What does increased risk look like for those with chronic lung disease?
COVID-19 is a virus that directly affects the lungs. While people with lung disease are not more likely to get the virus, they are more likely to have a more serious case if they do get it. Specifically, they are at more risk of hospitalization and, perhaps, more at risk of needing the Intensive Care Unit. Preventing the contraction of the virus and following the guidelines from public health is extremely important. These are:
- Proper hand washing techniques. Wash your hands with soap and water for at least 20 seconds.
- Stay at home.
- Stay away from those who are sick.
- Wear a face mask
Equally as important is following the specified drug regimen for managing your existing lung disease.
How can the virus impact people with asthma or COPD?
People with asthma or COPD can protect themselves by taking their usual medications, as prescribed. This will ensure that if you do get the virus, your lungs are functioning as well as they can be. If on an inhaled steroid or another type of puffer, make sure you take it regularly as prescribed. At this stage, we don’t know much about what happens to patients with asthma and COPD when they get coronavirus. There haven’t been many studies published at this point yet but it is likely that getting the infection with coronavirus may worsen your underlying asthma or COPD and may worsen your air flow obstruction. Those who also contract pneumonia risk even more serious health outcomes. We strongly urge everyone to follow the proper guidelines on handwashing, social distancing and isolation and avoiding those who are sick.
There is no evidence that wearing a mask/facial covering will lead to prologed symptoms or flare-up of an underlying lung condition.
For somebody living with lung disease, for instance asthma or COPD, are there additional measures (in addition to hand washing, hygiene and cleanliness) that they should take?
The same behaviours that protect the general population are the same behaviours that protect people with lung disease. Canadians with lung disease can reduce their risk by self-isolating and keeping away from members of the community who may have the virus. This guidance applies to all Canadians, and is especially important for those living with a chronic lung disease, such as asthma, COPD or pulmonary fibrosis.
Follow the guidelines below to reduce your risk of contracting COVID-19:
- Only be in contact with the people you’re sharing a home with.
- Avoid going outside as much as possible.
- If you do go out, stay at least two metres (6 feet) away from other people.
- If you have to go to the grocery store, bring some wipes and make sure you wipe down the grocery cart handle, bring an alcohol-based sanitizer with you to clean your hands off.
- Avoid touching your face.
- Follow your existing action plan, continue to take prescribed medication and inform your caregivers and your healthcare team of any changes, such as a fever.
Do we know the long-term effects of COVID-19 and does it damage your lungs? Could it be worse for those who already have lung disease?
It is still too early to know what the long-term impacts are, particularly for those living with lung disease. We know that the COVID-19 virus is primarily a respiratory virus and much of the injury occurs is in the lungs. Any time a virus invades our lungs, it activates our immune system. But it also causes inflammation. This inflammation can sometimes have a good impact on the virus and keep it at bay, but it can also damage some of the normal cells in our lungs and airways. This means that for those living with lung disease there is a risk that there will be further damage to the lungs with an infection with COVID-19. What we do know is that when we have something like inflammation in our bodies and when we’re repairing after an injury, we can develop scars. And, we can think about that even in the setting of people with lung disease – we may not be able to reverse some of the damage that occurs from this virus for those who already have underlying lung disease. Unfortunately, at this point we don’t know to what extent that will have an impact at an individual and also at a population level.
Does the risk for severity change depending on the type of lung disease I have and is there different advice for protecting myself from COVID-19 depending on the type of lung disease I have?
The guidelines for prevention and protection from COVID-19 for those at highest risk are the same regardless of the type of condition that puts an individual at greater risk. Individuals should strive to maintain their current regimen of medications, exercise, and/or follow their control plans to the best of their ability. Stay at home as much as you can to reduce potential exposure to COVID-19 and seek alternate ways to connect with support systems. Follow hygiene guidelines including proper handwashing.
There is an increased risk of more severe outcomes for Canadians:
- aged 65 and over
- with compromised immune systems
- with underlying medical conditions
How does someone with lung disease, who already has issues with breathing, know if they have symptoms of COVID-19 or just exacerbated symptoms of their own. What symptoms should they look for?
It can be difficult to tell the difference between worsening asthma, for example, and a COVID-19 infections, as many symptoms can overlap. One differentiating symptom may be fever, which can accompany COVID-19, but not an asthma exacerbation.
If you find that you are feeling more short of breath than usual, have a fever or a persistent cough, contact your healthcare provider. If your situation becomes dire and you cannot breathe, call 911.
It is key to continue to treat your existing lung condition and continue to take your prescribed medications and follow your action plan if you have it.
How long do people remain infectious after diagnosis, onset of symptoms, or resolution of symptoms?
The science and evidence continues to evolve. It is recommended that those who have symptoms stay in isolation for 10 days or until 24 hours after their symptoms are gone. Whichever is longer.
Do you get immunity once you acquired coronavirus? Could positive test renders some immunity to the virus even without developing the symptoms? Do you expect this to be like flu, which could be seasonal?
The coronavirus is still a very new virus and as a result it is difficult to predict with certainty whether people can get the virus twice and how it may/may not reappear.
Smoking, vaping and COVID-19
Is there any link between vaping/smoking/water pipe use and susceptibility to COVID-19?
Yes. The use of shared water pipes has been linked to the spread of certain infectious diseases. Furthermore, the use of cold water in the water pipes can facilitate survival of bacteria and/or viruses. While information regarding susceptibility of those who smoke to contracting COVID-19 is still forthcoming, we do know that those who smoke are two to four times more likely to contract bacterial and/or viral infections. Among Chinese patients who contracted COVID-19 and have a history of smoking, the odds of disease progression or death were found to be 14 times higher. While we do not know yet what effect vaping may have, it has dangers in general. We strongly urge those who smoke, vape or use water pipes to quit. For more resources on quitting, click here. For more information, visit https://untobaccocontrol.org/kh/waterpipes/covid-19/.
Should those who have lung cancer or are in remission be doing something differently? What about those who have weakened immunity for other reasons?
Coronavirus is spread through direct contact with someone who might cough or sneeze in your vicinity or through touching a surface where that virus has landed. We know that the virus can live on different surfaces for a number of hours. Knowing this, following strict social distancing measures is extremely important for anyone with compromised immunity. If you suspect you’ve been in an area where you could have contracted the virus, practice proper handwashing techniques and avoid touching your face. Simply put, practicing social distancing and isolation, proper hygiene and cleanliness guidelines is not only recommended, it is vital for individuals living with lung cancer, those under treatment or those with otherwise compromised immune systems.
What can caregivers or frontline staff who have lung disease do to protect themselves? What can healthy caregivers for those who have lung disease do to protect the patients?
Caregivers should adhere to the recommended guidelines as they pertain to social distancing, hygiene and cleanliness. It is just as important for the caregivers to ensure the person they’re caring for leads a healthy lifestyle. It is important to maintain good nutrition; continue exercising and maintaining social support and mental well-being. This could mean helping your loved one set up on video calls or social media to maintain a “social life” in a time of isolation.
Frontline staff or those who may be required to work outside of the home who have a lung disease should talk to their doctor. They may have to get dispensation from their physician to stay home because of increased potential for exposure and their high risk. That is a conversation for the staff member, the physician and the employer.
What should parents of children with asthma be doing to protect their children if they go to work and are not able to stay at home? What can they do to protect their kids?
Most importantly, they should keep their child on his or her asthma medication. When at work, they should try to practice safe public health guidelines. In other words, avoid socializing with coworkers and wash their hands frequently. When they come home at the end of the day, they should remove their work clothes, wash their hands and take a quick shower. Once they are changed and clean, they should hug their child.
When should people wear face masks and who should wear them?
We support the Public Health Agency of Canada’s recommendation of wearing a non-medical face mask in the community for periods of time when it is not possible to consistently maintain a 2-meter physical distance from others. We recommend that all individuals with underlying lung disease follow this recommendation to reduce the risk of spreading the SARS-CoV-2 virus.
The mask must be well fitted and you must continue to follow proper hygiene.
- Wear a mask if you’re told to wear a mask by a health professional, such as when you have a cough and need to go to the hospital.
- Wear a mask where social distancing of at least 2 meters is not possible.
- Even with a mask, you need to follow the handwashing and social distancing guidelines. You should not touch your mask and your face.
- Single-use masks are only generally effective for an hour, then they need replacing.
- Wash your reusable face mask after each use.
- You need to maintain proper hygiene while using the mask. Once someone coughs inside the mask, it would have to be replaced. Likewise, walking through an area where the virus is present, might cause it to settle on the mask. If you touch your mask and then your face, you may become infected.
- If the wearing of a face mask causes you anxiety or shortness of breath, avoid situations that that make physical distancing difficult.
How can we make sure that the air we have in our homes is actually good and clean now that we are spending so much time at home?
Look at anything you do that could decrease the air quality of your home. This includes avoiding burning candles, incense and smoking. This includes second-hand smoke. We recommend people stop smoking and vaping to protect themselves and the loved ones they live with. If you have a forced air furnace, change your air filter to ensure it is clean. Decrease or eliminate your use of scented personal or cleaning products. If you are using bleach to disinfect a surface, make sure you read the label to use it properly. If you are looking at an air purifier avoid ones that produce ozone. If you are using a Hepa-filter for room air purifying, make sure that it is maintained and the filter cleaned properly according to the manufacturer’s directions. Keep the humidity in your home under control, dust and clean.
Are there breathing exercises that people can be doing to strengthen the lungs just so they are best prepared to handle whatever situation might arise?
We recommend continued exercise, including cardio, strength, and flexibility. It will help with cardiovascular efficiency, it’s good for your mood and it passes the time. Exercise will make you more effective at using oxygen and give you a lot of extra physical and emotional capacity to be able to do your daily activities.
There’s a challenge around mental health and anxiety for those who are suffering with lung disease. What tips can you offer for dealing with increased stress, anxiety, or depression surrounding COVID-19 and the severity of it?
It’s normal to have high anxiety in these times. Look for helpful breathing techniques to cope with the stress or increased shortness of breath. It is recommended that people living with chronic lung disease look for support and create a support network of friends, family and neighbours.
If people are experiencing increased symptoms of mental health concerns, they should seek help. Look for mental health helplines in your community if you need to speak with someone or visit https://www.canada.ca/en/public-health/services/mental-health-services/mental-health-get-help.html.
Access to Medications
What can you tell us in terms of the use of steroids, Prednisone and inhalers with COVID-19?
If you are prescribed a steroid inhaler for your disease management, continue to use it. If you’re having an acute crisis of your lung disease and your action plan includes Prednisone, you should take it. But there is no evidence that Prednisone itself helps to treat COVID-19 infection. Do not start taking Prednisone in an effort to try to prevent or cure COVID-19.
Is it still safe to go to your doctor’s appointments and should people keep their asthma clinic appointments?
Keep visits to the hospital or a clinic only for emergencies. Check with your healthcare provider or your asthma clinic for alternative ways of staying in touch. Many clinics offer check-ups by phone or via video. Only seek medical help if you feel acutely ill. It continues to be important to manage your chronic disease but doing so from the safety of your home.
Should people who have a lung disease go directly to the hospital because of underlying conditions if they experience COVID-19 symptoms? Is it dangerous to go to the hospital and expose themselves to the risk of contracting COVID-19?
We advise that you monitor your health and your symptoms. If you start feeling worse than usual, activate your action plan. If your situation worsens and you’re getting subjectively more short of breath or your fever is spiking, it may be time to go to the emergency department. While being present in a hospital may put you at risk, the healthcare providers at the department are trained to isolate you to reduce the spread of COVID-19.
Should people who need regular blood work, blood transfusions, or have on-going ultrasounds, etc., appointments continue to go to their appointments?
If you have a regular appointment and it is something that you cannot miss then you need to go but, you need to be aware that you have to maintain social/physical distance from the other people who come. Bring your hand sanitizer with you and sanitize your hands frequently, and as soon as your appointment is finished, you should head back home.Many places have been implementing timed appointments to minimize the traffic through units. It is worth asking in advance ‘How are you limiting traffic in this area in order for me to protect my health?’
How important is it for people living with lung disease to get the pneumonia or influenza vaccine, and will it offer additional protection? What about a booster?
The vaccine for pneumonia is for a specific bacterium, called streptococcal pneumonia (pneumococcal pneumonia). This bacteria is responsible for common pneumonia. The flu vaccine protects against an influenza virus that is aimed at the most common virus causing illness in this upcoming season. Vaccines for people with lung disease are very important because these people are at higher risk for pneumonia. The benefits from vaccinations are even greater in those over the age of 65. The flu or pneumonia causes extra inflammation in the lungs and airways and it can cause extra mucus to develop. Sometimes that can be so much so that it might affect our lungs’ ability to deliver oxygen to the rest of our body. This could result in hospitalizations.
The pneumonia vaccine and the flu vaccine don’t offer any specific protection against the coronavirus. But we do know that some people who have been infected with coronavirus may get “super infected”. This means they can get co-infected with influenza or could develop a bacterial pneumonia. For this reason, there are benefits to having these vaccines on board because they may be able to offer protection from developing either the flu or a bacterial pneumonia in addition to COVID-19.
However, if you do not already have the vaccine or cannot get the booster, do not go to the clinic or hospital to get it now.
Should people stock up on any type of emergency equipment, such as oxygen, ventilators or inhalers?
Stay on prescribed medications. This includes oxygen as well. However, do not buy oxygen concentrators if you have not been prescribed oxygen by your healthcare professional. If you contract COVID-19 and the case is so serious that oxygen or ventilators are needed, you need to be in a hospital.
Are there any home remedies I can try? For example, the use of hot steam, humidifiers to breath, chicken soup, foods like garlic for inflammation, vitamins and supplements?
Use medications as prescribed by your doctor. There is no data at this point on successful treatment by alternative remedies. We caution against the use of steam as it may cause burns. Warm liquids like chicken soup may make you feel better, but are not a cure. Many people also speak of the benefits of caffeine as a bronchodilator. While caffeine will not harm you and does have some bronchodilating properties, we recommend using regular prescription instead of this remedy. The use of high dose supplements is not recommended; as they may negatively interact with medications you are taking. For most people, there is no need for additional vitamins or supplements, if they are keeping a normal, healthy diet.
Does malaria medication have a possible impact on COVID-19 and lung function?
At this point, we do not have enough evidence to conclusively determine the effectiveness of these drugs. We know some positive responses have been reported, but also some negative ones. While there isn’t enough evidence to use these drugs for treatment of COVID-19 routinely at this stage, we know there are on-going studies out there looking for a safe and effective treatment.
How does a shortage of ventilators affect those with lung disease? What are the priorities for ventilators?
Each provincial government is a developing a triage decision-making protocol that will be implemented by hospitals if there is a surge and resources must be rationed.
Can you address rumours of “flushing the virus”?
There is currently no known approved treatment. The Public Health Agency of Canada (PHAC) has not approved any product to prevent, treat or cure COVID-19.
You can refer to Health Canada’s list of hard surface disinfectants that may be effective for use against COVID-19. This list is updated regularly. Although they do not claim to kill viruses such as COVID-19, cleaners play a role in helping limit the transfer of microorganisms.
We encourage anyone who has information regarding potential non-compliant sale or advertising of any health product claiming to treat, prevent or cure COVID-19, to report it using PHAC’s online complaint form.