Discussions

Yes, you are correct that people who have the virus but are non-symptomatic can still spread the virus; we call this “viral shedding.” One of the limitations in our understanding of how this virus spreads is that we don’t really know how far “droplets” go…6ft is not some expertly-calculated upper-limit of dispersion, it’s more like an average around which most particles spread, but you should expect some variation including travel of viral particles well beyond 6 ft. There are many factors that can contribute to this: the force of expulsion and the prevailing air currents are two factors that come quickly to mind. It would be unwise to assume that one is at less risk of exposure only because they’re not sharing an aisle with someone or the cashier is lower than face level. We do have some new data on how long the virus can last on different surfaces (“fomites”): SARS-CoV-2 was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel (https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces). If you’re going to any site where > 10 people typically congregate, then wear N95 + goggles + gloves. Limit the number of people in your family who go outside to get groceries, gas, etc. The virus spreads along social contacts, so we must limit that number in order to reduce the burn rate.

Here are my suggestions (I’m a physician and I’m certified in Advanced Wilderness Life Support): -Oral Dissolving Tablet (ODT)/Sublingual formulation: awesome but is the most difficult to obtain and not all medications are offered in this formulation. Offers rapid administration and are usually stored in blister packs. I prefer ODT for medications that are important to give when the patient is nauseous/vomiting (traditional oral medications might not stay down long enough to get absorbed). For example, I keep my Ondansetron 8mg ODT (brand name Zofran) to rapidly (<5 minutes) reduce nausea. I absolutely love Zofran, as a doctor and as a patient, but it’s a prescription medication, so you’ll need to get creative.If you know someone with “angina” you might be familiar with their “nitro” pills; these are also ODT. -“Chewable”: sort-of like ODT. I keep all of my Asprin (81mg) in chewable forms. -Tablet and Capsules: good because they are 1.) robust (don’t lose their form/turn into powder easily), 2.) retrievable (you can spill them and re-acquire them without loss of efficacy), 3.) don’t require a measuring tool (liquids need a cup), 4.) easily accessible, and 5.) are stable and easy to administer in a variety of settings. A problem I encountered when storing my tablets/capsule meds: I buy bulk if I can so I end up having to store the pills in a new container to save space/weight. The pills often don’t fit perfectly in my new containers so I pack them with cotton. This not only protects the pills from abrasion but keeps my bag quiet. -Liquid formulations: AVOID. These are difficult to measure without some kind of graduated container (which you might not have, or more likely has become dirty). Also, imagine if you tip over an open bottle…you can pick pills up, but you’re never going to separate your liquid Tylenol from the dirt. AVOID SPILLS, CHOOSE PILLS! (I just made that up…rhyming helps the brain remember things)

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Yes, you are correct that people who have the virus but are non-symptomatic can still spread the virus; we call this “viral shedding.” One of the limitations in our understanding of how this virus spreads is that we don’t really know how far “droplets” go…6ft is not some expertly-calculated upper-limit of dispersion, it’s more like an average around which most particles spread, but you should expect some variation including travel of viral particles well beyond 6 ft. There are many factors that can contribute to this: the force of expulsion and the prevailing air currents are two factors that come quickly to mind. It would be unwise to assume that one is at less risk of exposure only because they’re not sharing an aisle with someone or the cashier is lower than face level. We do have some new data on how long the virus can last on different surfaces (“fomites”): SARS-CoV-2 was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel (https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces). If you’re going to any site where > 10 people typically congregate, then wear N95 + goggles + gloves. Limit the number of people in your family who go outside to get groceries, gas, etc. The virus spreads along social contacts, so we must limit that number in order to reduce the burn rate.

Here are my suggestions (I’m a physician and I’m certified in Advanced Wilderness Life Support): -Oral Dissolving Tablet (ODT)/Sublingual formulation: awesome but is the most difficult to obtain and not all medications are offered in this formulation. Offers rapid administration and are usually stored in blister packs. I prefer ODT for medications that are important to give when the patient is nauseous/vomiting (traditional oral medications might not stay down long enough to get absorbed). For example, I keep my Ondansetron 8mg ODT (brand name Zofran) to rapidly (<5 minutes) reduce nausea. I absolutely love Zofran, as a doctor and as a patient, but it’s a prescription medication, so you’ll need to get creative.If you know someone with “angina” you might be familiar with their “nitro” pills; these are also ODT. -“Chewable”: sort-of like ODT. I keep all of my Asprin (81mg) in chewable forms. -Tablet and Capsules: good because they are 1.) robust (don’t lose their form/turn into powder easily), 2.) retrievable (you can spill them and re-acquire them without loss of efficacy), 3.) don’t require a measuring tool (liquids need a cup), 4.) easily accessible, and 5.) are stable and easy to administer in a variety of settings. A problem I encountered when storing my tablets/capsule meds: I buy bulk if I can so I end up having to store the pills in a new container to save space/weight. The pills often don’t fit perfectly in my new containers so I pack them with cotton. This not only protects the pills from abrasion but keeps my bag quiet. -Liquid formulations: AVOID. These are difficult to measure without some kind of graduated container (which you might not have, or more likely has become dirty). Also, imagine if you tip over an open bottle…you can pick pills up, but you’re never going to separate your liquid Tylenol from the dirt. AVOID SPILLS, CHOOSE PILLS! (I just made that up…rhyming helps the brain remember things)