Coronavirus And COVID-19

• sCollecting Facts About Coronavirus And COVID-19

Many people are worried about the new Corona virus called SARS-CoV-2, that appears to have originated in Wuhan, Hubei Province, China. Following is some reliable information that is currently known.

 

The Family Of Coronaviruses

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. All human coronoviruses have a zoonotic origin. Many of us have experienced coronaviruses as a cause of bronchitis or a common chest cold. But this family of viruses also includes those that have caused serious outbreaks such as the Middle East respiratory syndrome (MERS-CoV) and Severe acute respiratory syndrome (SARS-CoV-1). Coronaviruses from animals can infect people and then spread between people such as with MERS and SARS coronaviruses in the past. When person-to-person spread has occurred with MERS and SARS, it is thought to have happened mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Spread of SARS and MERS between people has generally occurred between close contacts.

Common human coronaviruses

1. 229E (alpha coronavirus)
2. NL63 (alpha coronavirus)
3. OC43 (beta coronavirus)
4. HKU1 (beta coronavirus)

Other human coronaviruses

5. MERS-CoV (the beta coronavirus that causes Middle East Respiratory Syndrome, or MERS)
6. SARS-CoV-1 (the beta coronavirus that causes severe acute respiratory syndrome, or SARS)
7. Name of the new coronavirus is now - severe acute respiratory syndrome coronavirus 2
   (SARS-CoV-2) and the name of the disease it causes is COVID-19, previously called 2019 novel coronavirus. Many people just calle it coronavirus.

So far according to the World Health Organization, it appears that SARS-CoV-2 is easily transmitted, and the incubation period appears to be up to 2 weeks with a mean incubation period of 5.1 days. The symptoms are similar to flu symptoms.

Signs and Symptoms Of Coronavirus And COVID-19

Many people who have COVID-19 experience only mild symptoms. Someone may have a mild cough and not even feel ill.

Common signs of infection

• fever
• cough
• tiredness
• muscle aches

Some patients have had

• diarrhea
• headache
• Loss of taste and smell
• other aches and pains
• nasal congestion,runny nose or sputum production
• sore throat
• shortness of breath
• nausea or vomiting
• other gastrointestinal symptoms

In more severe cases, infection can cause

• difficulty breathing
• shortness of breath
• pneumonia is the most serious manifestation
• severe acute respiratory syndrome
• kidney failure
• death

Early symptoms are dry cough, sneezing, runny nose, nasal congestion. May have fatigue, muscle pain, headache and dhydration. Some people have digestive symptoms. Some people have reported loss of a sense of smell and taste a one or the only symptom. A dermatological study in Italy found of 88 COVID-19 patients studied,  44% of them had skin eruptions at the onset of the disease and the rest had skin eruptions after hospitalization. The skin manifestations did not correlate with disease severity.

Practitioners need to treat the person at this stage before it gets worse. Nip it in the bud.

This  virus moves from the upper nasal-pharyngeal airway down into the lower lungs.

1 out of 6 people who get symptoms of COVID-19 becomes seriously ill and develops difficult breathing. Older people, and those with underlying medical problems involving the lungs, high blood pressure, heart problems or diabetes, are more likely to develop serious illness. We do not know the true percent of people who have died as there are people who do not seek medical care and have mild illness, so the mortality rate is not really known. People with fever, cough and difficult breathing should seek medical attention.

Those individuals with preexisting deficiencies or diseases are less likely to fight it off and have higher risk of mortality. The virus starts at the upper respiratory system (nose, throat, sinus) but can proceed to the lower respiratory tract (lungs). When the virus gets into the lungs, it can attach to the receptors on the lung cells and cause inflammation. There is inflammation in the airways that causes shortness of breath.

The immune system is now becoming vigilant and attacking the virus. This can lead to severe inflammation, and shortness of breath. There can be edema and much phlegm, protein exudates, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration and multinucleated giant cells. Fibroblastic plugs have been noted in airspaces. Inflammation and edema now set in and there is lack of oxygen. The lung is weak and the rest of the body is getting less oxygen and it can become physically to the practitioner in discoloratio of dependant body parts. There is a cough but no sputum coming up. The virus can trigger what is called a cytokine storm where the immune system puts up a big fight and ends up not only attacking the virus, but also the lung tissue and can damage the lungs. Eventually, this can lead to organ failure.

You can get the latest data from the World Health Organization (WHO)

Where SARS-CoV-2 Attaches/Enters In The Body

There is controversy over use of ACE inhibitors and ARBs for hypertension after  it was discovered that the COVID-19 virus binds to the ACE-2 receptor to gain entry into cells. This, together with reports, mainly from animal studies, that ACE inhibitors and ARBs may increase expression of ACE-2, has raised concerns that use of these drugs may increase susceptibility to the virus. But other research shows that by reducing angiotensin 2 levels, these drugs may protect against lung injury in patients with COVID-19. Clinical trials are underway to test the safety and efficacy of RAS modulators, including recombinant human ACE-2 and the ARB losartan in patients with COVID-19. Practitioners can access more specific details on this at Medscape if they have an account.

Cardiovascular disease is not thenumber one common comorbidity that may complicate COVID-19. The latest information released March 31 by the US Centers for Disease Control and Prevention suggests diabetes is the most common comorbidity in COVID-19 cases. Of 457 patients admitted to ICU with completed information on comorbidities, 32% had diabetes, 29% had cardiovascular disease, and 21% had chronic lung disease.

Abnormalities Seen And Diagnosis

Due to the PCR test having a poor sensitivity (some studies say 75%-80%), many people are positive when the tests says they are not. Therefore signs, symptoms and other labs are helpful.

Besides the Signs and Symptoms of Coronavirus listed above, another oddball sign is hypoxemia in a patient that does not appear to have hypoxemia. They may have oxygen saturation of 85% on normal room air, but they don't look hypoxemic. They seem to be breathing fine and don't feel short of breath.

Many but not all patients will have symptoms of lower respiratory tract infection.

Lab findings are lymphopenia, thrombocytopenia, elevated D-dimer levels, elevated inflammatory markers (CRP), elevated LDH, ferritin, CPK,and procalcitonin levels.

X-ray may show what looks like pulmonary edema. Peripheral consolidation and ground-glass opacities are classically described.

Main Imaging recommendations:

• Imaging is not routinely indicated for COVID-19 screening in asymptomatic people.
• Imaging is not indicated for patients with mild features of COVID-19 unless they are at risk for disease progression.
• Imaging is indicated for patients with features of moderate to severe COVID-19 regardless of COVID-19 test results.
• Imaging is indicated for patients with COVID-19 and evidence of worsening respiratory status.
• When access to CT is limited, chest radiography may be preferred for COVID-19 patients unless features of respiratory worsening warrant using CT.

Additional Imaging Recommendations:

• Daily chest radiographs are not indicated in stable, intubated patients with COVID-19.
• CT is indicated in patients with functional impairment, hypoxemia, or both, after COVID-19 recovery.
• COVID-19 testing is warranted in patients incidentally found to have findings suggestive of COVID-19 on a CT scan.

How Is It Spread

Update on June 17th, 2020: It appears that this virus is not easily spread through contact on objects. It seems to have no more ability to be spread on  objects than does influenza or the common cold.

Originally it was suggested(not known, but suggested) that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air. It appears to be both though. The new coronavirus (SARS-CoV-2) is a respiratory virus which spreads primarily through contact with an infected person through respiratory droplets generated when a person exhales, coughs or sneezes.  These droplets land on objects and surfaces around the person. The aerosolized virus has been shown to last in the air for 3 hours. The virus has also been shown to be able to last for quite an extended time on things like metal or plastic objects. It lasts a shorter time on cardboard. Research finds the virus can last up to 72 hours on stainless steel and plastic. Other people then catch SARS-CoV-2 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch SARS-CoV-2 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 6 feet from everyone. It is important that everyone practice good respiratory hygiene. For example, sneeze or cough into a flexed elbow, or use a tissue and discard it immediately into a closed bin. It is also very important for people to wash their hands regularly with either alcohol-based hand rub or soap and water. Although some people will tell you that masks do not help, I disagree. Masks and even eye protection can be helpful to keep from getting this virus if you are in close contact with people who may be infected. It is even better if the infected person wears a mask while around other people to protect them.

Close contact is the most likely way to get this virus. Staying a 6 feet away from people will help ensure a decreased chance of it spreading to you.

It has been found in feces and urine of some people and therefore makes it even more important to wash your hands well after using the bathroom. It has also been found to be at higher levels in bathrooms, so staying away from public restrooms is probably beneficial.

A List of surfaces and how long the virus may live on these surfaces is shared below. This list is from Medscape.com, a site that practitioners use for information.

Metal: 5 days

Glass: up to 5 days

Ceramics: 5 days

paper: up to 5 days

Wood: 4 days

Plastics: 2-3 days

Stainless steel: 2-3 days

Cardboard: 1 day

Aluminum: 2-8 hours

Copper: 4 hours

Food/Water: Doesn't seem to spread through food, and has not been found in water.

I think you should wash fresh vegetables well personally.

Once Exposed, How Long Before You Feel Sick

There can be up to a 14-day incubation period, with an average of about 5.1 days between being exposed to the virus and acquiring illness. This means you can be passing it on to others during this time wihtout realizing it. It also means other people that appear well, may also pass it to you. Some people will have such a mild case that they never appear sick and will be able to pass it to people over a long period of time.

Who Has COVID-19

Although anyone can get it, according to WHO,  older people, and people with pre-existing medical conditions (such as diabetes and heart disease) appear to be more at risk of developing severe disease. Data from the outbreak in Wuhan, China, shows a 10.5% death rate among people with COVID-19 who also have cardiovascular disease, 7.3% for those with diabetes, 6.3% for those with respiratory disease, 6% for those with high blood pressure, and 5.6% for those with cancer.

It also appears that more men are susceptible to COVID-19 as well as death from COVID-19 than females. In Italy one analysis claims 70% of COVID-19 deaths were male. A gender gap was also noted in SARS-CoV-1 and MERS.

More recent information links blood type A as being at higher risk for COVID-19 infection and mortality, while blood type O may be somewhat protective. More research needs to be done at this, but preliminary evidence points in this direction.

In the U.S.A. the preliminary reports show the highest fatality is 10%-27% among those over 85 years, with 3%-11% fatality among those 65-84 years, 1%-3% in those aged 55-64 years and  people from 20-54 yeras are less than 1%. Although the report I saw listed no deaths under 19 years of age, that is not what I have heard recently. I think there are currently a small handful of them. Please realize these figures are based on people who have been tested and treated.  If everyone were tested and followed, these figures might be different. The final data may look much different than what is currently known.

New data shows less than 2% of nearly 150,000 COVID-19 cases in the US from mid-February to early April occurred in children under 18 years of age, the CDC reports.

The Fatality Rate Of COVID-19

The fatality rate is around 3.5%, (not everyone is tested, there may be many more with COVID-19 that are never tested)a good deal lower than the 10% reported for SARS-1 and much lower than the nearly 40% reported for Middle East respiratory syndrome (MERS), another recent coronavirus mutation from the animal trade.

Ultimately, the main thing to remember is people with pre-existing health conditions are at greater risk no matter what their age. Those who are old, often have more pre-existing health conditions, so this group of folks are at a greater risk due to those conditions.

Prevention Advise From WHO

• Frequently clean hands by using alcohol-based hand rub or soap and water; Why? Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
• Maintain a minimum of 1 meter and better yet 2 metres (6 feet) distance between yourself and anyone who is coughing or sneezing; Why? When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
• Avoid touching eyes, nose and mouth; Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
• When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands; Why? Droplets spread virus. By following good respiratory hygiene you protect the people around you from viruses such as cold, flu and COVID-19.
• Avoid close contact with anyone who has fever and cough.
• Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.
  Why? National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent spread of viruses and other infections.
• Stay informed on the latest developments about COVID-19. Follow advice given by your healthcare provider, your national and local public health authority or your employer on how to protect yourself and others from COVID-19.
  Why? National and local authorities will have the most up to date information on whether COVID-19 is spreading in your area. They are best placed to advise on what people in your area should be doing to protect themselves.
• It appears most countries are starting to tell people to wear masks. It is about time.

Cleaning Air In Areas Where Someone With Influenza Or COVID-19 Has Been

I have used ozone machines in the past to clean up the air in a room after an infectious person has been in the area. You can't have people or animals in the room when doing this though as it can be hazardous to run ozone machines in rooms with living entities in the room. Please don't do it. I write about this in other areas of this website in relation to their use in moldy building cleanup.

Another type of machine that is used both in moldy building cleanup and to remove viruses is the hydroxyl machines. They are used around people and one of them claims 99.99% effectiveness against pathogens. Check out their website for more details if you need something like this. They have written an article on the use of their machine and the COVID-19. Some of these machines are claimed to be safe to use while people are in the room, but this has been refuted and I am not sure if it is safe or not, so I would personally remove animals and humans from the room before running them unless they have good research on their machine proving these claims.

 

Masks

Everyone Out In Publc Should Have A Mask On

The person who most needs to have a mask on is the one who is sick. However, we should all have masks on.Let me tell you why.

I am shocked at people who are claiming masks will not protect the public from spread of the SARS-CoV-2 virus. Using a mask is one of the more effective methods to prevent the spread of respiratory viruses. A comprehensive Cochrane review examined multiple physical preventive measures (eg, screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) and found that masks were the most consistent and comprehensive measure.

In my opinion everyone who is out and about in public should have a mask on. A study published in the New England Journal of Medicine evaluated a group of travelers from Wuhan, China, returning to Frankfurt, Germany. The researchers found "that shedding of potentially infectious virus may occur in persons who have no fever and no signs or only minor signs of infection."

Knowing this role of asymptomatic transmission makes it even more important for people in public areas, especially crowded areas to all wear face masks. Any one of us could have the virus and be out and about at any time, not knowing it.

I am guessing this is not being discussed much as there is a shortage of masks. However, we do need to talk about this as masks should be an important aspect of decreasing virus spread and we need to let manufacturers know they need to tool up and make masks not just for hospital workers, but for everyone.

Making Your Own Masks

Masks are hard to come by, so some people are making their own at home. How safe are they? Do they work? This article on DIY Masks studied a variety of materials. If you are thinking of making your own mask, it is worthwhile reading. For those of you who are claiming masks don't help, that is as silly as saying washing your hands does not help. The virus is small and needs a tight mask. Yes, it is not 100% protection, but an N-95 mask or even as this article above shows, masks made from various materials around your house, will help. They show a regular surgical mask captured captured 89% of bacteriophage MS2 particles (5 times smaller than the SARS-CoV-2 virus). Material from a vacuum cleaner bag came in at 86% and dish towel material came in at 73% with cotton blend t-shirt material at 70%. When they used a double layer of materials these figures became 97% for surgical mask, and 97% for dish towels. Although the towel and vacuum filter were the best materials in this research for catching small particles, the fact is that they also had to address breathability. When they looked at how easily it was to breathe with the masks on, they concluded that pillowcase sand the 100% cotton t-shirt are the best materials for DIY masks.

A second article with additional research can be found here.

Additionally, these are a few research articles on the use of masks with viruses and chemicals that are small sized.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662779/

https://www.ncbi.nlm.nih.gov/pubmed/16490606

https://www.ncbi.nlm.nih.gov/pubmed/15454893

Directions To Make A Mask

https://www.craftpassion.com/face-mask-sewing-pattern/

 

Cleaning Surfaces

Is it safe to be using so many disinfectants to clean surfaces? Most of the disinfectants can be irritating to mucous membranes. Bleach is very irritating to mucous membranes such as found in your respiratory tract. People exposed to sprayed disinfectants, especially workers who spray them continuously, are at greater risk of respiratory illness. In an October 2019 study in JAMA Network Open found that nurses who regularly used disinfectants to clean surfaces were at higher risk of chronic obstructive pulmonary disease. A 2017 study linked exposure to disinfectants with asthma in German adults. Both of those studies dealt with year long exposure to disinfectants.  However, any kind of continued respiratory irritation will put a person at greater risk for infectious respiratory disease, so be careful about how overzealous you disinfect and only do it with good ventilation or use a respirator if you do it a lot. I am including some links here to show you  just how much antiseptic is being used, and even in the streets where sunshine quickly kills viruses. How crazy fearful have people become?

https://time.com/5816299/coronavirus-africa-ventilators-doctors/

https://www.callingtonhaven.com/coronavirus-aircraft-disinfectant.php

https://www.nation.co.ke/counties/nairobi/Coronavirus-fumigation-starts-Nairobi-CBD/1954174-5496790-vnubm9z/index.html

 

The Main Points I Think Are Important

Washing your hands often with soap and water

Coronaviruses, like this year's version that has left 100,000 worldwide infected with COVID-19, are encased in a lipid envelope — basically, a layer of fat. Soap can break that fat apart and make the virus unable to infect you. Additionally the rubbing and the slippery soap makes it easier to wash all germs away.

A study of 3700 people showed only 5% wash their hands well or at all. If you want to do a good job, use soap and wash for minimum of 20 seconds. Then when done, if you use a paper towel it also removes more germs from your hands.

Avoid touching contaminated surfaces

Use a clean paper towel to open bathroom doors. Disinfect dirty surfaces that you use every day, like the touchscreen on your phone and your computer keyboard. I suggest you get use to using your phones less when in public as otherwise if you grab a contaminated door knob and then your phone, now your phone is contaminated.

Wear A Mask

This was discussed above. Besides public places, wear a mask at home if you are ill or if someone else is ill.

Why People Are Worried And Who Should Be Worried

The reason people are worried about this virus is because they don't know what to expect. People are not sure China has given us "real" data. The population has never seen this virus before, so people have no innate built up immunity. There is no vaccine and no mainstream treatment currently available which makes many people nervous. Of course viruses change constantly and this is why a person can get the flu over and over again, so built up immunity is not all we might tell ourselves it is in the case of virsuses any way. However, this virus is a virus that is new to the human population, and appears it may kill higher numbers of people than we are use to with the flu. The data that we have seen so far, tells us that young people have less to be concerned about than older people, but they also can get seriously ill and die. Originally, according to Medscape, there are almost no cases below 35  yeras of age. In China children from 1-9 are 1% of the infections and none of the deaths. As people increase from their 40s-80s the mortality increases.  Clearly the older you are the more you should be concerned about this virus. Of people in their 70s who got the virus, 8% died and nearly 15% of those 80 and older died. That means this age group should socially distance themselves from others. They should use the phone or the internet to connect with others. If you have a family member, friend or neighbor that is older, call them and see if you can assist in some way. If you visit them, wear a mask and keep your distance.

Now that the virus has been in the United States a little while, the CDC Morbidity And Mortality Weekly Report in the week of Marych 19 said, A review of 44 deaths, showed more than a third occurred among adults aged 85 years and older, and 46% occurred among adults aged 65-84 years, and 20% occurred among adults aged 20-64 years.  This is early on and I am sure this data will change quickly.

People with heart problems, diabetes, or lung issues like COPD are also at a higher risk for severe disease and death. COVID-19 is similar to viral pneumonias, which tend to have a worse effect on people who already have a weakened immune system.

Pregnant women do not seem to be impacted by this infection, though only a few have been carefully tracked so far. One study published recently in The Lancet found that nine women who became infected with COVID-19 did not pass the virus on to their babies

Persons who develop symptoms after close contact with someone infected with COVID-19 should contact their healthcare provider, and persons with the illness should follow CDC guidance on how to prevent transmission to others.

People who smoke and vape are at greater risk. They should stop. Look at the symptoms listed in the New England Jouranl of Medicine that describes the E-cigarette or Vaping disease called Product Use-Associated Lung Injury. (There is currently an arugument about smokers possibly having a decreased reaction to SARS-COV-2, but this has not been substantiated and there is indeed a major argument going on in the medical community about this.)

“The most common respiratory symptoms were shortness of breath (85%), cough (85%), and chest pain (52%). Reported gastrointestinal symptoms included nausea (66%), vomiting (61%), diarrhea (44%), and abdominal pain (34%). All patients had one or more constitutional symptoms, with the most common being subjective fever (84%). Upper respiratory symptoms such as rhinorrhea, sneezing, or congestion were not commonly reported.”  Notice that these symptoms are very similar to COVID-19. For details on why this might be, check out Stephanie Seneff's article on the COVID-19 and glyphosate Connection.

Treatment

I would suggest that prevention is the best way to approach this. This time of year there are many viruses that are contagious in public areas. Follow the suggestions I listed above from WHO. To protect yourself from viruses, wear a mask when in public if you do not want to get any or them, including this virus. (Masks are currently in short supply.)  Don’t touch your fingers to your face. When you get home, wash your hands immediately. Better yet, carry alcohol based hand cloths with you. Watch out for those wipes with chemicals on them, they have their own hazards. Additionally, support your immune system and general health.

Traditional Chinese Medicine

If you practices Chinese medicine, I suggest you check out this lecture by Dr. John Chen: https://www.youtube.com/watch?v=DDp6g655LYU&feature=youtu.be 

Western Medicine

In western medicine the following are a few things that have been tried or are being used. I also list things that should not be used.

• Aspirin
• Acetaminophen may worsen COVID-19 condition. Both ibuprofen and acetaminophen may increase the duration of illness, suppress antibody production and increase viral shedding in colds and flu’s.
• Ibuprofen may worsen COVID-19 condition. Both ibuprofen and acetaminophen may increase the duration of illness, suppress antibody production and increase viral shedding in colds and flu’s. WHO is telling people not to use ibuprofen.
• Antiviral drugs: remdesivir (ebola), lopinavir (HIV), ritonavir (HIV) – combo used for HIV usually – but these two are disappointing, rintatolimod, azuvudine, danoprevir, plitidepsin and facipiravir.
• Immunomodulators: Interleukin-6, inhibitors (sarilumab, tocilizumab) and TZLS-501 (monoclonal antibody).
• Chloroquine – Hydroxychloroquine is a less toxic derivative of chloroquine.  – antimalarial - No one sure if it is working at this point. May be irreversibly toxic to retinas. On April 24th the  Emergency Use Authorization noted that "the FDA is aware of reports of serious heart rhythm problems in patients with COVID-19 treated with hydroxychloroquine or chloroquine, often in combination with azithromycin and other QT-prolonging medicines. We are also aware of increased use of these medicines through outpatient prescriptions." They listed several potential serious adverse effects that included QT prolongation with increased risk in patients with renal insufficiency or failure, increased insulin levels and insulin action causing increased risk of severe hypoglycemia, hemolysis in selected patients, and interaction with other medicines that cause QT prolongation.
• If using hydroxychloroquine or chloroquine to treat or prevent COVID-19, the  FDA recommends checking www.clinicaltrials.gov for a suitable clinical trial and consider enrolling the patient," the statement added.
• Inhaled nitric oxide
• Steroids – The word is not to use them. They may use them ICU, but as a general rule to not use them.  Works great to decrease inflammation in lung if severe, but risk is that they  may decrease the immune system too much. Higher risk of secondary infection. Will get nosocomial infection possibly and they are hard to treat as most of these infections are resistant to antibiotics. Steroids speed up viral shedding also.
• Immunosuppressants – Being used in cytokine storm to decrease immune reaction. Off label, experimental.
• Ventilators: Ventilator protocols are being questioned as practitioners start to feel they may be causing harm. It turns out that COVID-19 which was originally thought to act like an acute respiratory distress syndrome actually acts more like high-altitude pulmonary edema (HAPE). This means the current use of ventilators may be causing lung injury in COVID-19 patients and practitioners are reconsidering the need for lung-protective strategies that utilize lower pressure settings. Instead of high positive end-expiratory pressure, physicians should perhaps consider the lowest possible positive end-expiratory pressure and gentle ventilation.

• ECMO - Extracorporeal membrane oxygenation (ECMO) to eligible patients with acute respiratory distress syndrome (ARDS). Recommended by WHO.
• Plasma/Serum from those who have recovered from COVID-19.

For a scientific explanation of SARS-CoV-2 and COVID-19, I suggest you read this well written article by the herbalist Stephen Buhner.

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