like a kitchen sponge"
M, 64, an infectious disease doctor in Alabama, developed a cough, like a smoker’s hack. He was bone-tired, his mind foggy. About five days in, the misery intensified.
M, 34-year-old, had mild symptoms for several days and then abruptly developed shortness of breath, fever and chest pains.The fear is real,” he said. “It’s impossible not to be scared at times that it’s just going to take this insane turn into uncontrollably bad.
F, 20s, first symptom was shortness of breath. began to cough and feel tired, as though she’d just finished a sprint. then “I got tremendously worse,” she said. Her temperature rose to 101, along with a headache that she described as “the worst part of my entire experience.”
female, clinical psychologist. “I’ve never had anything like this. The symptoms feel unfamiliar to me, and therefore I don’t know how to mentally make sense of them.” The symptoms come and go. She feels better — for a while. “And then I take my dog outside and feel like I’m going to fall down,” she said. “And my fever is gone, and then it comes back. And while I have been sicker with other things like bronchitis or stomach viruses or really bad colds, this feels like a constant fatigue. It’s the weirdest thing".
F,47, former reporter, suddenly developed a headache March 11. “I had to get in bed and go to sleep. It hit me like a truck,” she said. Her symptoms came and went. At times, she felt just “under the weather.” Although she didn’t think she had covid-19, she managed to get a test and was on the treadmill last Sunday, feeling better, when her doctor called and said she was positive. She described the uncertainty that everyone is facing, including health officials - asked who should take care of children if my husband tests positive, too? was told ‘We haven’t had that scenario yet". By late Friday, her fever had spiked again, and she had another terrible headache. And her husband had tested positive.

actionable

A striking feature is feeling sick, then well again, then sick again.
Stay Calm - most important. This disease causes fear and anxiety.
Have a plan - in case both parents get infected, how to manage children.

https://www.express.co.uk/life-style/health/1264135/coronavirus-symptoms-signs-covid-19-infection-shivers-hallucinations

clinical

Describing his ordeal, the patient said: “The night I had last night I’ve never had anything like it, I’ve never experienced any kind of fever like what I have going on all the time. it felt as if “someone was beating me like piñata. The body aches and the tremors and the concern about not being able to do anything about it, I totally get why so many are so scared. He described a deep shiver and hallucinations, and seeing his late father even appear. "I was seeing people from college, people from college, people I haven’t seen in forever. It was freaky what I lived through."

actionable

Confusion, hallucinations etc may be part of the Covid-19 "experience".
The NHS describes confusion as >> Not being able to think or speak clearly or quickly, not knowing where they are (feel disorientated), struggling to pay attention or remember things or seeing or hearing things that aren’t there (hallucinations). Try asking the person their name, their age and today’s date. If they seem unsure or can’t answer you, they probably need medical help.

https://www.channelnewsasia.com/news/singapore/covid19-singaporean-survivor-treatment-ncid-recovery-12

clinical

First, a high fever seemed to lay siege to his body. "I could feel the fever coming up, and they did tell me that my fever was moving up quite rapidly,' he recalled. "I think on that night the fever was at 39.8 (degrees Celsius) and I was at 39.8 for several nights."
'MY BODY WAS TAKING A BEATING'. "I think psychologically I was in a bad place because I was not sure what was happening to me."
"Physically, I was tired, I was drained. At the peak (of my situation), I couldn't sit up for 30 minutes (or more), I would feel exhausted."
Next came strange hallucinations a couple of nights into his stay at the National Centre for Infectious Diseases (NCID).
They would come like a thief in the night. Sometimes at 11pm, sometimes at 1am. Was he awake, was he asleep? In the feverish haze, the 55-year-old Singaporean couldn't tell.
"I started hallucinating, but I did not tell the doctors I was hallucinating until towards the period where I felt comfortable enough to tell them," he recalled. "Because I didn't know whether hallucinations were part of the thing that COVID-19 patients went through."
Mr Bambang, who is a businessman, began seeing images that seemed utterly random.
There would be one where he was in a Dutch bakery and was trying to buy a percentage of the company. In another, he would be wondering why he was reporting his temperature to an accounting firm.
"That was the scary part, and I think it was the temperature that was really, really playing on my mind," he said. "Then I saw images of people that had passed away . Those were very, very tough nights ... When those images came up, it got me seriously worried.
"Finally, I managed to say it ... and tell the doctors." Much to his relief, they said the hallucinations were normal.
Then came energy-sapping pneumonia. And Mr Bambang had to be given 4 litres of oxygen through a nasal cannula to help support his breathing.
"I won't lie, there was one day that I broke down," he recalled. "That was the day I thought I was at my lowest, I was thinking: 'How come I am not getting any better, why am I getting worse and worse?'

actionable

The mental signs of Covid-19 infection should be clearly understood and recognized... confusion with fear, not knowing whether awake or dreaming, feeling helpless and hopeless. Imagining seeing dead people. There might be a feeling you are going mad, and when you are given a diagnosis of Coronavirus infection, or told this is common in the infection, there is relief.
The support of friends and relatives, being encouraged and supported is vital. Don't try to fight it by yourself. Share your experience and fears with calm, positive people.

https://www.theartnewspaper.com/news/v-and-a-chair-nicholas-coleridge-describes-his-brueghel-like-delirium-after-contracting-coronavirus

clinical

patient describes the virus a a “very dirty computer virus, infiltrating every part of your system, and contaminating all your files”.
His daughter called for an ambulance after his family saw him becoming “loonier and loonier”.
“It was rather interesting because this Covid hits you suddenly out of left field. For me, first came a catatonic tiredness…. punctuated with very, very high temperatures going well above 40 and icy legs but no cough,” he said, adding that this led to delirium, with visions of snakes, Bruegel-like figures and fantastical figures.
He was eventually admitted to intensive care though he said he has “almost no memory” of being in ICU. “They pump you through with so many antibiotics and barrel loads of oxygen, that it does play with your head,” he said. At one point, a doctor told Coleridge’s wife that she should prepare for his possible demise.

actionable

Note the presentation - fever, but without any cough. Physical Tiredness and confused mental state with strange behavior. The description of the virus like an invasion, something that takes over the body has been described by several patients. This is not commonly seen in other infections.

https://edition.cnn.com/2020/04/15/us/coronavirus-icu-delirium/index.html

clinical

A 40-year-old nurse with coronavirus, was emotional and full of relief on the ensuing call with his wife after more than a week on a ventilator in an Idaho hospital's intensive care unit. But over the next couple days, it became clear that while Jesse's body was on the mend, his mind wasn't right.
He yanked an IV line out of his arm. He requested an Uber to take him home -- a $200, nearly three-hour trip -- even though he could barely get up. He talked in circles for days about going on a road trip and was obsessed with trying to rent an old-school Ford Bronco to drive himself home. He couldn't grasp what exactly was going on.
"He didn't understand why the world was at war with (Covid-19), why health care workers were heroes, why he was involved," his wife said. "We had the same conversation for four days straight."
His experience is just one example of "ICU delirium," an acute brain condition characterized by confusion, inattention and an inability to understand the world around you. This is particularly common in patients who are sedated and on a ventilator for extended periods of time. And patients must be heavily sedated to tolerate a ventilator, which works via a tube snaked down the throat to deliver air to lungs flooded with fluid.
"My brain wanted to keep on looping over and over and over, and I kept on asking without realizing that I had asked these questions lots of times," he said.
The effect of coronavirus on the lungs is well known, but its significant impact on the brain has been less widely acknowledged. As more and more patients come off ventilators and recover from coronavirus, many will return home not just with physical changes but with psychological ones, too.
Two weeks since coming off the ventilator, the patient remains easily fatigued and is still working to piece together what exactly happened.
"At this point it's starting to get clear, but for a while there, especially right after I was starting to gain consciousness and especially after ... they took the intubation tube out, it was really, really confusing to me," he said.
Delirium is fairly common among ICU patients even in normal times.
But the coronavirus pandemic is like a "delirium factory," said Dr. Wes Ely, a professor of medicine at Vanderbilt University Medical Center who specializes in ICU delirium.
"If you had to design an experiment to make delirium as big of a problem as you could in an ICU, Covid is it," he said.

actionable

Confusion, being out of sorts with reality. Trying to make sense of it all, being unable to do so - with fear and anxiety. This is part of what many patients face. Knowing this in advance might help. Memory seems to be affected too. It will take time for patients with severe infection and hospitalization to return to normal - not just physically, but especially mentally. Prepare for this.


Homoeopathy

https://www.avsprasad.com/articles/a_remedy_suggestion_for_covid.html

Description

I feel Spongia tosta might be indicated in many cases of coronavirus infection. I give reasons in this article.

Thoughts

It is important to look at remedies which have a prominent action on the respiratory system with characteristics like dry cough, fever, dyspnea, exhaustion and pneumonia (esp bilateral). There are other peculiar features like loss of smell and taste which are covered by remedies like sticta, kali-i etc which also have bilateral pneumonia. We need to study these and be prepared with the keynotes.
Further, based on the various patient histories we see on this page, one should be prepared to look even at remedies like coca (acute mountain sickness with breathlessness) or elaps (useful in my clinical experience for pulmonary hypertension and blood disorders). We must create a small materia medica of 15-20 drugs which have as their keynotes the various prominent features described by confirmed covid-19 patients.


Related Info

https://www.thenation.com/article/environment/coronavirus-habitat-loss/

Description

Explains why new viruses are suddenly causing epidemics.

Thoughts

The buck stops with us.

https://www.vox.com/2020/3/21/21188210/coronavirus-restaurant-bar-workers-economy-service-industry

Description

Effect of the pandemic on restaurant workers and all those who cannot "work from home". It is a very well-written article which gives a glimpse into what is happening across the world.

Thoughts

If we feel the world has changed for us, cannot begin to imagine their situation. The same holds true for laborers, construction workers, contract workers etc esp in India.

https://www.youtube.com/watch?v=T_NCh8Rqiq4

Description

Shows how Malls, Restaurants, Wedding events are all hit badly. Travel agencies, Music festivals, Sports too...Olympics including! Gyms...

Thoughts

Interestingly, even funerals are affected! No more large funeral services.
copy paste https://www.youtube.com/watch?v=gPEHmRXh6mM to see businesses that are doing well. One surprise (actually no surprise) is cleaning services! Also Drive-in restaurants or movie theaters...!

https://youtu.be/Mvlqh0JN55M

Description

Following Dr.Ming Lin being fired in New York for complaining of lack of PPE, Dr.Zubin Damania calls for an overhaul of the medical system.

Thoughts

Hope it is a real turning point in history. Shared it widely.

https://www.youtube.com/watch?v=-UO3Wd5urg0

Description

31 March 2020
Dr. Jay Bhattacharya is a professor of medicine at Stanford University. He is a research associate at the National Bureau of Economic Research and a senior fellow at both the Stanford Institute for Economic Policy Research and the Stanford Freeman Spogli Institute.
His March 24, 2020, article in the Wall Street Journal questions the premise that "coronavirus would kill millions without shelter-in-place orders and quarantines." In the article he suggests that "there's little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high."

Thoughts

only time will tell the mortality rate...but one needs to act before the numbers are out.

https://www.thelancet.com/coronavirus/archive

Description

To assist health workers and researchers working under challenging conditions to bring this outbreak to a close, The Lancet has created a Coronavirus Resource Centre. This resource brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All their COVID-19 content is free to access.

Thoughts

Even the New York Times is offering free access to its coronavirus content. Studying this pandemic becomes so much easier! We have the time - we need to have the focus, and must try to bring all the useful pieces of the puzzle together.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

Description

Certain medicines used to treat diabetes and hypertension may increase the risk of a bad outcome in covid-19 infections.
"We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19".

Thoughts

Don't stop your BP or diabetes meds, but do discuss your medications with your doctor - it is possible that an alternate class of medications can be used during this pandemic. This also includes ibuprofen (brufen).

https://punemirror.indiatimes.com/pune/cover-story/disaster-mgmt-cell-turns-into-virtual-war-room/articleshow/74719272.cms

Description

A small part of Pune's Municipal Corporation handles the tracking of Coronavirus cases in Pune, Maharashtra.

Thoughts

It's easy to complain that the government is not doing enough etc. We have no clue about the kind of efforts being put in at all levels.

https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30003-3/fulltext

Description

The SARS-CoV-2 virus is sensitive to heat, and also seems to survive better on smooth surfaces. It is destroyed by common disinfectants. In culture, 4 deg C seems ideal for its survival, and above 70 deg C it doesn't last long.

Thoughts

Interesting about the smooth surfaces. Wonder why?!

https://www.mayoclinic.org/diseases-conditions/coronavirus/multimedia/how-dirty-are-common-surfaces/vid-20483428

Description

Some surfaces are dirtier than others. In public spaces, door handles, cart handles at stores, railings, restaurant menus and surfaces touched often by people are full of germs.
At home, computer keyboards, doorknobs, phone screens are constantly touched, and are full of germs.

Thoughts

Recognize and clean surfaces that are frequently touched.