COVID-19
Started by BicepsTriceps
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deleted171991
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deleted171991
To change the subject, a bit of "relaxation material":
Nope, agree with you on this.
Could be big. Worry about the confounding of coinfection without a cardiac muscle biopsy...
I figured that if we ever reached a steady state in this disease spread, IVIG would end up being a potentially useful tool, but without enough COVID exposure was unsure of the utility at this point.
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One of my patients died in week 3. Was getting better but suddenly developed refractory hypoxia. He was on vent throughout and also on hydroxychloroquine. Another was also getting better on 1 L but suddenly day 8 we have gone from 1 to 15 L. I don’t understand this infection at all. Why does it rebound ?
Anybody seen a picture of these Tesla vents? curious to see how they produced so many in such a short period of time
their surplus respmed vents. Give me a second and I'll find the quote
https://www.cnet.com/roadshow/news/tesla-ceo-elon-musk-ventilator-covid-19/
""China had an oversupply, so we bought 1255 FDA-approved ResMed, Philips & Medtronic ventilators on Friday night & airshipped them to LA"
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deleted171991
This virus causes multiorgan pathology, because we have no immunity to it (and it causes a hell of a cytokine storm). Anything can go wrong, even late in the disease. It's the kind of adversary you need to beat more than once.
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Maybe it was flash pulmonary edema from acute CHF?
Do you guys have any idea why there is such a huge discrepancy in outcomes for infected patients? On the one hand, this disease is 10 to 50 times more lethal than the flu, and it's fairly common for people under 50 to end up intubated in the ICU, something that is almost unheard of with the regular flu. But then on the other hand, they say a huge fraction of patients have very mild symptoms or may be completely asymptomatic and never even know they had it!
This is truly bizarre, because if you get the flu, you get smashed and definitely feel it, so why would this much more virulent disease have a median presentation that is milder than the median influenza presentation?
This is truly bizarre, because if you get the flu, you get smashed and definitely feel it, so why would this much more virulent disease have a median presentation that is milder than the median influenza presentation?
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deleted171991
There were at least two strains in China, with different levels of severity of disease. In the meanwhile, they have tracked even more than two, AFAIK.
Viruses mutate, Actually, one of the ways we could get out of this mess would be a lucky mutation which would make the infections milder.
Not everybody has the same level of symptoms with the flu either. For example, I can't remember the last time I had myalgias in my life.
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deleted171991
That, too. Also the immune response differs from individual to individual, and, since the cytokine storm seems to be more dangerous than the virus itself, that's why we are seeing multiple people dead in the same family, I guess. I think genetics matter, like in malaria.
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deleted171991
Personal Protective Equipment (PPE) Pearls – COVID-19 - emDocs
How can you best protect yourself when evaluating and managing patients with COVID-19?
www.emdocs.net
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It's arguable that different strains actually impact disease severity.
See: Response to “On the origin and continuing evolution of SARS-CoV-2”
There were multiple methodological errors in the paper that claimed that and one of their figures basically doesn't even make sense.
I think overall we're getting a flood of open access papers that have undergone very quick or minimal reviewing as this thing progresses. Likely literally papers that seem that they must have had a turnaround time of a couple weeks based on the data they're presenting. Also getting some very iffy papers out of China to take with a grain of salt. It's hard to derive anything significant from a lot of the papers coming out except descriptive information or if the paper is demonstrating very solid methods and outcomes.
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EMCrit - Critical Care for Non-Intensivists during COVID19 Pandemic
Crit Care during COVID19
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deleted171991
Darn, the Spanish flu must have had no idea of this theory.
har har
Should I rephrase that into something easier for you to understand? Just because a virus has a mutations doesn’t mean the mutations necessarily impact virulence. You literally said that in the post I quoted. The point of the paper I referenced was that there isn’t great evidence to show that these strains actually have different levels of virulence at this time.
Maybe. But acting more like ARDS. In the end he was propped on one side because he would desat with any turn.
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deleted171991
That's the debate, whether it has mutated or not, and whether that now affects clinical course.
It definitely can (it's a virus, they mutate, and many times that changes their virulence), but, after the exchange right above your post, I don't think there is evidence that its mutations have changed anything,
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deleted171991
Advanced Cardiac Life Support Recommendations During the COVID-19 Pandemic | Alfred Health Guideline - INTENSIVE
This guideline describes the "Advanced Cardiac Life Support Recommendations for ALL Patients During the COVID-19 Pandemic" at Alfred Health.
intensiveblog.com
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deleted171991
COVID Ethics: Should clinicians see patients without appropriate PPE? - First10EM
Should clinicians see patients without appropriate PPE? It is a difficult ethical question, but one we may need to consider during a pandemic.
first10em.com
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deleted171991
A N.Y. Nurse Dies. Angry Co-Workers Blame a Lack of Protective Gear. (Published 2020)
“I’m okay. Don’t tell Mom and Dad. They’ll worry,” he wrote to his sister. He may be the first nurse in New York City to die from the coronavirus.
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Lung Ultrasound in COVID-19
Medical Education video on performing and interpreting lung ultrasound in suspected SARS-CoV-2 (COVID-19) patients
litfl.com
Combatting COVID19 - Is Lung Ultrasound an Option?
Cian McDermott and Rachel Liu take us through how ultrasound can be used in the diagosis and prognostication of Covid 19 patients #FOAMed
www.stemlynsblog.org
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deleted171991
ERcast - Lessons Learned and First Hand Account From Kirkland, WA - emDocs
Kirkland, Washington was the first U.S. city with reports of a large-scale COVID-19 outbreak.
www.emdocs.net
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deleted171991
ICM Anaesthesia COVID-19
Information, guidance and resources supporting intensivists and anaesthetists to understand and manage Coronavirus (COVID-19)
icmanaesthesiacovid-19.org
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deleted171991
FDA grants EUA status for Prisma Health’s VESper ventilatordevice
Prisma Health has secured EUA from the US FDA for VESper ventilator expansion device, which will help increase ventilator capacity for COVID-19 patients.
www.nsmedicaldevices.com
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Covid 19: A primer on ICU care for the non-intensivist. St Emlyn's
A beginner's guide to working on the ICU if redeployed to critical care during Covid-19 pandemic #FOAMed
www.stemlynsblog.org
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deleted171991
Why Germany's Coronavirus Death Rate Is Far Lower Than In Other Countries
Italy's fatality rate hovers around 10%. France's is at around 5%. Yet Germany's fatality rate from COVID-19 is just 0.5%. As of March 25, there were 175 deaths and 34,055 cases.
www.npr.org
@FFP thanks for sharing all this info.
I can't remember if I read it in something that you've shared, but have you seen anything about proning patients early in the course of disease and not waiting until on ventilator? I thought I read something about that, and wanted to share it with someone.
I can't remember if I read it in something that you've shared, but have you seen anything about proning patients early in the course of disease and not waiting until on ventilator? I thought I read something about that, and wanted to share it with someone.
From the article:Why Germany's Coronavirus Death Rate Is Far Lower Than In Other Countries
Italy's fatality rate hovers around 10%. France's is at around 5%. Yet Germany's fatality rate from COVID-19 is just 0.5%. As of March 25, there were 175 deaths and 34,055 cases.
"When Drosten's university medical center developed what became the test recommended by the World Health Organization, they rolled these tests out to their colleagues throughout Germany in January.
"And they of course rolled this out to labs they know in the periphery and to hospital labs in the area where they are situated," Drosten said. "This created a situation where, let's say, by the beginning or middle of February, testing was already in place, broadly."
Drosten said that has meant quicker, earlier and more widespread testing for COVID-19 in Germany than in other countries."
And that's it. Test, isolate the positives until they're well, everyone else stays healthy. Individual labs aren't overrun, timely results, the system is able to handle the load.
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This really doesn't tell me much other than they are testing early. So what are they doing with those patients who test positive afterwards? Quarantining them, hospitalizing them? I mean we can only guess, but there are no actual answers in the article.Why Germany's Coronavirus Death Rate Is Far Lower Than In Other Countries
Italy's fatality rate hovers around 10%. France's is at around 5%. Yet Germany's fatality rate from COVID-19 is just 0.5%. As of March 25, there were 175 deaths and 34,055 cases.
How come the ones who test positive aren't getting that sick? Or am I missing something? So does that mean that if you catch the illness early enough in the course and isolate, the symptoms are much milder? Since there's no actual proven treatment, how are these 35K people fighting this illness and preventing it from getting severe?
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Fair question.
My comment was more about avoiding the run on resources.
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deleted171991
I would definitely try proning cooperative and non-altered patients on NIV, before intubating them. You remember correctly; some doctors have been doing this, but don't ask me where.
I asked an awake person to prone themself. Their sats went up within the next hour. Unfortunately they did not like being prone so went back supine and continued texting on their phone. Due to precautions I’m not going back in the room to keep reminding them. They’re still on high flow but not intubated at least!
Treatment of Critically Ill Patients With COVID-19 With Convalescent Plasma
This case series describes clinical outcomes in 5 Chinese patients with laboratory-confirmed COVID-19, ARDS, and high viral loads despite antiviral treatment who were given human plasma with SARS-CoV-2 antibodies obtained from previously infected and recovered patients.
jamanetwork.com
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deleted171991
I think this is our best chance for severe cases. I'm surprised we haven't been talking more about this.Treatment of Critically Ill Patients With COVID-19 With Convalescent Plasma
This case series describes clinical outcomes in 5 Chinese patients with laboratory-confirmed COVID-19, ARDS, and high viral loads despite antiviral treatment who were given human plasma with SARS-CoV-2 antibodies obtained from previously infected and recovered patients.
This is five patients... I didn’t read the whole article but just the summary didn’t sounds right to me
“Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion”... like two weeks isn’t the normal time frame for a lot of pts to recover oxygenation and stop shedding viruses?
why did you like this study?
Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents...
Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of a long-term care skilled nursing facility were tested for SARS-CoV-2; 23...
www.cdc.gov
Following identification of a case of coronavirus disease 2019 (COVID-19) in a health care worker, 76 of 82 residents of an SNF were tested for SARS-CoV-2; 23 (30.3%) had positive test results, approximately half of whom were asymptomatic or presymptomatic on the day of testing.
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