What do I need to know about coronavirus?

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Birdstrike said:
You always have to be careful not to make too many clinical conclusions from basic science research. I think the point of the study was to help find a way to develop a vaccine that stimulates both good antibody and T cell responses, not just one or the other. I don't know that the authors were attempting to definitively conclude anything clinical one way or the other, or that a T cell responses alone without antibodies, are a magic bullet against COVID-19. I found it interesting, though.
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Right. So I was wondering what I had missed when you were relating this article to there being herd immunity.

Although believe me... immunology is far from my area of expertise.
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MediMike said:
Right. So I was wondering what I had missed when you were relating this article to there being herd immunity.
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Hoping. Nothing more. I want this virus to be over.
 
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Getting a little tired of companies saying their medicine is beneficial without posting ANY research at all

Gilead now reports a subgroup analysis from some trial data that remdesivir has a mortality benefit.
 
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How are you guys handling anticoagulation in these patients? Absent other indications of PE (arrhythmia, RV strain on bedside echo, hemodynamic instability, marked tachy etc.) I've usually just started them on prophylactic LMWH. However, there's one hospitalist who's been insisting on getting a CTPA on everyone and it seems like there's been a decent yield, although usually small and of questionable clinical significance. Makes me think a little about being more aggressive w/ empiric therapeutic anticoagulation based on dimer levels.

On a somewhat related note, I'm thinking that if/when I get sick I'm going to start taking aspirin and think about a NOAC...
 
turkeyjerky said:
How are you guys handling anticoagulation in these patients? Absent other indications of PE (arrhythmia, RV strain on bedside echo, hemodynamic instability, marked tachy etc.) I've usually just started them on prophylactic LMWH. However, there's one hospitalist who's been insisting on getting a CTPA on everyone and it seems like there's been a decent yield, although usually small and of questionable clinical significance. Makes me think a little about being more aggressive w/ empiric therapeutic anticoagulation based on dimer levels.

On a somewhat related note, I'm thinking that if/when I get sick I'm going to start taking aspirin and think about a NOAC...
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I usually don't send a ddimer, ferritin, or CRP. largely because I don't want to deal with the results. ferritin and CRP are trended, and ddimer might get at CTPA but unless there is an abrupt change in physical exam or vitals...unclear how it really changes management. Many of these COVID pt's have DDimers > 20, and we know they end up getting microthrombic angiopathic disease, so it makes sense to just start them on heparin whether you see a PE or not. However I can see some inpatients arguing about getting more bang for the buck by CT'ing them anyway....if you plan on CT the chest for whatever reason just do a CTPA and you get more info.

I don't know what the right thing to do is. I just admit them. I presume there are general guidelines.
 
Kinda just feels like we’re throwing poop at walls until some of it sticks. The “cure” was better living prior to the outbreak.
 
turkeyjerky said:
How are you guys handling anticoagulation in these patients? Absent other indications of PE (arrhythmia, RV strain on bedside echo, hemodynamic instability, marked tachy etc.) I've usually just started them on prophylactic LMWH. However, there's one hospitalist who's been insisting on getting a CTPA on everyone and it seems like there's been a decent yield, although usually small and of questionable clinical significance. Makes me think a little about being more aggressive w/ empiric therapeutic anticoagulation based on dimer levels.

On a somewhat related note, I'm thinking that if/when I get sick I'm going to start taking aspirin and think about a NOAC...
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I differ the decision to start anticoagulation to the hospitalist. That being said, having discussed it with them, they are using a certain cut off d dimer, and doing empiric full anticoagulation for anyone who is ICU level (PPV, vent, HFNC, etc.) I think putting all these patients in the scanner especially if your scanner needs to be deconned between usages as the patient is confirmed positive or PUI is a logistical nightmare for department flow.
 
RoyBasch said:
I differ the decision to start anticoagulation to the hospitalist. That being said, having discussed it with them, they are using a certain cut off d dimer, and doing empiric full anticoagulation for anyone who is ICU level (PPV, vent, HFNC, etc.) I think putting all these patients in the scanner especially if your scanner needs to be deconned between usages as the patient is confirmed positive or PUI is a logistical nightmare for department flow.
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absolutely. For some reason it takes up to 60 minutes to decontaminate a CT room where I work.
 
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thegenius said:
absolutely. For some reason it takes up to 60 minutes to decontaminate a CT room where I work.
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Probably your ct crew is understaffed. That's what happens at my shop at night. They're down to 1 person for ct, and if she gets a covid patient, it takes a whole hour to decon. But they have a lot more people during the daytime, so the process really doesn't take that long.
 
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GeneralVeers said:
This virus cleared out the nursing homes in March-May and the most susceptible patients died. A high number of the remaining nursing home residents got it and and are now theoretically immune. That is probably what we are seeing now. Transmission in the under 50 year olds simply will not cause a lot of deaths.

I posted the Sweden death curve in the other forum, and had we not locked down, we might be near the end of this already as their ascent and decline were much more rapid. Admittedly our country has a much bigger geographic area so spread will always be more slow.
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Why do you think fatalities are increasing now, then?
 
miacomet said:
Why do you think fatalities are increasing now, then?
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There are still a significant number of people left who are at high-risk from the disease who didn't contract it the first time around. That is why deaths are going up. We opened up, and the rate of cases increased as expected, and deaths lagged 2-3 weeks after opening.

If we hit 200,000 deaths this year, that will mean total annual deaths will go from 2.8 million to 3.0 million, or an increase of 7%. Not exactly the kind of apocalyptic increase you would expect considering the news coverage.

Interestingly, once COVID goes away in a year or two, we should see a significant decline in annual deaths as we are just front-loading the deaths for people who had 1-5 years of life left anyway.
 
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La Cumbre Lines said:
Good point. This will likely never be included in the mortality numbers for COVID-19 and will get glossed over. I do think it’s important to look at and wish it was easy to find this data for other pandemics like the Spanish flu.
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For the Spanish Flu, just consider this: they didn't even know what a virus was, or that they even existed. They found Haemophilus influenzae and ran with it. It was 1918, so, they couldn't do anything about it, anyhow.

So, to your point, you're even more correct than you know, as, that data isn't hidden - it simply doesn't exist (we're not the Jedi Archives here).
 
La Cumbre Lines said:
All it takes is comparing all cause mortality in the years before, during and after the pandemic. I’m sure that data is available somewhere.
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But, that's what I'm saying - 100 years ago, they didn't know their asses from a hole in the ground. I had a distant relative die in or around 1910, and she was 10 or 12. What did family say did her in? I **** you not, "a dog jumped on her, and, her heart burst". It was probably undiagnosed DM 1. Then again, it wasn't until 1923 when Banting and that other guy got insulin out of a dog.
 
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La Cumbre Lines said:
Fair enough. Interesting history better described by your personal family history. Begs the question, what will they think of us in 100 years following a further explosion in the information/technology age (rhetorical)? I like to think they knew more than the record reflects. We just don’t have a great written historical record and data capture. I’m hesitant to think we know so much more than they did, because the arrogance that portends will likewise humiliate us in 100 years.
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You're a smart guy. I like that.

As I've said IRL many times, 100 years ago, you were healthy, or, you were dead. MI? Dead. Diabetes? Dead. Renal failure? Dead. Pneumonia? Dead. Asthma? Dead. ANY autoimmune stuff? Dead. Mentally ill? Dead in an asylum. All these things we now treat, and folks (including me) live. As you say, 100 years from today, I don't EVEN want to know what they're going to say about us.
 
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Apollyon said:
You're a smart guy. I like that.

As I've said IRL many times, 100 years ago, you were healthy, or, you were dead. MI? Dead. Diabetes? Dead. Renal failure? Dead. Pneumonia? Dead. Asthma? Dead. ANY autoimmune stuff? Dead. Mentally ill? Dead in an asylum. All these things we now treat, and folks (including me) live. As you say, 100 years from today, I don't EVEN want to know what they're going to say about us.
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Likely that we were panicky idiots with infantile science ‍♂️
 
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Apollyon said:
But, that's what I'm saying - 100 years ago, they didn't know their asses from a hole in the ground. I had a distant relative die in or around 1910, and she was 10 or 12. What did family say did her in? I **** you not, "a dog jumped on her, and, her heart burst". It was probably undiagnosed DM 1. Then again, it wasn't until 1923 when Banting and that other guy got insulin out of a dog.
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May your family member rest easy knowing the revenge taken upon the canines by the medical community.
 
GeneralVeers said:
There are still a significant number of people left who are at high-risk from the disease who didn't contract it the first time around. That is why deaths are going up. We opened up, and the rate of cases increased as expected, and deaths lagged 2-3 weeks after opening.

If we hit 200,000 deaths this year, that will mean total annual deaths will go from 2.8 million to 3.0 million, or an increase of 7%. Not exactly the kind of apocalyptic increase you would expect considering the news coverage.

Interestingly, once COVID goes away in a year or two, we should see a significant decline in annual deaths as we are just front-loading the deaths for people who had 1-5 years of life left anyway.
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Well, since there is no evidence of long term immunity, potentially 6-12 months, if that, there's a not insignificant possibility of 1-2 mm excess deaths, not all of them elders, within a year if exponential growth continues. That seems concerning.
 
miacomet said:
Well, since there is no evidence of long term immunity, potentially 6-12 months, if that, there's a not insignificant possibility of 1-2 mm excess deaths, not all of them elders, within a year if exponential growth continues. That seems concerning.
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Assuming no long-term immunity, we may just have to live with an extra 200K deaths in society, yearly for the next few years. I don't know of another option. Remember, that's 200K deaths this year WITH extensive lockdowns and significant social distancing.
 
GeneralVeers said:
Assuming no long-term immunity, we may just have to live with an extra 200K deaths in society, yearly for the next few years. I don't know of another option. Remember, that's 200K deaths this year WITH extensive lockdowns and significant social distancing.
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I think it could well be 1-2mm within eighteen months- the cases grow exponentially, and we've had over 100k in less than six months.
I suppose the other alternative would be to attempt to emulate the successes of other countries; you are not in favor of this? Or you think it would not be possible?
 
miacomet said:
I think it could well be 1-2mm within eighteen months- the cases grow exponentially, and we've had over 100k in less than six months.
I suppose the other alternative would be to attempt to emulate the successes of other countries; you are not in favor of this? Or you think it would not be possible?
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I disagree with you here. Cases are "growing" likely due to a combination of re-opening and increased testing. The number of new infections isn't growing exponentially and deaths are certainly not.

If the mortality is 0.2% among all people who contract it, even assuming every single person in the U.S. is infected you are looking at 600K deaths as a worst case scenario.
 
GeneralVeers said:
I disagree with you here. Cases are "growing" likely due to a combination of re-opening and increased testing. The number of new infections isn't growing exponentially and deaths are certainly not.
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So, then, you don't think we will hit more than 200k deaths this year? Or next?
Why not try and emulate other countries that are doing somewhat better?
Why are Republican governors shutting down parts of their states again?
 
miacomet said:
So, then, you don't think we will hit more than 200k deaths this year? Or next?
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I won't even begin to predict, because I will be wrong. I think 200K is a reasonable estimate by Dec 31st.

Why not try and emulate other countries that are doing somewhat better?
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It's too late to do what Germany did. Also see UK, France, and Spain. As we've posted time and again, broad lockdowns in Western societies are not associated with reduced deaths.

Why are Republican governors shutting down parts of their states again?
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Fear, panic, and blame-avoidance culture. I'm glad the gyms in AZ are suing the governor and want to see what becomes of it.
 
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GeneralVeers said:
I won't even begin to predict, because I will be wrong. I think 200K is a reasonable estimate by Dec 31st.


It's too late to do what Germany did. Also see UK, France, and Spain. As we've posted time and again, broad lockdowns in Western societies are not associated with reduced deaths.


Fear, panic, and blame-avoidance culture. I'm glad the gyms in AZ are suing the governor and want to see what becomes of it.
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So you think the initial lockdown and reduction and deaths was inevitably temporary?
Why do you think Germany has done better? Even Italy is doing better now; their lockdown was highly successful, although obviously this is a bigger country.
Do you think the continued high infection rate will be at all disruptive to society? As in, teachers refusing to go back to school etc?
 
miacomet said:
So you think the initial lockdown and reduction and deaths was inevitably temporary?
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Define temporary? If you locked down for 6 months there wouldn't be an economy left. While the virus is broadly present in the population, as soon as we re-opened infections, and deaths would go up again. We always lose site of why we locked down in the first place, which makes the re-lockdowns puzzling. I'm not sure what they are meant to accomplish.

Why do you think Germany has done better? Even Italy is doing better now; their lockdown was highly successful, although obviously this is a bigger country.
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As I've stated, locking down nursing homes early and not allowing employees/visitors in and out. This prevented thousands of deaths in Germany. We did mostly the opposite in this country.

Do you think the continued high infection rate will be at all disruptive to society? As in, teachers refusing to go back to school etc?
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It's already disruptive, though the "infection rate" doesn't need to be. Districts that don't re-open schools should have their tax money returned to property owners who pay the taxes, or the money should get returned to parents as a voucher. The teachers in many school districts are lazy, or just plain nuts:
www.washingtonexaminer.com

Los Angeles teachers abandon student well-being for social justice

Los Angeles has preemptively decided not to allow students to return to school this fall, citing concerns about the coronavirus and its spread. These concerns might be reasonable were it not for the ridiculous demands being made by the massive teacher's union.
www.washingtonexaminer.com www.washingtonexaminer.com
 
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I'm curious why you think the actual number of true cases aren't increasing. I mean, it's clear that we're picking up a higher proportion of cases now than we were in March/April, however we had broadly available testing from May onwards.

We likely don't have the overall case load that we did at the peak in late march and april, but that was driven by by the outbreak in the NE. I'm sure that right now, the ex-NE US caseload is higher than it's been before. It's certainly far, far higher than it was in May.

It's frustrating that the gov't continues to downplay everything and the media continues to focus merely on the numbers, which either causes pushback or scares people.

I'm also continually puzzled as to why there's minimal talk of increasing health care capacity. Why aren't we instituting outpatient treatment programs to safely discharge people on supplemental 02?
 
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miacomet said:
Well, since there is no evidence of long term immunity, potentially 6-12 months, if that, there's a not insignificant possibility of 1-2 mm excess deaths, not all of them elders, within a year if exponential growth continues. That seems concerning.
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There's no evidence of not having immunity either. The one or two studies out leave out most of the immune system. Even if there actually is no long term immunity then there's nothing that can be done.
 
La Cumbre Lines said:
I think we have been a month or two behind COVID-19 this whole time. I’d bet there was widespread national transmission in the US occurring from January to March that we didn’t really pick up on. It’s hard to accurately look at the curves or numbers when we weren’t even testing at that time. Also I don’t think test is very good. We really should just be looking at hospitalization numbers and death numbers comparing them to season adjusted numbers from the previous year. Case numbers are incredibly misleading.
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Exactly. The case numbers are garbage since testing has been incredibly variable. We need to flow the daily death rate which shows us where we were 2-3 weeks prior on the actual case load.
 
thegenius said:
Good first step
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It is a good first step (trial vaccine shows adequate immune response). I filled out an application to be a guinea pig for their final phase trial. I haven't heard anything back yet.
 
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I'm not sure if being in healthcare makes us more or less attractive as guinea pigs, but here's the link, if interested. And this is where I got the link from, in case you're worried is a scam or something like that. It's not, it's legit.
 
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Would anyone actually take a coronavirus vaccine, given the rush to bring one to market and questionable safety profile? Doesn’t it normally take like 10-20 years for a vaccine to be developed, tested, vetted, and brought to market?
 
TwoHighways said:
Would anyone actually take a coronavirus vaccine, given the rush to bring one to market and questionable safety profile? Doesn’t it normally take like 10-20 years for a vaccine to be developed, tested, vetted, and brought to market?
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I’ll take one. I have no problem with it.
 
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TwoHighways said:
Would anyone actually take a coronavirus vaccine, given the rush to bring one to market and questionable safety profile? Doesn’t it normally take like 10-20 years for a vaccine to be developed, tested, vetted, and brought to market?
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Sign my a** up.
 
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Meh, I’d opt for exposure to the virus itself before taking a vaccine with no long term risk profile. It’s going to be a moot point though if this thing moves through the population and burns itself out prior to a vaccine actually becoming available.
 
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TwoHighways said:
Meh, I’d opt for exposure to the virus itself before taking a vaccine with no long term risk profile. It’s going to be a moot point though if this thing moves through the population and burns itself out prior to a vaccine actually becoming available.
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The COVID vaccine Astra-Zeneca is working on (Oxford article I posted 5 posts above) has been around, in some form, for almost 15 years when they first started developing it for SARS, then MERS. On my list of worst fears, there's probably 5 billion things above "New vaccines." But I respect your right to get the virus as opposed to the vaccine, and odds are you'll be just fine.
 
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The rhetoric from the mod is quite alarming in and of itself. "Anti-science" and "consensus" and citing "facts" that are unproven as a means to shut down debate. It's a private site and I get that they have every right to shut down any conversation they deem fit to shut down for whatever reason, but doing so is far more dangerous for our society than any further spread of disease that may happen as a result of such discussions. Administration clearly doesn't see for forest from the trees. Questioning the efficacy of masking = cancelled. What's next? Is discussing the possibility of herd immunity through exposure grounds for cancellation?

Was anybody masking on the Princess cruise ship? Can I even ask that, or is that grounds for dismissal?
 
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TwoHighways said:
The rhetoric from the mod is quite alarming in and of itself. "Anti-science" and "consensus" and citing "facts" that are unproven as a means to shut down debate. It's a private site and I get that they have every right to shut down any conversation they deem fit to shut down for whatever reason, but doing so is far more dangerous for our society than any further spread of disease that may happen as a result of such discussions. Administration clearly doesn't see for forest from the trees. Questioning the efficacy of masking = cancelled. What's next? Is discussing the possibility of herd immunity through exposure grounds for cancellation?

Was anybody masking on the Princess cruise ship? Can I even ask that, or is that grounds for dismissal?
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Without addressing any of your comments as that would restart a discussion which has already been repeatedly prohibited, I'm just wondering... are you trying to get banned? Whether you agree with the opinion of the mods or not, they've made their position very clear. You have also agreed that they are well within their rights to boot out anyone who doesn't play by their rules, just as other posters with similar views to your own have stated that they agree that private businesses have every right to punt someone who refuses to wear a mask in their store....
And yet you're posting more commentary that they have explicitly asked people not to.
 
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I'm sure someone will have some emotions and irrational fear to override the science ("Cuz Science!"), but here you go:

German Study Finds No Evidence Coronavirus Spreads In Schools

“'It is rather the opposite,' Prof Berner told a press conference. 'Children act more as a brake on infection.' These results of the investigation provide evidence that virus transmission in families is not as dynamic as previously thought,” Berner said in a comment within the study."

1- Summary article, CNBC. 2- Yahoo. 3- Study itself
 
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Vitamin D is helpful!

www.mdpi.com

Immunologic Effects of Vitamin D on Human Health and Disease

Vitamin D is responsible for regulation of calcium and phosphate metabolism and maintaining a healthy mineralized skeleton. It is also known as an immunomodulatory hormone. Experimental studies have shown that 1,25-dihydroxyvitamin D, the active form of vitamin D, exerts immunologic activities...
www.mdpi.com www.mdpi.com
 
The following paragraphs are a major takeaway from the article. Sorry for the length

----

The rise of the COVID-19 pandemic, the out-of-proportion rate of symptomatic infection, morbidity and mortality observed in African American and obese individuals suggests the possible impact of vitamin D on host response and susceptibility to the infection as obese and Black individuals are known to have an elevated risk for vitamin D deficiency [2,180,181]. Apart from the immunomodulatory and anti-viral effects, 1,25(OH)2D acts specifically as a modulator of the renin–angiotensin pathway and down-regulates the expression of angiotensin converting enzyme-2 expression, which serves as the host cell receptor that mediates infection by SARS-CoV-2 [182]. It is therefore proposed that supplementation of vitamin D can reduce the risk and severity of COVID-19 infection [183,184].

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Although the efficacy of vitamin D is still unclear as the results of ongoing clinical trials are still pending, it is advisable that one should maintain adequate vitamin D intake to achieve the desirable serum 25(OH)D level of 40–60 ng/mL (100–150 nmol/L) in order to minimize the risk and severity of COVID-19 infection. It is well documented that worldwide on average approximately 40% of children and adults have circulating levels of 25(OH)D <20 ng/mL (50 nmol/L) and approximately 60% <30 ng/mL (75 nmol/L) [185]. Thus, patients presenting to the hospital with COVID-19 are likely to have vitamin D deficiency or insufficiency. It is therefore reasonable to institute as a standard of care to give at least one single dose of 50,000 of vitamin D to all COVID-19 patients as soon as possible after being hospitalized. For patients who are intubated and are being fed by a G-tube, they should be treated with a liquid form of vitamin D. Drisdol is a pediatric liquid vitamin D2 formulation that contains 8000 IUs per mL that can be given daily to these patients to treat vitamin D deficiency.

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BoardingDoc said:
Without addressing any of your comments as that would restart a discussion which has already been repeatedly prohibited, I'm just wondering... are you trying to get banned? Whether you agree with the opinion of the mods or not, they've made their position very clear. You have also agreed that they are well within their rights to boot out anyone who doesn't play by their rules, just as other posters with similar views to your own have stated that they agree that private businesses have every right to punt someone who refuses to wear a mask in their store....
And yet you're posting more commentary that they have explicitly asked people not to.
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If posing a legitimate question worthy of scientific discussion is grounds for dismissal, well, I don’t what there really is to say.

It actually seems like a great thing to re-examine (the diamond princess cruise ship data) in that it was a controlled population in close proximity. Given we’re a few months into this thing and have learned more about the virus, why not go back and look through that data? It’s no big loss for a lowly MS1 to get canned, but it would expose the hypocrisy of the anti-science label being thrown out by the mod that acted to close the mask thread, and in my view, erode the credibility of the SDN.
 
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