Right now, we are in a dire crisis with COVID19 spreading rapidly.  This virus can cause severe damage to the lungs.  So far we are seeing a high percentage of people who are being put on ventilators to help their lungs recover.  Many of these people have pre-existing lung damage from smoking tobacco, marijuana, or vaping.  In an article in the New York Times titled “Smokers and Vapers may be at greater risk for COVID-19“, they mention that the chemicals in all forms of inhaled smoke can damage lungs, making them more vulnerable to more severe damage from the deadly virus. Also, the act of putting something to your lips, could risk transmitting the virus.

If you’ve been considering quitting tobacco, vaping, or smoking marijuana, now is the time to do it.  Your life may depend on it!

Here’s a list of how you can quit smoking.

• Set a quit date.  This is a date that you determine will be the day you will end your smoking habit for good.  I recommend that people choose a date that has an emotional significance to them such as a child’s birthday or religious holiday so that you can mark the anniversary of being smoke-free each year.
• If you are someone who likes to fidget with smoking paraphernalia (playing with lighters, vape pens, etc.), find something to do with your hands.  Fidget spinners, knitting, rubbing a “worry stone”, rubbing a coin in your pocket, etc. are all things to keep your fingers occupied.
• If you have an “oral fixation” where you feel like you need to chew something or suck on something, find some strong mints or sugar free gum and use that daily.
• If you are addicted to nicotine, contact your doctor to get nicotine replacement AND medication to stop the craving (Chantix or Zyban).  The combination of both drastically reduces the craving and statistically increases your ability to quit forever.
• Remove paraphernalia of smoking such as ashtrays, lighters, boxes of cigarettes, vaping cartridges, etc. from sight.  If you don’t see it, you would be less inclined to use it.
• Encourage your friends not to smoke around you.  Peer pressure plays a big role in the smoking addiction.  Let your friends know you are quitting and need their help.  Who knows, you may even be a positive influence on them as well!
• Need more help?  There are numerous resources online from your local health department.  Try smokefree.gov.

A recent study published in the New England Journal of Medicine showed that the coronavirus (COVID-19) is a very hardy virus and can live on surfaces in some cases for a few days.  Here are some highlights of the study:

• Coronavirus was able to live on plastic and stainless steel for up to 72 hours.
• It was not able to live as long on cardboard or copper surfaces.
• It does not like extremely dry or extremely humid environments.
• It may live longer in mucus and fluid droplets.

Want to keep yourself safe?  Here is some advice based of these findings and general knowledge about viruses.

• Wipe down metal surfaces such as doorknobs regularly with a disinfectant.  Chlorox wipes are the best, but any cleaning spray that says “active against viruses” would be fine.  You can also use alcohol (make sure it’s 70% or higher) and put it in a spray bottle.
• Be careful with deliveries such as groceries and take out food.  If the person packing those items has coronavirus, you could get sick.  I advise unpacking those items carefully, possibly dumping the food onto your own dishes immediately and discarding the containers.  Afterward, you should wash your hands thoroughly with soap and water (>20 seconds!).  If you get boxes or packages that you don’t need right away, let them sit out.  All viruses will die out and become inactive on surfaces with time.
• Try to get deliveries in paper bags rather than plastic.  It appears that paper/cardboard is not a good environment for viruses.  Cloth is another option.
• If you are living with someone with coronavirus, be very careful with the utensils and dishware they use.  You may want to consider having them use disposable utensils and plates.  If you use your own dishware, make sure you put it in the dishwasher and use “heated dry”.  The heat in most dishwashers is enough to kill viruses.
• UV light can make viruses inactive. However, most UV ray light machines sold (not medical grade) may not kill all of the viruses.
• Go outside when it is warm and sunny.  Viruses do not seem to like these environments.
• Keep a distance of at least 6 feet from other people.  When someone sneezes or coughs, a large plume of droplets is thrown into the air around them.  These can contain millions of viruses each!  If you can smell someone’s cologne or perfume you are likely too close.
• Wipe down or wear gloves before touching any “common touch” surfaces in public such as shopping carts/baskets.
• Avoid wearing jewelry.  As the NEJM study mentioned, coronavirus can live on metal for up to 72 hours!  It’s easier to keep the wedding band off than cleaning it every single time you wash your hands.  Wear the wedding ring on a chain around your neck as an alternative.
• Wipe down your phone and case regularly.
• Avoid unnecessary trips in public.  Think about whether you really need to be going outside right now.  Postponing even one unnecessary trip to the grocery store may save your life!

Here are some excellent tips for those suffering from COVID-19 written by Punyadech Photangtham, MD, Giosely Collado, PA, and Ricardo Martinez.

What should I do if I have the COVID-19 Virus +, or am sick with Fever, Cough (presumed positive )

• Not every patient needs to be tested.
• Not all positive patients need to be admitted to the Hospital.  Most people with coronavirus (greater than 80% will have symptoms like a bad cold or flu), however there are people who will develop severe shortness of breath.  These people should go to a hospital.
• Your physician or healthcare provider will evaluate you and prescribe medicines to help you cope with fever, coughing, and/or headaches.  They can also determine if your symptoms are severe enough to warrant a trip to the hospital.
• You are recommended to quarantine at home for 14 days.  That means, stay in your room isolated from the rest of the household/family, wear a mask and avoid contact with other family members.
• A family member can prepare your food and leave it outside the door of your room.
• Do not share glasses, dishes, silverware with other household members.  Consider using disposable paper plates and utensils.
• To go to the bathroom, put on a mask covering nose and mouth.  When finished, clean and disinfect touched surfaces to prevent passing on the virus.
  NOTE: Family members are recommended to use masks and gloves, wash their hands with soap often and thoroughly, and monitor symptoms of fever and/or cough.
• If in the house there are more than one person, or all, with the virus, then all should be quarantined for 14 days.
• Follow your Medical Provider instructions.
• Avoid leaving your home for any reason.
• If you need medicine call your pharmacy and explain your situation. The pharmacy can deliver your prescription and leave it outside the door of your home.
• If you need to take out garbage, call a family member or a friend and explain your situation.  Leave the garbage outside the door of your room.  This person using gloves and a mask can dispose of your garbage.
• If you need food and groceries do the same – using precautions, the volunteer can leave the food and/or groceries at your door WITHOUT having direct contact with you.

  Will I have the Covid-19 sickness again?  We do not know.  After you recuperate from this incident you may have 1-3 years of immunity, but it is difficult to know if the virus will mutate during that period negating the immunity.

  When can I go back to work? You are recommended 14 full days of quarantine.  If after the first week you do not have fever anymore (without the use of medicine/pills) then you can start sharing time with other household members inside your house, and after the finish of the second week then go back to work.

  How can I prevent getting COVID-19?  You are recommended to avoid groups bigger than 10 people, and maintain a distance of 6 feet with other people.  Ideally everyone should be staying at home right now as much as possible.  Try to check in with your loved ones through FaceTime or calling them.  Practice frequent and good quality hand hygiene and avoid touching your face.  When washing your hands, make sure you wash for at least 20 seconds on every surface and in between the fingers.

We are in an unprecedented medical situation in the US right now.  COVID-19 is seeping into every town.  Our country has vastly underestimated the power of the coronavirus.  Unlike the flu or other cold viruses, after infecting people COVID-19 can manifest with mild symptoms at first.  Most people think it’s just a “head cold” or allergies, so they may not feel the need to stay home but during this time they can spread it to other people with even a handshake.  Over a few days, these people can become ill in varying degrees ranging from flu-like symptoms to shortness of breath requiring them to be on a ventilator.

You may think “I couldn’t possibly have the coronavirus, I feel fine”, but if you infect others, they may have severe complications which could land them in the hospital and add more stress to the already overwhelmed healthcare system.  Many hospital across the nation are experiencing unprecedented number of patients, many of whom require ventilators to help them breathe.

Right now, to help your fellow Americans and all of mankind, PLEASE STAY HOME AS MUCH AS POSSIBLE.  Do not go to buy groceries more than necessary, wash your hands and clean all common surfaces in your environment (door handles, faucets, etc.).  Here are some other tips to help stay safe if you do go outside your home.

Right now, hand sanitizers and toilet paper are practically impossible to find.  However, here are some other items you may want to stock up on which you may not have considered and why.

• Gatorade or pedialyte.  Infections that cause fevers get dramatically worse when dehydration sets in.  Both gatorade and pedialyte have electrolytes that can keep you from getting dehydrated.  Mixing a glass with half gatorade and half water is about the equivalent salt concentration of “normal saline” that one would get in a IV infusion at the hospital.
• Chicken broth or chicken soup.  If you are very ill and vomiting, you may not be able to eat solid foods.  Chicken broth is easy to digest and typically has a lot of salt.
• Dried fruits.  Dried fruits are high in fiber and potassium, an important electrolyte.  Fiber is necessary for normal bowel movements.  Fresh fruits may not keep as long in the pantry.  Dried fruits are good alternatives if you can’t leave the house to buy the fresh version.
• Multivitamins.  If you are not eating full meals, you will need to get your vitamins in pill or liquid form.
• Acetaminophen AND aspirin, ibuprofen or naproxen.  You need acetaminophen and one of the other three to reduce fever.  They work by different mechanisms and you can alternate taking them to keep the fever down.
• Throat lozenges.  Coughing constantly can make your throat feel raw and painful. I recommend lozenges with benzocaine or phenol as these are actual anesthetic medications.
• Salt. If you run out of gatorade or chicken broth, plain salt added to water can be an easy way to replenish sodium lost from sweating.
• White rice, white bread, white pasta.  These are typically easy to digest if you have an upset stomach and provide rapid energy replacement.  I know you will recall from earlier blogs that I typically avoid these “white” items for weight loss, but in this situation you actually want to maintain your weight with these foods.
• Tomato juice, pasta sauce.  These foods are rich in both sodium and potassium.
• Honey.  Honey is a natural cough suppressant.  Added to ginger tea, it can be quite soothing.
• Dark chocolate.  This is another cough suppressant, and has antioxidants and fats which can help provide your body with long-lasting fuel.
• Sinus rinse.  Nasal congestion can be difficult to get rid of.  The sinus rinse can help.