Someone very dear to me came down with a really rough case of Covid-19.  They developed pneumonia that made the most horrendous sound when they breathed.  

This person was soaking through 5 shirts a day, blacking out, fever of 103 (medicated it would go down to 101)  for over a week and shooting joint pain. They were sleeping all the time and had Skype sessions with a doctor every two days to assess progress.  Meanwhile, I was halfway around the world, in a country with no current confirmed or even suspected cases of SARS-CoV-2. I felt helpless and was in a tailspin for days, watching from far away. . .

Then we found something I could do to help!  This person was too weak to go down the rabbit hole of google, but they wanted to research the questions they had about Covid-19.  They were worried about their family, about their lung health, and more. So they sent their questions and I put together the email for them below.  I am NOT a doctor and these researched answers DO NOT take the place of medical advice from a doctor; however, both this person and I thought that the information may help others as it is a synopsis of what is currently being written in news articles, research articles, and on official websites like the CDC website. 

I tried to find primary sources and original research articles where I could.

Ok here it is – written on March 28th with some additional information added and anonymized to protect their privacy:

Dear – – – – – ,

LOVE YOU LOTS!  Figured I’d answer your questions over email because sometimes it’s just nice to be out of messenger and it might make it easier to come back to the info.   Also, don’t feel like you need to click on the links! I hyperlinked to the articles I referenced, but I captured the most relevant information so if you don’t want to go down the rabbit hole, you don’t have to – LOL.

FYI if you do start reading articles online, you’ll see references to both SARS-CoV-2 and Covid 19. It was confusing for me – so I looked it up – according to this article:

“The pandemic spreading across the globe now is a pandemic of what was initially called 2019 novel coronavirus. It now is officially named “severe acute respiratory syndrome coronavirus 2,” also known as SARS-CoV-2. The disease caused by SARS-CoV-2 is called COVID-19.

“Viruses, and the diseases they cause, often have different names,” according to the World Health Organization. “For example, HIV is the virus that causes AIDS. People often know the name of a disease, such as measles, but not the name of the virus that causes it (rubeola).”

Okay, onto your questions! 🙂

“I want to find maybe some yoga breathing exercises. I still am struggling and don’t want to push it but as I get better I want to try”

This is a fun one!  I asked health worker friends what lung exercises would they give a COVID patient recovering from pneumonia. They had some great ideas!  Here are the recommendations:

A)   Sing!   Maybe the kiddos will have a sing-along with you over facetime!

B) Try blowing a cotton ball with a straw.  Your kids might have fun doing this with you over Facetime.

C) Use a Incentive inspiratory spirometer  – I know you don’t have access to one of these, but turns out you can build one at home!  I thought the kids might have fun building this for you as a science experiment.  

If you can’t make the spirometer (requires rubber tubing which you might not have on hand) then one respiratory therapist recommended that you: “Slow deep breath in, hold for a second (open up alveoli) and push air out—10x/hr or as tolerated.”  

10 x an hour seems like a lot!  I’m sure it’s not easy to take deep breaths right now . . . but at least that gives you a goal.

D) If you are laying down a lot, the suggestion is to get up and walk around or sit upright as much as possible. One health worker wrote: “Fluid tends to build up more when the patient is laying down. I’ve had a few tell me first hand that getting up is incredibly difficult, but then they feel almost like a release in their chest cavity/lungs that helps with breathing.”

E) This video was recommended.  It first talks about pursed lip reading which was already in the other videos I sent, but it seems to have better/more useful tips. It also talks about a few more methods.

F) My yoga guru friend from India suggests Pranayama.  This is a really nice video for how to do it.  This is another interesting video on alternate nostril breathing.

Ok, next question! 

“Can you look up any updates on people getting reinfected? I remember a while back I read someone in China got reinfected. Wasn’t sure if there were any updates on that.”

Ok so it looks like there are optimist scientists and pessimist scientists with answers to this question – well, they all agree that we don’t know the answer yet.

Animal studies have been positive in that they haven’t been able to reinfect rhesus monkeys with the disease. 

There is also the question of, if we do get immunity to Covid 19 after being sick with it, how long does the immunity last?  “Some other viruses in the coronavirus family, such as those that cause common colds, tend to induce immunity that is relatively short-lived, at around three months,” says Peter Openshaw at Imperial College London.”  (quote pulled from this article) Also, for ordinary coronavirus infections, you can get infected over and over again and we don’t know whether or not that is true with the Covid 19.   

The anecdotal/news stories about people in Japan and China getting reinfected can’t be confirmed as an actual reinfection of the disease. It could be that they got a false positive on one of the tests.  There were problems with reliability of the test kits early in the outbreak. Or, there is a chance they just had low levels of virus in their system still even though they felt better, according to this article.  

That being said . . .there is an interesting research article of four health care workers in china who met ALL of the following criteria to be discharged or allowed to discontinue quarantine: “(1) normal temperature lasting longer than 3 days, (2) resolved respiratory symptoms, (3) substantially improved acute exudative lesions on chest computed tomography (CT) images, and (4) 2 consecutively negative RT-PCR test results separated by at least 1 day.”  After all of that, they tested positive again 4 to 5 days later. Even though they were positive, they didn’t show any symptoms and their chest CT scan showed no changes to their lungs. One article suggests maybe Covid is “biphasic”  meaning it has two phases and could peak again a second time showing up as a positive on a test, but that likely you are not still contagious (patients found positive again appear to not have infected anyone else).  

I’ll leave off with this positive piece of information from this article, “Some people sickened by SARS, the dangerous coronavirus that emerged in China in 2002, did develop a measurable immune response that lasted a long time.”

All the articles I could find about reinfection were dated 20 March (today is the 28th) so I’ll keep double checking on this one for the latest news.

Next question:

“Should my partner be drinking tonic water? Is it good for prevention?”

So, the news is out debunking tonic water as anything that might be helpful.  I will say though that it was a doctor who recommended this to my sister.  Basically I think anything that is ANTI-VIRAL couldn’t hurt. It is very small amounts of quinine in tonic water, but quinine IS an antiviral.  When I used to work in a hospital, if one of us accidentally got a “needle stick” (after giving an injection to a patient, the needle accidentally pierces our skin, through the glove – usually the patient has moved suddenly or something happens to cause this) and this patient was HIV positive, we would take antiviral medication to ensure we didn’t contract HIV. This medication doesn’t come without side effects though.  But in the case of tonic water, I would say, why not? It couldn’t hurt and at the very best might slow down any viral replication if your partner does get the virus. Antivirals can kill or prevent the growth of viruses.

More about the amount of quinine in tonic water: The amount of quinine in a malaria medication or for treating nighttime leg cramps can have adverse effects – including hypotension, hypoglycemia, ringing of the ears – etc. There is a rare but serious side effect, affecting 1.67 out of 1000 people who use quinine at medical dosing – this rare side effect is called immune thrombocytopenic purpurad”

Tonic water contains no more than 83 mg of quinine per liter and if quinine were prescribed to you as a medication, it would come in capsules of 324mg and usually people have to take 648 mg two times a day to treat malaria (8 hours apart). So you would have to drink 7.8 liters of tonic water 2 times a day, 8 hours apart to reach that same dose.  Pediatric dosing is different, and is based on the weight of the child. Even though I couldn’t find much online about it . . . I personally would avoid children drinking tonic water. It’s just my gut reaction and I don’t have anything here to cite.

I would definitely have the family cook with all natural antivirals – I mean, why not?  I even found an article in a medical journal about all natural antivirals including their impact on coronaviruses. It was hard to read though and I need more time to understand it, but in the meanwhile here is a go-to that your family can start using right away in the foods that they eat.

Ok and onto the last question you asked:

“Also, personal opinion. If you were me…how long would you wait before being around your family?  My first Dr said 72 hours after I’m fever free, My PCP said 2 full weeks from the start of the fever +72 hours fever free. My fever started Thursday night. I know I’m not fever free yet but as it’s dropping I’m praying/planning.”

Basically, they say for this one, “The science is evolving,”  and there is no easy answer . . .

A recent study has shown that mild cases are most contagious earlier (4 days after onset of symptoms) but those patients with severe cases who had pneumonia, they were most infectious day 10/11 post the onset of symptoms. (FYI this study was not peer-reviewed and the number of patients studied was 16, so it’s not a large study)  I think that this is where your PCP who said 2 full weeks from the start of the fever +72 hours fever free is coming from. . . she’s being safe and I think that’s smart considering what the research study I linked above showed and that you developed pneumonia from it, so your “peak” of being contagious would be at day 10 or 11 from when you first started feeling sick.  

The CDC says 72 hours after being fever free AND your other symptoms have improved AND it’s been at least 7 days since your symptoms first appeared. So I think your first doctor may be a little hasty in saying just 72 hours fever free.

Something to consider, children CAN get Covid-19 and the initial news that children just don’t get this and we don’t need to worry seems to have been off the mark.  Babies/toddlers under 1 year old have a worse time with Covid-19 . . .here are some helpful numbers, “Eleven percent of infants became severely ill, compared with 7 percent for children ages 1 to 5; 4 percent of those ages 6 to 15; and 3 percent of those 16 and older. (Adults, on average, fall into this severe/critical category 18.5 percent of the time.)”  In a study of 2,143 children from China who had Covid 19, about a third of them experienced moderate symptoms with evidence of pneumonia. 

So . . in my humble, non medical opinion . . . I would take the advice of your PCP and not of your first doc.  What you went through was so miserable it just seems better safe than sorry in this case so that your kids and partner hopefully don’t get it.  But I am SO SAD for you as I can’t imagine not being able to hug your children and partner right now.

Love you LOTS

Ready for more questions if you have them <3