Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center. He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep medicine and neurology with expertise in neuromuscular respiratory failure and sleep breathing disorders. He has also trained in internal medicine and has extensive experience in urgent care. He has been practicing medicine for over 10 years.
I want to go on record as saying that I really, really hope that the COVID-19 pandemic will not turn out to be as bad as the direst predictions are saying. It is certainly a time of tremendous confusion and worry. After what has already happened, many people are questioning their "trusted" sources of information and thinking about what they can do to prepare themselves and their families if things get really bad.
We already know what we can do to help prevent the spread of the virus: excellent hand washing, social distancing, treating our underlying medical conditions like diabetes and asthma, quitting smoking, etc. It is also a great time to be especially mindful of how sleep has a major influence on your immune system and helps keep you healthy. If you are having trouble sleeping during this stressful time, you can schedule an online appointment to meet with me and avoid having to go to a brick-and-mortar clinic. But is there anything that we can do to prepare now in case we or our loved ones get really sick and the medical infrastructure is overrun?
The only truly effective therapy for COVID-19 right now is supportive care for severe cases by using ventilators in the ICU. Ventilators help you breathe if your lungs have been overwhelmed by the acute respiratory distress syndrome (ARDS) that COVID-19 can cause. The goal is to keep you breathing while your body slowly clears the viral infection itself. One of the biggest concerns is what happens if hospitals, and particularly ICUs, are no longer able to keep up with demand. President Trump has invoked a Korean War-era act to ramp up the production of ventilators but the outcome of this is uncertain. Following the old adage "an ounce of prevention is worth a pound of cure," it might be worthwhile considering the worst-case scenario and decide if you want to invest in preventative measures. To be clear, I am not advocating that everyone go out and buy the expensive equipment and medications described below. I am also recommending that, if you're really sick, you should go to the hospital and get the help that you need. But there are some scary trends out there suggesting lock-downs and shortages might be coming and, while you have the opportunity to do so, here are some possible "Hail Mary" options to consider having at your home to ride out the pandemic:
These devices assist your breathing, helping you to maintain normal respirations and "gas exchange" - bringing oxygen into your body and getting rid of toxic carbon dioxide.The "ST" models are optimal for more severe respiratory failure because they can give full breaths in cases where the patient's respiratory muscles are too weak to initiate a breath. The other BPAP models can only augment the depth of each patient-triggered breath.
ARDS typically leads to "hypoxia," or a low-oxygen state, that can cause your entire body to shut down. The safest way to treat this issue at home is with oxygen concentrators, which strip the oxygen molecules out of the air and deliver them to your body through a nasal cannula. Oxygen tanks are seldom used these days due to the dangers inherent in their extreme flammability and their unwieldiness.
While there has been a lot of interest in CPAP machines, used with or without supplemental oxygen, for treating COVID-19. However, the mechanism of CPAP machines makes them, in theory, significantly less effective than BiPAP machines in terms of regulating breathing volume and oxygen saturation with severe lung disease. Nevertheless, they are certainly better than nothing.
Please note, use of PAP machines with traditional PAP interfaces ("PAP masks") has the theoretical risk of increasing dispersion of the novel coronavirus into the immediate environment near the user through the exhalation port. All masks that work with PAP machines by necessity have an exhalation port to allow fresh air to enter your lungs and prevent the rebreathing of air with higher carbon dioxide content that is toxic. For this reason, first responders and hospital staff have been avoiding using PAP masks with CPAP and BiPAP to treat their patients with COVID-19. For home use, the main worry would be, "Am I increasing my spouse's, partner's, or family's risk of exposure to coronavirus by using this machine?" However, it stands to reason that if you're at home and sick with COVID-19, you've probably already exposed them to the virus.
While there are no medications that have clearly been shown to be effective against this current strain of coronavirus, it might be worthwhile consulting with a physician to discuss the possible benefits of having one or more of these medications on hand in case things get out of control:
Unfortunately, Tamiflu, which we normally use for acute influenza, doesn't seem to be effective against novel coronavirus. There are other antivirals out there that, although there is no definitive evidence that they help yet could, in theory, treat the virus. These include:
- Kaletra - recently approved for the treatment of COVID-19 in Israel, on the market in the U.S.
- chloroquine - under investigation, on the market in the U.S.
- favipiravir - under investigation, not on the market in the U.S.
- remdesivir - under investigation, not on the market in the U.S.
- favilavir - under investigation, not on the market in the U.S.
Other Medications to Consider
In theory oral steroids, like from a Medrol dose-pack, could help to reduce the massive inflammatory response that is part of ARDS. Whether to use steroids or not in treating ARDS from COVID-19 is currently being hotly debated in the medical community. The CDC and has come out against routinely using steroids to treat COVID-19 and the WHO has recommended that they only be used in clinical trials for the illness but anecdotally, many clinicians are using them in practice.
Antibiotics, like Z-paks, might be a good idea to have around to treat superinfections. Although antibiotics don't have any direct effect against viruses, bacteria can grow in the fluid that the coronavirus causes to accumulate in the lungs, turning into pneumonia which response to antibiotics. Anecdotally, there are a lot of reports surfacing in the media about high-profile people with COVID-19 being treated with a regimen of chloroquine and azithromycin (Z-pak).
Bronchodilators: like albuterol, to help open up the upper airway passages that can be narrowed by inflammation from COVID-19.
Antipyretics: make sure that you have copious amounts of acetaminophen and NSAIDs, like ibuprofen, around to reduce severe fevers.
Let's all hope and pray for a soft-landing from this latest challenge to humanity.