A Message from Dr Leila Kasrai Regarding COVID-19

Dear Patient,

I hope you and your family are healthy, and that you’re able to practice appropriate social and physical distancing during this difficult time. The impact of the COVID-19 pandemic on our lives, our families and the world as we know it, has been unprecedented. There remains significant uncertainty. Although we are constantly evaluating and learning from our COVID-19 experience, there are still many questions for which we don’t have conclusive answers.

I have received many requests for advice on what medications to stock up on in case of symptoms. I recommend the same medications as you would use for influenza.

Tylenol (or acetaminophen), ideally the Cold and Flu version. There are daytime and nighttime formulations. This will help reduce symptoms including fever, headaches, muscle aches and congestion. Typically, an Ibuprofen based version would also be acceptable, but there is some concern that Ibuprofen may exacerbate symptoms. This is not yet proven, but I would avoid it for now.

Zinc lozenges have been shown to reduce viral infection duration. Not by much (very little in fact), but they can’t hurt. However, as I understand it, they are very scarce and hard to find.

Something for nausea. Gravol is the simplest solution and still readily available. You may want to acquire a suppository version too, in case you are too nauseous to keep down the oral form.

Something to rehydrate. Electrolyte solutions are effective but not the most palatable. Try to avoid high sugar solutions, but some sugar is warranted. I recommend broth (contains some additional nutrients) and low sugar “sports drinks” which can be watered down.

A humidifier. Inhaling more moisture helps to keep secretions loose and easier to expel. Consuming hot drinks such as tea will help to moisturize your respiratory passages. A Netty Pot or nasal rinse device may also help to clear nasal secretions.

Tamiflu, which has been used to help reduce the impact of influenza infections in the past, has been shown to be ineffective against this virus and is not recommended.

Plaquenil (hydroxychloroquine) is getting some attention on the internet as possibly helping with the COVID-19 infection. There is no good evidence to support this claim. It is purely speculative, and public health currently does not endorse its use. Potentially that could change as evidence emerges. There are significant side effects of Plaquenil, some of which may exacerbate COVID-19 symptoms. Currently, I do not recommend it.

The current speculation is that most of us will eventually get infected. This is a scary notion, but you should be aware that there is tremendous benefit in slowing down the rate of new infections. This allows for turnover of scarce hospital resources so that we have the capacity to support as many of the severely ill patients as possible.

If you develop symptoms (fever, cough, headaches, muscle aches, sore throat,) stay at home. Inform us by phone or email. At this point, it is unlikely that heading to an assessment center will be particularly helpful, and it may expose you or others to COVID-19, if you don’t already have it. Alternatively, try calling an assessment center hotline first to see you should proceed. Many individuals are being turned away without testing. That would be particularly frustrating.

Treat your symptoms with the medications mentioned above. Isolate yourself within the house. You will likely experience 2-4 weeks of misery.

Try to avoid spreading the virus to those you live with, although it may be too late to prevent this by the time you have symptoms.

If you feel you are becoming dehydrated. Try taking your fluids in small quantities. No more than an eighth of a cup every 10 min. This will increase your chances of keeping it down.

I recommend only proceeding to the hospital if you are becoming dehydrated and can’t keep fluids down, or if you are experiencing significant shortness of breath.

These are websites I consider reliable sources of information:

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html
https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Many of us will be self isolating for several weeks to months without ever developing any symptoms. I suggest using this time to start implementing lifestyle adjustments that we’ve been ignoring because we are all too busy. No excuse now. Consider connecting with a virtual Personal Trainer. Take a virtual exercise class. There are many great apps and YouTube videos to help train yourself in meditation, exercise without equipment, or yoga. Personally, after years of promising myself I would eventually get around to it, I finally started yoga this week.

Continue connecting with friends and family on virtual platforms like Whatsapp, Facetime, or Duo. Remaining connected is important. Reach out to friends you haven’t had time to connect with regularly. Do not sit and focus on the gloomy news all day.

Understandably, there is currently a heightened sense of anxiety throughout society. Particularly for those with symptoms or loved ones with symptoms. Developing meditation and relaxation techniques now will be more important than ever.

I wish you a very uneventful few weeks.

Dr Leila Kasrai, MD, MPH, FRCSC