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Earlier this month we shared expert insights for maintaining productivity while working from home during Covid-19. Many of you subsequently shared your own stories and tips, which included both practices that follow common advice and new and creative ideas.

Several recognised that the pandemic makes working from home far more challenging than usual; people are sharing workspaces with family and dealing with anxiety, stress and other mental health problems.

Sarah M, a service desk analyst from the UK, admits she's finding the isolation rather "depressing" and urges others not to take day-to-day human interaction for granted. Haralds Gabrans, a digital marketing manager from Latvia, says he's struggling to accept that this is "the new normal", and that it will go on for more than a few weeks.

Despite the challenges, many have discovered working from home amid a pandemic can still be a productive and even rewarding experience with the right mindset and behaviours.
Structure versus flexibility
Many have told us they are working longer hours, since being at home blurs the lines between the beginning and end of the workday. Without cues from colleagues heading out for lunch, or the side chats we often engage in at the office, it can also be hard to remember to take breaks.

Several people suggested putting structure and daily routines in place, including scheduling frequent breaks.

Angeliki (Pavlou) Heinz, an audio marketing and development manager in Germany, meets her husband in the kitchen for regular coffee breaks "just like normal colleagues". Similarly, Diana Nilsson, co-founder and chief operating officer at Tracemyfile in the UK, says her family "never compromises on breakfast, lunch, tea time and dinner together, regardless of if our work is done or not".

Christina Brazzale, a digital marketing manager in the UK, says working from home actually provides fewer distractions than her usual office environment, and pushes her to make more of her lunch break than simply eating at her desk. "Now, as I'm at home, I can't wait to head out for some sunshine, fresh air and a brisk walk," she says. "It's definitely helped me make a serious effort to take my breaks, which is very refreshing."

At the same time, however, some are finding that they're encountering increased social pressure to accomplish more professional, personal, creative or household tasks during this time.

Hannah Allyse Kim, a children's literary editor in South Korea, has been quarantined at home for more than a month. Her message: go easy on yourself. "You may feel as though you can tackle all the home improvement and organisation projects now that you're confined to the house. Don't pressure yourself," she says. "Completing only a few extra projects each day outside of your scheduled work leaves time for recharging your mind, whether that's picking up a book you've been meaning to read or trying out a new recipe in the kitchen."

Yvonne Dodd, a transformation coach from the UK, agrees. She suggests having a daily schedule, "but don't beat yourself up if you don't stick to it rigidly; have fun with your kids; get out in the fresh air and get some exercise (if possible)".
Get creative
For many, the days are starting to feel jumbled together, and, at times, dreary. One tip several readers offered was to work in a spot in your home that gets good natural light, or to work in any outdoor space you have. Anastasia Balandina from London works from her balcony when the sun is out, and describes this experience as "life-saving".

Another way to revive flagging energy for yourself, your colleagues or your family is to come up with creative, silly games or group activities. Nilsson spices up time with her family by doing at least one fun activity together every day. "We take turns to choose an activity. Examples: making a slime together (I would never do it otherwise), making raw balls (my kids wouldn't do it otherwise), making a family TikTok video (really?), a puzzle. This way we stay productive but also have time to appreciate each other."

Meg Tweed, a recruitment resourcing consultant in the UK, also plays a daily game with her colleagues. "We have a short meeting/update every morning and have begun to bring in an element of fun to them by doing a 'treasure hunt', where we have an item each week and whoever brings the best one wins. This week is an embarrassing photo of us as a child!"

Robert Stride lives in Switzerland where he can't roam far outside. He invented a little game for himself to stay sane: "Ten places in your home you really need to visit." Every day he visits a different location in his flat. "Day one was the washing machine, day two was the shoe rack, day three was the toilet bowl brush, day four the flat door, which we know must remain closed. Tomorrow I'll visit the dishwasher."

In London, Hannah Cordle is taking regular "bounce breaks on my kids' trampoline" and participating in virtual runs with her colleagues, "tracking our daily steps on Strava and visiting strange tourist destinations en route". In Switzerland, Sarah Holland has turned her kitchen worktop into a ping pong table.

Get your kids involved
Readers who are self-isolating with young children may well be finding it hard to follow tips about avoiding distractions and keeping workspaces sacrosanct. Many of you suggested ways to keep your children busy, including chores, games and taking shifts with your spouse.

Emma Cantril, owner of Intelligent Profile in the UK, says she has given her kids daily jobs. "Having worked from home for 20 years, I would say the biggest challenge is having to manage the sudden influx of family, cooking, washing, cleaning and how impossible it is to have a quiet space for everyone to focus," she says. "To avoid being overwhelmed with a mess at the end of the working day, make sure everyone tidies as they go along. Otherwise, it's impossible to cope and you will spend precious time in the evening sorting everything."

Jonathan Wareham, a sales director from Treviso, Italy, who is under full lockdown with his wife and three children, also agrees that chores and outdoor time is important. He adds that it's important to be "honest with yourself and your kids about the situation".

Though Wareham has found home-schooling his kids to be the most stressful task, he says balance is crucial. "We have now accepted that we will make a daily effort and do what we can BUT refuse to stress ourselves and the kids out!" He says it's important to give kids time to be both creative and bored.

Stay positive
In the midst of the crisis, many readers also touched on adjusting your mindset to embrace a more positive outlook.

Wareham says it's important to establish a good attitude early on. "Take this opportunity as a positive, to challenge and build up your character and that of your family," he says. As he and his own family have had to adapt to being constantly together, he adds that flexibility is key. "Start to recognise your negative traits. This gives you the opportunity to grow." Try to enjoy the stillness, he adds, and recognise that your concept of time will change.

Ultimately, he reminds us that time with family is precious, even if it is not on our own terms. "See the lockdown as a time to build lasting bonds with your family and to understand what is important in this short life. Remember that together you are building a unique memory, that these moments will stay with you and your family forever."
Want to share your experiences or tips? Join the comment thread on our page.

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Top working from home tips from around the world

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Earlier this month we shared expert insights for maintaining productivity while working from home during Covid-19. Many of you subsequently shared your own stories and tips, which included both practices that follow common advice and new and creative ideas.

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Digital Learning is the need of the hour

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The COVID-19 pandemic has changed education forever. This is how

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Research suggests that online learning has been shown to increase retention of information, and take less time, meaning the changes coronavirus have caused might be here to stay.

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Lora Jones, Daniele Palumbo & David Brown BBC News

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Coronavirus: How the pandemic has changed the world economy

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Key maps and charts explain how the virus has impacted markets and businesses around the world.

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Can you boost your immune system to fight COVID-19?

This is the question on everyone's mind as we face a worldwide crisis. We don't yet know how to fully prevent or manage the damage caused by COVID-19, the disease caused by a coronavirus that is new to us all.

We see online claims that we can "boost" our immune system with just about everything from Vitamin C or Vitamin D to essential oils and silver nanoparticles. But how do we know which of these recommendations, if any, really work?

That's a tough question to answer, mainly because the immune system is not "one thing" that we can easily measure. It's an intricate and delicate system with many different components. Helping one section might impair another, or boosting a certain section may have nothing to do with fighting viruses.

That makes knowing what to do challenging. Plus, how do we know if something that helps with another virus will help with this new coronavirus? As you can see, there is much we simply cannot know.

Finally, if you are older or have an underlying health condition (including diabetes and high blood pressure), you have an increased risk of severe symptoms, and potentially, loss of life from COVID-19. We recommend taking every precaution to avoid it.

If you're young and otherwise healthy, your risk of complications is much lower. If you do contract the virus, you'll probably have mild symptoms and fully recover within a couple of weeks.

However, it's possible that you may be infected with the virus without showing any symptoms. So maintaining excellent hygiene and practicing social isolation are crucial to avoid spreading it to high-risk individuals.

Low-carb nutrition and immune function

As you may have read at Diet Doctor, we believe the evidence is strong to support the many health benefits of eating low-carb diets.

In fact, it may be more important now than ever to maintain a healthy lifestyle, including a long-term healthy eating pattern. That means an eating pattern that provides essential nourishment and also keeps your blood sugar and weight in check.

It appears that individuals with type 2 diabetes and other metabolic conditions are at higher risk of complications from COVID-19. The evidence is clear that low-carb and ketogenic diets can be effective tools for treating and reversing these metabolic conditions.

While we can't prove that low-carb nutrition boosts immune function per se, it makes sense to limit the conditions (e.g. high blood pressure or high blood sugar) that might make things worse.

In addition, one recent study showed that a keto diet reduces the risk for mice infected with influenza. That's a far cry from saying a keto diet will do the same for influenza in humans or for COVID-19. But one question we should ask is, if we follow a diet that is proven to help with weight loss and metabolic health and may also beneficially affect immune function, what do we have to lose?

With that in mind, here are some of our top tips to decrease your risk for catching the virus or having complications from COVID-19.

The basics

These are things that you can do today that don't cost anything. We recommend you prioritize these basic steps for protecting and improving your health - and potentially your immune system.

While these actions are always important aspects of maintaining good health, they may be crucial during times of increased risk, like now.

Proper handwashing: the coronavirus is killed by proper handwashing for 20 seconds with soap or using hand sanitizer that is greater than 60% alcohol.

Don't smoke: Smokers have an increased risk of catching infections and suffering severe complications from those infections. We shouldn't need more reasons not to smoke, but a time like this highlights the importance even more.

Get adequate sleep: Sleep is important for health in general, and as a bonus it may also benefit our immune function. For instance, one study showed those with insomnia had, on average, less immune response to the influenza vaccine, while another study in twins showed those with worse sleep had altered expression of genes related to immune function. Last - and we can file this one under "How in the world did they convince people to do this study?" - 153 volunteers were inoculated with the rhinovirus (the virus that can cause the common cold). They found those who slept less than seven hours were three times more likely to develop symptoms than those who slept more than eight hours.
Again, the science in this area may not be robust, but when it comes to overall health, proper sleep helps. In times like these, you should prioritize sleep hygiene.

If you're isolated at home, that likely means more time on electronics like tablets, phones, and TVs. This may be a good time to invest in blue-light blocking glasses and to look for non-tech related activities to do in the evening, like puzzles, crosswords, or reading an actual book (not an ebook!).

The right amount of exercise: Observational studies show that those who exercise tend to suffer fewer infections than those who do not. While those studies have confounding variables, the general consensus is that exercise overall is likely beneficial, with some caveats.
Some studies show bouts of strenuous exertion (>1.5 hours with an average heart rate >75% maximum) may temporarily decrease immune function. In addition, elite athletes who "overtrain" tend to suffer from infections more frequently than others.

Our advice? Stay active, but remember: now is not the time to start a new high intensity exercise routine. If you already enjoy strenuous exercise, consider decreasing the frequency or intensity by 10-20% (this is not scientifically backed but is recommended by some experts). Also, try to focus on home or outside exercise. Shared gym equipment, like weights and cardio machines, may be surfaces that transmit the virus.

For more guidance, see our Let's Get Moving course or our recently published exercise guide.

Stress management: While acute stressors may temporarily enhance immune functions, chronic stressors likely diminish immune function. Worrying about the stock market, stressing about having enough toilet paper, and focusing on the uncertainties of the future can raise cortisol levels, which may negatively impact our immune function. While data is difficult to interpret in this area, one study showed medical students with increasing stress levels before their final exams had decreased function of natural killer cells, the cells that are the "first responders" of our immune system.
We can't make this stressful situation disappear. But we can all take measures to control our response to stress. Meditation, mindfulness exercises, and getting outside and going for walks are all examples of activities that are free and relatively easy to do.

The website Ten Percent Happier has a free "coronavirus sanity guide" that may help. Whether stress management techniques help your immune system or not, they can potentially help blood pressure, blood sugar, and make your days much more pleasant.

If you drink alcohol, drink in moderation: In times of stress, some people turn to alcohol as a coping mechanism. While meditation, nature walks, and mindfulness exercises are likely healthier ways of coping, for some they aren't enough, and alcohol adds a little something extra. There's no judging here. We all have to do what we can to get through tough times.
However, studies show a relationship between chronic heavy alcohol consumption and increased susceptibility to infections. Perhaps most pertinent for the discussion about COVID-19, some of these studies showed an increased risk among heavy drinkers of acute respiratory distress syndrome (ARDS), the lung complication responsible for most of the COVID-19 related deaths.

The trick is knowing where to draw the line. While there is little science, most experts suggest that a reasonable daily limit is two drinks for men and one drink for women. Keep in mind that following a low-carb lifestyle may decrease your tolerance to alcohol, so you may need to adjust your intake. You can read more about alcohol and low-carb lifestyles in our evidence-based guide.

Supplements

Could taking vitamins, minerals, or other supplements help protect you from COVID-19? Contrary to what you might read on the internet, this is a question that can't be answered definitively. Here's what we do know about certain supplements that reportedly have immune-boosting properties.

Vitamin C

For decades, Vitamin C has been used to help prevent the common cold. Among other functions, this vitamin can help maintain healthy skin that provides a barrier to germs and other harmful invaders. In addition, some - but not all - studies suggest it may improve the function of certain white blood cells that fight infection. In addition, there is conflicting evidence about the potential mortality benefits of high dose Vitamin C for patients with sepsis, the most severe form of systemic infections.

While it's unclear whether taking a Vitamin C supplement is beneficial for COVID-19, for most people there's no harm in taking up to 2,000 mg per day (the upper limit set by the National Academy of Medicine).

For smokers and high-risk individuals, it's definitely worth considering. Vitamin C is water-soluble, so your body will excrete whatever you don't need into your urine. However, at very high doses, Vitamin C may cause diarrhea or increase the risk of kidney stones (especially in men), so be sure not to exceed 2,000 mg daily.

Vitamin D

As both a hormone and a vitamin, Vitamin D plays a number of important roles in health.

In recent years, people have taken very high doses of Vitamin D with the intention of boosting immunity. But is this an effective tactic? A 2017 systematic review of 25 randomized trials found that taking a Vitamin D supplement seemed to have a mild protective effect against respiratory-tract infections in most people, but provided much greater protection in those who were very deficient in Vitamin D.

If your Vitamin D levels are low, you may have a better chance of staying well if you supplement with 2,000 IU per day (or more, with medical supervision). Many - perhaps even most - people are deficient in vitamin D. So it's probably wise to take a Vitamin D supplement right now, especially if you're at increased risk for COVID-19.

Of course, your body can make Vitamin D on its own when your skin is exposed to sunlight, so try to get some sun whenever you can. How much sun depends on the time of year and your location. A good starting point is 15 minutes of exposure to a large body part (such as the torso or back). Just remember to avoid sunburns, as excess sun exposure carries its own risks.

Zinc

Zinc is a mineral involved in the white blood cell response to infection. Because of this, people who are deficient in zinc are more susceptible to cold, flu, and other viruses. One meta-analysis of seven trials found that supplementing with zinc reduced the length of the common cold by an average of 33%. Whether it could have a similar effect on COVID-19 isn't yet known.

Taking supplementary zinc may be a good strategy for older people and others at increased risk. If you decide to take zinc, make sure to stay below the upper limit of 40 mg per day, and avoid administering nasally, due to the risk of olfactory complications.

Turmeric

Turmeric is a spice commonly used in Indian and Asian cuisine, including curries. It contains a bright-yellow compound known as curcumin, which emerging research suggests might enhance immune function. However,there isn't any convincing evidence showing that it helps fight viral infections yet.

On the other hand, adding turmeric to your food adds flavor, and taking a curcumin supplement is unlikely to cause any harm in otherwise healthy people. If you have any medical conditions - especially if you take blood thinners - check with your doctor before supplementing with curcumin.

Echinacea

Echinacea is an herb that can reportedly help prevent the common cold. But is this reputation well-deserved? A recent systematic review of randomized trials found that echinacea may possibly have a mild protective effect against upper-respiratory infections but doesn't appear to reduce the length or severity of illness. While it's impossible to say whether it might offer any protection against COVID-19, it appears to be safe to take on a short-term basis. If you're at high risk, you may consider taking it for the next several weeks.

Garlic

Garlic, a popular and pungent herb with a characteristic aroma, is widely believed to have antibacterial and antiviral effects, including helping to fight the common cold.

A 2014 randomized controlled trial did find that people who took a garlic supplement had fewer colds and recovered more quickly from colds than people who didn't take garlic. Although this is encouraging, this is just one study. Other high-quality trials are needed to confirm whether garlic is truly beneficial for the common cold or other upper-respiratory infections. For now, enjoy garlic for its zesty flavor and unmistakable aroma rather than counting on it to boost your immunity during the coronavirus pandemic.

Nutrition

Fruits, veggies and seeds

Getting plenty of fruits, vegetables, and seeds is a common recommendation seen on many sites, but the evidence is inconclusive if it truly helps. In one often-quoted study, elderly volunteers were randomized to less than two or greater than five daily servings of fruits and vegetables. They found the group with the higher fruit consumption had a better immune response to the pneumonia vaccine but not to the tetanus vaccine.

Another claim is that "eating the rainbow" and getting "adequate phytonutrients" improves immune function and reduces infection risk. Unfortunately, "eating the rainbow" and getting "adequate phytonutrients" are poorly defined terms, and such messages are usually compromised by being based on nutritional epidemiology studies heavily impacted by the underlying diet (i.e mostly in high-carb diets) and healthy-user bias.

Therefore, we cannot conclude that any one specific food will improve your immune function. However, as with many other potential health benefits, it makes sense to stick to a diet that provides adequate essential nutrition and is rich in minimally processed natural foods. It may not be more complicated than that.

Refined carbs and sugars

Laboratory evidence suggests sugar may impair white blood cell function, but no credible evidence shows eating it makes you get more infections. However, other evidence suggests acute rises in blood sugar may increase risk of infections and complications. Therefore, it would make sense that we want to limit these blood sugar elevations. Refined carbohydrates and simple sugars are two of the biggest offenders for blood sugar spikes and therefore should probably be avoided.

This is different than saying studies show avoiding these foods results in fewer infections. (We don't have that evidence.) Plus, as we have mentioned many times, it's difficult to isolate the effect of one food since any food's effects have to be studied within the context of the underlying diet (i.e. standard American diet vs. a low-carb diet).

However, one simple solution is to use the measurement of your own blood sugar as a guide. If higher blood sugar is associated with more complications, it makes sense we want to limit that.

We suggest measuring your blood sugar either with a regular glucometer or, even better, with a continuous glucometer (CGM) if you have access to one. If the foods you eat cause your blood sugar to rise above 140mg/dl (7.8mmol/L), consider eating something different.

Studies show that a low-carb, moderate protein, higher fat diet effectively reduces blood sugar and can even reverse type 2 diabetes. We don't have proof that this will "boost your immune system," but it may help keep blood sugars in check which may be associated with decreased infectious risk.

Chicken soup/bone broth

Treating colds and the flu with chicken soup may be the most popular urban myth of all time. Surprisingly, it may not be 100% a myth.

One study showed chicken soup "inhibited neutrophil migration," which the authors suggest could improve our ability to recover from infections. However, this is one of those instances where laboratory findings may not translate to clinical improvements such as fewer or less serious infections. But it's hard to argue with a tasty homemade soup with chicken, a few low-carb veggies, and plenty of real salt. Immune booster or not, it sounds like a great meal for a wintery day in self-isolation. We chalk that one up to good self-care.

Fasting

With all the focus on how certain foods affect your immune system, you may also wonder, what about fasting? One study in mice showed that fasting, or more specifically refeeding after a fast, restored immune function that had been suppressed by chemotherapy. During the fasting period itself, however, it appeared to impair the immune system. In addition, the beneficial response to refeeding may be lessened in the elderly.

These are very important caveats. Over the long term, intermittent fasting and refeeding may boost the immune system. However, during an acute pandemic, where the immediate risk of infection is higher than usual, it may not be a good time to try fasting, given the potential for a temporary decrease in immunity.

This may sound surprising for those who have heard the phrase, "starve a fever." The theory is that humans have evolved to not feel hungry and purposely avoid food during an acute illness as a protective mechanism, which may in turn limit nutrients the virus needs to replicate. To be clear, this is all conjecture without any quality supporting evidence.

Other evidence suggests that ketones are beneficial for immune function, and perhaps that could be why some recommend fasting. But considering all of the data together, if that were the case, you would likely be better off eating a keto diet and not fasting.

Based on the limited data available, we suggest not fasting longer than 36 hours during the outbreak of the coronavirus, especially if you are older than 60 years old. It's logical that you can continue with shorter-duration time-restricted eating, although there is no data on this either.

Over-the-counter pain and fever medications for coronavirus

Should you take one of the common over-the counter (OTC) medications for the headaches and fever that are often the symptoms of COVID-19 illness?

In particular, what about taking non-steroidal anti-inflammatory drugs (NSAIDs)? These include drugs like aspirin, ibuprofen (Advil, Motrin, Midol) and naproxen (Aleve, Naprosyn).

Some treating doctors have tweeted their experience that while younger people in general have milder reactions to the coronavirus, those younger people with severe COVID-19 related complications tend to also be taking NSAIDs such as ibuprofen.

The French Health Minister (who is also a doctor) made a sweeping recommendation to use paracetamol (also known as acetaminophen) instead. It is important to note that this is not a new scientific study. These are clinical observations from a handful of doctors. But is there enough concern that you should avoid ibuprofen and other NSAIDs and instead switch to acetaminophen or paracetamol?

Some older observational studies support more severe disease complications arising from colds and flu in those who are taking NSAIDs. But this could be because the more severe diseases cause more symptoms, and that is why more people take NSAIDS to combat those symptoms.

Remember, a fever is part of your body's response to combat the virus. By itself a fever is not dangerous for most people unless it is sustained above 104 degrees Fahrenheit (40 Celsius). It is uncomfortable, but not dangerous.

Without having clear data, it is difficult to know what to do. But perhaps err on the side of caution for now until better quality data is available. Instead of taking an OTC pill for a headache or fever, consider starting with cool sponge baths, damp washcloths, and remember to rest and drink plenty of fluids with electrolytes, such as using Diet Doctor's electrolyte elixir drink.

If you still need more aggressive care, one strategy could be to use acetaminophen first for symptoms like fever or body aches, and only if that doesn't control your symptoms, then consider taking NSAIDs for the shortest time possible to help you feel better.

If you are already taking daily NSAIDS for arthritis or other chronic pain issues, it is a little more complicated and you should discuss with your physician if an alternative exists, or if you might consider changing to another medication for now. We will keep an eye on the emerging data and update this section as more information becomes available.

Summary

In short, the reason that this new coronavirus is spreading so rapidly and having such a significant impact on people around the world is that we lack immunity to it. Our immune systems have never seen it before.

The more actions we take to keep ourselves generally healthy, the better.

Good hand hygiene and social distancing can help prevent catching the virus. Doing what you can to reduce specific risk factors may help your body recover quickly if you do become exposed.

Even if you don't become exposed, your overall health may benefit from the following:

1. Eating a nutritious diet that minimizes high blood sugar

2. Prioritizing restful sleep

3. Managing your stress

4. Stopping smoking

5. Participating in moderate exercise that you enjoy

6. Getting sunshine and fresh air where possible

While there is not yet robust scientific evidence specifically around the immune system and COVID-19, taking some specific supplements may improve your overall health and are likely to not be harmful if taken as directed.

If nothing else, we recommend taking Vitamin D because you may be deficient at this time of year.

Likewise, a low-carb diet that minimizes high blood sugar and is rich with nutrients and whole, minimally processed foods may contribute to better overall health.

Remember, however, that a low-carb diet does not have some magical quality that will keep you safe from infection. You still need to wash your hands and practice social distancing to prevent the spread of this new virus. Eat low carb for life. Not for the coronavirus.

/ Dr. Bret Scher

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Boosting Your Immune System to Fight the Coronavirus - Diet Doctor

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Can you boost your immune system to fight COVID-19? This is the question on everyone's mind as we face a worldwide crisis. We don't yet know how to fully prevent or manage the damage caused by COVID-19, the disease caused by a coronavirus that is new to us all.

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Under study for COVID-19
Hydroxychloroquine and a related drug, chloroquine, have been under study as possible treatments for COVID-19 (the illness caused by the new coronavirus). However, the FDA has just revoked its emergency use authorization for these two drugs. This is because the drugs may not be effective in treating COVID-19, and their risks may outweigh their potential benefits for this use. Do not use these medications to treat COVID-19 unless your doctor recommends that you do so.

For current information about the COVID-19 outbreak, explore our live updates. And for information on how to prepare, advice on prevention and treatment, and expert recommendations, visit our COVID-19 hub.

Hydroxychloroquine oral tablet is available as a brand-name drug and a generic drug. Brand name: Plaquenil.

Hydroxychloroquine comes only as a tablet you take by mouth.

Hydroxychloroquine is used to treat malaria, lupus erythematosus, and rheumatoid arthritis.

Child danger warning: Accidentally swallowing just a few tablets has been fatal in some children. Keep this drug in a child-resistant bottle out of reach of children.

Worsened skin conditions warning: Tell your doctor if you have skin conditions, such as psoriasis or porphyria. This medication may make these conditions worse.

Eye damage: This medication can damage your eyes, leading to vision problems that can be permanent. This damage is more likely when the drug is used in high doses.

Heart damage: This medication can cause heart disease. Although uncommon, some cases have been fatal.

Hydroxychloroquine is a prescription drug. It comes as an oral tablet.

Hydroxychloroquine is available as the brand-name drug Plaquenil. It's also available in a generic version. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Hydroxychloroquine may be used as part of a combination therapy. That means you may need to take it with other drugs.

Why it's used

Hydroxychloroquine is used to treat lupus erythematosus and rheumatoid arthritis. It's also used to prevent and treat malaria.

How it works

Hydroxychloroquine is an antimalarial drug. It treats malaria by killing the parasites that cause the disease.

It isn't fully understood how this drug works to treat lupus erythematosus or rheumatoid arthritis. However, it's believed that this drug affects how your immune system works, which may be a benefit in lupus erythematosus and rheumatoid arthritis.

Hydroxychloroquine oral tablet doesn't cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with hydroxychloroquine include:

Mild side effects may go away within a few days or a couple of weeks. Talk to your doctor or pharmacist if they're more severe or don't go away.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you're having a medical emergency. Serious side effects and their symptoms can include the following:

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Hydroxychloroquine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you're taking. To find out how this drug might interact with something else you're taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with hydroxychloroquine are listed below.

Heart drug

Taking digoxin with hydroxychloroquine may increase the levels of digoxin in your body. This may increase your risk of side effects from digoxin.

Insulin and other diabetes drugs

Hydroxychloroquine and diabetes drugs all decrease your blood sugar level. Taking hydroxychloroquine with these drugs could cause hypoglycemia (low blood sugar). Your doctor may need to reduce your dosage of insulin or the other diabetes drugs.

Examples of other diabetes drugs include:

Drugs that affect heart rhythm

Hydroxychloroquine should not be taken with other drugs that could cause heart arrhythmias (irregular heart rate or rhythm). Taking hydroxychloroquine with these drugs could cause dangerous arrhythmias. Examples of these drugs include:

Certain malaria drugs

Taking hydroxychloroquine with certain other malaria drugs can increase your risk of seizures. Examples of these drugs include:

Antiseizure drugs

Taking antiseizure drugs with hydroxychloroquine can make the antiseizure drugs less effective. Examples of these drugs include:

Immunosuppressant drugs

Taking methotrexate with hydroxychloroquine has not been studied. It may increase your risk of side effects.

Taking cyclosporine with hydroxychloroquine can increase the amount of cyclosporine in your body. This may increase your risk of side effects from cyclosporine.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Though rare, this drug may cause an allergic reaction. Symptoms can include:

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don't take this drug again if you've ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

Alcohol misuse can damage your liver, which can affect how hydroxychloroquine works in your body. If you drink alcohol, ask your doctor about whether it's safe for you to drink while taking hydroxychloroquine.

Warnings for people with certain health conditions

For people with skin problems: This drug may worsen the skin conditions psoriasis and porphyria.

For people with liver problems or alcohol misuse: Liver problems or a history of alcohol misuse can make this drug less effective.

For people with certain enzyme deficiencies: This drug may cause red blood cells to rupture (break open) in people with low levels of glucose-6-phosphate dehydrogenase (G6PD). G6PD is an enzyme, which is a type of protein.

Warnings for other groups

For pregnant women: This drug should be avoided in pregnancy. Some studies show that the medication can be passed through the mother's bloodstream to the baby.

Talk to your doctor if you're pregnant or plan to become pregnant. This drug should only be used during pregnancy if the potential benefit justifies the potential risk.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: Small amounts of this drug pass through breast milk, but it's not known what effect this may have on a child who is breastfed. You and your doctor should decide whether you'll take this medication or breastfeed.

For seniors: This drug is processed by your kidneys. Older adults with reduced kidney function may not be able to process this drug well, which can increase the risk of side effects, including vision damage. Older adults may require more frequent eye exams while taking this drug to monitor for signs of vision damage.

For children: This drug can be dangerous to children. Accidentally swallowing even just a few tablets can lead to death in a small child. Keep this drug in a child-resistant bottle out of reach of children.

Children shouldn't use this drug for long periods. Children taking this medication for a long period of time may experience permanent damage to their vision and other side effects.

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

your age

the condition being treated

how severe your condition is

other medical conditions you have

how you react to the first dose

Drug forms and strengths

Generic: Hydroxychloroquine

Brand: Plaquenil

Dosage for malaria
Adult dosage (ages 18 years and older)

Acute attack:
Typical starting dose is 800 mg. This is followed by 400 mg three times: 6 hours after the first dose, 24 hours after the first dose, and 48 hours after the first dose.

Prevention:
Typical dosage is 400 mg once per week, taken on the same day each week, starting 2 weeks before exposure to malaria.

Continue using this medication during exposure and for 4 weeks after leaving the area that has malaria.

Child dosage (ages 0-17 years)

Acute attack:
The typical starting dose is 13 mg/kg (maximum dose: 800 mg).

Additional doses of 6.5 mg/kg (maximum dose: 400 mg) should be given at the following times: 6 hours after the first dose, 24 hours after the first dose, and 48 hours after the first dose.

Prevention:
The dosage is based on body weight.

6.5 mg/kg (maximum dose: 400 mg) should be given on the same day each week starting 2 weeks before exposure to malaria.

Your child should continue to use this medication during exposure and for 4 weeks after leaving the area that has malaria.

Dosage for lupus erythematosus
Adult dosage (ages 18 years and older)

Typical maintenance dosage: 200 mg to 400 mg per day, given as a single daily dose or in two divided doses.

Maximum dosage: 400 mg per day.

Child dosage (ages 0-17 years)
Dosage for children younger than 18 years hasn't been established.

Dosage for rheumatoid arthritis
Adult dosage (ages 18 years and older)

Typical starting dosage: 400 mg to 600 mg per day, given as a single daily dose or in two divided doses.

Maintenance dosage:
When your body responds well to the medication, your doctor may lower your dosage to 200-400 mg per day, as a single daily dose or in two divided doses.

You may not see the best effect of this medication for several months.

Don't take more than 600 mg per day or 6.5 mg/kg per day (whichever is lower). If you do, your risk of eye problems will increase.

Child dosage (ages 0-17 years)
Dosage for children younger than 18 years hasn't been established.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Hydroxychloroquine oral tablet is used for short-term treatment of malaria, but it may be used for long-term treatment of lupus erythematosus or rheumatoid arthritis.

Hydroxychloroquine comes with risks if you don't take it as prescribed.

For malaria prevention: Start this medication 1 to 2 weeks before traveling to a country where malaria is present. Take it while you're there, and continue to take it for 4 more weeks after you've left the area. Taking your medication as directed by your doctor will give you the best chance of not getting malaria.

For treating lupus erythematosus: Take your medication as directed by your doctor, even when you're feeling well. This will give you the best chance of treating lupus and avoiding problems with your skin, joints, and other organs. It will also improve your quality of life.

For treating rheumatoid arthritis: Take your medication as directed by your doctor, even when you're feeling well. This will help reduce swelling, pain, and stiffness in your joints and improve your quality of life.

What to do if you miss a dose: If you miss a dose, take the missed dose as soon as you can. However, if it's almost time for the next scheduled dose, skip the missed dose and continue your regular dosing schedule.

Don't take a double dose to make up for the missed one. You risk more serious side effects.

How to tell if the drug is working: For rheumatoid arthritis, you should have reduced joint inflammation, and you should be able to move better within 6 months of starting the medication.

For lupus erythematosus, you should have less joint swelling, less pain, fewer lupus-related rashes, and a better ability to move around.

For malaria, your fever should go away, and you should have less diarrhea and vomiting.

Keep these considerations in mind if your doctor prescribes hydroxychloroquine for you.

General

Do not crush, cut, or break hydroxychloroquine tablets.

Take each tablet with a meal or a glass of milk.

Take this drug at the time(s) recommended by your doctor. If you take this drug at times other than the ones prescribed, the level of the drug in your body could increase or decrease. If it increases, you could have more side effects. If it decreases, the drug might lose its effectiveness.
For treating malaria: Take this medication once weekly on the same day each week.

For treating lupus and rheumatoid arthritis: Take this medication at the same times every day for the best effect.

Storage

Store this medication at room temperature up to 86°F (30°C).

Keep the drug away from light and high temperatures.

Don't store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.

Don't worry about airport X-ray machines. They can't harm your medication.

You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.

Don't put this medication in your car's glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor will examine you to check your health and make sure that you aren't having side effects from your medication. The tests they may do include:

Eye exams. Your doctor may give you an eye exam when you start this drug and every 3 months while you're taking it.

Reflex tests. Your doctor may test your knee and ankle reflexes and check you for muscle weakness if you're on this medication long term.

Blood tests. Your doctor may order certain blood tests to monitor your health while you're taking this medication.

Heart tests. Your doctor may order certain tests, such as an EKG, to monitor your heart while you're taking this medication.

Hidden costs

Beyond the cost of this drug, you may need to pay for additional eye exams and blood tests. The cost of these things will depend on your insurance coverage.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Hydroxychloroquine: Side effects, dosage, COVID-19 (under study)

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Under study for COVID-19 Hydroxychloroquine and a related drug, chloroquine, have been under study as possible treatments for COVID-19 (the illness caused by the new coronavirus). However, the FDA has just revoked its emergency use authorization for these two drugs.

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FDA Notice
The Food and Drug Administration (FDA) has recalls of several hand sanitizers due to the potential presence of methanol.

is a toxic alcohol that can have adverse effects, such as nausea, vomiting, or headache, when a significant amount is used on the skin. More serious effects, such as blindness, seizures, or damage to the nervous system, can occur if methanol is ingested. Drinking hand sanitizer containing methanol, either accidentally or purposely, can be fatal. See here for more information on how to spot safe hand sanitizers.

If you purchased any hand sanitizer containing methanol, you should stop using it immediately. Return it to the store where you purchased it, if possible. If you experienced any adverse effects from using it, you should call your healthcare provider. If your symptoms are life threatening, call emergency medical services immediately.

When it comes to preventing the spread of infectious diseases like COVID-19, nothing beats good old-fashioned handwashing.

But if water and soap aren't available, your next best option, according to the Centers for Disease Control and Prevention (CDC), is to use an alcohol-based hand sanitizer that contains at least 60 percent alcohol.

Unless you have a stockpile of store-bought hand sanitizer, you'll likely have a hard time finding any at a store or online right now. Due to the rapid spread of the new coronavirus, most retailers can't keep up with the demand for hand sanitizer.

The good news? All it takes is three ingredients to make your own hand sanitizer at home. Read on to find out how.

Making your own hand sanitizer is easy to do and only requires a few ingredients:

The key to making an effective, germ-busting hand sanitizer is to stick to a 2:1 proportion of alcohol to aloe vera. This keeps the alcohol content around 60 percent. This is the minimum amount needed to kill most germs, according to the CDC.

Jagdish Khubchandani, PhD, associate professor of health science at Ball State University, shared this hand sanitizing formula.

His hand sanitizer formula combines:

2 parts isopropyl alcohol or ethanol (91-99 percent alcohol)

1 part aloe vera gel

a few drops of clove, eucalyptus, peppermint, or other essential oil

If you're making hand sanitizer at home, Khubchandani says to adhere to these tips:

Make the hand sanitizer in a clean space. Wipe down countertops with a diluted bleach solution beforehand.

Wash your hands thoroughly before making the hand sanitizer.

To mix, use a clean spoon and whisk. Wash these items thoroughly before using them.

Make sure the alcohol used for the hand sanitizer is not diluted.

Mix all the ingredients thoroughly until they're well blended.

Don't touch the mixture with your hands until it's ready for use.

For a larger batch of hand sanitizer, the World Health Organization (WHO) has a formula for a hand sanitizer that uses:

isopropyl alcohol or ethanol

hydrogen peroxide

glycerol

sterile distilled or boiled cold water

DIY hand sanitizer recipes are all over the internet these days - but are they safe?

These recipes, including the ones above, are intended for use by professionals with both the expertise and resources to safely make homemade hand sanitizers.

Homemade hand sanitizer is only recommended in extreme situations when you're unable to wash your hands for the foreseeable future.

Improper ingredients or proportions can lead to:

lack of efficacy, meaning that the sanitizer may not effectively eliminate risk of exposure to some or all microbes

skin irritation, injury, or burns

exposure to hazardous chemicals via inhalation

Homemade hand sanitizer is also not recommended for children. Children may be more prone to improper hand sanitizer usage, which could lead to greater risk of injury.

Two things to be aware of when using hand sanitizer:

You need to rub it into your skin until your hands are dry.

If your hands are greasy or dirty, you should wash them first with soap and water.

With that in mind, here are some tips for using hand sanitizer effectively.

1. Spray or apply the sanitizer to the palm of one hand.

2. Thoroughly rub your hands together. Make sure you cover the entire surface of your hands and all your fingers.

3. Continue rubbing for 30 to 60 seconds or until your hands are dry. It can take at least 60 seconds, and sometimes longer, for hand sanitizer to kill most germs.

According to the , an alcohol-based hand sanitizer that meets the alcohol volume requirement can quickly reduce the number of microbes on your hands.

It can also help destroy a wide range of disease-causing agents or pathogens on your hands, including the new coronavirus, SARS-CoV-2.

However, even the best alcohol-based hand sanitizers have limitations and don't eliminate all types of germs.

According to the CDC, hand sanitizers won't get rid of potentially harmful chemicals. It's also not effective at killing the following germs:

Also, a hand sanitizer may not work well if your hands are visibly dirty or greasy. This may happen after working with food, doing yard work, gardening, or playing a sport.

If your hands look dirty or slimy, opt for handwashing instead of a hand sanitizer.

Knowing when it's best to wash your hands, and when hand sanitizers can be helpful, is key to protecting yourself from the new coronavirus as well as other illnesses, like the common cold and seasonal flu.

While both serve a purpose, washing your hands with soap and water should always be a priority, according to the CDC. Only use hand sanitizer if soap and water isn't available in a given situation.

It's also important to always wash your hands:

after going to the bathroom

after blowing your nose, coughing, or sneezing

before eating

after touching surfaces that could be contaminated

The CDC lists specific instructions on the most effective way to wash your hands. They recommend the following steps:

1. Always use clean, running water. (It can be warm or cold.)

2. Wet your hands first, then turn the water off, and lather your hands with soap.

3. Rub your hands together with the soap for at least 20 seconds. Make sure to scrub the back of your hands, between your fingers and under your nails.

4. Turn the water on and rinse your hands. Use a clean towel or air dry.

Hand sanitizer is a handy on-the-go way to help prevent the spread of germs when soap and water isn't available. Alcohol-based hand sanitizers can help keep you safe and reduce the spread of the new coronavirus.

If you're having a hard time finding hand sanitizer at your local stores and handwashing isn't available, you can take steps to make your own. You only need a few ingredients, such as rubbing alcohol, aloe vera gel, and an essential oil or lemon juice.

Although hand sanitizers can be an effective way of getting rid of germs, health authorities still recommend handwashing whenever possible to keep your hands free of disease-causing viruses and other germs.
Read this article in Spanish

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Alcohol-based hand sanitizers can help keep you safe and reduce the spread of germs if soap and water aren't available. It's also effective against the novel coronavirus. To make your own, you only need a few key ingredients: rubbing alcohol, aloe vera gel, and an essential oil (or lemon juice).

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COVID - Coronavirus Statistics - Worldometer

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Daily and weekly updated statistics tracking the number of COVID-19 cases, recovered, and deaths. Historical data with cumulative charts, graphs, and updates.

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India News, Breaking News, Entertainment News | India.com

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Also Read - New Delhi: Amid rumours and MHA's continuous effort to busting those fake news on an extension of lockdown, Prime Minister Narendra Modi made it clear to the state Chief Ministers that there will be no lockdown 5 or 6 - the unlock phase has already begun. There is no going back. Decision to Auction 41 Coal Blocks 'Historic', Will Create More Than 2.8 Lakh Jobs: Amit Shah

Here is what PM Modi said to the CMs in the last two days Also Read - COVID-19 an Opportunity For India to be Self-Reliant, Says PM Modi, Launches Coal Mine Auction

1. There won't be any fresh lockdowns anywhere in the country.Also Read -
2. Give more momentum to economic activities that have already resumed.
3. Bring in investment, increase business and employment opportunities.
4. Fight against coronavirus should continue.
5. Raise awareness about the number of patients who have recovered from coronavirus infection to get people out of "stigma due to fear of getting infected."
6. Trace, track and isolate - the three-pronged fight must become quicker
7. The helplines should be helpful, not helpless.
8. In states where Arogya Setu App has been downloaded more, there have been very positive results. We have to constantly try to increase the reach of the Aarogya Setu App and ensure more and more people download this app
9. We should form a team of senior doctors to guide patients via telemedicine and to provide them with the right information. Apart from this, we also have to raise an army of young volunteers who can run the helpline effectively for the public.
10. The spread of Covid-19 is more in a few big states and cities. 'Deeply Grateful': PM Modi on India's Election as Non-permanent Member of UN Security Council

On Tuesday and Wednesday, Prime Minister Narendra Modi interacted with the CMs to chart out the final course of action to fights with the COVID-19 crisis.

The COVID-19 death toll stood at 11,903 while the number of cases jumped by over 10,000 for the sixth day to cross another grim milestone of over 3.5 lakh cases, according to Union Health ministry data. The COVID-19 caseload climbed to 3,54,065 with 10,974 new infections being reported in the last 24 hours.

Of the 2,003 new deaths, Maharashtra accounted for the highest 1,409 fatalities taking its COVID-19 death tally to 5,537, while the death toll in Delhi stood at 1,837 after 437 more people died of the disease, according to the data updated at 8 am. Maharashtra, Tamil Nadu and Delhi are the three worst-affected states.

"The sudden surge in deaths is based on the entry of data by the states. Maharashtra and Delhi have reconciled data from previous days," a Health Ministry official said.

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Lockdown Extension News: Here is What Will Happen in From July 1 | 10 Things PM Modi Said to CMs

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Also Read - New Delhi: Amid rumours and MHA's continuous effort to busting those fake news on an extension of lockdown, Prime Minister Narendra Modi made it clear to the state Chief Ministers that there will be no lockdown 5 or 6 - the unlock phase has already begun.