Advice about Covid-19 from a pulmonary critical-care doctor

March 29, 2020 • 11:15 am

Reader Rick sent me this video, which I’ve listened to in its entirety (57 minutes). It’s made by Dr. David Price, a critical pulmonary-care specialist at Weill Cornell Hospital in New York City. Usually he deals with all kinds of respiratory ailments, but, as he says, now he’s dealing only with COVID-19 patients. Here Price offers advice, and it’s somewhat reassuring, as the precautions you need are not onerous but are IMPORTANT. Reader Rick added this information.

I found this encouraging.

Dr. David Price is a critical care pulmonologist. He does a conference call describing  his experience.  It’s a long video, but quite valuable.

Bottom line: COVID-19 is becoming well understood.  If you practice good hand cleanliness procedures and distancing, you have nothing to worry about.

  1. Hand to face is the critical path. Spray, rarely.
  2. Get into the habit of knowing where your hands are and be sure they are clean. (sanitizer)
  3. Wear a mask, not to protect you, but simply to avoid hand to face contact.
  4. You don’t need an N-95 mask. Anything will do.  Give N-95 to your local hospital.
  5. Carry sanitizer with you when you go out.
  6. Be friendly and social, just stay 6′ away.
  7. Shrink your social circle.  You don’t want to be in large groups.
  8. Go to the hospital only if you are short of breath. Headache, fever, muscle ache, cough – stay home.
  9. Course of the disease is 7 -14 days. Immunity then follows.

If  you follow the simple rules, you will not get COVID-19.  This should be liberating.

Again, I’m not a doctor and so you must make your own judgment about this doctor’s advice.  The first 20 minutes of the video are recommendations for general behavior (i.e., wear a mask in public, but only to keep you from touching your face. Price doesn’t mention gloves).  From 20-30 minutes in, Price discusses what you should do if you think your’e infected, or if you have a family member who is infected. From 30 minutes to the end, Price deals with general questions.

47 thoughts on “Advice about Covid-19 from a pulmonary critical-care doctor

  1. Just yesterday I watched a youtube video featuring a Korean doctor who has much experience with pandemic stuff. Go here
    for the video. This doctor says he has seen cases where it appears that a patient was infected twice. If this is true then the immunity thing is wrong.

    1. And perhaps there is not one single answer that is true in all cases. Regardless, the information on prevention is most valuable–the immunity question is immaterial at the moment.

    2. No test is 100% accurate.

      It is quite possible that people who were tested positive for COVID-19 in the first case “only” had the flu or another cold. The clinical pictures of COVID-19 in its mild course are too unspecific to allow a clear identification.

    3. Dr. Price mentions rebound and immunity.
      Reinfection with a virus is not likely. The idea that this virus is different may come from the fact that there is commonly a bump as someone is feeling better to revert to the symptoms briefly. This is normal and not a reinfection.
      There is no reason to think recovered patience are not immune. The illness triggers the creation of antibodies that remain effective for some period as is the case for the flu.
      He also mentions that the normal course of the virus will be to reduce in severity and become a common cold within a few years.

      1. Then there are the demographics – it appears that males suffer more serious effects of the disease and are more likely to die. The numbers are very preliminary but stark on first pass and worth noting.

  2. I wear gloves when I am in public for precisely that reason. When I wear gloves I am constantly reminded to avoid bringing my hands to my face. Wearing a pair one size too small (XL rather than XXL) doesn’t hurt, either, as the slight tightness keeps that cardinal rule always at the forefront.

  3. Of course the facts are that more than 2000 are dead in this country and climbing. Trump has continued to get nasty with governors and others who he does not like being the true leader we all expected. The only thing exceptional about this country so far is how poorly we have done so far and where we are headed. Places like Singapore have shown the best performance and the leader of this country was on tee vee today. What he said that probably was most true is that their country had confidence in their government and followed their advice and fast action.

  4. I’m skeptical about masks keeping people from touching their face. If you watch people wearing masks, they are constantly adjusting the masks and touching their faces.

    1. Adjusting the mask does not necessarily mean touching your face. The inside of the mask touches your face. The outside does not.

    2. If a person is a) properly trained, and b) follows the training, then the mask will reduce face touching.

      Item (a) must come first. When I see people in the grocers pull the mask down with the gloved hand to take a cell phone call, any advantage is more than lost, as the mask is not contaminated, and the phone being held to the face is contaminated.

      [sorry. I am really bitter right now. Second funeral-by-webstream in two weeks today. 22YO college senior former student this time]

  5. Meanwhile, here is Fauci:

    “I mean, looking at what we’re seeing now, I would say between 100,000 and 200,000 … deaths,” Fauci told CNN’s State of the Union, though he added: “I just don’t think that we really need to make a projection, when it’s such a moving target that you can so easily be wrong and mislead people.”

    As it happens this is what I guess here a couple of days ago: US: 200,000; W/W: 2 million.

    Contra Fauci, I also suggested a poll on numbers here. Polls have been conducted by this site on the Presidential elections. A poll on C-19 could be informative as to just how deadly we expect this pandemic to be.

  6. From a basic research viewpoint, and also from the applied standpoint, I think it will be both exceptionally interesting of great value to know what parts of the COVID-19 virus are recognized by people who have gained immunity. I suspect that we are in a much better position to learn that now than even 10yrs ago.

    Otherwise, I posted this on the Dialog here this morning, but it may have gotten lost there. In any event, this post is a better place for it.

    In my morning FB feed from a friend in Stockholm who just recently started working at one of the major hospitals there, and now finds herself directly in the trenches. FB translation with my tweaking.


    A little update how I feel it to work on a GI dept reception that has become covid-19 department. There are many medical terms and I hope you who don’t know these anyway understand how tough we are.

    We are having a terrible time. I caught up with 4 days intro with gastro patients before we became covid-19 dept. First we were a lock department (we were March 10th). Suspected from the emergency room ended up with us and depending on whether they were pos or neg, they were sent on to the right care unit. 1 week later we only became a dept for covid-19 because infection at Huddinge Hospital [S of Stockholm] did not have places anymore. The situation is getting worse and worse.

    It’s more than chaos… We have 7-8 patients per team. Many have saturation monitoring, nhf, oxygen, NIV, telemetries (heart monitoring).

    No resources because there are so many sick and staffing do not want to be with us. Our 3 bosses are now sick too.

    Last days we have had 1-4 deaths / day and now even relatives are not allowed to enter dying patients.
    Patients who die in covid-19, choke to death. There is a lot of anxiety and worry at the end of life for them. Sure we can calm with meds but don’t have time to keep 100 % track of whether they need more or other meds to make it easier for them in the last hours.
    So now patients are allowed to choke to death in solitude and we don’t know when it will happen…

    The day before yesterday, one of the nurses (highly experienced and no diseases or meds) collapsed she was sent to the heart attack…

    We have overhead as a visor. Try to look through one of these and take blood tests with it…

    Not always the right mouth protection either and often you get to work with the wrong size of gloves…

    Latest is that they made home builds out of 30 cpap and turned them into NHF (Nasal high flow device that gives high flows of oxygen with pressure). Usually we have a maximum of 3 with NHF. They are not proven but they think they should work…

    There are often nutritional drinks instead of food for those who can’t eat themselves or risk swallowing wrong because we don’t have time to feed them. ADL, ie helping wash, brushing your teeth, hygiene, goose training etc is very priority because there is no time and opportunity.

    We have the opportunity to nurture 29 patients on dept.

    So I cry for every pass because I feel incomplete.

    So what is said on TV and radio is BULLSHIT and embellished, based on what I experience.

    It’s short. St Göran now has 5 dept for covid-19 only in addition to IVA. And what I understand, we are the hospital that has the most patients in this group throughout Stockholm region.

    Thank you to all of you who get in touch and send hugging ❣ It warms a lot but unfortunately I can’t have time to answer everyone but give an attattoo update like this instead.

    Take care of yourself out there and enjoy that we have summer time and spring now

  7. Dr Price appears extremely confident that aerosols do not (or hardly ever) transmit the disease.
    He does not give any non-anecdotal evidence for this assertion, but just states. How has that been established? It would be the mirror image of TB, where you can even drink from the same glass without contracting the disease. Flu, cold and measles are also spread via aerosols.
    I’m kinda skeptical, in other words. Don’t get me wrong, I do think that hand to face transmission is real and important (I do follow ‘the rules’), but I just doubt it is that important, like the 99% he is contending. I do not think that is established.
    For the rest it is an absolutely great talk.

    1. I believe he might feel that aerosols are transmitting the disease but he started clearly that he is taking full precautions including N95 masks when engaging in aerosol producing procedures (nebs, CPAP, intubation, suctioning, decreased physical distancing in enclosed spaces). I believe his feelings were that if a person is producing aerosols “in the wild” the risk is low if you maintain physical separation; not complete lack of risk

      1. Much of this would be better taken if he simply said “we think..”, “respiratory viruses usually..”, or “in most cases”. Or — trigger to seek medical care may be for symptoms [e.g., cough] if one has reason to believe they are in a risk group or in an area with high transmission.

        1. I don’t know but he has been in the thick of this for three weeks or thereabouts. As a respiratory specialist. Apparently without infection.

          Elsewhere, I believe the precautions forwarded to the population are as they are because the lack of widespread PPE available to that population and the simplicity of the instructions makes it difficult to misunderstand, even if it’s not followed.

          I also believe he addressed the time to seek aid – difficulty in breathing being the main symptom.

          1. I’m taking Dr Anthony Fauci’s estimate of up 200K deaths very seriously. Price’s advice is from the point of view of lightening the load on medical resources. But not necessarily reassuring to most older humans.

            In my case: I have excellent lung function, rarely experience deep, bronchial coughs, and rarely get fever more than half a degree F above normal. Given this, despite my generally good health, at my age I wouldn’t wait for “shortness of breath” to go to the nearest hospital.

  8. Thank you for this post.
    Some weeks back I was advised by a microbiologist to observe rigorous hand hygiene and above all else – do not touch your fucking face!
    Keep safe everyone.

  9. I’m not sold on the idea of wearing a mask for personal protection. However there is an altruistic reason to wear one: if you are unknowingly shedding virus and cough or sneeze then you protect others around you.

      1. As mentioned in the other thread, DIY masks can be effective. A double layer of an old T shirt, for instance. Even scarves.

        1. +1

          If you have to, it’s simple to pull a scarf or neck warmer (?) up – better than nothing

          *why does autocorrect and autocorrect and a small screen suck so bad?

          1. It has been noted that people tend to give mask-wearers a little more room on the street and in markets. That can’t hurt!

  10. I am a trained healthcare professional and can attest that masks get itchy, uncomfortable, and sometimes become dislodged. Any of those scenarios invite a hand-to-face transaction.

    Also, there are far more opportunities to contract coronavirus than a grocery cart handle. The freezer door handle, the checkout touchpad and stylus, the checkout divider, your credit card following removal from the card reader, and food containers/wrappers. That’s why I elect to don disposable gloves (I prefer oversized food service gloves as you are much less tempted to touch your face). Incidentally, I have a plumber that never fails to eject spittle during conversation.

    When grocery shopping I gear up with the following: outer raincoat completely snapped, mask, face shield, and gloves. I can’t imagine wearing this getup in Las Vegas during July so I may resort to scheduling grocery delivery in the middle of the night (daytime slots nearly impossible to secure). I am in a very high-risk group and must be hypervigilant.

    Of course, I may relax my ‘armor’ once more data is in and has been analyzed.

    1. “I can’t imagine wearing this getup in Las Vegas during July”

      I feel for you. My primary job is teaching engineering. I also practice. One part of what I do involves work in, and training other to work in, IDLH environments. A 4 hour shift (no more than four hours in gear, from start don to complete doff if the goal) in August can be very, very rough, even when circumstances only call for filter respirators.

      We teach the crew to break if there is any concern (dehydration, equipment failure, loss of attention, anything). We can do that in the controlled work environment. Really tough to do that shopping for groceries.

      To put it in perspective, the training for me to train and test workers was 2 weeks (maybe 60 hours of actual training), and it is a full 8 hour day for an employee to do orientation, training, and fit test for a basic respirator. More time is needed for some cases (supplied air, special atmospheres, confined space, and so on)

  11. I impressed by way the virus spreads, very fast and am okay with the other prevention measure of washing your hands, keeping away social distance and sanitizing your hands. But when it come to dont touch your face or mouth, thats when i start touching and it come automatically. I think that affects most of us here

  12. Wash your hands, don’t touch your face.

    I’m in the K.I.S.S. camp on this one.

    Simple, but I find not touching my face an odd challenge.

  13. Haven’t been able to find hand sanitizer since the Coronavirus thing started here weeks ago, or masks. I do agree about the frequent hand washing, and practice it. There actually was an instruction sheet for makig masks in today’s ((4/1/20) New York Times.

    1. The guy who designed the N95 mask says blue shop towels are one of the best materials. Several videos are on YouTube.

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