Covid19 - clinical / epidemiological thread

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nimbus said:
Harrowing tale of young nurse who died of blown out RV/peri-intubation arrest.

www.npr.org

A Story Of Youth, Hope And Loss — And The Mystery Of COVID-19

Audrey and Kelsey Ellis, twins born exactly 10 minutes apart, always made sure to spend their birthday together. Last year, on their 29th birthday, the celebration would be overwhelmed by illness.
www.npr.org www.npr.org
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Ughhhh that was devastatingly hard to read. Every day with a functioning right ventricle is a good day...

From a medical perspective, it would seem that an RPELLA was the wrong support strategy for this situation. She likely would have done better with VA ECMO, Protek Duo, or even a surgical RVAD... Unlikely it would have made a difference in the long term, though, unless she was a candidate for heart-lung txp (sounds like the RV was beyond recovery)
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Hork Bajir said:
Ughhhh that was devastatingly hard to read. Every day with a functioning right ventricle is a good day...

From a medical perspective, it would seem that an RPELLA was the wrong support strategy for this situation. She likely would have done better with VA ECMO, Protek Duo, or even a surgical RVAD... Unlikely it would have made a difference in the long term, though, unless she was a candidate for heart-lung txp (sounds like the RV was beyond recovery)
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I read that yesterday and emailed my PD. No where did it say anything about anticoagulants in a patient they had diagnosed w Type 4 PH. And you see a blowing up RV in this patient and you aren’t thinking PE? TPA anyone? I specifically didn’t post it on here w my criticisms but now that someone else did, I am chiming in.
I am surprised they published that story.
It’s Covid though. Likely would have made no difference in outcome like you said.

I have pushed TPA on one of these and they still died. I have ordered TPA on one of these and then then VV ECMO and he still died two weeks later.
 
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Hork Bajir said:
Ughhhh that was devastatingly hard to read. Every day with a functioning right ventricle is a good day...

From a medical perspective, it would seem that an RPELLA was the wrong support strategy for this situation. She likely would have done better with VA ECMO, Protek Duo, or even a surgical RVAD... Unlikely it would have made a difference in the long term, though, unless she was a candidate for heart-lung txp (sounds like the RV was beyond recovery)
Click to expand...
As soon as I read that they were watching YouTube I was furious that she wasn't transferred to a tertiary center. Don't screw around in young people give them a chance! She could have gone on to ecmo and been up for a transplant (though that early in the pandemic probably not) but either way that seemed like a garbage plan.
 
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chocomorsel said:
I read that yesterday and emailed my PD. No where did it say anything about anticoagulants in a patient they had diagnosed w Type 4 PH. And you see a blowing up RV in this patient and you aren’t thinking PE? TPA anyone? I specifically didn’t post it on here w my criticisms but now that someone else did, I am chiming in.
I am surprised they published that story.
It’s Covid though. Likely would have made no difference in outcome like you said.

I have pushed TPA on one of these and they still died. I have ordered TPA on one of these and then then VV ECMO and he still died two weeks later.
Click to expand...

This was very early, March 2020. Bad timing.
 
chessknt said:
As soon as I read that they were watching YouTube I was furious that she wasn't transferred to a tertiary center. Don't screw around in young people give them a chance! She could have gone on to ecmo and been up for a transplant (though that early in the pandemic probably not) but either way that seemed like a garbage plan.
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Come on, you think she would have survived the transfer? In winter in Oregon?
 
chessknt said:
As soon as I read that they were watching YouTube I was furious that she wasn't transferred to a tertiary center. Don't screw around in young people give them a chance! She could have gone on to ecmo and been up for a transplant (though that early in the pandemic probably not) but either way that seemed like a garbage plan.
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100%, should have been at a ECMO and advanced heart failure center, this should have been a transfer as soon as they realized ionotropes and diuresis weren’t going to cut it.
 
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chocomorsel said:
Come on, you think she would have survived the transfer? In winter in Oregon?
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They can do remote ecmo starts which would have made transfer safe. And I acknowledge she probably wouldn't have made it without a transplant that probably wouldn't have been offered and maybe transfer was discussed but didn't make it in to the article but reading about a procedure being practiced in a 30 year old for the first time instead of transferring somewhere with better resources is what irritated me. I don't think the hospitals we're full by early March so it isn't like ohsu was at capacity...
 
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chessknt said:
They can do remote ecmo starts which would have made transfer safe. And I acknowledge she probably wouldn't have made it without a transplant that probably wouldn't have been offered and maybe transfer was discussed but didn't make it in to the article but reading about a procedure being practiced in a 30 year old for the first time instead of transferring somewhere with better resources is what irritated me. I don't think the hospitals we're full by early March so it isn't like ohsu was at capacity...
Click to expand...

Remote ECMO transfer still take a lot of time. The hospital has to be called, accept the patient, deploy the team to either drive or fly there in the middle of winter in Oregon, and then the patient has to be lined up. How long does that take usually?
But yes I understand the frustration of the YouTube video. Which I would think if you know how to deploy a left sided Impella you would know how to do it on the right side, so they were probably making sure where to line it up in the PA.
 
An impella RP is a vastly different beast to an impella CP or 2.5.
Most experience for acute RV failure would be centrimag (if chest open) protek duo or peripheral VA
 
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Newtwo said:
An impella RP is a vastly different beast to an impella CP or 2.5.
Most experience for acute RV failure would be centrimag (if chest open) protek duo or peripheral VA
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Good to know. I am no expert on this stuff, but I would think a transfer would definitely take longer than the time she had.
 
Wait 7 weeks for elective surgery?

8441D83A-C503-46D2-8E7C-BC6DD0C4174D.jpeg


Error - Cookies Turned Off

associationofanaesthetists-publications.onlinelibrary.wiley.com associationofanaesthetists-publications.onlinelibrary.wiley.com
 
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Lawpy said:
Thoughts pls @pgg @chocomorsel @nimbus @vector2 @DocVapor @BobLoblaw78 and everyone

jamanetwork.com

Association of Vitamin D Levels and Clinical Characteristics With COVID-19 Test Results

This cohort study examines the associations of vitamin D levels, race, and other characteristics with positive COVID-19 test results.
jamanetwork.com jamanetwork.com
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Didn't read the whole thing, but the quickest and easiest answer is "Go outside more, exercise more and supplement with Vit D (and others) will help you versus those that don't."

Anything associated with immune response that is lower will theoretically make sense that it could affect your response to COVID. I have a hard time determining why it affects black people more than white people which makes me slightly hesitant to endorse it. Does having a low Vit D associated with positive test mean your immune response is already exhausting its substrates (is it correlation or causation)?

I find little harm with the multiple supplements (vit C, zinc, melatonin, etc) being suggested for COVID outside of them not working. Just avoid 20 per day. I don't think this is the proof we need to go beyond this recommendation.
 
MirrorTodd said:
And sadly, Darwinism doesn't apply to people like this.
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Wouldn't these people and their children get COVID and die off??

I am trying to get the temperature of the room with the following question. Would people have their teen daughters get the COVID vaccine? If they had already had COVID? This is not a hypothetical situation in the slightest. Unless there is definitive proof that the vaccine has significant improvement over prior infection.... Unless there is definitive proof that the vaccine doesn't have significant long term adverse effects.... I think I will recommend holding off.
 
BobLoblaw78 said:
Wouldn't these people and their children get COVID and die off??

I am trying to get the temperature of the room with the following question. Would people have their teen daughters get the COVID vaccine? If they had already had COVID? This is not a hypothetical situation in the slightest. Unless there is definitive proof that the vaccine has significant improvement over prior infection.... Unless there is definitive proof that the vaccine doesn't have significant long term adverse effects.... I think I will recommend holding off.
Click to expand...

There could be adverse long term effects for anybody, not just teen females. FWIW, my 23yo daughter had it. And I know the vast majority of 26yo interns in my hospital had it too.


www.nytimes.com

The F.D.A. is set to authorize the Pfizer-BioNTech vaccine for those 12-15 years old by early next week.

The move opens up the U.S. vaccination campaign to millions more Americans.
www.nytimes.com www.nytimes.com
 
Arguably, you’re getting exposed to the spike protein one way or another. Any long term side effects will likely be due to that.
 
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Thanks for the feedback. I was weighing the risk vs benefit for a female teen who had already had COVID (or in my case both did). I think that natural immunity provides similar benefit, thus erasing benefit from the vaccine. Risk from infection is very low for this age group, but they have already been infected so that boat has sailed anyway. Risk from vaccine remains withouta any benefit (unless I am missing something).
 
BobLoblaw78 said:
Thanks for the feedback. I was weighing the risk vs benefit for a female teen who had already had COVID (or in my case both did). I think that natural immunity provides similar benefit, thus erasing benefit from the vaccine. Risk from infection is very low for this age group, but they have already been infected so that boat has sailed anyway. Risk from vaccine remains withouta any benefit (unless I am missing something).
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So I think if you wanted to go about this the “right” (albeit cumbersome) way, you’d have her titers drawn. There are plenty of reports of people with a mild COVID course that end up with a minimal immune response and very low titers. If that’s the case, I’d vaccinate. If she’s got antibodies coming out the wazoo, skip it.

Obviously teenagers are at very low risk for serious COVID complications. My bigger worry is that my kids would be vectors and transmit it to someone who is high risk without knowing it. I realize that this is becoming a smaller problem as more and more people get vaccinated, but if my kid doesn’t have the antibodies, I’d have them get the shot.
 
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If you are not vaccinating your kids against the flu i don't understand why you would for covid.
 
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dhb said:
If you are not vaccinating your kids against the flu i don't understand why you would for covid.
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I think most ppl vaccinate their kids for flu, so that does't leave too many ppl. But to play devil's advocate, it is less effective but also a known risk from vaccination. COVID could theoretically have much worse adverse effect incidence then the flu vaccine with it's many years of evidence/data.
 
A little off topic but saw this on Twitter. COVID ICU and hospitalist pay in Ontario, CAN. Attending intensivists were paid $450CAD/hr for a night shift. Even residents were getting $125CAD/hr. Not sure if US pay for intensivists and residents were competitive. Maybe universal healthcare ain’t so bad.
 

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VA Hopeful Dr said:
That's not accurate.

www.cdc.gov

The NIVD is preliminary influenza vaccination data updated weekly.

Includes: coverage estimates, using existing and new data sources
www.cdc.gov www.cdc.gov
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I said 2/3. I looked at your reference and you are correct. The actual percentage for 2020 was 62.326568761387587429%. I am so embarrassed...


CDC reference:
"Current flu vaccination coverage among children is estimated to be 58.2% as of the week ending April 17, 2021 (MMWR week 15), lower than the 62.3% coverage estimated during the week ending April 18, 2020 (MMWR 15) in 2020."
 
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BobLoblaw78 said:
I said 2/3. I looked at your reference and you are correct. The actual percentage for 2020 was 62.326568761387587429%. I am so embarrassed...


CDC reference:
"Current flu vaccination coverage among children is estimated to be 58.2% as of the week ending April 17, 2021 (MMWR week 15), lower than the 62.3% coverage estimated during the week ending April 18, 2020 (MMWR 15) in 2020."
Click to expand...
2019-2020 was the first time we've broken 60% in the past decade. Usually it hovers in the mid to upper 50s.

Estimates of Flu Vaccination Coverage among Children — United States, 2017–18 Flu Season | FluVaxView | Seasonal Influenza (Flu) | CDC

Estimates of Flu Vaccination Coverage among Children — United States, 2017–18 Flu Season
www.cdc.gov www.cdc.gov
 
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VA Hopeful Dr said:
2019-2020 was the first time we've broken 60% in the past decade. Usually it hovers in the mid to upper 50s.

Estimates of Flu Vaccination Coverage among Children — United States, 2017–18 Flu Season | FluVaxView | Seasonal Influenza (Flu) | CDC

Estimates of Flu Vaccination Coverage among Children — United States, 2017–18 Flu Season
www.cdc.gov www.cdc.gov
Click to expand...
I don't even care, but I can't help being pedantic to people that are pedantic.

Again from your reference CDC site:
"Vaccination coverage with ≥1 dose of flu vaccine was 63.8% among children 6 months through 17 years, an increase of 1.2 percentage points from the 2018–19 flu season (62.6%)"

"during the 2018–19 flu season. Vaccination coverage with ≥1 dose of flu vaccine was 62.6% among children 6 months through 17 years,"
 
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BobLoblaw78 said:
Wouldn't these people and their children get COVID and die off??

I am trying to get the temperature of the room with the following question. Would people have their teen daughters get the COVID vaccine? If they had already had COVID? This is not a hypothetical situation in the slightest. Unless there is definitive proof that the vaccine has significant improvement over prior infection.... Unless there is definitive proof that the vaccine doesn't have significant long term adverse effects.... I think I will recommend holding off.
Click to expand...
Maybe not definitive, but this preprint from UC Irvine suggests a better immune response from vaccination compared to those with previous infection. The mRNA vaccines seem to elicit a focused immune response that targets a few key antigens. This benefit can be had even in those with previous natural infection

 
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BobLoblaw78 said:
I don't even care, but I can't help being pedantic to people that are pedantic.

Again from your reference CDC site:
"Vaccination coverage with ≥1 dose of flu vaccine was 63.8% among children 6 months through 17 years, an increase of 1.2 percentage points from the 2018–19 flu season (62.6%)"

"during the 2018–19 flu season. Vaccination coverage with ≥1 dose of flu vaccine was 62.6% among children 6 months through 17 years,"
Click to expand...
Ha, ok so 2018 was the first year.
 
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So a family member is all excited we can get $9000 from FEMA for a covid related funeral. Naturally I am the one that must take care of getting the death certificate updated because the lazy primary simply wrote the generic cardiopulmonary arrest.

My question is why on God's green earth are covid funerals being reimbursed? Are we reimbursing flu related funerals? MVAs? Cancer? Murder? Electrocution? Skydiving Accidents? Are these less horrific and financially burdensome to the loved ones? Why is our government so incredibly dysfunctional and pandering to such an extreme.

Now before someone asks the irrelevant question are we taking the money, you clearly don't know my relatives. Oh they taking money, that's why they are pushing me so hard. I'm so disgusted by the program I don't care, but I do understand the position if we are always paying for these wasteful foolish programs we might as well occasionally get a few nickels back as well.

The real question is would I want this program scraped in its entirety and all families including my own receive nothing for covid related funerals? That's a resounding yes.
 
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We'llBeDoneIn15Minutes said:
So a family member is all excited we can get $9000 from FEMA for a covid related funeral. Naturally I am the one that must take care of getting the death certificate updated because the lazy primary simply wrote the generic cardiopulmonary arrest.

My question is why on God's green earth are covid funerals being reimbursed? Are we reimbursing flu related funerals? MVAs? Cancer? Murder? Electrocution? Skydiving Accidents? Are these less horrific and financially burdensome to the loved ones? Why is our government so incredibly dysfunctional and pandering to such an extreme.

Now before someone asks the irrelevant question are we taking the money, you clearly don't know my relatives. Oh they taking money, that's why they are pushing me so hard. I'm so disgusted by the program I don't care, but I do understand the position if we are always paying for these wasteful foolish programs we might as well occasionally get a few nickels back as well.

The real question is would I want this program scraped in its entirety and all families including my own receive nothing for covid related funerals? That's a resounding yes.
Click to expand...

No one died in my family but I’m not giving my PPP loan back and it was a lot more than 9k.
 
dhb said:
No benefit of doing so i guess.
Only gomers and healthcare workers get a flu shot.
50 or 60% whichever is still an insane amount of people.
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Funny. You get looked at as an uneducated redneck by many people if you don't do it here. (maybe it depends on what part of the country you are in)
 
We'llBeDoneIn15Minutes said:
In today's "Well, like, Duhhhh..." news, Lab Leak most likely origin of Covid.

Next up, shocking revelations that the world isn't flat.

www.wsj.com

WSJ News Exclusive | Lab Leak Most Likely Origin of Covid-19 Pandemic, Energy Department Now Says

The U.S. agency’s revised assessment of how the pandemic started is based on new intelligence.
www.wsj.com www.wsj.com
Click to expand...
Might be worth reading the actual article:

The Energy Department made its judgment with “low confidence,” according to people who have read the classified report.

The Energy Department now joins the Federal Bureau of Investigation in saying the virus likely spread via a mishap at a Chinese laboratory. Four other agencies, along with a national intelligence panel, still judge that it was likely the result of a natural transmission, and two are undecided.
 
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VA Hopeful Dr said:
Might be worth reading the actual article:

The Energy Department made its judgment with “low confidence,” according to people who have read the classified report.

The Energy Department now joins the Federal Bureau of Investigation in saying the virus likely spread via a mishap at a Chinese laboratory. Four other agencies, along with a national intelligence panel, still judge that it was likely the result of a natural transmission, and two are undecided.
Click to expand...
I wonder if that's the same intelligence panel of 50 geniuses that said Russians were behind the fake Hunter Biden laptop? 🤔😉
 
VA Hopeful Dr said:
Might be worth reading the actual article:

The Energy Department made its judgment with “low confidence,” according to people who have read the classified report.

The Energy Department now joins the Federal Bureau of Investigation in saying the virus likely spread via a mishap at a Chinese laboratory. Four other agencies, along with a national intelligence panel, still judge that it was likely the result of a natural transmission, and two are undecided.
Click to expand...


Unfortunately without the full and open cooperation of the Chinese government, we will never know. It’s interesting that these questions never came up with SARS-Cov1 and MERS. Different political/geopolitical times.

Hopefully H5N1 doesn’t mutate into an important human pathogen.
 
We'llBeDoneIn15Minutes said:
In today's "Well, like, Duhhhh..." news, Lab Leak most likely origin of Covid.

Next up, shocking revelations that the world isn't flat.

www.wsj.com

WSJ News Exclusive | Lab Leak Most Likely Origin of Covid-19 Pandemic, Energy Department Now Says

The U.S. agency’s revised assessment of how the pandemic started is based on new intelligence.
www.wsj.com www.wsj.com
Click to expand...

We'llBeDoneIn15Minutes said:
I wonder if that's the same intelligence panel of 50 geniuses that said Russians were behind the fake Hunter Biden laptop? 🤔😉
Click to expand...


Funny you reference the “geniuses”, then immediately dismiss the “geniuses” when their statements don’t actually confirm your thesis. It’s human nature to pick and choose the “experts” who agree with you.
 
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nimbus said:
Funny you reference the “geniuses”, then immediately dismiss the “geniuses” when their statements don’t actually confirm your thesis. It’s human nature to pick and choose the “experts” who agree with you.
Click to expand...
No I was directly referencing the "intelligence panel," as in the 51 intelligence officers than signed a worthless letter proclaiming laptop nonsense. Those geniuses.

Anytime a government agency goes against the government narrative, it should give you pause. Simply going along pushing the agenda isn't as significant.
 
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The US government is going to suppress any information regarding a lab leak. That is because COVID was not created in China. It was created here in the United States. We shipped it to China and those incompetent idiots let it accidentally leak from a lab.

If we admitted that it was a lab leak, then our part in creating it would also be exposed and the US government would be liable for trillions of dollars in compensation to the victims of COVID in USA and the world.
 
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I'm old enough to remember when the lab leak theory was a conspiracy, school closures were harmless ,natural immunity didn't exist, toddlers had to mask for preschool and you had to show a vax card to enter a restaurant.

Looking back, that Florida Man seemed to be right about a lot of things.
 
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