How We're Handling Grandma's COVID Infection (2)
Thank you to all the friends who keep checking in — you're so warm. A quick update, and please don't worry: Grandma's vital signs are stable right now. Blood pressure 138/83, heart rate 88, blood oxygen 94%, temperature 37.0°C. She has an appetite, ate some plain congee, and is sleeping peacefully.
We're all confident she'll pull through. 🙏🙏🙏
Today's progress:
After the doctor's consultation this morning, we decided she would take "Merck's Molnupiravir."
Her blood oxygen dropped as low as 88% at one point today; after oxygen it came back to 94%, and as high as 99%.
We had a few options at the time: an ambulance, a private hospital's emergency room, or admission to a public hospital. In the end, for our own reasons and because of Hong Kong's medical policies, she wasn't admitted, and she didn't get a lung CT either (details below).
Our current approach: monitoring and care at home, with an emergency plan ready.
To make things easier for everyone, I've pulled together the information I've collected each day and found useful; updated content is marked in blue. I hope it helps. Let me stress again: all of it is specific to Grandma's individual situation — 86 years old, with twenty years of high blood pressure. It isn't medical advice, just experience shared by friends. If you want to use any of it, please be sure to consult a doctor and other professionals. Here goes:
- General
Grandma got infected when she went out for her flu shot, so the first priority is still avoiding infection — go out as little as possible.
Despise the enemy strategically, respect it tactically: monitor the elderly person's vital signs more closely than usual, but don't panic either. Stay calm and give them a relaxed environment, reducing anxiety and tension; a peaceful state of mind helps recovery.
Frail elderly people may not run a fever at all. Fever is the body's immune response, a self-protection mechanism of life. When someone's physical condition is extremely poor, even this alarm signal may disappear. That's why so many elderly people who passed away had similar profiles: blood pressure not high, temperature normal, no fever.
Be careful about going to the hospital: getting there is exhausting and also increases the elderly person's exposure to the virus, so if it isn't necessary, you don't have to go;
Have a plan ready: if you do need to go to the hospital, which one? Do you call an ambulance? How long will it take to get there? Will they be seen right away? Do they have ventilators and ECMO?
Encourage the elderly person — their mindset, confidence and will to live all matter a lot. Our shared line is: Grandma's vital signs are very good, she doesn't meet the criteria for admission, and that's why the hospital didn't take her. (Rather than: we couldn't get her a bed 😢.) They say the will to live has a big effect on physical condition. If an elderly person is too tense, that also hinders recovery.
You must have a "home oxygen concentrator" and a "portable oxygen tank"! You must have a home oxygen concentrator and a portable oxygen tank! You must have a home oxygen concentrator and a portable oxygen tank! On the way to the hospital on your own, the home concentrator is no use, but the portable tank is.
- Medication
Paracetamol (compound acetaminophen): probably less likely to conflict with blood pressure medication.
Ibuprofen-type drugs: may have an effect on high blood pressure.
Use Lianhua Qingwen with caution: it has strong side effects; if you must take it, halve the dose for the elderly and children.
Use cough medicine with caution: some cough medicines raise blood pressure or trigger angina, so read the instructions carefully, and be cautious with anything containing ephedrine-type ingredients.
If phlegm is thick and hard to cough up, consider Mucosolvan (ambroxol).
Doses for underlying conditions may need adjusting: during a fever, if the person drinks and urinates a lot, blood pressure may fall, so blood pressure medication may need to be reduced appropriately to avoid harm or misdiagnosis from blood pressure that's too low.
Can the COVID-specific drug Paxlovid be used?
A very important question — but honestly, I don't know.
What we do know:
People over 60 can take it, but! There are many restrictions.
Special groups, especially patients with kidney impairment, should use it with caution.
It conflicts with many medications for underlying conditions. For example, my grandma's cholesterol-lowering drug. But if fighting the virus is the priority, you can stop that drug and take Paxlovid. This must be done under a doctor's guidance; we have no hands-on experience with it. We've booked a doctor's consultation for tomorrow and will update afterward.
Under the doctor's guidance, we used "Merck's Molnupiravir."
Things to note: you have to finish the full five-day course. Because it works by preventing viral replication, sometimes the symptoms aren't obvious while the virus is still replicating, so finishing the course is the best choice. Reportedly, in clinical trials comparing it against a placebo, its toxicity didn't exceed the placebo's.
Click to view: the Molnupiravir package insert and the Shanghai Pharmaceutical Association's introduction
I found a great tool: a CHECKER for whether COVID medications conflict with other medications, which you can use yourself before taking anything.
Website: https://www.covid19-druginteractions.org/checker
- Monitoring
Monitor temperature, pulse, blood oxygen and blood pressure, and assess the overall condition — do not, do not, do not look at just one indicator.
The second day after testing positive is when things are relatively severe, so monitor much more frequently. Assess temperature, pulse, blood oxygen and blood pressure every 1–2 hours. A fingertip pulse oximeter can be worn continuously.
Blood oxygen: a very important indicator; if it keeps falling to 93% or below, seek medical care.
Heart rate: without a fever, an elderly person's heart rate is about 80 beats per minute; for every 1°C rise in temperature, pulse rises by about 10 beats per minute. If there's no fever and the heart rate exceeds 90 beats per minute, consider a little diuretic.
Temperature: an elderly person's normal temperature may be only 36°C, so 37°C already counts as elevated. A heart rate of 88 beats per minute is within the acceptable range.
A lung CT is an important indicator. When viral pneumonia is just causing lung consolidation, a stethoscope sometimes can't pick up positive signs; by the time you can hear crackles, it may already be late. So if the elderly person's condition and the medical setup allow, getting one can rule out a lot of uncertainty.
Blood pressure: monitor continuously and compare with normal days.
Monitor fluid intake and output — that is, urine output versus fluid intake.
Here's a new piece of counterintuitive knowledge: elderly people shouldn't drink very large amounts of water.
Drink moderately, slightly warm water, enough to sweat. If they drink too much and don't pass it in time, it increases the load on the heart, increases blood volume in the lungs, and increases the burden on the lungs.
Watch the elderly person's mental state and how much they eat. It's not only the vital signs — if they're eating very little or stay drowsy and confused, be on alert too!
- Care
Drinking: warm water, in small amounts, often. Again: pay attention to fluid intake and output. Count the fluid from congee, water and taking medicine as intake; count urine and sweat as output.
Eating: small, frequent meals; there should be some nutrition to provide enough resistance, but watch out for foods that increase phlegm. If they're sweating a lot, food can be a tiny bit saltier, because sweating loses salt — but only if they really are sweating; otherwise extra salt increases the burden on the heart.
Set the home oxygen concentrator's level properly. You want blood oxygen above 95%; too low and the oxygen flow isn't enough, too high and the elderly person will feel uncomfortable. On the Vision Aire 5 we use, the second setting reaches a 27% concentration, but every machine is different, so use your own judgement.
For concentrators with a humidifier bottle, change the distilled water often and keep it clean. If possible, keep the water at around 37°C — this little tip humidifies the oxygen so the airways don't dry out, which is more comfortable. 37°C is about the same as the warmth of your hand.
The elderly person's cooperation matters a lot. Tell her that eating, drinking warm water, breathing oxygen and taking medicine are four equally important parts of the treatment.
- Symptoms that mean you need to go to the hospital
Chest pain, chest tightness, shortness of breath, angina
Rising pulse
Blood oxygen that keeps falling to 93% or below
Breathing rate above 30 breaths per minute
Above 38.5°C even after fever medication, for 2 days
Temperature below 35°C
Persistent pain or persistent pressure in the chest
Dizziness, being unable to wake up or stay awake
Pale, gray or bluish skin, lips or nails
Weakness or unsteady walking
Seizures
Persistently unable to eat or drink, or diarrhea or vomiting for more than 2 days
Marked worsening of existing underlying conditions
- Seeking Care
Hong Kong's "private hospitals" don't admit COVID-positive patients. Hong Kong's current medical policy is: all COVID-positive patients go to public hospitals — even if a patient is already staying in a private hospital and unfortunately catches COVID, they're taken by ambulance to a public hospital for admission. A few private hospitals' emergency departments will occasionally see positive patients, but won't admit them, and will afterward send them by ambulance to a public hospital.
I went down the list "Medical services provided by private hospitals for persons tested positive for COVID-19" published by Hong Kong's Department of Health and phoned them one by one. As of December 25, 2022, the hospitals that clearly accept positive patients in their emergency departments are:
Union Hospital, Hong Kong +85226083388
Hong Kong Adventist Hospital – Tsuen Wan +85222756688
"Hong Kong Sanatorium & Hospital" is the only private hospital I could find that admits positive patients, but a bed is nearly impossible to get — we tried every channel, and it just didn't work.
Some private hospitals won't do lung CTs for positive patients. Because she was positive, Hong Kong Sanatorium & Hospital didn't give Grandma a lung CT, so if it's not an emergency, be sure to phone and ask clearly before going to a private hospital.
In an emergency, calling an ambulance is the most effective option. Because ambulances have equipment on board, make sure you understand the process and plan clearly: what number to call, what to do, and where the nearest public emergency room is.
More information below:
Today, December 25, is Christmas — and it happens to be Grandma's birthday.
Happy birthday to my strong, optimistic, deft-handed Ama — wishing you health, safety and smooth days ahead. Love you! Portrait of Ama
Grandma in New York
In front of the grand piano in the lobby of the Harvard Club. Painted by Vincent Xeus. Thank you, Vincent & Stella, for your love and support.