by Robert Hooper | Coronavirus, General, Professional
I am reminded of a cartoon from the 1960’s. People can be seen bowing before an altar, an empty altar, with the name ”Nothing” on it. On the top of the altar, there is nothing. It is empty. In the rear looking towards the altar, one person whispers a question to a second person, “Is nothing sacred?”
Science is not sacred. Science is not a thing. Science is a process, a technique, and a method to study problems, questions, theories and their solutions in an organized manner. What then are scientists? They are people who use the method. They are individuals from almost any field of human endeavor doing research in their fields of interest. But, most of all they are humans.
“Is nothing sacred?”
We are washing our hands more these days. Coronavirus has seen to that, but it was not always so. There was a time in human history when, among doctors, it was not thought fashionable, necessary, or appropriate to wash hands. In fact, the presence of bloody debris on doctor’s clothing and hands was a sign of importance.
A physician in the 1840s, Dr. Ignaz Semmelweis, observed and studied a problem with infections in labor and delivery at Vienna General Hospital. Infection rates and mortality rates for women having their babies in the hospital were extremely high. His observations led him to believe that maybe the doctors themselves were transferring infections to patients in the hospital. He implemented what we would consider to be basic hygiene steps and instituted hand washing for the doctors between each patient’s evaluation and exam. The changes resulted in a dramatic improvement. Infection rates, in the area of the hospital where this was used, plummeted.
Unfortunately, this was not well received. The doctors working at his time in history would not accept his observations and facts. Dr. Semmelweis was shamed, belittled and driven from the profession. Many decades would pass and many others would confirm his work before the value of hand washing was accepted by the medical profession.
…shamed, belittled and driven from the profession.
Change is difficult to accept. Belief in the change has to occur before it can be accepted. A scientific study is a man-made creation. One fact is studied, but multiple measurements are made. The measurements are reviewed and conclusions are reached by men. Can other researchers duplicate the results? The process of science is a back-and-forth path. Even when a fact becomes established and proven to be verifiable, it may not be accepted into practice for many years. Likewise, established facts or practices that are proven wrong by new research will not be discarded untill many years or decades pass. In each case, the delay is often the result of other more human reasons.
Well-designed scientific studies in medicine and its related fields are large and very expensive endeavors that can last several years. They require years of commitment and dedication from the researchers. Reputations, careers, professional positions, titles, rewards and not the least, egos, become established, glorified, tarnished and destroyed based on scientific study results and positions taken regarding those results. Unsurprisingly, human behavior enters into acceptance. When the facts are not clear or not definitive, time is required for new studies to provide new information or knowledge about the subject. The factual debate may last years, decades, or even centuries. Unfortunately, strong personalities expressed through loud voices with bully pulpits will often sway the profession, government or public to positions that do not tell the entire or accurate story. It can be, as in Dr. Semmelweis’ case, decades before a truer picture is known.
Public awareness of papers by researchers in any field is usually limited to observing the results of those studies and the generally accepted facts of the time. The scientific review process is not generally in the public view. The back-and-forth, the arguments, the clashing of the egos, has been carried out without public awareness. Now the new coronavirus pandemic is unfolding before us. The airways and social media are full of studies, opinions and arguments regarding the appropriate approach to diagnosing, treating and preventing coronavirus infections. The chaos you hear is real because no one knows what the elephant looks like. Like the blind men describing an elephant, each has his hands on some limited part of the animal’s anatomy, but the full picture will not be known for some time.
The chaos you hear is real…
One thing should be kept in mind. Medicine and its practice remains a learned art that applies experience, knowledge and technology to help humans manage their sufferings. Scientific facts have improved those skills and the techniques used to treat and assist those in need. Remember, while today’s reported scientific facts may indicate future practices (Semmelweis and hand washing), it may represent one person’s need for recognition and praise ultimately signifying nothing.
This scientific noise about the coronavirus will settle with time and a truer picture of what it means will become clearer. For the time being, the noise is being amplified by our politicians and media that have little experience in things medical and have their own needs for recognition. Do not expect that to change soon.
RGH June 2020
by Robert Hooper | Coronavirus, General, Sleep Apnea, Sleep Disorders
Are you at increased risk of a serious coronavirus infection if you have obstructive sleep apnea? No one knows, although one day that information will be available. What do you do when placed in a situation with an unknown that can affect you drastically? What we always do; look for information and compare it with our previous similar experiences. Leaving our home for a day’s activity when the clouds are dark and rain is in the forecast, it is only smart to take along the umbrella or raincoat. The same is true for the coronavirus. We need to consider:
What do the experts tell us?
What is our experience with other infections?
Experts
The experts tell us coronavirus is a contagious respiratory infectious agent. It may cause life-threatening illness and it also may infect people without causing illness. The number infected is not known and the percent of life threatening illnesses is not established, but it is gradually appearing that it is a smaller percentage than was initially predicted.
What causes some to be very ill and even die? The picture is becoming clearer with time. The elderly, the chronically ill, the immunosuppressed and others with poor health are more likely to be severely ill. The death rate for those individuals is much higher than for the population in general. In some areas, over half of those who die with the illness are from these groups.
Are there others? Yes there are. We have heard the ‘news’ reports about them. Why in otherwise healthy individuals can the infection cause severe illnesses? Experts can only speculate on the subject. The possibilities include exposure to a heavy dose of the virus. A heavy dose is more likely to make someone severely ill than a lighter dose. The healthy person may have unrecognized underlying medical conditions. They may have an unrecognized deficiency in their ability to fight off this specific type of viral infection. For most of these unfortunate individuals, no one will be able to explain why.
We do know that heart disease, hypertension, diabetes and obesity are frequently cited as problems associated with dying from an infection with the coronavirus.
Experience
What does our experience tell us? A common experience most of us will have is with influenza. In fact, as time passes, coronavirus has begun to act like a severe influenza. Coronavirus is more contagious than influenza, but it is beginning to appear to have a similar mortality. There is no immunization available at present to prevent the illness and it is certainly best to avoid catching it.
Older individuals are familiar with other infectious agents. Some will remember polio, SARS, H1N1 (swine flu) and the early concerns about HIV. With knowledge and experience, we have learned to live with some of these problems, to treat some and to watch as others pass from importance. So it will be with the coronavirus.
Obstructive sleep apnea and coronavirus
What about you as an obstructive sleep apnea patient? You should listen to experts and rely on experience. As a specialist in sleep medicine, I would advise you that obstructive sleep apnea is an underlying medical condition that places you at increased risk of a more severe infection if you contract the coronavirus. In addition, many individuals with obstructive sleep apnea also have hypertension, diabetes and weight problems. Hypertension, diabetes and weight problems are known risk factors for severe coronavirus infections.
We know that patients with untreated sleep apnea have more respiratory infections. They develop problems with many chronic illnesses. These problems are related to the severity of their apnea. The number of obstructive breathing events per hour (the apnea hypoxia index) without treatment is a measure of the underlying severity. The more events recorded the more severe your apnea. It is a fact that patients successfully treated with CPAP have less respiratory infections and fewer complications from chronic illnesses.
I suspect these facts will prove to be the same for the coronavirus. Untreated significant apnea will prove to be a risk factor for developing severe coronavirus infection . However, successfully treated patients should have substantially less risk.
In summary
Having obstructive sleep apnea increases the risk of a severe coronavirus infection.
The risk will increase with the severity of the apnea.
Treatment of apnea will reduce the risk.
If you have apnea, consider yourself to be at increased risk for a coronavirus infection.
Use your CPAP.
by Robert Hooper | General, Sleep Apnea
Week four of our national shut down. Do you have your obstructive apnea under control? I hope this finds you healthy and sleeping well. What does having this virus around mean to you and others with obstructive sleep apnea?
Obstructive sleep apnea is a chronic condition. The coronavirus is a new infectious agent that produces a short-term illness. It is a respiratory infection and in many ways parallels influenza. It appears to be more contagious and may produces a more intense severe illness. None of us want to experience it.
Seasons and years come and go. Influenza comes and goes. The common cold is a frequent visitor to the lives of busy people. These things happen while people have the ongoing problem of obstructive sleep apnea. Now we can add coronavirus to the list.
Treatment Recommendations
Many aspects of our treatment recommendation are the same. The two most important are:
Continue to use your CPAP
Have a regular cleaning schedule for your equipment
A respiratory outbreak, certainly the current coronavirus episode, calls for some attention to treatment recommendations. While is it important to use the equipment, it is even more important to use your equipment during a widespread respiratory infections outbreak. Regular CPAP users have fewer respiratory illnesses during these community wide infectious episodes. While we do not have experience with the coronavirus, it seems likely that regular CPAP usage will help in a similar manner as it does with the usual respiratory illness. So by all means:
USE YOUR CPAP – All Night Every Night
Cleaning Recommendations
Special attention should be paid to cleaning your equipment. Sleep physicians are aware of the wide range of cleaning habits of our patients. Many of us do not follow the guidelines suggested by the manufactures. It might be time to reassess your cleaning pattern in the times of the coronavirus.
If you and yours are well and free of respiratory symptoms, cleaning your equipment should be on a fixed schedule. Mask, tubing and humidifier should be cleaned at least once a week. With a consideration of the nature of coronavirus, a dilute gentle soap solution would be the preferred cleaning agent. Soap is a superior agent for coronal virus disinfecting. If you haven’t been cleaning, start now.
KEEP YOUR EQUIPMENT CLEAN
What if you are diagnosed with, or suspected of having, the coronavirus?
Usage becomes even more important. When ill with respiratory symptoms, sleeping with your CPAP will speed up your recovery and lessen the severity of your illness. It is more important that ever that you use your CPAP during the illness.
Cleaning your equipment is more important. When you have the coronavirus infection it is best to clean your mask, tubing and humidifier daily. The machine and bedside table should be rubbed down with a disinfectant wipe. The pillowcase and sheets should be washed frequently if not daily. The room should be aired out daily, if possible, between sleeping hours.
