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What country is this in?
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Can we stop with the plaquenil ****? This is Vitamin C for sepsis all over again.
A ****ty study out of Italy with 30 patients and all of a sudden the president thinks it's the cure. Insane.
It's also dangerous talk. Folks are going to take it thinking they're immune and end up spreading more disease.
A ****ty study out of Italy with 30 patients and all of a sudden the president thinks it's the cure. Insane.
It's also dangerous talk. Folks are going to take it thinking they're immune and end up spreading more disease.
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Yesterday I went to three stores, still no flour, no sugar, no milk! Learned my lesson, I don't mind stocking a few pills.
I don't think I will be immune with this med. Caution as usual.
The paranoid survives.
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deleted171991
Yes, Young People Are Falling Seriously Ill From Covid-19
The risk is particularly dire for those with ailments that haven’t yet been diagnosed
www.bloomberg.com
Your post is sheer conjecture... and isn't even backed by 30 counter-examples.
I f I were the president, I'd do the same. Any port in a storm.
First off, vitamin C is very low risk, potentially high reward so compared to all the other iatrogenic crap we do in medicine, I wouldn’t pick vitamin C as a bad one.
Also, there are several Chinese trials showing efficacy of chloroquine. It’s Chinese data, however, so big grain of salt. China has had this virus the longest, where is their data and protocols? All this time, did they figure anything out (aside from quarantining people?)
There isn't data. It's 20 patients in an Italian study that had a decrease in viral swab load. There literally is no data.
Vitamin C was proven not to work in two recent trials. It's people jumping at a "cure" without any real evidence.
Also would love to see the Chinese trials showing efficacy of chloroquine that are not just in vitro.
It's so small as to practically be a case study, but I appreciate the idea. If it helps even a bit, it's worthwhile. I doubt that they'd fudge results with the eyes of the entire world on that team.
But you don't have to fudge results. You overestimate your effect difference, decrease your number of patients and regression to the mean takes care of the rest. I mean sure, give somebody hydroxychloroquine what do I care. It's not arsenic or poison for the most part. It's just voodoo science.
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deleted171991
I just want to remind everybody what I teach my trainees: EVERY substance we use in medicine, even water or oxygen, can be harmful in the wrong dose, or given to the wrong patient. There is no harmless medication or substance. The sicker the patient, the more careful we should be.
We didn't design the human body. We don't have the blueprints. We still have no idea how the body works at molecular level, what dominos will fall when we play with it.
First Do No Harm. The road to hell is paved with good intentions.
We didn't design the human body. We don't have the blueprints. We still have no idea how the body works at molecular level, what dominos will fall when we play with it.
First Do No Harm. The road to hell is paved with good intentions.
A slightly different perspective......
www.statnews.com
"If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe."
Written by John P.A. Ioannidis, professor of medicine, epidemiology and population health, biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.
A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data
A fiasco in the making? As the #coronavirus pandemic takes hold, we are making decisions without reliable data.
www.statnews.com
"If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe."
Written by John P.A. Ioannidis, professor of medicine, epidemiology and population health, biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.
Manhattan is essentially shut down. Last i checked about 5 people on ECMO in the metroplex. All the Manhattan hospitals are overwhelmed.
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Overwhelmed how?
Secondary sources only: but some of the hospitals are running out of ICU beds. While others are getting crazy amounts of admits.
I'm skeptical just as you are. And time will soon tell whether this appears to be a legitimate intervention. Whole countries, as well as some major hospitals in the US, have added it to their COVID19 protocols.
Put it this way: I sure wouldn't recommend that we take our collective foot off the pedal from trying to create more-targeted, definitive therapies.
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deleted171991
PulmCrit- Is Lopinavir/Ritonavir down and out?
A lot has happened since the last post on Lopinavir/Ritonavir (it was only March 4, but it seems like a year ago). Here is a quick reminder of where
Several trials seemed to use Kaletra with ribavirin to find efficacy in previous coronavirus based diseases. Seems like kaletra by itself is not useful, but maybe with ribavirin it can help in COVID? I think I like hydroxychloroquine better, maybe even with azithromycin (because azithro seems to help with anything and everything!)PulmCrit- Is Lopinavir/Ritonavir down and out?
A lot has happened since the last post on Lopinavir/Ritonavir (it was only March 4, but it seems like a year ago). Here is a quick reminder of whereemcrit.org
Italy now has the most coronavirus related deaths in the world.
www.worldometers.info
Italy COVID - Coronavirus Statistics - Worldometer
Italy Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
www.worldometers.info
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deleted171991
Azithro has an immunomodulatory effect even by itself (which I am sure you know about).
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B
But still only 3k...Italy now has the most coronavirus related deaths in the world.
Italy COVID - Coronavirus Statistics - Worldometer
Italy Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.
China took dramatic government action combined with an almost total social buy in. There were no half measures in the way they conducted their lockdown. All factories, restaurants, schools, and other areas of population mixing closed for weeks. Neighborhood complex security guards given Gestapo-like powers to check temperature upon leaving and entering residential complexes, and in some cases doing daily temperature checks within apartments. No non residents allowed to enter apartment complexes, no matter if its brother or GF of resident. People not allowed to leave their homes without wearing facemasks under penalty of arrest. People with symptoms of Covid were invariably transferred to hospitals/"facilities" whether they liked it or not. Nothing voluntary or home about their quarantines.
The other thing that happened in China was that the initial stage of the outbreak happened during Chinese New Year, a 3 week period of time during which everything was shut down anyway. At first this was a disaster because it led to the seeding of the disease from Wuhan to the rest of China as Wuhan residents traveled to their hometowns and carried the virus with them, but it also ensured that the new epicenters would not explode since everything was shut down already. Then all the Chinese government had to do was extend the CNY shutdowns for a further couple weeks until the outbreak burned itself out. It's not a mystery, a disease can't spread when people are confined to their homes for weeks at a time.
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Eye opening experience I found on the medicine section of reddit:
And it continues...
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Right I was thinking about cpap non invasive.
I'm still inexperienced but what are your thoughts on remdesivir? I realize RCTs are very critical but from what's known so far, is it promising?
Also are ACE inhibitors and ARBs continued to be used? I heard of controversy behind their potential to increase covid infection sites but that's still not confirmed, and the ESC still recommends using it. Also the problems could still arise from high Ang II levels.
Also are ACE inhibitors and ARBs continued to be used? I heard of controversy behind their potential to increase covid infection sites but that's still not confirmed, and the ESC still recommends using it. Also the problems could still arise from high Ang II levels.
No, what is "the concern"?
Could you name a few?
Arch Guillotti
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Teva will donate 6 Million tablets through wholesalers to hospitals by March 31, and more than 10 Million within a month
Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA) announced today the immediate donation of more than 6 million doses of hydroxychloroquine sulfate tablets through wholesalers to hospitals across the U.S. to meet the urgent demand for the medicine as an investigational target to treat COVID-19. The company is also looking at additional ways to address the global need.
Teva Pharmaceutical Industries Ltd. (NYSE and TASE: TEVA) announced today the immediate donation of more than 6 million doses of hydroxychloroquine sulfate tablets through wholesalers to hospitals across the U.S. to meet the urgent demand for the medicine as an investigational target to treat COVID-19. The company is also looking at additional ways to address the global need.
I would like to know what you are thinking too. The high death rate, and severe illness of some young people is a huge concern. Equipment/supply shortages are also big which will just worsen the death rate. What else?
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deleted643396
It’s hospital beds, ventilators, and healthcare workers that are about to be overwhelmed. The death rate is not the issue. It’s the consumption of resources, which will have downstream affects on all aspects of healthcare. Keep your eye on what is happening in NYC because they will be in trouble really soon.
“Flattening the curve” and “social distancing” have nothing to do with changing the natural death rate of the virus. It is so the spread is slowed and dragged out over time so the healthcare system can keep up. Although, the deaths will be much higher if the healthcare system is overwhelmed.
I did just say that in my post right. Doesn’t that just lead to more death though?
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deleted643396
I just edited my response.
The previous assertion by others that the virus is not that scary because the death rate is not much higher than the flu and only affects the old completely misses the point of why this is being taken so seriously.
Or the stopped reporting, who knows.
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deleted643396
@FFP posted a video somewhere yesterday of a Governor Cuomo press conference who actually does a really good job breaking down the problem and why the extraordinary steps are being taken.
This family lost four members. Two currently on “life support”.
The ones who are left say that the dead were healthy. It’s the obesity I bet that was their biggest problem unfortunately.
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deleted171991
While obesity alone decreases respiratory functional capacity and increases oxygen consumption, it's not obesity that gives ARDS, or HLH, or HF. It's most likely a genetic issue, where they had severe cytotoxic response on top of that poor cardiorespiratory reserve. That's what kills a lot of people in C19.
Also, most likely they had (undiagnosed) diabetes and hyperglycemia, an excellent growth medium for any microbe, and an immunodepressant. Btw, beats me why we still feed (diabetic) people sugary tube feeds in the ICU, especially during infectious diseases.
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Based on what I have heard as risk factors to poor outcomes, in absence of evidence that they had other risk factors (mom was 70s) everyone else early to mid fifties.
Just saying if the were otherwise healthy taking the word of their family members...yes obesity leads to diabetes. Bu I am not gonna make that assumption just cuz they are fat they are diabetic.
Yeah, maybe genetics too. Maybe my genes are a strong predictor that I will do fine with this illness. IDK
I see you edited your post immediately. Trying to play nicer in the sandbox?
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deleted171991
There are multiple issues at play here:
1. We have obese people, most likely with at least borderline hyperglycemia, with a poor immune system, and decreased cardiorespiratoy reserve (if they have to run a mile even while "healthy", they "die").
2. They probably had a severe form of viral pneumonia, most likely due to their poor immunity.
3. What may have killed them was not only the cytotoxic effect of viral pneumonia, but some form of exaggerated immune response +/- poor hospital care (they probably ended up in the same hospital system). I have seen morbidly obese people survive ARDS of other infectious causes with proning etc. I can also see a scenario where they become tachycardic as hell and allow to tick away at 130-140 for days, because people are afraid to give beta-blockers to sick patients.
4. The fact that we have four relatively young people from the same family die makes me think that the immune storm in this disease plays a cardinal role in death. Almost all people who have severe forms have fever. (That by itself is weird for somebody like me, who hasn't had a fever in decades.) I think people's immune systems respond differently to this virus, and that's the key to life or death.
5. Totally unrelated, I think, at some point, we will discover that even postprandial hyperglycemia is bad in an infectious disease, and that sick people/animals avoid food for a reason.
6. I think obesity is a factor, but not enough by far. As I said, I've seen bigger people survive ARDS with good care (not with C19 though). I know it's not easy, because if you take a small lung and a big person, to begin with, and you knock out most of that lung, there isn't much to work with.
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I want to hear more re your thoughts on beta blockers on critically ill. Often tachycardia is a compensatory response to maintain CO and DO2. I’ve seen beta blockers given to tachy pts with unrecognized heart failure and pts arrest.
For septic tachy, I favor vasopressin over NE (SICU nurses refuse to titrate this... idiots). I try to avoid beta blocker. I’ll tolerate HR 120s. If 130-140s and on pressors, I get worried with beta blockers and negative inotropy. What do u do?
