PLATTSBURGH — Dr. Harvey Hurwitz helped pen an at-home care protocol for confirmed or suspected COVID-19 patients last spring, but believes the eight steps are even more valuable today.
"That was just the beginning; it's not like the situation now," he said. "It's only now that you're really seeing the disease mushroom."
'OBLIGATION TO ACT'
Hurwitz, a Boston University School of Medicine alumnus, served two years in the U.S. Air Force as a general medical officer, practiced nearly 40 years of internal medicine downstate, where he was also employed as a director of medicine, and now works as an internist and college physician at the SUNY Plattsburgh Student Health and Counseling Center.
When the virus started its spread around the North Country, the 84 year old was forced to take a step back from the frontlines.
But the doc didn't stop.
Hurwitz said he often thought of one of his favorite sayings by Buddhist monk and Zen master Thich Nhat Hanh, who was chairman of the Vietnamese Buddhist Peace Delegation during the Vietnam War and played a major role in bringing mindfulness to the West, "To see and not to act is not to see at all."
"I see how bad (the virus) is," he told the Press-Republican. "I feel I have an obligation to act."
Using input from his son, area nephrologist Dr. Craig Hurwitz, Pulmonologist Dr. Sabieli Kabeli and his own knowledge base, Hurwitz wrote the "Managing Possible or Confirmed C0VID-19 at Home/in a Dorm" protocol.
Hurwitz recommended the protocol, meant for those aged 14 and up, be used in coordination with the Centers for Disease Control and Prevention (CDC) guidelines for, "What To Do If You Are Sick."
While those tips were good for isolation procedures, he said they did not go into detail for medical care at home, which was where his protocol came into play.
He spoke strongly of its need, saying he couldn't find anything else as thorough, and believed it could prevent complications, decrease hospitalizations and help patients to overall "mount a challenge" against the novel coronavirus.
"The other important thing is that it gives the patient a feeling of some control," Hurwitz said. "They're not just waiting at home or in a dormitory for something to happen.
"He or she can do something very, very constructive that might be very, very helpful."
Step One advises individuals rest and follow quarantine and isolation orders as instructed. The second says individuals should stay hydrated, while the third advises they not smoke or vape.
Hurwitz felt the fourth step, deep breathing exercises, was possibly the most critical, saying they could increase the resistance of the lungs to the potentially very damaging effects of COVID-19. The protocol features the link to a YouTube video where a London hospital doctor performs a breathing exercise tutorial.
"They are so important," Hurwitz said. "It's such an important thing that you can do."
Step Five focuses on leg exercises, to keep muscles and blood circulation moving, while Steps Six through Eight hone in on caring for the oral and nasal cavities, suggesting steam inhalations, salt-water gargles and proper humidification.
"The air is drier in the winter and this is made worse by our heating systems," Hurwitz said, adding that low humidity is a risk factor for viruses. "The mucous membranes in our noses also become drier and make us more susceptible to viral infections."
The Environmental Protection Agency recommends indoor humidity levels be kept between 40 and 60 percent to reduce the chances for viruses to spread, he said.
WHERE TO FIND IT
The protocol is now featured on the SUNY Plattsburgh website under the COVID-19 Campus Updates tab and also at northernnephrology.com.
SUNY Plattsburgh Student Health & Counseling Center Director Kathleen Camelo, MD, who is also president of the New York State College Health Association, has also sent the protocol to all student health centers in the state and to all the students and faculty at SUNY Plattsburgh.
"How a patient is managed at home could make a significant difference in the outcome," Hurwitz said. "Getting the protocol out is the most important thing, so that people have access to it."
Email McKenzie Delisle:
Managing Possible or Confirmed C0VID-19 at Home/in a Dorm
This guideline is written for ages 14 and older
If you have an underlying medical condition such as asthma, diabetes, congestive heart failure, lung disease or kidney disease, you must be under the care of a medical provider. The Centers for Disease Control and Prevention (CDC) has a website titled, "What to Do If You Are Sick," if you have possible or confirmed C0VID-19. This is very good for isolation procedures and when to seek medical attention. It provides minimal advice for taking care of yourself at home.
Simple early measures taken at home or in a dorm will make you more comfortable and can help most bronchial infections. If you can keep your body and lungs healthier, there is the possibility it may help you mount a stronger challenge to this virus. These measures have no side effects, so there is no downside to following them.
When to seek emergency medical attention
• Trouble breathing or significant shortness of breath on exertion
• Severe, persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Bluish lips or face (can indicate low oxygen levels in your blood)
1. Rest and stay in quarantine/isolation as instructed.
2. Stay hydrated. Drink six to eight glasses of fluids (juice, water, soups) daily. Avoid alcohol. Fluids keep you healthier and thin your pulmonary secretions. Your urine should be colorless or a very light yellow. If the urine is becoming darker, you are getting dehydrated.
3. Do not smoke or vape. Any smoke is an irritant, including cannabis.
4. Deep breathing exercises during the day. When you are ill and breathing with shallow breaths, some lung tissue can collapse (atelectasis). This makes you more prone to pneumonia. A London hospital doctor, Dr. Sarfaraz Munshi describes a breathing technique that could have significant preventive value. He urges patients to begin practicing the breathing technique at the start of your infection. His following pulmonary program is backed up by the chief medical officer of the American Lung Association. The video of this program can be seen on YouTube at https://www.youtube.com/watch?v=HwLzAdriec0
Dizziness can occur so do this pulmonary program safely sitting.
a. Take five deep breaths in and each time hold the breath for five seconds.
b. On the sixth deep breath, you will take it in and do a big cough, covering your mouth. This is one cycle.
c. Now repeat a second cycle.
d. Then lay on your stomach on the bed with a pillow under your chest taking slightly deeper than normal breaths for the next 10 minutes. Most of your lung tissue is towards your back so laying in the prone position helps keep the smaller airways open.
e. Repeat this several times a day. Purpose of this technique: The initial deep breaths help all the airways to open up. You want any mucus to dislodge and be removed by the big cough at the end of the sixth breath.
5. Simple leg exercises can be helpful. When you are ill and weak and not moving too much, the leg muscles get very weak. Two exercises to keep your legs stronger and improve circulation are:
a. Lying flat on your back on the bed, push a knee down against the bed. This causes the thigh muscle (quadriceps) to contract. Hold the contraction for 10 seconds. Do five to 10 repetitions and repeat with the other leg. Do this three to four times daily.
b. Flex your feet towards and away from you 10 to 20 times. Do this three to four times daily or anytime you think of it.
6. Steam inhalations may be helpful to help healing and loosen mucus in the upper and lower airways. There are no controlled research studies. Check with your medical provider. Steam three times daily for 10 to 15 minutes each time. This recommendation is for patients who are14 years and older. Do not use boiling water from a stove or microwave. Ways to get steam:
• A facial steamer is simple.
• You can sit at the sink and put on the hot water. Put a towel over your head to capture the steam.
• You can sit in the bathroom with the hot shower on. You do not want to stand for a long time in a hot shower when you are ill with fever, because blood can pool in your legs and you can get faint.
7. Gargles are very helpful if your throat is sore. Put a very small amount of salt (a pinch) in glass of warm (not hot) water. Gargle periodically during the day. Steaming will also help your sore throat and can replace a gargle.
8. Humidification. A small (1 to 1.5 gallon) steam vaporizer or cool mist humidifier is very helpful when the heating systems are on and the air is very dry. Air conditioning can cause dryness in the room. A steam vaporizer should be safely kept away from children to prevent them from tipping it over and burning themselves. Saline nasal spray-use this at any time to help humidify the nose.
For Fever, Headache, and Muscle Aching Currently, acetaminophen (Tylenol) is the preferred medication to reduce COVID-19-related fever. Acetaminophen comes in 325 mg and 500 mg tabs; take as directed and do not exceed 3,000 mg (six 500 mg tablets) in a 24-hour period. If you have an underlying medical condition, check the dose with your medical provider.
If a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (also known as Motrin or Advil) is needed to relieve symptoms, or you are already using ibuprofen to relieve your symptoms, use the lowest effective dose.
This protocol was designed by Harvey Hurwitz, MD who is an internist and college physician at the SUNY Plattsburgh Student Health & Counseling Center. Craig Hurwitz, MD, a kidney specialist in Plattsburgh, New York and Sabieli Kabeli, MD, a pulmonary disease specialist in Plattsburgh provided input. Both are consultants to the SUNY Plattsburgh Student Health & Counseling Center.