Coronavirus Concerns Covid 19

During my education I studied biochemistry as a young woman and then after finishing my biochemistry degree, I had to make a choice. On the one hand I could take a route that would involve training to deal with diseases like Ebola and on the other hand I could head towards human genetics. Both fields require a solid understanding of epidemiology and use of statistics to analyze results. Both also require understanding how humans think, especially when herd instinct kicks in. After much consideration I decided to do Human Genetics and not virology. I had two reason that really swayed my decision. First I had young children. People who work with outbreaks are at a higher risk because of their job. The job also requires a lot of travel and being away from home. The second reason was my asthma. My asthma is relatively mild. I can go for weeks at a time without any trouble. However if I get a cold, even a minor one, I tend to be wheezy for weeks afterward. Plus I have to avoid strange perfumes, strange food and just about everything you would require to be flying around the world dealing with outbreaks. And so, with great reluctance and much regret, I did not to pursue a career in virology. However I have been fascinated with the epidemiology of outbreaks ever since.

The novel coronavirus is now properly named severe acute respiratory coronavirus 2 or SARS-CoV-2. People who are sick with it have a cluster of symptoms creating a disease called Covid19. There is all sorts of on line speculation about whether or not this was a bioweapon or made by humans. Personally, I think not simply because nature is always a lot better doing these things than we are plus natural viruses of this type have been occurring since before humans ever smeared a petri dish. It’s also irrelevant. Whether or not its human made, the virus is out there and it’s making people sick so who cares how it happened. We can take someone out to the firing squad after this is all over.

There is a lot we don’t know yet about this brand new virus. What we do know indicates that it is a lot more deadly than the flu. The flu kills a lot of people, mostly elderly with preexisting conditions or children with health problems like being on chemo therapy for cancer. The new virus seems to target those who are weaker in the same way but with much more ferocity. There are a couple of peculiarities. For one thing it seems that children are not being as affected. Also men die more than women. For some interesting theories as to why this, The Scientist (Katarina Zimmer Feb 24, 2020) has some neat educated guesses.

Should you worry? Well…government officials in Canada and the USA are now making cautious worried noises about how we should all be getting ready, just in case.

…I am definitely getting worried. This virus is showing all the signs of becoming a pandemic. I say that based on my own background and training even as the worry tone officials talking on TV have is kind of getting to me. Take this quote for example:

Meanwhile in the US, the Centers for Disease Control and Prevention warned that Americans should “prepare for the expectation that this might be bad”. “It’s not so much of a question of if this will happen in this country any more but a question of when this will happen,” said Dr Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases.

…I think you should probably be worried too, but in a sensible way.

Those who live in hurricane country will recognize this feeling. We are at the stage where there is a hurricane out there. It is is wobbling in the general direction of where we live. It might land. It might miss us and go out to sea and dissipate. It would be a good idea to start getting ready now before any big panic just in case it does land at our homes, but we certainly shouldn’t panic yet. The best cure for panic is preparations. So how do you prepare for a pandemic?

Here is the basics of what you need to know.

1. If the virus hits your area (and if you are in Italy and Iran it already has) the local medical system will be overwhelmed. About 20% (1 out of 5) people will need to be in hospital to have a chance to survive. That is a lot of people in hospital. By way of comparison my small town has 76 people in it. That means if the virus infected everyone in my town 15 people would need an intensive care unit. Our local hospital which serves over a hundred such small towns has four intensive beds. In a pandemic only the lucky ones of that 20% who need an intensive care unit will get into a hospital that can provide one. So you need to avoid getting sick, not depend on the local medical system helping you after you get sick. The poorer your country and worse the medical system, the more important that is. I live in Canada which is one of the best health care systems in the world. If I am worried about my health care system being able to handle this here, you should be too. Avoid this virus, don’t hope you can get treated for it.
2. Think about your water supply. I get my water from a small independent well. If you have to depend on others for your water you may want to stockpile some.
3. In several places the government has responded to the outbreak by simply shutting down entire sections of  the population. No one goes in, no one goes out. This means no one coming in to stock up the grocery stores and pharmacies.
4. People will panic and people will stop showing up to work. (This is already happening in South Korea.) Be ready to take care of yourself in your home.

What can you do? What preparations should you be considering?

Pandemic Preparations

The US government has lots of good common sense advice on how to be ready for a pandemic. You don’t need a bunker ten years of food, guns and ammo and entire suits with independent air supply. You do need to have a good look at your home and ask yourself how will your family fare if the government suddenly shuts down all the roads and you are stuck in your house for two weeks to one month.

Things you can do now:

Stock up on the regular medications you would use anyway and have enough on hand so if the government does shut down your town for two weeks to a month, you don’t have to worry about finding enough of your medication to survive. Don’t buy ten years worth but do have enough on hand for a while. In Canada, most of us on regular prescriptions buy them three months at a time. So buy now if you are on your last week of meds. While you are at the pharmacy, top up your supplies of non-prescription stuff like allergy medicine, heartburn medicine, pain killers, and bandages. You don’t want to risk walking out among sick people in a pharmacy just because you didn’t have anything at home for your burning gut after you ate too much chilli.

Stock up on groceries including water. Don’t waste your money on military style emergency meals (unless you like eating those anyway.) None of this may happen and you’ll feel like an idiot if you spent a whole bunch of money on groceries you’ll never use. Think of that approaching hurricane idea. Just buy a little extra of the stuff you already use. Plus think about what you will eat if the grocery store is closed for a month. If you normally drink fresh milk, what can you use to replace that if you can’t get to the store? Maybe you want to try freezing a couple of extra jugs, just in case. If you like almond or soy milk just as much maybe get a few extra of those. Use common sense. Stuff like oatmeal keeps forever so if you normally eat oatmeal, just make sure you have enough for a month instead of a week. If you don’t normally eat oatmeal don’t buy it now. If you stick to food you will eventually eat anyway you won’t be wasting your money if this particular hurricane veers off to sea instead of landing. And don’t forget spices and sauces. You’ll want to avoid food boredom. Toilet paper and tissues don’t spoil either.

If there is a pandemic, schools and daycares will close. Plan for that. Think about entertaining the kids if you are stuck inside your house for two weeks. Now might be a good time to hide a few new toys and games in the house. (If nothing happens you can give them as gifts when birthday or holiday time comes around. ) If you work in an occupation where you know you’ll be called out to deal with this (doctor, nurse, hospital worker) plan your back up for who cares for the kids now. Again, you’re ready without wasting your money.

Don’t bother buying all kinds of medical equipment. Honestly, if there is a pandemic and you self isolate properly you won’t need it because you won’t be exposed. If you end up having to care for a mildly sick family member there are simply common sense replacements you can use. Again the US government has plenty of solid advice for coping with a pandemic. Now is the time to read it and plan. Planning prevents panic. Panic over this virus will hurt and kill a lot more people than this virus ever will.

Keep up to date. My favourite place for updates is Coronavirus Update which seems to give news faster and sooner than our local news media and they appear to check it carefully before posting. They also have lots of background details like incubation periods, mortality, probably more than you need to know.

Good luck, wherever you are in the world. Let’s hope and pray this virus fizzles out soon and we can all laugh and say our preparations were not required.

 

Carotid Artery Dissection is Healed!

We had two updates, one from the neurologist by telephone and one from the interventional radiologist via another telehealth conference. The MRI results were carefully quantified and reviewed and then forwarded to both of these specialist. The neurologist called and told us that the carotid artery shows up in the MRI as healed, no more pseudoaneurysm and, providing the interventional radiologist agrees, we can declare the carotid artery dissection completely healed and stop the blood thinners.

After this news I found myself feelings like I was in shock. It was a pleasant shock, but still a shock. I was trembling. I was in tears. All these longs months, all the worry, all the fear, all the careful watching. We are done. He is healed. We can start thinking longer term again. It was really hard to wrap my brain around the news. I ended up suppressing all my happy happy thoughts a bit and reminding myself the interventional radiologist must agree first.

And the interventional radiologist agrees with one caveat. It can be difficult to do comparisons between imaging modalities. There has been so much improvement between the last CT and this MRI he can’t quite believe it or trust it. He agrees the MRI does indeed look like the artery is fully healed a huge and very pleasant surprise since he did not think pseudoaneurysm ever would given how big it was. He even had another radiologist (someone whose ability and skills he really trusts) look at it just to make sure and this fellow also agreed the artery has healed.

His recommendation is that my husband continue with the blood thinner (generic form of plavix for a full six months since the last time we saw the pseudoaneurysm just to be on the safe side and follow the standard recommendations for a dissection and then image one last time with CT to really confirm the astonishing healing shown in the MRI. We agreed to this. My husband has six weeks of his blood thinner left so he will finish the bottle and have the hopefully one last CT and then we can call the carotid artery dissection incident finished and done with. Amazingly enough, there is no evidence of any kind of a stroke from the dissection on MRI. So if asked, we can honestly say no it was not a stroke, it was carotid artery dissection with transient symptoms.

I had another happy cry.

Can you see me smiling?

 

Health Update – Carotid Artery Dissection with Pseudoaneurysm.

A short report that is nice because it contains good news. We are seven months since the diagnosis of a carotid artery dissection. My husband got called in for an MRI. The reason for the doctors being concerned about this is because my husband is at a much higher risk of throwing a clot due to the healing carotid artery dissection with a large pseudoaneurysm because of narrowing at the site of the injury.  You may recall there was a debate about stenting (relatively high risk especially when compared with his clinical symptoms which are none.) The MRI was for testing if the carotid artery dissection caused a stroke of if it is throwing off small clots and causing micro strokes. Micro strokes are tiny strokes that do not show up clinically but accumulate over time and eventually can lead to dementia. They can only be seen using MRI. Our doctor gave us a copy of the report on the MRI and the neurologist’s report and it was overall positive.

The MRI did not show sign of anything beyond a “smooth narrowing” of the artery. Compared to the last report from October with a CT that is an improvement. To be properly cautious, it is hard to compare across modalities however since the clinicians seem to think that’s a positive improvement, we’ll definitely take it. There is still a thrombus/clot where there was before but the MRI seems to show it was smaller (again the cross modality issue makes me hesitant to say it.) Also the MRI works by producing a specific signal when a specific magnetic frequency is used. The signal that came back was for a blood clot and not the later final stage of a healed clot. It apparently takes 4-6 months for this process to start so it is not a surprise nor is it bad news. It just means the healing is not finished. The thrombus certainly is no bigger.

The really good news is the MRI could not detect the stroke damage. Strokes show up as bright spots and the brighter and more solid the spot, the worse the stroke. In my husband’s case there is only one very small, very faint and only slightly brighter spot and no where near where he should have he had caused by the carotid artery dissection. Best of all, no sign of any other micro strokes or secondary damage or anything else. He has two tiny plaques in his arteries, matched on both sides, which are often found even in healthy young men and we already knew about those from the previous CTs. The letter from the neurologist states he has ruled out any progressive neuropathies or vasculopathies (i.e. blood vessels and nerves, brain are as normal as can be for 76 years). The specialist thinks it was just the unlucky seatbelt accident. Further our family doctor told us he can confidently state my husband is now clinically stable if a travel insurance company were to ask. (Due to the past history of carted artery dissection that might still be an issue but we’re not ready to start traveling right now anyway.)

We also got permission to try reducing the last of three blood pressure medications he is on back down to the level he was using to control his blood pressure before all this started. (He has been on a double dose of his ace inhibiter since the dissection after using it for many years to lower his blood pressure.) Again, it has to be done carefully with daily monitoring twice a day (morning before taking the pill and evening) but six days into it and my husband’s blood pressure has actually been a bit lower sitting nicely at about 130/80 give or take 5 points with the majority being about 125/75 for the evening check and slightly higher for the morning check before taking the pill.

There we are. Slight improvement, no sign of the bad stuff the MRI was supposed to detect, no need for stenting at this time, no more visits to the doctor until late spring unless something changes. Blood pressure med down to the previous level. At some future point yet to be determined, another imaging check of the artery will be done (likely by ultrasound) and if it is healed my husband can stop taking the generic plavix blood thinner although the neurologist said he should be taking a baby aspirin for the rest of his life.

There is a special Hebrew blessing for when one has had a near miss with death and been delivered from it. I am tempted to ask my husband to arrange now. (It has to be said in a minyan of ten Jews after a Torah reading) but I won’t just yet. Instead, I’ll ask for the continued healing prayer to keep on being said since we are not all the way there yet. (You can hear a woman sing the prayer in Hebrew here.) In English it goes like this:

May the One who blessed our ancestors Abraham, Isaac, and Jacob, Sarah, Rebecca, Rachel, and Leah bless and heal Yitzhak son of Dina. May the Holy Blessed One overflow with compassion upon him, to restore him, to heal him, to strengthen him, to enliven him. The One will send him, speedily, a complete healing, healing of the soul and healing of the body along with all the ill, among the people of Israel and all humankind, soon, speedily, without delay, and let us all say:  Amen!