Coronavirus: The Real Fight Hasn’t Started Yet
NOTE: Thank you for the love everyone. It’s been overwhelming all the wonderful stuff you’re saying. I would like to take a moment while I have your attention to thank my staff who are working their faces off. Long days, intense business, and putting themselves at risk coming to work while many are quarantining.
Life won’t return to normal for a while, so I think Coronavirus will dominate our blog and social media for a bit.
That being said, seasons are changing despite the pandemic.
I’ve spoken to a number of people where the theme of the conversation was, “You don’t have coronavirus, you have allergies.” Because of global warming (another wonder of 2020), it’s getting warmer sooner and plants are doing their thing and causing us all to sniffle, sneeze, and even get fevers or cough.
How do you handle the change of seasons? Consult our Guide to Spring. Fill out the form below and get it emailed directly to you.
Now, let’s talk COVID-19... Again.
Dear Random Businesses, Stop Emailing Me!
I’m so relieved to know how some forum or stupid business I occasionally interact with is responding to the COVID19 pandemic. What the hell, right? Every business is taking this time to send out their game plan, as if we needed to know how our Spirulina company is adapting to “these challenging times.”
At least I know who to unsubscribe from.
As I’ve hinted at in our past two articles, Coronavirus Myth Busting and Coronavirus: We’ve Panicked, Now What? these are often accompanied with charlatans with their guide to what supplements you can take to cure–yes, some are actually saying cure!–coronavirus.
One of the more insulting ones comes from a mucky-muck in the alternative medicine world with credentials after his name. My muscles in my eyes are permanently cramped from rolling them so hard, especially when he said “I’ve studied coronavirus…”
The audacity is astonishing. I’m going to gladly earn the title of “Big Mouth Jerk Face Pharmacist” as I’d rather be the jerk who stopped or slowed hysteria, hoarding, misinformation, and maybe even stopped a few people from getting sick and dying.
“I Need Good Information”
Part of our problem right now is information. We’re taking in ALL of it. The media is giving us sensationalized information. You don’t need information, you need direction.
Unplug from the media. Focus directly on a few sources. NY and California Department of Health are good sources, as we’re kind of the big issues right now. World Health Organization. CDC. Those guys.
Here’s some stuff you should definitely know:
- This is serious. Because we have no testing, drugs, vaccines, or whatever, this will cause a lot of unnecessary death from both the virus AND the strain it will put on the healthcare system, as it is an intense disease to manage.
- We must overreact. The places that have succeeded (few deaths and even hospitalizations) have gone overboard with testing and quarantine. Those who haven’t have had lots of death. Anyone downplaying this is doing a disservice to the front line people, the soon-to-be-sick, and those who have died.
- Many people are asymptomatic carriers. This is good. The 20% or so who do have serious symptoms have an intense illness. This is bad. See #1
- The droplets seem to carry a high viral load compared to other illnesses. This, along with the asymptomatic percentage, is why distancing and quarantine are needed.
- It’s not just a disease of the elderly or patients with preexisting conditions any longer. More than half of the US’s hospitalizations are under 50. Other countries are reporting the same. Our social media manager is very young and got it!
- The numbers reported are way low, as they’re reporting tested people, and almost no one can get tested yet.
- The severe symptoms can last 21 days. Death normally happens a month out. The death numbers will lag the new cases. Things seem OK now, but we'll be in deep trouble in a week or two.
- Nothing works to prevent or protect you except staying home.
This Isn’t Hard!
I’m growing a little exasperated.The number of people who are in high-risk categories who are still out and about is mind-blowing.
This is going to get real VERY soon. New York and NYC will be the epicenter of this disease.
The only thing you can do is stay at home. STAY HOME.
If we had the ability to test everyone, then quarantine positive cases and their contacts (and their contacts), then this would go away “tomorrow” and our economy wouldn’t grind to a halt. We have no treatment, and no supplement nor any percentage of rubbing alcohol will help you.
We wasted time by denying responsibility months ago, and now we’re behind the 8-ball.
The only thing we can do to get life back to normal ASAP is to stay home now. We ship. We deliver. We need to lock down life now. Stay home.
Plaquenil, Drugs, and Hysteria
I’ve intentionally said nothing about the small bits of real, good data flying around about drugs you should or should not use.
Why? I’m not an expert. It’s irresponsible to speculate as consumers or non-researchers/expert healthcare professionals, especially as this COVID19 is something new that’s unfolding daily.
That being said, everyone and their mom is looking now at Plaquenil, or hydroxychloroquine, as there are SMALL trials saying it helps reduce ICU dependency.
Quick question… What happened when everyone knew they had to prep for quarantine? They rioted over toilet paper. I haven’t wiped my a$$ in days!
What, then, do you think will happen if people think a drug, supplement, or whatever is a real treatment?
It would probably be important to know that most of the ‘data’ we have on hydroxychloroquine is in vitro, or test tube data
Let me be frank and let me be a bit mean: you’re not getting Plaquenil or any drug “in case.” Any prescriber giving this dangerous drug to the general public “in case” is doing a disservice. I’ve reached out to my doc friends in Woodstock and told them I’ll slap them if they do.
Here’s me being a jerk again, because some of ya’ll need it:
You should not seek out or try to procure hydroxychloroquine “to have on hand” in case.
Wipe that thought out of your mind. Save it for people who need it.
If you need it and I get the call that the hospital is short, I’ll drive it over to whatever hospital your at myself. That situation is not real and far from the one where you get 20 pills to stack on top of your 80 rolls of toilet paper
The drugs that work or any vaccine when available should be reserved for ONLY people who need it. For Plaquenil, people who are already on it for autoimmune disorders AND people who are severe COVID19 patients if and when they actually prove it will be an option.
“But, what if I already take Plaquenil for my very real conditions?” You probably can’t even get a refill at this point as the hoarding began last week when this info broke. It’s unavailable and prices are skyrocketing.
My suggestion for those who use Plaquenil regularly:
- If you have 30 days or more, do nothing. See #3 if need be.
- If you have less than 10 days, request your refill for 30 days
- If you are in between 11 and 30 days, contact your doctor via email or some non-urgent communication and ask him what you can do in the event of a Plaquenil shortage.
Ibuprofen, Elderberry, and Why Most Advice is BS
Part of the reason why it’s wise to not jump into the “this is what you should do for coronavirus” misinformation pile is that some seemingly benign recommendations can actually turn out to be pretty darn dangerous.
Ibuprofen, it seems, increased the risk of serious symptoms of COVID19. Overnight, our shelves were wiped of acetaminophen. Then, the WHO reversed its official recommendation based on some conflicting data, so now ibuprofen is OK again. What should I be doing?
The only thing you should be doing is staying at home.
The people at ground zero are having a difficult time staying on top of safe, best practices and the variables that influence this disease.
We don’t want to contribute to the problem. We don’t want to contribute to the chaos.
An herbalist is circulating her theory that elderberry increases cytokine production as a mechanism for action, and coronavirus can do the same thing, and therefore you shouldn’t use elderberry for coronavirus prevention.
Whether or not that’s true (who the hell knows–especially her!), here’s what’s real:
- You shouldn’t be taking anything to prevent coronavirus. You can’t. Imagine if there was some supplement that worked and all of those people in Italy, for example, who died, would have done so unnecessarily. There’s nothing. Stay home, that will protect you best.
- Experts don’t know. So some herbalist blogger lady, Youtuber, chief acupuncture guy, or Big Mouth Pharmacist should NOT be telling you about secret or risky supplements.
- Most people aren’t getting real elderberry, anyway. See my blog on the subject, 15 Fun Facts About Elderberry.
Here’s the practical advice for all of you out there: If you’re taking whatever supplements STOP ALL SUPPLEMENTS ASAP if you get symptoms or come in contact with someone with COVID-19.
We don’t know what will be good or bad, so it’s best to just stop if it becomes more real.
If you are taking these things to help make yourself feel better about the whole thing, I’m OK with it. Just make sure you understand that we don’t understand it all, and something “natural” could naturally make things worse.
You Don’t Need a Thermometer
I’m also blown away at the number of people coming out to get supplies for what could be either a first aid kit or a craft project.
Don’t make your own hand sanitizer. Don’t go out into a public place where asymptomatic carriers are out because they’re not taking it seriously to buy aloe, rubbing alcohol, and essential oils to make what I’m calling “feel-good-hand-juice-rubby stuff.”
Wash your hands. Stay home.
All we have in stock is hand de-sanitizing lotion. You don't want to know how that's made in good ol' Woodstock.
This whole thermometer thing… So many people are looking for a thermometer, and I go back to my argument against diagnostic tests: what are you going to do differently if you have a test?
If you have a fever, you know it. If you have a thermometer, you know if your fever is 99, 100, or 101. How does that change anything?
You don’t need a thermometer. You need to stay home, and you won’t have an issue with needing to check your temperature, as you won’t be exposed to the virus.
We only have rectal thermometers in stock. The only difference between them and normal thermometers is the taste.
Here’s our out-of-stock list at Village Apothecary:
We don't know when any of them will be in stock again. Especially the fifth one.
Visualizing the Risk
I’ve explained to the staff and colleagues how we’re setting up our practice to protect the staff using zombies as an analogy. I’m leaving this conclusive list for my pharmacist friends so they can see what we’re doing.
(Does the zombie thing make you nervous? It shouldn’t. Well maybe)
- Everyone outside the store is a zombie and have zombie germs that will kill you and turn you to a zombie if you get within 6 feet of them
- Inside the store is a sterile, sacred place. Anything that goes out is safe, anything that comes in is tainted. This includes the people.
- Stop bringing bags into work. Bring your license, a CC, and some cash in a ziplock with your keys.
- Wear scrubs or raggy clothes. When you get home, take off your clothes outside or in a safe space right inside the door. We don't need to scare the neighbors.
- Throw these into a bag and keep them there for 4-5 days, minimum. Wash your hands immediately, then clean the entrance and anything you’ve touched.
- Go shower. Now you’re clean and safe in your house.
- Delivery guy
- He’s a potential zombie, so he can’t come in.
- We bring out everything to him.
- He’s not really a zombie, at least not yet. He should hand sanitize, wash his hands frequently, etc
- He isn’t to touch or get within 6 feet of all the zombies. Drop the stuff off and go.
- Curbside assistance
- Anything that comes in the store: cash, insurance cards, credit cards, are considered tainted with zombie juice. Alcohol/bleach credit cards and insurance cards. What a service!
- No long conversations. If there’s an issue, call the store and deal with it.
- Everyone needs to stay 6 feet from the door and each other outside
- Clean, clean clean
- Bleach all surfaces after any breach, meaning if the door opens or something zombie juice laden comes inside.
- Every 15-60 minutes, clean inside surfaces to keep sterile :)
- Staff should be washing their hands as soon as zombie contaminated or every 15-20 minutes as needed
“What Do I Do?”, The List
If you’re staying home, you’re doing everything right. Don’t fret. You don’t need to go crazy. You’re doing it right.
As people are looking for direction, I believe I can give a consolidated list here:
- See my Zombie analogy above :) Everyone’s a zombie and outside is filled with zombie juice
- Don’t leave the house especially if you fall into the high-risk category
- If you need groceries or prescriptions, there are probably resources in your community where you can get essential items delivered. In Woodstock, The Table is feeding everyone. Any donation of $20 will prep 10 meals. If you’ve got the dough, send it their way.
- Make a list of everyone you’ve come in contact with (six feet or closer) in the past 7 days, as well as any places you’ve visited. This list should be short.
- Keep in touch via phone or email those who are on your list. If they get sick or if you do, call all your contacts and contacts’ contacts.
What happens if I get symptoms?
- Stop taking any supplements you may be on for “coronavirus prevention.”
- You’ll want to not leave the house. Most people are asked to deal with this on their own at home unless it starts to get serious. I’m including an image I shared on my Facebook page this morning as well as a link to a COVID19 procedures manual. The most important and relevant for you is the list of the stages of severity, posted below. You’ll be able to see easily what is mild vs severe.
- You can call your DOH to see where your nearest testing site is, if they even want you to get tested. Stupid, but that’s reality. Be ready to wait on hold.
- After you get tested, try to white knuckle it as best as possible. Again, check out our video later today- I interview our staff member who has COVID19 to document a real-life walkthrough of the whole thing.
Here’s NYS DOH page which has all the resources from the real experts. This is the site you should spend the most time on: https://coronavirus.health.ny.gov/home
It’s Time for Acceptance
That’s a lot and this is scary times. It will be fine, especially if we heed the warnings and take it all seriously.
Most of the weight we're carrying around isn't actually from the disease or the changes we're making. The burden is in the emotional.
"What is going to happen? When will this be over? I really want this to be over as soon as possible! Why aren't things like the way I want them to be? How will I survive this?"
We're worried about a future we can't control or change. We're frustrated because right now isn't what we want. We're attaching to life as it was or how we think it should be.
We can fester in this, hold onto this ball of razor blades, or push this boulder up a hill. Or we can just let it go.
Acceptance isn't giving up. It's just saying, "It is what it is."
Once this weight of self-induced suffering is lifted off our backs, we realize how much mental and emotional space we have to actually do something productive.
I recommend writing down all the different outcomes you are fearing and start drafting some ideas on how you can either prevent or deal with them. Don't forget to not be a Negative Neally and just point out the bad. What are potential good things that may happen over the next few weeks? Put "not dying of COVID19" on the list.
After you deal with the now with clarity afforded by acceptance, I recommend you build out your plan to not allow yourself to be beholden to the commonly circulated concerns: money and healthcare.
I say this as someone who's already stared down the barrel of this gun. How was I to feed my family and provide a great life for them if I no longer owned pharmacies? I'm surely doomed!
Once I accepted that things were the way they were, I could plan and deal with my reality better.
I realized, quite quickly, that it's not black and white or pass and fail, but 50 shades of grey (without all the slapping and choking). I started making changes to protect myself and my family if I ever have to be out of work.
I fleshed out all the contingencies, which included making lots of difficult sacrifices. It took some time and sacrifice, but we got there. What mattered most was that I was OK, the kids were OK, and Erin was OK. Different, but OK.
This is painful, yes. But the suffering and intensity—that's all you.
It doesn't have to be, though. It is what it is. Deep breaths (4 seconds in, hold for 2, out via mouth for 6). What is real, right now? What do you need to best care for yourself, right now?
Accept, and then begin again.
Just trying to keep it real...
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth