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Dr. T Bear
Dr. T Bear, Board Certified MD
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I’ve had a fever of 100-102F for a week. No cough. Ibuprofen

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I’ve had a fever of 100-102F for a week. No cough. Ibuprofen keeps my body aches and headaches in check. Only rarely do I have a slight shortness of breath but ibuprofen clears that pretty well. I suspect it cannot be COVID19 because my lungs seem quite okay. Should I wait it out? Is there something better I can do?
JA: The Doctor can help. Just a couple quick questions before I transfer you. When did you start using ibuprofen? How severe were any side effects?
Customer: Nearly a week ago. No side effects.
JA: Have you seen a doctor about the shortness of breath?
Customer: No. I went most of the week with no shortness of breath. Just in the past couple days I noticed it. But it’s very mild. I don’t have a doctor
JA: Anything else in your medical history you think the Doctor should know?
Customer: No allergies. I think I may have caught a flu in Las Vegas. I returned to Boston March 15. Two days later I started having a fever.
Hi there thanks for your is quite possible you have the flu or another virus especially if you have a known exposure and that is still more prevalent than the corona virus...however I’m going to give you some information as well as some guidance that may help you in treating whatever it is you are fighting off right now and what to do should your symptoms change.

If you are considering being tested you should ask yourself the following:
1. do you have two of the three symptoms, fever greater than 100.4 Degrees Fahrenheit, cough, or shortness of breath.

2. Have you traveled Internationally in the last month-or been exposed to anybody suspected or with known covert 19?
3. Testing supplies are very limited nationally so many places only test if you are likely to need admission...otherwise you will need to be self quarantined.

1. If you’re exposed to COVID, you’re likely to see symptoms in about 2-9 days, with median of 5 days.
2. The common symptoms are acute respiratory distress and fever, often high, which may be intermittent but can be persistent and last over 10 days.
3. Breakdown of cases: About 80% of those who contract COVID only get mildly ill; 14% get hospital-ill, 6-8% critically ill. The mortality rate seems to be between 1-3%, but that needs to be adjusted for age. Mortality is 10-15% over 80, and drops lower for younger cohorts.
4. The bulk of those who fall ill are aged 40-55, with 50 being the median. But being young and healthy (zero medical problems) does NOT rule out serious illness or death; it may just delay the time course to developing significant respiratory illness by about a week or longer.

Things you should buy ahead of time: Kleenex, Acetaminophen (Tylenol) in 325 mg tablets, Mucinex, Robitussin or DayQuil/NyQuil, whatever your cough medicine of choice is.

If you don’t have a humidifier, that would also be a good thing to get. (You can also just turn the shower on hot and sit in the bathroom breathing in the steam). Also a good time to make a big batch of your favorite soup to freeze and have on hand.
If you have a history of asthma and you have a prescription inhaler, make sure the one you have isn’t expired and refill it/get a new one if it is.

You basically just want to prepare as though you know you’re going to get a nasty respiratory bug like bronchitis or pneumonia. You just have the foresight to know it’s coming.

For symptom management, use the meds I mentioned. For a fever over 101, take Tylenol.Use both cough suppressants and expectorants (most cough meds have both). Drink a ton, hydrate hydrate. Rest lots.

If you're sick, you should not be leaving your house except to go to the doctor, and if you do, wear a mask (regular is fine, you don’t need an N95). You DO NOT NEED TO GO TO THE ER unless you are having trouble breathing or your fever is very high and unmanaged with meds.

90% of healthy adult cases thus far have been managed at home with basic rest/hydration/over-the-counter meds. We don’t want to clog the ERs unless you’re actually in distress. The hospital beds will be used for people who apamctively need oxygen/breathing treatments/IV fluids.

If you have a pre-existing lung condition (COPD, emphysema, lung cancer) or are on immunosuppressants, now is a great time to talk to your PCP or specialist about what they would like you to do if you get sick. They might have plans to get you admitted and bypass the ER entirely.

One major relief to parents is that kids do seem to do well with coronavirus although they are not immune — they usually bounce back in a few days, no one under 18 has died, and almost no kids have required hospitalization (unless they have a lung disease like CF).

You may have heard that there is some social media chatter about ibuprofen versus acetaminophen use for treatment of fever in suspected/confirmed COVID -19 patients. If want to know more about the science behind this read below. The short version is there MIGHT be a difference and acetaminophen can be used for fever in COVID-19 patients.
The Health Minister of France has recommended that acetaminophen be used instead of ibuprofen or other nonsteroidal anti-inflamatory medications for the treatment of systems associated with COVID- 19 infections. This recommendation is based on anecedotal information from France and a letter published in Lancet that hypothesized that anti-inflammatory medications such as ibuprofen could lead to an increased expression of angiotensin-converting enzyme 2 (ACE2).1 Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. The letter suggests that patients who use medications that increase ACE2, ibuprofen for example, are at a theoretical higher risk of severe COVID-19 infection. Other scientists postulate that ibuprofen’s anti-inflammatory properties could
“dampen down” the immune system, which could slow the recovery process. It may be likely, based on
, that COVID-19 reduces a key enzyme that
regulates the water and salt concentration in the blood and could contribute to the pneumonia seen in
extreme cases. Ibuprofen aggravates this situation, while acetaminophen does not2. Acetaminophen is
also associated with less overall adverse effects when compared to NSAIDs, such as acute kidney injury
and gastrointestinal complications. For the treatment of fever, acetaminophen is a safe and effective

The How's and When's of Hand Washing

• Anytime you go into a store, restaurant, gas station etc. use hand sanitizer once you are in your car. Assume everyone and everything is contaminated.
• NEVER touch door handles (especially in bathrooms) - use a paper towel, TP, or your shirt but do NOT touch door handles!
• Do not touch your face (especially in public) - If you have to touch your face wash your hands prior to touching your eyes, nose, mouth, etc
• Hand sanitizer is just as good as washing with soap and water as long as your hands are not soiled. Keep hand sanitizer in your car/house/work/purse/everywhere
• Use enough hand sanitizer that it takes 20 seconds to rub it off
• When washing with soap and water rub your hands together for at least 20 seconds, water can be hot or cold. Do NOT touch sink to turn off water - use a paper towel or your elbow
• Do NOT shake people's hands. Elbow bump, wave, middle finger, whatever makes you happy. If you absolutely have to shake someone's hand wash hands afterwards
• Wash your cell phone often as it is the dirtiest thing that you own. Put a little hand sanitizer in a napkin and wipe it down and let it air dry. Never place your phone on the back of the toilet or any other disgusting place
• Wash your hands after using the bathroom! (This is a normal expectation not just now)

Other General Tips for Staying Safe
• Stay away from other people (at least 6 feet)
• If you have to go shopping go when it is least crowded and avoid other people
• If you are sick and feel like you need to go to the hospital -CALL AHEAD before showing up
• If you are sick wear a mask around others to protect them
• Cough or sneeze in your elbow not in your hands

Another question I have had frequently is whether or not this is airborne or what respiratory droplets may have heard it can live in the air for several hours.

The aerosol part has to do with medical procedures like give nebulizer treatments, intubated patients and certain diagnostic exams which don’t apply to every day life walking just stick to the 6 ft guideline and should be safe with that to allow potential infected droplets fall to the ground.
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