預防未顯示症狀的感冒和 COVID-19 (Scroll down for English version)

聖誕節快到了！隨之而來的是急症室和急症病房（當然包括兒科！）中令人恐懼的「冬季激增」……之所以如此命名，是因為冬季患者激增，導致醫療系統超負荷

在今天的工作會議上，蕃薯媽媽學到了「免疫債」這個詞，這個詞很適合描述我們現在身處的後疫情時代 （也是不言自明了！）

蕃薯媽媽今天才意識到，今年三月我們停止戴口罩，這才不過是九個月前！對蕃薯媽媽來說，這似乎是上世紀的事了，因為從那時起，生活似乎已經完全改變。確實，不戴口罩會對生活帶來巨變，儘管許多人仍然選擇戴口罩來預防感冒。

由於身體不適應，蕃薯媽媽自己也不喜歡戴口罩，所以我們研究了其他預防感冒的方法。幾星期前大蕃薯似乎每隔一周就會感冒一次，並傳染給家人。當我們環顧四周時，這種現像似乎非常普遍（好吧，我想這種病毒被稱為普通感冒是有原因的！）

以下是一篇關於預防普通感冒的好文章

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024156/

重點來了：

為了預防感冒，最一致的證據顯示每天至少要服用 1 克維他命 C。在多項試驗中，服用 維他命 C可將成人症狀持續時間縮短 8%，兒童症狀持續時間縮短 18%，而且在加拿大冬季可能更有效。可以考慮使用人參和大蒜素；兩者都可能有效，但還需要進行更大規模的試驗。來自遭受冷應激的患者的證據強調了穿暖和衣服的重要性。對於治療來說，在感冒的最初跡像出現時服用紫錐菊可能會減少症狀的持續時間和嚴重程度。鋅含片也可能有效。由於劑量和配方的差異，已發表的研究在這兩種情況下都很難作有效解釋。

真實試驗情況：

這是我們的藥櫃裡存貨，有點金髮女孩（英語：Goldilocks principle，又稱金髮女孩效應，來自英國作家羅伯特·騷塞（Robert Southey）的童話故事《三隻小熊》）的狀況…

蕃薯爸媽的藥片對孩子來說太大了！

大蕃薯的維生素對 小蕃薯 來說仍然太大了，他完全無法咀嚼！

所以小蕃薯得到液體維生素！

對於成人：

-就個人而言，我們會服用維他命C和鋅，最好是高劑量的。我們發現通常都需要單獨購 買。

對於學齡前兒童：

-大蕃薯會服用維他命C咀嚼片，對他來說就像吃糖果一樣

對於幼兒：

-液體維他命C。最近蕃薯媽媽閱讀了說明書後，竟然發現可以服用雙倍劑量以獲得更高的免疫力。

https://www.hktvmall.com/hktv/en/main/YOU-and-ME-Shopping-Mall-Limited/s/S2232001/Personal-Care-%26-Health/Personal-Care-%26-Health/Health/Vitamin/Black-Elderberry-Pulp-For-Kids-Vitamin-C-120ml-Parallel-Import/p/S2232001_S_SAM0168P

（沒有收傭金的哈哈）

自此以後，每當 大蕃薯生病時，細蕃薯就服用雙倍劑量。以前，無論大蕃薯有什麼病，細蕃薯都不可避免地會在一周內受到感染。但由於我們現在已經加了劑量，所以無論他感染什麼，都是相對溫和的！我們觀察到顯著的進步。

我們不能肯定這是因為我們的預防措施，但到目前為止（上天保佑），雖然感冒頻繁，但兩隻蕃薯的症狀相對較輕。最嚴重的那次是大蕃薯長達一個月的咳嗽（在我們的第一篇文章中介紹過），但他們從未發過很高的燒，就算如果發燒，也通常會在一夜之間康復。幸運的是，沒有什麼值得去醫院的重症。

在重新閱讀這項研究後，蕃薯媽媽現在正考慮為爸爸及自己儲備紫錐菊，以應對感冒初發的症狀。蕃薯媽媽還在其他地方（不是在科學文章中）讀到，因寒冷天氣而感冒是一個神話。但看來「冷應激」確實存在，你媽媽讓你穿暖和點也是有原因的！週日我們剛去中山紀念公園野餐，蕃薯爸爸回來就感冒了（他穿著T恤和風衣……）蕃薯媽媽也在考慮下次感冒時（或者感到發冷時）基於科學依據要求爸爸弄點人參雞湯驅寒… （作為一個愛喝湯的人，在這種天氣下，這簡直就是一石三鳥！）

預防 COVID-19（和普通感冒）

噴鼻劑

昨天與蕃薯爸爸共進午餐的一位同事告訴他，他中 COVID-19。當蕃薯媽媽聽到這件事後立即跑到我們的藥櫃裡拿出了一種 COVID-19 噴鼻劑。這是基於媽媽在 2022 年 12 月感染 COVID-19 的經歷。當時媽媽的情況與爸爸相同，不斷自行檢測，但直到密切接觸传染期的第 4 天才確診。在那之前，媽媽一直在想自己是否已經被感染了（等待不是和感染一樣糟糕嗎？） 當蕃薯媽媽康復後，聽說叔叔（神經外科醫生）帶著 COVID-19 鼻噴霧劑去哥斯達黎加開會。幾週後，爺爺（非醫生）告訴我們他在泰國也買了一些噴霧劑。蕃薯媽媽開始研究這個問題，很遺憾媽媽在感染 COVID-19 時不知道這一點！當媽媽在泰國出差期間受到感染，她的團隊中有內科專家，其中1 名在英國獲得資格，1 名在泰國獲得資格，但在他們的第一個同事感染後，都沒有提到這種噴霧劑。媽媽猜想是因為這種藥物在當時才推出了兩個多月，還比較新。

https://www.bangkokpost.com/thailand/general/2400651/thai-anti-covid-nasal-spray-ready-for-commercial-sale

我們自用的噴劑，假期時在布吉島上的藥房購買

我們的 Covitrap 鼻噴劑盒上都是寫著泰語，我們不得不使用谷歌翻譯。令人驚訝的是，經過一番研究，蕃薯媽媽發現一本著名醫學雜誌上發表了關於其安全性和有效性的隨機對照試驗，因此證明品質相對較佳。這款藥物是由 COVID-19 抗體製成，還提供屏障：

這是報告:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511465/

蕃薯爸爸報告說他感覺到噴完後鼻子裡有一層薄膜

這款噴劑相對來說比較$$$，但幾天後就會用完。

以下是其他 COVID-19 鼻噴劑的有用資訊：

https://www.goodrx.com/conditions/covid-19/nasal-spray-covid

蕃薯媽媽特別感興趣的是木糖醇鼻噴霧劑：「一些報告顯示木糖醇鼻噴霧劑可以幫助預防新冠肺炎。與其他鼻噴劑類似，使用木糖醇可能有助於減少鼻腔中的病毒數量並阻止病毒進入身體。

一項試管研究（在試管中進行，而不是在人體中進行）顯示，木糖醇鼻噴霧劑中的成分可以幫助降低病毒量，並使戴口罩更舒適。研究聲稱，木糖醇可能對引起新冠的病毒具有抗病毒作用。有限的病例報告還暗示，木糖醇鼻噴劑與其他治療方法一起使用可能有助於改善新冠肺炎症狀。未來會進行更多的臨床試驗來證實這些發現，並且這些試驗將持續到 2024 年。”

這很有趣，我們現在嘗試為孩子們搜購木糖醇鼻噴霧劑，其中一些對所有年齡都是安全的。例如。 （我們在囤的貨）：

https://www.hktvmall.com/hktv/en/main/%E7%BE%8A%E8%B2%B4FACE/s/H7517001/Personal-Care-%26-Health/Personal-Care-%26-Health/Medicine/Ear-Nose-%26-Throat-Medicine/Kids-Xlear-Saline-Nasal-Spray-75-fl-oz-22-mlParallel-Import/p/H7517001_S_BBD-0032?scrollTo=descriptionsTab

(同上，我們沒有收取佣金的哈哈)

我們的鼻噴劑：成人（左）和 2-6 歲兒童（右），均來自 Otrivin

蕃薯媽媽比較偏愛 Otrivin，因為媽媽喜歡含有生理鹽水以外成分的鼻噴劑，而萬寧/屈臣氏的鼻噴劑並不多。當我們在泰國看到兒童版的otrivin時便非常高興，因為香港好像沒有賣。經過仔細檢查後，蕃薯媽媽發現兩者都含有木甲唑啉，顯然與木糖醇不同

金髮女孩的情況又出現了：成人鼻噴劑（如圖）太辣（含薄荷醇！），對孩子來說藥物太重。兒童用的（圖中）對於一歲的細蕃薯而言也是太重藥量，所以 細蕃薯只好用鹽水噴霧了。我們想等生理食鹽水用完後才幫他換成木糖醇。

給兩隻蕃薯使用鼻噴劑來預防普通感冒（和 COVID-19！）的原因

1. 學術研究報告建議鼻噴劑可能有助於減少鼻子中的病毒數量並阻止其進入身體。” （上圖），蕃薯媽媽決定在第一次出現普通感冒症狀時就給孩子噴鼻劑。

2. 媽媽的朋友的兒子在普通感冒後反覆出現耳朵感染。當媽媽問起原因時，她說全科醫生解釋道，小孩不知道如何擤鼻涕，所以他們會吸入黏液，黏液可能會進入他們的耳朵。所以媽媽認為，如果我幫小孩子噴鼻可以幫助他們清除黏液。

3. 2位患有嚴重鼻塞（鼻竇炎）的朋友告訴我，洗鼻有助於緩解他們的症狀。有關如何操作的詳細信息，請參閱：

https://www.webmd.com/allergies/ss/slideshow-nasal-irrigation

我們確信如果嘗試沖洗兩隻蕃薯的小鼻子，他們會非常抗拒，所以鼻噴霧是我們對沖洗孩子小鼻的溫和版替代解決方案

Tips for prevention of cold, flu and COVID-19

Christmas is coming!  And with it, the much dreaded “winter surge” in A&E and acute wards (including paediatrics of course!)…  So named due to the surge of patients during winter, overloading the medical system.

In my work meeting today, I learnt the term “immunity debt”, which is an apt term for describing what is happening nowadays post-COVID-19 (self-explanatory too!)

I only realized today that we stopped wearing masks this March, which was only 9 months ago!  It seems much longer to me, since life seems to have changed completely since then.  Really, not wearing masks makes a huge difference, although many still choose to wear them for cold prevention.

Not being a fan of masks myself, due to discomfort, I have researched other forms of preventing colds, since at one point Rory seemed to be getting a cold every other week & infecting the rest of the family.  A phenomenon which seems incredibly common when I look around (well, I suppose there is a reason it’s called the common cold!)

Here is a nice article on prevention of common cold:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024156/

KEY POINTS

For prevention, the most consistent evidence supports use of at least 1 g of vitamin C daily, which decreased symptom duration by 8% in adults and 18% in children in several trials and which might be even more effective during Canadian winters. Use of ginseng and allicin could be considered; both show promise but larger trials are needed. Evidence from patients subjected to cold stress reinforces the importance of dressing warmly. For treatment, Echinacea purpurea taken at the first signs of a cold might reduce duration and severity of symptoms. Zinc lozenges might also be effective. Published studies are difficult to interpret in both cases because of differences in dose and formulation.

Real-life application:

This is from our medicine cabinet, a bit of a Goldilocks situation…

Baba and mama’s tablets are too big for the children!

R’s vitamins are still too big for X, as he can’t chew them!

So X gets liquid vitamin!

For adults:

-Personally, we buy vitamin C and zinc, preferably in high doses, usually this has to be bought separately I find (1^st 2 from left).

For preschoolers:

-R takes those chewable vitamin C, they are like sweets to him! (3^rd from left)

For toddlers:

-Liquid vitamin C (4^th from left).  My greatest find recently was that I read the instruction leaflet and found that double dose could be given for higher immunity.

https://www.hktvmall.com/hktv/en/main/YOU-and-ME-Shopping-Mall-Limited/s/S2232001/Personal-Care-%26-Health/Personal-Care-%26-Health/Health/Vitamin/Black-Elderberry-Pulp-For-Kids-Vitamin-C-120ml-Parallel-Import/p/S2232001_S_SAM0168P

(no commission received haha)

After this, whenever R got sick, X got double dose.  Previously, he would inevitably catch whatever R had within a week.  But since we’ve double-dosed, whatever he catches, is relatively mild!  We have seen quite a difference.

We take ours when we’re afraid of catching something, whereas the kids get theirs daily.  I can’t say for sure that it is because of our preventive measures, but so far (touchwood), although frequent, our kids’ infections have been relatively mild.  The worst was R’s month-long cough (covered in our 1^st post: https://vocus.cc/article/655f0ce7fd89780001b4b27b ), but they have never had very high fever and if they had fever, usually they recovered overnight.  Luckily, nothing that warranted a trip to the hospital.

On re-reading the research, I am now contemplating stocking up on Echinacea purpurea for Baba and I (mama) for the 1^st signs of cold.  I also read elsewhere (not in a scientific article) that getting a cold from cold weather was a myth.  But it seems there really is “cold stress” and there’s a reason why your mother tells you to wrap up warmly!  We just went to a picnic at Sun Yat Sen Memorial Park on Sunday and Baba got a cold when he came back (he was wearing a T-shirt and a windbreaker…)   I am also contemplating asking for ginseng chicken soup next time I get a cold, (or think I’m coming down with one) on scientific grounds….  (Being a soup-lover and in this weather, this sounds like killing 3 birds with 1 stone!)

Prevention of COVID-19 (and common cold)

Nasal spray

A colleague Baba had eaten lunch with yesterday informed him that he had gotten COVID-19.  When I heard about this, I immediately went to our medicine cabinet and pulled out a COVID-19 nasal spray.  This was based on my own experience of getting COVID-19 in December 2022.  I was in the same situation as Baba back then and kept testing myself for COVID-19, but only started to test faintly positive on the 4^th day of exposure.  Before then, I was shitting myself wondering if I had gotten it (isn’t the wait just as bad as getting it?)  When I recovered, I heard that my uncle (a neurosurgeon) had taken COVID-19 nasal spray to a conference in Costa Rica.  And then a few weeks later, grandpa (a non-medic) told me he had bought some in Thailand.  I started researching this topic & regretting I hadn’t known about this when I had COVID-19!  I caught COVID-19 during a work trip in Thailand, where internal medicine specialists were in my team, 1 qualified in UK and 1 in Thailand, but there was no mention of such a spray after our 1^st colleague got infected.  I guess it was relatively new at the time, only made available in the previous 2 months.

https://www.bangkokpost.com/thailand/general/2400651/thai-anti-covid-nasal-spray-ready-for-commercial-sale

Our COVID-19 nasal spray, bought on holiday in a random pharmacy in Phuket

Our Covitrap nasal spray was all in Thai and I had to use google translate for the instructions.  Surprisingly, upon doing a bit of research, I found a randomized control trial on its safety and efficacy published in a famous medical journal, therefore the quality of evidence is relatively good.  It is made of COVID-19 antibodies and also provides a barrier:

The article:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511465/

It is relatively $$$ and runs out after a few days though.

Here is useful information on other COVID-19 nasal sprays:

https://www.goodrx.com/conditions/covid-19/nasal-spray-covid

Of particular interest to me was Xylitol nasal sprays:  “Some reports suggest that xylitol nasal sprays could help prevent COVID. Similar to other nasal sprays, it’s suggested that they may help reduce the amount of virus in your nose and stop it from entering your body.

One in vitro study (done in a test tube and not with humans) suggests that the ingredients in xylitol nasal sprays can help lower viral load and make it more comfortable to wear face masks. The study claims that xylitol may act as an antiviral against the virus that causes COVID. Limited case reports also hint that xylitol nasal sprays may help improve COVID symptoms when used with other treatments. Clinical trials are needed to confirm these findings, and they are ongoing through 2024.”

This was interesting because I have tried to buy xylitol nasal spray for the kids, some which are safe for all ages.  E.g. (which I stocked up on):

https://www.hktvmall.com/hktv/en/main/%E7%BE%8A%E8%B2%B4FACE/s/H7517001/Personal-Care-%26-Health/Personal-Care-%26-Health/Medicine/Ear-Nose-%26-Throat-Medicine/Kids-Xlear-Saline-Nasal-Spray-75-fl-oz-22-mlParallel-Import/p/H7517001_S_BBD-0032?scrollTo=descriptionsTab

(again, no commission!)

Our nasal sprays:  adult (left) and kids 2-6 years old (right), both from Otrivin

I am partial to Otrivin because I like nasal sprays that have something more than just saline and there aren’t many of those in Mannings/Watsons.  I was very happy when I saw kids’ otrivin in Thailand, as it doesn’t seem to be available in Hong Kong.  On closer inspection, I have discovered that both contain xylometazoline, which apparently is not the same as xylitol

Again, a goldilocks situation:  Adult nasal spray (in picture) is too spicy (menthol!) and too much medicine for the kids.  Kids (in picture) has too much medicine for our 1 year old, so X gets saline spray.  I think I will change him to xylitol when the saline runs out.

Reasons for giving my kids nasal spray to prevent common cold (& COVID-19!)

1.      After reading “it’s suggested that they may help reduce the amount of virus in your nose and stop it from entering your body.” (above), I decided that we would give our kids nasal spray at the 1^st sign of common cold.

2.      One of my friend’s son repeatedly had ear infection after common cold.  When I asked why, she said the GP explained that young kids don’t know how to blow their noses, so they inhale their mucus and it can goes into their ear.  My logic is that if I spray my kids’ nose, it can help clear out the mucus.

3.      2 friends with severely blocked nose (sinusitis) have told me that nasal irrigation helped relieve their symptoms.  For details on how, see:

https://www.webmd.com/allergies/ss/slideshow-nasal-irrigation

As I’m sure my kids would struggle if I tried to irrigate their noses, nasal spraying is my mild kid-friendly version of nasal irrigation