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What You Need to Know About Pulse Oximeters
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This month there has been a revolution among New York doctors in understanding how to treat severe coronavirus cases, with the potential for significantly lowering the Infection Fatality Rate from whatever it has been in earlier months. Emergency rooms are now advised to be less in a rush to ventilate patients with low percentages of oxygen in their blood. Conversely, people at home with coronavirus symptoms are advised to check their oxygen with a simple pulse oximeter device rather that wait to seek help until they can hardly breathe.

iSteve commenter SimpleSong writes:

One caveat–as anyone who works in healthcare can tell you, if you put on a pulse oximeter and it’s not getting a good signal, it will often basically become a random number generator. So you may have a lot of false positives with this.

Bad signals take a bit of expertise to troubleshoot, it can be you don’t have it on properly, or your hands are extremely cold and have poor circulation, or you are wearing nail polish (even clear nail polish can screw up the signal because it uses infrared as well as visible), or you put it on too large a finger or too small a finger. Anesthesiologists are always screwing with these things during cases, probably more than any other monitor, and they have the really high end ones. So you might get a lot of false positives with this.

However if you feel sick or you know you have coronavirus and you are weighing whether to go in to the hospital, the false positives are probably worth it.

Second aside: respiratory phys is interesting–you need your lungs for two things, to eliminate carbon dioxide and absorb oxygen, but the drive to breathe is solely from carbon dioxide levels. The feeling of suffocation or shortness of breath is caused by CO2 alone (specifically, high CO2). If you breathe an atmosphere of pure nitrogen you will feel perfectly fine for a few seconds, then immediately die. On the other hand an atmosphere of 10% CO2 and 20% oxygen will make you feel like you are suffocating, possibly induce a panic attack, but nevertheless could probably be breathed indefinitely.

Third aside: if the best treatment for this turns out to be oxygenation, that is very, very good news. Because the atmosphere is only 20% oxygen is pretty easy to improve oxygenation, just crank that up to 100% oxygen and now each breath delivers five times as much oxygen. This is technically easy to do and doesn’t require intubation or a ventilator. A 4 dollar non-rebreathing facemask can get you well above 50% and basically anybody can use it. Heck people with COPD spend years with nasal cannulae and oxygen generators managing their disease at home.

Ventilators are required primarily for CO2 elimination (although they also help with oxygenation). While it’s easy to increase the oxygen that is inhaled with simple passive measures like facemasks, to get rid of more CO2, you just have to breathe, no other option, so if the patient can’t do it you need the vent, with all the complexities and risks associated with that.

 
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  1. It’s a good idea to buy multiple oximeters to cross-verify results. When i received mine as a test I simply exhaled and held my breath. It took approx 10-15 seconds but then my sp02 levels dropped to 92 until I inhaled again. As this worked multiple times I figure the oximeter works fine.

    • Replies: @Elli
    The last time I tried holding my breath with a pulse ox, it took 80 seconds for SpO2 to drop to 96%.

    I took it as a lesson to watch the patient, not the monitors. This disease is a lesson to watch both.
  2. You’ll not be breathing an atmosphere of 10% by volume carbon dioxide indefinitely. Look up hypercapnia.

    • Replies: @SimpleSong
    I should qualify this statement a little further, I don't mean to be flip about inhaled CO2, but hypercarbia is a much more fixable problem than hypoxia, and pretty well tolerated. 10% may be pushing it but let me run down some ballpark numbers:

    Normal CO2 is 40 mmHg in your veins. People with various lung diseases may have it up to 60 mmHg, during an exacerbation I've seen them get > 100 mmHg. Atmospheric pressure is 760 mmHg. So exhaled breath, which is in equilibrium with venous blood, is around 5-10% CO2.

    Inhaled CO2 is normally close to zero, so with each breath you get rid of a certain amount of CO2. How much depends mostly upon the volume of your breath and the concentration of the CO2 in your veins. For illustrative purposes, we'll say the healthy guy with 40 mmHg venous CO2 gets rid of 4 units of CO2 per breath.

    Now suppose you turn up the CO2 in the room to 40 mmHg (~5% CO2). For his first breath, he gets rid of no carbon dioxide: 40 mmHg went in, 40 out. So CO2 starts to build up in his tissues. Increasing CO2 makes his blood more acidic, which triggers a drive to breathe, a feeling of suffocation, fast heart rate, lower blood pressure, most likely panic. After a short period his CO2 is now up to 60 mmHg.

    If he is otherwise completely healthy he will be hyperventilating at this point and likely reaches a new equilibrium. If before he took 6 breaths of 500 mL per minute, now he takes 12 breaths of 500 mL per minute. He moves four times as much gas, but he inhales 40 mmHg in, 60 mmHg out, so half as much goes out per unit volume, but he is ventilating twice as quickly. So he stays at a stable 60 mmHg, which is survivable.

    Now all the bad effects of hypercarbia are due to the increasing blood acidity, so if this guy is in the hospital and you hook him up to an infusion of bicarbonate, he'll actually maintain a normalish pH and will feel relatively fine. That just takes an IV and a pump--easy. After a few days his kidneys will start automatically adjusting his pH and he won't even need the infusion anymore. That's how the COPD guy who lives at 60 mmHg lives his life without feeling like he's constantly suffocating--his kidneys have taken over and somewhat normalized his pH.

    All this is contingent upon the person being healthy enough that they can 1.) increase their respiratory rate to compensate, 2.) circulatory system is healthy enough that they can tolerate tachycardia and low blood pressure for a while. Not everybody is healthy enough to do this. Somebody who is not healthy enough to turn up their respiratory rate and is tiring out needs to be put on a ventilator to keep up.

    And it isn't going to be pretty, I mean this guy is going to be hyperventilating, panicking, etc. due to the hypercarbia. But he will be alive, despite inhaling at atmosphere with over 100 times more CO2 than normal (400 ppm versus 5%). If you dropped the oxygen by a factor of 100, it's lights out, immediately.

    If you have maxed out on inhaled oxygen, 100% inhaled still isn't cutting it, then the only option is ECMO, which is a huge, huge deal.

    Anyway that's how fentanyl kills--it resets the set point of the CO2 driven drive to breathe, so your repiratory rate goes too low and you die of hypoxia.
  3. The problem is that you cannot get oxygen without a prescription, and it is almost impossible to get one. A non-rebreathing face mask does you no good without an oxygen device to connect it to.

    • Replies: @Anonymous
    Set a craigslist alert for "oxygen concentrator" and you'll probably find someone locally selling a used unit. Try to find one with a built-in purity sensor so you know you're getting >87% oxygen. If you can't find one there, ask a local glass blower. They often use secondhand medical oxygen concentrators to power their glass blowing torches.
    , @William Badwhite

    The problem is that you cannot get oxygen without a prescription
     
    You can get it from aviation supply businesses. Sporty's has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.
    , @Bizarro World Observer
    I have a huge tank of it in my garage, which is refilled at my local welding supply store. No prescription, and the same quality as medical oxygen.
  4. thanks for this, Steve.

    What I am looking for right now are reasons why this coronavirus might not have a second wave that is worse than the first. At the moment, there is lots of good news — All of us can see the second derivatives which right now are “bending” in a good way,

    but this is , as Greg Cochran said in one of his lucid moments, possibly only 1940, not 1944 (analogy to that big war). Every little bit, like NYC doctors figuring things out, helps when we are fighting a crafty enemy.

    I think of our unwanted little friend the coronavirus as, worst case, potentially the first bio-AI large-scale threat we have seen (AIDs was more of a society driven threat, and terrorism was always a law enforcement issue). If that is true, we are going to need an awful lot of ingenuity ….

    Absent a worst case scenario, I do not see how it is possible that the second wave can be as lethal and as much worse than the first wave as the 1918 second wave was, here and now in 2020. Or that is what I want to believe.

    But then I remember that these coronaviri have hitched rides for millions and millions of years in places where they were not wanted, and their best performers were a lot more sophisticated than the smartest of us are able to figure out, or have ever been able to figure out…

    And let’s be honest. I might be missing something because I only am fluent in English, Spanish, Russian, Italian, and French, but the smartest of us are not exactly inspiring great confidence at the moment.

    Excelsior

  5. wwebd said: Nature can be frightening, I guess, but either God created this world or not.

    If God created this world, Nature at its worst is no match for a creature whom God loves.

    I know which side I will bet on.

    • Replies: @ThreeCranes
    Pascal’s wager brought up to date.
  6. anonymous[186] • Disclaimer says:

    All the top-ten oximeters (all seem to be american made or under an american imprimatur) are unavailable for purchase. Sold out. There’s a lot of crap from China, however. There’s no way to ascertain the quality of those, and they’re dirt cheap, so it’s not a stretch to assume they aren’t of the highest quality.

    I guess if any good comes out of this, it’s to showcase how pitifully unprepared we are for this kind of thing, as well as our lack of collective ability to ramp up manufacturing here when items to combat a virus are required.

    Still can’t easily get a box of fucking high-end masks at this point, and I still can’t grasp why finger-pointing and shaming globalists hasn’t gained momentum. For the last 5 years, whenever my globalist friends would start up, I would repeat the same refrain, “globalism is death.” They would just chuckle. An entire political party is behind it, and they’re dancing around with no social repercussions. They really need to own this, don’t they?

    Huge puzzler.

    • Agree: ThreeCranes
    • Replies: @The Alarmist

    ... and I still can’t grasp why finger-pointing and shaming globalists hasn’t gained momentum.
     
    IKR. In fact, the globalists are using this to force even more globalism down our throats. Have you noticed that nearly all major outbreaks of "nationalism" have vanished from the news?
    , @Jack D

    All the top-ten oximeters (all seem to be american made
     
    Boy did they fool you.

    I highly doubt that a single one of them is American made. In fact, I doubt that the were EVER made in America (certainly not the inexpensive self-contained fingertip type home monitors). They were a Japanese invention to begin with. Maybe some of the original hospital type tabletop units that sold for thousands of $ could have been US made (more likely made for the US mfrs in Japan), but by the time these were available as consumer devices, the manufacturing would have been done 100% offshore, almost certainly in China. In the short run, we couldn't make a device like this anymore even if we wanted to - the whole infrastructure is gone. And if we could make it, we sure as hell couldn't make it to sell for under $50 retail let alone the $15 that the China brand units bring (or brought before they were bid up).
    , @Elf Himself

    ...whenever my globalist friends would start up, I would repeat the same refrain, “globalism is death.” They would just chuckle. An entire political party is behind it...
     
    "An?" Singular?
  7. Anonymous[186] • Disclaimer says:

    And remember to maintain social distancing, and drink a lot of fluids.

    https://www.vigovideo.net/hotsoon/s/WUWkbgfvG78/

    • Thanks: adreadline
  8. Anonymous[269] • Disclaimer says:
    @anonymouse
    The problem is that you cannot get oxygen without a prescription, and it is almost impossible to get one. A non-rebreathing face mask does you no good without an oxygen device to connect it to.

    Set a craigslist alert for “oxygen concentrator” and you’ll probably find someone locally selling a used unit. Try to find one with a built-in purity sensor so you know you’re getting >87% oxygen. If you can’t find one there, ask a local glass blower. They often use secondhand medical oxygen concentrators to power their glass blowing torches.

  9. As I commented in another thread, bad medical care in hospitals is one of the leading killers in America.

    Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm.

    source: https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

  10. Good piece(s).

    Maybe your owner could find a way for readers to award gold stars without commenting?

  11. @anonymous
    All the top-ten oximeters (all seem to be american made or under an american imprimatur) are unavailable for purchase. Sold out. There's a lot of crap from China, however. There's no way to ascertain the quality of those, and they're dirt cheap, so it's not a stretch to assume they aren't of the highest quality.

    I guess if any good comes out of this, it's to showcase how pitifully unprepared we are for this kind of thing, as well as our lack of collective ability to ramp up manufacturing here when items to combat a virus are required.

    Still can't easily get a box of fucking high-end masks at this point, and I still can't grasp why finger-pointing and shaming globalists hasn't gained momentum. For the last 5 years, whenever my globalist friends would start up, I would repeat the same refrain, "globalism is death." They would just chuckle. An entire political party is behind it, and they're dancing around with no social repercussions. They really need to own this, don't they?

    Huge puzzler.

    … and I still can’t grasp why finger-pointing and shaming globalists hasn’t gained momentum.

    IKR. In fact, the globalists are using this to force even more globalism down our throats. Have you noticed that nearly all major outbreaks of “nationalism” have vanished from the news?

  12. “What You Need to Know About Pulse Oximeters”

    Oximeters = Good.
    Anyone who doesn’t believe in this newest vein in corona hysteria = Bad.

    • Thanks: Stan d Mute
    • Replies: @Hibernian
    Making good ones available could reduce the hysteria, especially when the usual suspects attempt to sustain the hysteria forever.
  13. Kevin Drum bought one, risking his life to go to the drug store for it. Is her an iSteve reader?

  14. I had an idea once that you should be able to go to the public library and borrow different health monitoring devices. Like an oximeter and maybe, something like a fitbit, and something that would passively monitor your sleep by a kind of smart camera.

    • Replies: @Joe Stalin
    Too bad in Chicago all the public libraries are CLOSED due to Gov. "Jelly Belly" Pritzker edicts

    You can borrow laptop computers from the CPL, so if someone with a little bit of cash could buy some and contribute them to CPL. On the other hand, who's going to ensure the calibration of these devices? You would need to have some firm that would do that, and that would definitely be expensive.
  15. @Stephen Dodge
    wwebd said: Nature can be frightening, I guess, but either God created this world or not.

    If God created this world, Nature at its worst is no match for a creature whom God loves.

    I know which side I will bet on.

    Pascal’s wager brought up to date.

  16. @Ashwin
    It’s a good idea to buy multiple oximeters to cross-verify results. When i received mine as a test I simply exhaled and held my breath. It took approx 10-15 seconds but then my sp02 levels dropped to 92 until I inhaled again. As this worked multiple times I figure the oximeter works fine.

    The last time I tried holding my breath with a pulse ox, it took 80 seconds for SpO2 to drop to 96%.

    I took it as a lesson to watch the patient, not the monitors. This disease is a lesson to watch both.

  17. @MikeatMikedotMike
    "What You Need to Know About Pulse Oximeters"

    Oximeters = Good.
    Anyone who doesn't believe in this newest vein in corona hysteria = Bad.

    Making good ones available could reduce the hysteria, especially when the usual suspects attempt to sustain the hysteria forever.

  18. @Tony BC
    You'll not be breathing an atmosphere of 10% by volume carbon dioxide indefinitely. Look up hypercapnia.

    I should qualify this statement a little further, I don’t mean to be flip about inhaled CO2, but hypercarbia is a much more fixable problem than hypoxia, and pretty well tolerated. 10% may be pushing it but let me run down some ballpark numbers:

    Normal CO2 is 40 mmHg in your veins. People with various lung diseases may have it up to 60 mmHg, during an exacerbation I’ve seen them get > 100 mmHg. Atmospheric pressure is 760 mmHg. So exhaled breath, which is in equilibrium with venous blood, is around 5-10% CO2.

    Inhaled CO2 is normally close to zero, so with each breath you get rid of a certain amount of CO2. How much depends mostly upon the volume of your breath and the concentration of the CO2 in your veins. For illustrative purposes, we’ll say the healthy guy with 40 mmHg venous CO2 gets rid of 4 units of CO2 per breath.

    Now suppose you turn up the CO2 in the room to 40 mmHg (~5% CO2). For his first breath, he gets rid of no carbon dioxide: 40 mmHg went in, 40 out. So CO2 starts to build up in his tissues. Increasing CO2 makes his blood more acidic, which triggers a drive to breathe, a feeling of suffocation, fast heart rate, lower blood pressure, most likely panic. After a short period his CO2 is now up to 60 mmHg.

    If he is otherwise completely healthy he will be hyperventilating at this point and likely reaches a new equilibrium. If before he took 6 breaths of 500 mL per minute, now he takes 12 breaths of 500 mL per minute. He moves four times as much gas, but he inhales 40 mmHg in, 60 mmHg out, so half as much goes out per unit volume, but he is ventilating twice as quickly. So he stays at a stable 60 mmHg, which is survivable.

    Now all the bad effects of hypercarbia are due to the increasing blood acidity, so if this guy is in the hospital and you hook him up to an infusion of bicarbonate, he’ll actually maintain a normalish pH and will feel relatively fine. That just takes an IV and a pump–easy. After a few days his kidneys will start automatically adjusting his pH and he won’t even need the infusion anymore. That’s how the COPD guy who lives at 60 mmHg lives his life without feeling like he’s constantly suffocating–his kidneys have taken over and somewhat normalized his pH.

    All this is contingent upon the person being healthy enough that they can 1.) increase their respiratory rate to compensate, 2.) circulatory system is healthy enough that they can tolerate tachycardia and low blood pressure for a while. Not everybody is healthy enough to do this. Somebody who is not healthy enough to turn up their respiratory rate and is tiring out needs to be put on a ventilator to keep up.

    And it isn’t going to be pretty, I mean this guy is going to be hyperventilating, panicking, etc. due to the hypercarbia. But he will be alive, despite inhaling at atmosphere with over 100 times more CO2 than normal (400 ppm versus 5%). If you dropped the oxygen by a factor of 100, it’s lights out, immediately.

    If you have maxed out on inhaled oxygen, 100% inhaled still isn’t cutting it, then the only option is ECMO, which is a huge, huge deal.

    Anyway that’s how fentanyl kills–it resets the set point of the CO2 driven drive to breathe, so your repiratory rate goes too low and you die of hypoxia.

    • Replies: @Gabe Ruth
    Thank you, that is fascinating.
  19. Slightly on, or off topic, high levels of inhaled CO2 have often been used to help study panic attacks, since they tend to induce them in people who are otherwise healthy. Here is a study where they gave people either 5% inhaled CO2 or 35% inhaled CO2 and measured the degree to which they freaked out (but didn’t die.)

    https://www.ncbi.nlm.nih.gov/pubmed/16527360

    Spoiler alert: they freaked out. Anxious people really freaked out.

    Deep breathing exercises, going out to get some fresh air (indoor CO2 is higher than outdoor)–these have a very real physiologic basis in calming one’s self.

  20. I’m not buying this but it’s worth a look — this guy suggests subways were not the prime culprit in NYC spread

    https://marketurbanism.com/2020/04/19/automobiles-seeded-the-massive-coronavirus-epidemic-in-new-york-city/

  21. One caveat–as anyone who works in healthcare can tell you, if you put on a pulse oximeter and it’s not getting a good signal, it will often basically become a random number generator. So you may have a lot of false positives with this.

    I bought a pulse ox in February and have been checking my O2 sat every few hours ever since.

    It normally chills around 97%. When I was really sick at the start of March (I think I had a mild case of covid but was not tested and will never know) it dropped to 95% a few times but breathing faster brought it back up real quick. Sometimes it spikes to 99% and this seems to correlate with my pulse going up. I have cross-checked this with the readings from my fitbit (the fitbit consistently delivers readings that are ~5pp lower, but they correlate; when pulse ox says 97, fitbit says 92. When plus ox says 99, fitbit says 95).

    The other day I took some measurements and suddenly it was reporting that my O2 sat was at 92%. It consistently gave this reading on every finger. As part of troubleshooting, I wiped the sensor down with rubbing alcohol, in case it was dirty. This fixed it and it went right back to reporting 97%

  22. @anonymous
    All the top-ten oximeters (all seem to be american made or under an american imprimatur) are unavailable for purchase. Sold out. There's a lot of crap from China, however. There's no way to ascertain the quality of those, and they're dirt cheap, so it's not a stretch to assume they aren't of the highest quality.

    I guess if any good comes out of this, it's to showcase how pitifully unprepared we are for this kind of thing, as well as our lack of collective ability to ramp up manufacturing here when items to combat a virus are required.

    Still can't easily get a box of fucking high-end masks at this point, and I still can't grasp why finger-pointing and shaming globalists hasn't gained momentum. For the last 5 years, whenever my globalist friends would start up, I would repeat the same refrain, "globalism is death." They would just chuckle. An entire political party is behind it, and they're dancing around with no social repercussions. They really need to own this, don't they?

    Huge puzzler.

    All the top-ten oximeters (all seem to be american made

    Boy did they fool you.

    I highly doubt that a single one of them is American made. In fact, I doubt that the were EVER made in America (certainly not the inexpensive self-contained fingertip type home monitors). They were a Japanese invention to begin with. Maybe some of the original hospital type tabletop units that sold for thousands of $ could have been US made (more likely made for the US mfrs in Japan), but by the time these were available as consumer devices, the manufacturing would have been done 100% offshore, almost certainly in China. In the short run, we couldn’t make a device like this anymore even if we wanted to – the whole infrastructure is gone. And if we could make it, we sure as hell couldn’t make it to sell for under $50 retail let alone the $15 that the China brand units bring (or brought before they were bid up).

  23. OT: There now seems to be a concerted effort in the media to label HCQ as useless and even dangerous. I have no real opinion on the subject. I just found it interesting, and revealing of the depths of TDS, that Democrats and their operatives in the media (which is to say, for the most part, simply “the media”) poo-pooed what seemed like a useful drug simply because the Bad Orange Man had said a few nice things about it.

    There were a few uncontrolled clinical studies (done in the heat of medical battle against CoV) that indicated it might be useful. Tucker Carlson interviewed a number of doctors who had used it on the patients and said that it seemed to work. Dr. Mark Siegel, who is often on FOX, and always seems like a reasonable and knowledgable physician, even said that it saved his father. Now there is a study, drawing on data from VA hospitals that says HCQ is no good, however the way the study was described made it sound like it was also rather uncontrolled and perhaps useless.

    Also the treatment protocol is HCQ and Zithromax (an anti-biotic). Is it the HCQ that is effective? The Zithromax? Both? Neither?

    The response to it seems to be much more political than medical and/or scientific.

    • Replies: @Anon
    @ The response to it seems to be much more political than medical and/or scientific.

    Very politicized! Trump focused on finding a short term solution (opposed to a long-term vaccine) and was crucified. The second-in-command over at the nice WHO is all for remdesivir, tho, and nobody said a peep.
    Of course remdesivir is not doable at home.

    Covid is a treacherous nasty bug, no doubt, but the public conversation is all about lockdowns or curves. It should be about prompt home treatment. One wonders what happened to “empower the people”.

    Do any of these people have an aging parent they’re responsible for?
    , @Difference maker
    They will do anything to win. It is always a political game

    Hcq and Zithromax affect the heartbeat. They also prevent viral proliferation; they don't clear the virus. The immune system has to do that
  24. @songbird
    I had an idea once that you should be able to go to the public library and borrow different health monitoring devices. Like an oximeter and maybe, something like a fitbit, and something that would passively monitor your sleep by a kind of smart camera.

    Too bad in Chicago all the public libraries are CLOSED due to Gov. “Jelly Belly” Pritzker edicts

    You can borrow laptop computers from the CPL, so if someone with a little bit of cash could buy some and contribute them to CPL. On the other hand, who’s going to ensure the calibration of these devices? You would need to have some firm that would do that, and that would definitely be expensive.

  25. @anonymouse
    The problem is that you cannot get oxygen without a prescription, and it is almost impossible to get one. A non-rebreathing face mask does you no good without an oxygen device to connect it to.

    The problem is that you cannot get oxygen without a prescription

    You can get it from aviation supply businesses. Sporty’s has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.

    • Replies: @Mehen

    You can get it from aviation supply businesses. Sporty’s has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.
     
    A hospital tank has a valve from .5 liters/minute to 5 liters/minute. Most patients are set to 1-2 liters/minute. At that rate your consumer product would last between 5 to 10 minutes.
  26. Anon[294] • Disclaimer says:

    Doctors in Spain, Italy and Mexico have known this for —to my knowledge— for more than a week. Besides social distancing, masks, etc., one can do the following, checking with physician obviously.

    Profilaxis:
    – Use throat solution to gargle and inyect 2 ml of same solution in each nasal opening. I use Estericide Bucofaringeo, which promotes healthy pH. You can use any solution that has triple action: vs virus, vs bacteria, vs fungus. Can be done daily, twice daily, more. The idea is to stop the virus at the entry point.
    – something to modulate inmune function. Either homeopathy or vitamins (4,000 u vit D a day, 50 mg Zinc a day for 3 weeks, 1 week rest)

    Covid positive (read as “useful to have on hand”):
    – Ivermectin. A parasite drug that is regarded as extremely safe for humans. I will take this as soon as anyone near me is confirmed. Empirically, Patients have shown incredible recuperation in two days. I stress, AT THE BEGGINING. Not in the hospital. 1 6mg tablet today, one in a week. Inexpensive over-the-counter.

    – home treatment recommended by my internist (assuming previous bloodwork for Dimero D marker of coagulopathy, Ferritinina for inmune function, and EKG to preclude danger of arrythmia)
    * Bisolvon, throat medicine w bromhexine, substance that empirically seems to work very well. 10ml, 3x day.
    * Azithromycin 500 mg, 1 tablet a day for 6 days.
    * Hidroxicloroquine (EKG necessary). 400 mg morning & evening first day, 200 mg morning and evening next six days. It is a bit different from Didier Raoult protocol, giving a stronger shot on first day. Again, check w physician.
    * Clexane subcutaneous inyections. 1 mg x 1 kg of ideal weight. Comes in 40, 60, 80 mg. So 1 inyection morning and night, according to your weight, for 6 days.
    * Thermometer & Oximeter, measure body temperature and oxigen levels. Anything below 90% is of grave concern. Measure now everyone in your family so you have practice and point of reference.

    Anyway, it seems to me the Italians (given ZERO credit in Anglo media) have hit the nail in the head with heparin. The thesis is more than about clots, as follows:
    1) heparin prevents clots
    2) covid attaches itself to the body’s native ‘heparin’, so heparin tricks the virus into attacking it, thus reducing viral load.
    3) it has anti-inflammatory properties (can’t remember if because of #2), so helps with excessive inmune system reaction.

    See here how intrepid NY doctors are discovering —grudgingly, tho— the impact of blood clotting on covid patients. Notice China is cited but certainly not Italy:

    https://www.reuters.com/article/us-health-coronavirus-usa-blood/alarmed-as-covid-patients-blood-thickened-new-york-doctors-try-new-treatments-idUSKCN22421Z

    So italian doctors are suggesting to other countries or for next covid wave a home attention program, similar to what’s outlined above but including anti-bodies testing. That would also work well AT THE BEGINNING for at-risk groups and to avoid total shutdowns.

    https://www.maurizioblondet.it/due-verita-sul-cv-19-dei-medici-della-junta/

    DO CHECK heparin w your physician, dosis would need to be lowered/denied if danger of hemorragia present.

  27. @William Badwhite

    The problem is that you cannot get oxygen without a prescription
     
    You can get it from aviation supply businesses. Sporty's has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.

    You can get it from aviation supply businesses. Sporty’s has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.

    A hospital tank has a valve from .5 liters/minute to 5 liters/minute. Most patients are set to 1-2 liters/minute. At that rate your consumer product would last between 5 to 10 minutes.

    • Replies: @William Badwhite

    At that rate your consumer product would last between 5 to 10 minutes.
     
    Ouch. Up to $3/minute. That's on par with Whiskey's phone sex habit.

    Sporty's is pretty expensive for other aviation supplies so maybe it could be found elsewhere. Welding supply perhaps.
  28. Just be careful with those cheap ones from Ebay – they are notoriously inaccurate especially in the range you need them to work, i.e. when the oxygen levels become dangerously low. Read the reviews, and there are actually medical articles on this subject. The ones built-in in smartphones are also not particularly accurate. Also, make sure to clean your index finger and the oximeter itself before use, dirt will affect the readings.

  29. Anon[294] • Disclaimer says:
    @Mr. Anon
    OT: There now seems to be a concerted effort in the media to label HCQ as useless and even dangerous. I have no real opinion on the subject. I just found it interesting, and revealing of the depths of TDS, that Democrats and their operatives in the media (which is to say, for the most part, simply "the media") poo-pooed what seemed like a useful drug simply because the Bad Orange Man had said a few nice things about it.

    There were a few uncontrolled clinical studies (done in the heat of medical battle against CoV) that indicated it might be useful. Tucker Carlson interviewed a number of doctors who had used it on the patients and said that it seemed to work. Dr. Mark Siegel, who is often on FOX, and always seems like a reasonable and knowledgable physician, even said that it saved his father. Now there is a study, drawing on data from VA hospitals that says HCQ is no good, however the way the study was described made it sound like it was also rather uncontrolled and perhaps useless.

    Also the treatment protocol is HCQ and Zithromax (an anti-biotic). Is it the HCQ that is effective? The Zithromax? Both? Neither?

    The response to it seems to be much more political than medical and/or scientific.

    @ The response to it seems to be much more political than medical and/or scientific.

    Very politicized! Trump focused on finding a short term solution (opposed to a long-term vaccine) and was crucified. The second-in-command over at the nice WHO is all for remdesivir, tho, and nobody said a peep.
    Of course remdesivir is not doable at home.

    Covid is a treacherous nasty bug, no doubt, but the public conversation is all about lockdowns or curves. It should be about prompt home treatment. One wonders what happened to “empower the people”.

    Do any of these people have an aging parent they’re responsible for?

  30. @Mr. Anon
    OT: There now seems to be a concerted effort in the media to label HCQ as useless and even dangerous. I have no real opinion on the subject. I just found it interesting, and revealing of the depths of TDS, that Democrats and their operatives in the media (which is to say, for the most part, simply "the media") poo-pooed what seemed like a useful drug simply because the Bad Orange Man had said a few nice things about it.

    There were a few uncontrolled clinical studies (done in the heat of medical battle against CoV) that indicated it might be useful. Tucker Carlson interviewed a number of doctors who had used it on the patients and said that it seemed to work. Dr. Mark Siegel, who is often on FOX, and always seems like a reasonable and knowledgable physician, even said that it saved his father. Now there is a study, drawing on data from VA hospitals that says HCQ is no good, however the way the study was described made it sound like it was also rather uncontrolled and perhaps useless.

    Also the treatment protocol is HCQ and Zithromax (an anti-biotic). Is it the HCQ that is effective? The Zithromax? Both? Neither?

    The response to it seems to be much more political than medical and/or scientific.

    They will do anything to win. It is always a political game

    Hcq and Zithromax affect the heartbeat. They also prevent viral proliferation; they don’t clear the virus. The immune system has to do that

  31. @anonymous
    All the top-ten oximeters (all seem to be american made or under an american imprimatur) are unavailable for purchase. Sold out. There's a lot of crap from China, however. There's no way to ascertain the quality of those, and they're dirt cheap, so it's not a stretch to assume they aren't of the highest quality.

    I guess if any good comes out of this, it's to showcase how pitifully unprepared we are for this kind of thing, as well as our lack of collective ability to ramp up manufacturing here when items to combat a virus are required.

    Still can't easily get a box of fucking high-end masks at this point, and I still can't grasp why finger-pointing and shaming globalists hasn't gained momentum. For the last 5 years, whenever my globalist friends would start up, I would repeat the same refrain, "globalism is death." They would just chuckle. An entire political party is behind it, and they're dancing around with no social repercussions. They really need to own this, don't they?

    Huge puzzler.

    …whenever my globalist friends would start up, I would repeat the same refrain, “globalism is death.” They would just chuckle. An entire political party is behind it…

    “An?” Singular?

  32. @Mehen

    You can get it from aviation supply businesses. Sporty’s has a 10-liter cylinder for about $14. I have no idea how that compares to medical supply.
     
    A hospital tank has a valve from .5 liters/minute to 5 liters/minute. Most patients are set to 1-2 liters/minute. At that rate your consumer product would last between 5 to 10 minutes.

    At that rate your consumer product would last between 5 to 10 minutes.

    Ouch. Up to $3/minute. That’s on par with Whiskey’s phone sex habit.

    Sporty’s is pretty expensive for other aviation supplies so maybe it could be found elsewhere. Welding supply perhaps.

  33. @anonymouse
    The problem is that you cannot get oxygen without a prescription, and it is almost impossible to get one. A non-rebreathing face mask does you no good without an oxygen device to connect it to.

    I have a huge tank of it in my garage, which is refilled at my local welding supply store. No prescription, and the same quality as medical oxygen.

  34. I always thought breathing pure oxygen would kill you as sure as anything. Is this untrue?

    Pure oxygen can be deadly. Our blood has evolved to capture the oxygen we breathe in and bind it safely to the transport molecule called haemoglobin. If you breathe air with a much higher than normal O2 concentration, the oxygen in the lungs overwhelms the blood’s ability to carry it away.

    • Replies: @Steve Sailer
    Especially if your Apollo space capsule catches fire.
  35. @FUBSY
    I always thought breathing pure oxygen would kill you as sure as anything. Is this untrue?

    Pure oxygen can be deadly. Our blood has evolved to capture the oxygen we breathe in and bind it safely to the transport molecule called haemoglobin. If you breathe air with a much higher than normal O2 concentration, the oxygen in the lungs overwhelms the blood's ability to carry it away.

    Especially if your Apollo space capsule catches fire.

    • Replies: @JMcG
    Too soon Steve, too soon.
  36. @Steve Sailer
    Especially if your Apollo space capsule catches fire.

    Too soon Steve, too soon.

  37. @SimpleSong
    I should qualify this statement a little further, I don't mean to be flip about inhaled CO2, but hypercarbia is a much more fixable problem than hypoxia, and pretty well tolerated. 10% may be pushing it but let me run down some ballpark numbers:

    Normal CO2 is 40 mmHg in your veins. People with various lung diseases may have it up to 60 mmHg, during an exacerbation I've seen them get > 100 mmHg. Atmospheric pressure is 760 mmHg. So exhaled breath, which is in equilibrium with venous blood, is around 5-10% CO2.

    Inhaled CO2 is normally close to zero, so with each breath you get rid of a certain amount of CO2. How much depends mostly upon the volume of your breath and the concentration of the CO2 in your veins. For illustrative purposes, we'll say the healthy guy with 40 mmHg venous CO2 gets rid of 4 units of CO2 per breath.

    Now suppose you turn up the CO2 in the room to 40 mmHg (~5% CO2). For his first breath, he gets rid of no carbon dioxide: 40 mmHg went in, 40 out. So CO2 starts to build up in his tissues. Increasing CO2 makes his blood more acidic, which triggers a drive to breathe, a feeling of suffocation, fast heart rate, lower blood pressure, most likely panic. After a short period his CO2 is now up to 60 mmHg.

    If he is otherwise completely healthy he will be hyperventilating at this point and likely reaches a new equilibrium. If before he took 6 breaths of 500 mL per minute, now he takes 12 breaths of 500 mL per minute. He moves four times as much gas, but he inhales 40 mmHg in, 60 mmHg out, so half as much goes out per unit volume, but he is ventilating twice as quickly. So he stays at a stable 60 mmHg, which is survivable.

    Now all the bad effects of hypercarbia are due to the increasing blood acidity, so if this guy is in the hospital and you hook him up to an infusion of bicarbonate, he'll actually maintain a normalish pH and will feel relatively fine. That just takes an IV and a pump--easy. After a few days his kidneys will start automatically adjusting his pH and he won't even need the infusion anymore. That's how the COPD guy who lives at 60 mmHg lives his life without feeling like he's constantly suffocating--his kidneys have taken over and somewhat normalized his pH.

    All this is contingent upon the person being healthy enough that they can 1.) increase their respiratory rate to compensate, 2.) circulatory system is healthy enough that they can tolerate tachycardia and low blood pressure for a while. Not everybody is healthy enough to do this. Somebody who is not healthy enough to turn up their respiratory rate and is tiring out needs to be put on a ventilator to keep up.

    And it isn't going to be pretty, I mean this guy is going to be hyperventilating, panicking, etc. due to the hypercarbia. But he will be alive, despite inhaling at atmosphere with over 100 times more CO2 than normal (400 ppm versus 5%). If you dropped the oxygen by a factor of 100, it's lights out, immediately.

    If you have maxed out on inhaled oxygen, 100% inhaled still isn't cutting it, then the only option is ECMO, which is a huge, huge deal.

    Anyway that's how fentanyl kills--it resets the set point of the CO2 driven drive to breathe, so your repiratory rate goes too low and you die of hypoxia.

    Thank you, that is fascinating.

  38. What you REALLY need to know (not stated in the article), is that you should consider going to the ER if the OxSat is less than about 90.

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