CPAP use for Coronavirus mitigation & severe pneumonia

[dbainbr]

Well, if someone in my house has it, I might want to use my APAP nearly full time, Hey, it's worth a try.

[PoolQ]

with HEPA filters you want to put a standard filter first in the airflow so it catches as much as possible and less to clog the HEPA. After the HEPA may "spring" load the HEPA against the inlet, but it will protect nothing. My HEPA filters have a course filter surface on the front. seats the HEPA nicely, pre-filters for the HEPA and IMHO works quite well

[2SleepBetta]

It looks like interest in the thread is waning, but it may pick up so here goes with what looks to be, at least in part, additional useful material. 


Full disclosure, still lacking criticism it seems the idea in the child-like (my apologies, kids) sketch of the PAPPER IN A WIND-TUNNEL-FUNNEL that hit me (just as I was finishing an earlier post in this thread) addresses issues of the troubling open system problem of xPAP: contamination of the whole living space if mask exhaust is not well controlled and promptly discharged outdoors or captured in a filter. As pointed out by others, the space may already be fully contaminated and have other sick people by then.


Here are helpful reading materials, some new and some recapping info above. All is offered here in our context of doing what you can to save life now with what you have now and being prepared for those hours the best we can be. With our focus on how to utilize xPAP in the covid emergency, the greatest challenge is from their open system discharge of pathogens into the living space. Is it more practical to filter/scrub them out with unproven attachments to xPAP devices or to simply flush them out from the source immediately and continuously using a large volume of relatively fresh air, much as a brief flow of water carries a load of matter away from the toilet bowl. 


What means of eliminating the problem allows a reasonable level of patient assistance and access with least contamination of air and surfaces in his room? If patient can sit on bed or commode and can tolerate (at some stage of infection) having xPAP mask off to eat or drink, how minimize contamination of the room or overall quarters and any caregiver needed then?

       -HEPA topics

•      Here's a bit of information about (German made) Miele vacuum cleaner HEPA filter and the enhanced European HEPA standard capture of up to 99.95% of 0.1micron matter. Their post-motor cannister filter is about 8in X 2.5in outside its "plastic frame". I can visualize improvising a mounting of something like it onto, or connecting it to, an Autoset or Vauto intake or mask outlet, given helps, above, in this thread. 
  
•      But, “Your typical HEPA filter is not going to be able to remove coronavirus from the air,” said Dr. Erin Sorrell, an assistant professor of microbiology and a member of Georgetown’s Center for Global Health Science and Security. “The filter itself is .3 microns and the virus itself is roughly .1 microns.” That is per Dr. Erin Sorrell  https://microbiology.georgetown.edu/sorrell/# whose qualifications in airborne virology are extensive. She is also quoted/referred-to here https://www.bhg.com.au/can-air-purifiers...oronavirus regarding the air purifier filtration limitations, the benefits of higher humidity levels, 40% or higher, and of opening doors to fresh air. 
  

       -Other topics      

• -The following article discusses virus infection anomalies of the present covid infections; sickness level does not vary consistently with patients' different viral loads and neither does infectious dosage level with sickness (terms are defined). https://www.newscientist.com/article/223...-19-worse/ Concentrations of viral dosage (infectious dosage) and viral load carried (and being shed) by patient both bear on understanding how to reduce exposures, with or without xPAP. 

• -A chilling detailed account of a covid take down of a healthy person is included here, not to be scary but because it helped me understand how it attacks, why it is so insidious and why hand and surface cleaning is a matter of survival if the virus is present. (I am unfamiliar with the New York Magazine, the source, which I am taking as credible. It has dropped its paywall to promote understanding of covid.)  https://nymag.com/intelligencer/2020/03/...ction.html (Link was working, but not now and site may only be down as I hit publish.)

• -In this thread, and from airborne virologist experts I think I understand, the biggest payoff toward covid avoidance is, yes, just as experts have been saying. Besides distancing and that most important hand washing technique and time, our scrupulous attention to not touching face or eyes unnecessarily and to cleaning surfaces is vital and #1. 

• Whoever we help that is infected must stay in their same (continually sanitized surfaces) space if possible. If xPAP is used in that space by a sick person then we must do the surest thing we know to prevent the caregiver from getting their infectious dose--given that huge virus populations are being shed from the sick person's viral load of them. It's true that almost any mask or filter is better than none to avoid contact with a bath of infectious droplets while near a person. No doubt the enhanced standard HEPA filters (99.95% of >=0.1 micron) will reduce the dosage of virus entering the xPAP or going out of its mask.  But how significantly vs benefits of attention to sanitation measures and significant risks of handling the contaminated filter.

[Sleeprider]

The term "hypoallergenic" in a filter does not imply a more efficient filter, rather it only means the materials are generally considered not to trigger allergies. This term has been used in marketing for a long time for everything from furnace filters to vacuum cleaners. It's pretty meaningless.

[srlevine1]

The term "hypoallergenic" in a filter does not imply a more efficient filter, rather it only means the materials are generally considered not to trigger allergies.  This term has been used in marketing for a long time for everything from furnace filters to vacuum cleaners.  It's pretty meaningless.

   steve

[70sSanO]

My summary of all this...

Seeking medical care is the best route if someone has contracted COVID-19.

BiLevel (preferred) to CPAP is at least some benefit in non-ICU situations or if there is no other option. For those who have the skills to make modifications to improve equipment, go for it. For most people it will be a best effort to use what we have. Having different size masks to fit others in the house. Oxygen is probably a plus.

The best prevention is to distance yourself, and be diligent to use good hygiene. Not touching your face is primary. Not being stupid, or defiant, and wanting to maintain a lifestyle or family gatherings. Every person is a potential threat. Not ever getting the virus trumps everything in this thread.

A mask (preferably N95+) and eye protection should be used, if possible, when it is necessary to interact with the public for essential items/appointments. Pride comes before a fall. Even multi-layer dense cotton is better than nothing (health care professional have resorted to this). Care in the removal and cleaning of masks and eye protection is important.

Best effort to isolate a person in a particular room who may have contracted the virus. Caregiver needs to wear protection; I would think even a plastic trash bag, mask, and goggles is better than nothing. Some method to remove infected air in the room, even a HEPA air purifier can help. Special hygiene care to protect potential infection in other areas in the home.

Everybody stay safe out there.

John

[knucklesthecat]

Noobie here - this thread has SO decreased my anxiety, feeling now that at least I have some control if the worst happens.  Thanks everybody!

[Muddpa]

WOW, I read the post and I have no answer, except to pray and cross my fingers.  Please everyone try to stay safe and healthy.

[3rdMarDiv]

Very good article here that came out from NPR yesterday CPAP Machines Were Seen As Ventilator Alternatives, But Could Spread COVID-19

Doing further research I found that ResMed has a section devoted to Covid-19 and their response and also has a FAQ section. Within the FAQ section I found a response to concerns about spreading Covid-19 via CPAP use. See Below:

https://www.resmed.com/en-us/covid-19/

Information is changing daily, but the latest we’ve seen suggests that:

    Invasive ventilation carries a lower risk of spreading COVID-19 through aerosolization or droplet dispersion (exhaling air particles that have a contagion) because air exits through a tube just as it came into the patient.
    Non-invasive ventilation, Evidence suggests that non-invasive ventilation procedures are more likely to produce large droplets (>10 μm) rather than aerosols, and that these are largely confined to within one meter due to their large mass. This suggests that the risk of droplet dispersion as a result of using non-invasive ventilation or bilevel devices may not be that different to that of any COVID-19 patient in the hospital who is coughing or sneezing. Additionally, non-invasive ventilation systems with a good interface fitting do not create widespread dispersion of exhaled air, according to an experts’ panel cited by the U.S. National Center for Biotechnology Information (NCBI). Recommendations have been published to support good mask fit to reduce aerosols, including the use of full face masks. Nonetheless, the risk of aerosol dispersion needs to be mitigated with appropriate isolation of patients and the use of Personal Protective Equipment (PPE) for healthcare workers, such as N95 masks/respirators and eye protection, which are standard protective equipment in a COVID-19 ICU.

As with everything else involving information about the covid-19 outbreak information is many time contradictory. I would hope that ResMed is not trying to mitigate negative information about CPAP spreading the virus and is trying to provide accurate information.

I'm still thinking that the article provided by SR above should be taken as a likely scenario and I am going to continue on with the assumption that it is to be heeded. But, from a rationalizing standpoint I like what ResMed is saying about our machines being no different than what is produced by any infected person in a home environment.

I'm hoping that ResMed is correct in their statements. I would like to see what their evidence is. I also do not know why, as leading experts, they are saying that the "evidence suggests". I would think they should be saying "our evidence has proven".

My reading shows them to be a bit wishy-washy about this question.

[SuperSleeper]

I'm hoping that ResMed is correct in their statements. I would like to see what their evidence is. I also do not know why, as leading experts, they are saying that the "evidence suggests". I would think they should be saying "our evidence has proven".

My reading shows them to be a bit wishy-washy about this question.

Two things:

1. Their legal dept is all paranoid about lawsuits, so they would never say "our evidence has proven". That's why they use weasle-words such as "evidence suggests..."

2. Keep in mind, they're in the business of selling CPAP machines, so they're not going to outright say that CPAP is dangerous for COVID-19 patients. Consider the source.

That said, I think when push comes to shove, the benefits of CPAP likely outweigh the advantages in a worst-case scenario where no other options are available. We need to be aware of the risks and do our best to mitigate them as best we can using PPE and perhaps some degree of negative pressure for patient rooms to vent exhaled air outside if possible.