I sent this text out to my family this morning. I have two sons currently at University.

I just received this cure in a dream.

I believe we are all going to get Coronavirus at some point.

Remember, I have THREE oxygen concentrators. If any of you start with symptoms tell me because it is the great need for oxygen therapy that puts people in the hospital and nobody should be in the hospital at this point. It is too dangerous.

Tell me if you are having symptoms and I will mail you one of my machines.

Here is my cure from Heavenly Father:

‪OREGANO OIL 3-5 drops per foot. Cover with CBD Oil. Socks on. Do this three times per day until symptom free. Between applications, scrub feet in hot soapy water. Stay hydrated and Clean. This is my recipe for the CURE! 10 grams vit C and Zinc lozenges. TRY IT! Recipe From God!‬

Love, Mama

I have been on Oxygen Therapy for the past few years and have some insights on Coronavirus.

While it is great that the focus on intubation has kicked into high gear and machinations are in place to craft more ventilators, I believe if Oxygen Concentrators were available to the public without a prescription, many potential patients could be cared for at home.

As I have navigated the world of treatment for patients like me what has become abundantly clear is that all roads lead to drug therapy. I do not like using meds for what ails me. I have Asthma compounded by a chronic Hypoxia that consistently leaves me in the low 80’s of blood saturation without oxygen supplementation.

In 2014 my husband was laid off from his career and two weeks later the company that had been providing me with a tank refill concentrator at home came to pick up my equipment. No insurance meant no oxygen therapy.

Fortunately I had been guided by Heavenly Father into a purchase of a refurbished Innogen Oxygen Concentrator during the two weeks before my equipment was repurposed.

This little machine kept me out of the hospital multiple times during our years of unemployment and then underemployment as my husband worked a contractor job with no healthcare benefits. Ironically, he worked for an insurance company.

When Paul found a new job I was excited to get my healthcare back but was surprised when my insurance refused to pay for me to be on oxygen therapy using my innogen technology. The two healthcare companies (United Health/Kaiser) I have been a part of the past four years both denied my request to upgrade my equipment. They were happy to prescribe meds, but were not even willing to put me on the old fashioned tank refill concentrator because I was “Too Young” at 48. And the new technology was not on their approved lists for usage.

I would like to suggest that the FDA ease the rules around oxygen concentrators. Let anyone purchase them who wants one. Subsidize companies to manufacture them and have them available to anyone who is ill without a prescription. I was able to purchase a second portable concentrator paying for it myself, but I had to get that prescription first.

The machines are pricey at $3,000.00 to $5,000.00 each. But this focus on concentrators at home could free up space in hospitals for the really sick patients who need intubation and ventilators.

I am also a Birth Activist and Childbirth Educator. Parents expecting babies in the near future should be taught the fundamentals of natural childbirth to also prepare for an out of hospital birth.

I have been yelling about Husband and Wife Homebirth for a longtime and I believe it will be the key to keeping our children safe as the pandemic unfolds.

My best friend is a nurse in Missouri. She just posted this excellent summary from a nurse on the front lines in New Orleans. (We can help the health care system by using home herbal healing for as many patients as possible). The loss of smell indicates an immediate need for Zinc.

This was in the COVID site for Nebraska nurses. Too valuable not to share.

All my medical friends, pass this on to the doctors in your hospitals.

“I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this * has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won’t make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the “lockdown”, our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn’t appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil’s potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient’s standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn’t often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.”