Coronavirus and SCI/D

[crags]

I'm a mid-level quad (C6/C7), 32 years and in what I would say is decent health. No sores, but ortho/neuro/uro problems. While I don't have the issues of being on a ventilator, like all quads we suffer from greatly impaired respiratory function due to the paralysis of the accessory muscles of respiration which lead to diminished capacity and ability to clear secretions. Both extremely dangerous if one gets pneumonia.

I get my flu shot every year and have completed the two course vaccination (Prevnar 13 and Pneumovax) to give me reasonable protection against pneumonia.

Which leads me to my question about this coronavirus. Someone in my (our) situation be considered part of the vulnerable population and be more concerned about vulnerability?

And, considering that most of the fatalities due to the coronavirus are due to pneumonia, what would be the likelihood of a quad being able to survive a Corona caused pneumonia?

Would be pneumonia vaccinations offered any protection against pneumonia from the coronavirus? Or is that pneumonia strain new and would not be covered by the vaccinations already developed?

It all to be moot anyway since I have a MOLST form which specifies permissible medical treatment in the event I cannot specify and a DNI (do not intubate) is specifically enumerated.

[SCI-Nurse]

I don't think we really know much about SCI/D and coronavirus yet, but what we do know is that people with SCI do have somewhat depressed immune systems to start with, and those with higher injuries who have less ability to cough and clear secretions are much more vulnerable to pneumonia, and also to ARDS, which can result from pneumonia.

Unfortunately, neither flu shots nor pneumonia immunizations provide any protection from the coronavirus. The pneumonia immunization does not prevent pneumonia from viruses (like the flu, or coronaviruses), but only from a number of bacterial causes of pneumonia.

Keep in mind that pneumonia is not caused by an specific infectious agent, but is actually a complication of a respiratory infection from either bacteria or viruses, which is much more likely to occur in those who are immuno-suppressed or have a decreased ability to cough up secretions.

At this time, the best prevention is to avoid being around people who could have been exposed to the coronavirus:

• This may mean avoiding large crowded spaces, such as theaters, concert halls, etc.
• Be sure that your caregivers, if any, do not come to work with any signs or symptoms of respiratory infection (either the flu, bad cold, or cough or fever).
• Have a back-up plan for care so you are not forced to have them come to work when sick.
• Be sure family members and caregivers know how to properly sneeze and cough, and be meticulous about hand hygiene.
• Washing hands properly with soap and water for at least 20 seconds is fine...reserve the use of hand sanitizer for places where there is no access to hand washing facilities.
• Maintain at least 5 feet distance from anyone you see in public who is coughing or sneezing.
• Do not shake hands with anyone, and avoid huggers as well.
• People with upper respiratory infections should wear masks. There is little evidence that wearing ordinary surgical masks (anything other than an N95 mask) will do anything for prevention of acquiring an infection, other than to keep you from touching your face, mouth, nose, or eyes with dirty hands.

(KLD)

[air ohs]

GREAT Info thanks

[nevada]

I am a C 6/7 age 62 and was just going to ask the same questions as Crags did so thank you for the information SCI Nurse. I am at my winter home where currently there has only been one confimred case. My wife thinks we should head back up north to our summer home as there has not been a recorded case there. I don't go out all in public all that much but my wife is very worried that I will catch it should we stay here. I do use a manual chair so I was wondering if I should go to full fingered gloves vs. the cut off ones that I am currently using. I find it much easier to use hand sanitizer vs. soap and water after I do go out. I self cath so that is just one more entry point but I hope the hand sanitizer will stop that point of entry. My own opinion is that I think we should stay here at our winter home for the next two months as we had planned and let the chips fall as they may.

[Tetracyclone]

I am a C 6/7 age 62 and was just going to ask the same questions as Crags did so thank you for the information SCI Nurse. I am at my winter home where currently there has only been one confimred case. My wife thinks we should head back up north to our summer home as there has not been a recorded case there. I don't go out all in public all that much but my wife is very worried that I will catch it should we stay here. I do use a manual chair so I was wondering if I should go to full fingered gloves vs. the cut off ones that I am currently using. I find it much easier to use hand sanitizer vs. soap and water after I do go out. I self cath so that is just one more entry point but I hope the hand sanitizer will stop that point of entry. My own opinion is that I think we should stay here at our winter home for the next two months as we had planned and let the chips fall as they may.

From what I have read I doubt that cathing can be an entry point for this virus. It must enter by nose or mouth in order to reach the lungs. Granted, much is not known. I do not think there will be anywhere safe from this. i am down in Palm Springs and while there are no reported cases it is likely in the area and will show up in testing in several weeks. It takes that long for the virus to incubate and begin making you sick.

I'm doing my best but have a soar throat and red spots in it. I feel sick, but have no fever. It will be what it will be.

here is a funny: Hubby went out to Walmart to find lozenges for me and they were completely sold out. A drop of tea tree oil in hot water with honey probably works better, and I had that.

What I dread is hearing my doctor's office tell me I should go in to see him. That is the last place I want to be. Tomorrow.

[SCI-Nurse]

I'm doing my best but have a soar throat and red spots in it. I feel sick, but have no fever. It will be what it will be.

You could have strep throat. Call your doctor's office on Monday, and see if you can get it cultured. Strep throat in adults can lead to heart valve problems.

(KLD)

[Mize]

Since we now know that people can transmit the virus when they are asymptomatic, I think the 5 foot rule needs to apply when talking to ANYONE and I would extend it to more like 8-10 feet as the breath pattern of droplets is gravity based so that, if you're lower than the talker - say in a a wheelchair - they can get you from further away.

[Tetracyclone]

You could have strep throat. Call your doctor's office on Monday, and see if you can get it cultured. Strep throat in adults can lead to heart valve problems.

(KLD)

I am about to do so.

[crags]

from CDC regarding incubation:

Q: When is someone infectious?

A: The onset and duration of viral shedding and period of infectiousness for COVID-19 are not yet known. It is possible that SARS-CoV-2 RNA may be detectable in the upper or lower respiratory tract for weeks after illness onset, similar to infection with MERS-CoV and SARS-CoV. However, detection of viral RNA does not necessarily mean that infectious virus is present. Asymptomatic infection with SARS-CoV-2 has been reported, but it is not yet known what role asymptomatic infection plays in transmission. Similarly, the role of pre-symptomatic transmission (infection detection during the incubation period prior to illness onset) is unknown. Existing literature regarding SARS-CoV-2 and other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2–14 days.

[Mize]

from CDC regarding incubation:

Q: When is someone infectious?

A: The onset and duration of viral shedding and period of infectiousness for COVID-19 are not yet known. It is possible that SARS-CoV-2 RNA may be detectable in the upper or lower respiratory tract for weeks after illness onset, similar to infection with MERS-CoV and SARS-CoV. However, detection of viral RNA does not necessarily mean that infectious virus is present. Asymptomatic infection with SARS-CoV-2 has been reported, but it is not yet known what role asymptomatic infection plays in transmission. Similarly, the role of pre-symptomatic transmission (infection detection during the incubation period prior to illness onset) is unknown. Existing literature regarding SARS-CoV-2 and other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2–14 days.

Exactly why symptomatic should not be a requirement for staying away from people. Just stay away from people for now.

[SCI-Nurse]

Exactly why symptomatic should not be a requirement for staying away from people. Just stay away from people for now.

I am not making that recommendation. This is being promoted by those who are in the midst of the media panic about this virus. On the other hand, this is a good way to avoid the flu, which is much more common.

(KLD)

[Mize]

KLD, in my case I work with a large % of people who travel internationally. They all stand 2-3 feet over my head when we have gemba board meetings (basically standing in a hallway looking at a board of key performance indicators) and all of us have, at some point or another, been hit by speech spittle from an overly excited speaker.

I mention this because 4 weeks ago I caught a cold from a colleague in exactly this way (though he was sniffling) that lasted 2 weeks. If I can catch a cold that way, I'm assuming I can catch a corona virus. I'm considering working from home full time for a while. Between SCI and asthma, I definitely don't want to play with this one if I can avoid it.

[SCI-Nurse]

KLD, in my case I work with a large % of people who travel internationally. They all stand 2-3 feet over my head when we have gemba board meetings (basically standing in a hallway looking at a board of key performance indicators) and all of us have, at some point or another, been hit by speech spittle from an overly excited speaker.

I mention this because 4 weeks ago I caught a cold from a colleague in exactly this way (though he was sniffling) that lasted 2 weeks. If I can catch a cold that way, I'm assuming I can catch a corona virus. I'm considering working from home full time for a while. Between SCI and asthma, I definitely don't want to play with this one if I can avoid it.

If you can work from home, in your situation, I would agree. Every person's circumstances are different though, so what is right for you may be over-kill for someone else.

(KLD)

[Tetracyclone]

KLD-
I went to Immediate care and they say I do not have a bacterial infection. They id not bother to test for the flu, so I will return to my GP, who takes real interest in me, and get more advice.

[triumph]

Crags:

you said you have a DNI (do not intubate). Just wanted to share my experience. At age 68 I developed pneumonia and had to be hospitalized due to breathing difficulty. I'm Polio, high level paralyzed. After several hours in ER for observation my niece noticed my oxygenation was getting low and she called the nurse. I was taken to surgery and intubated - never had been before. I got severe C-Diff from all the antibiotics and ended up in rehab for 5 months, having lost all my ADL skills. At 4 1/2 months they discovered my tube was too big and was actually blocking my breathing recovery and I was changed to a child size tube. Within days the tube was removed and I was ready to go home.
This is kinda drastic case, but I just want to say that temporary intubation might save your life one day and you might want to revisit that order. When my incision for the tube was initially made I was told later that there was a large mucus plug that was removed - I had been unable to cough it up.

Soon after I got home I got a cough machine and keep it handy at home. I use it occasionally for help with a cough.