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I’m reluctant to wade into this thread but in the interest of helping someone who may have honest questions I will.
I am a board certified internal medicine physician working in the Fort Worth, Texas area.
If anyone has a question regarding COVID-19 I will be happy to try and answer.
Please be aware I will ignore troll posts.
Thanks, wash your hands, limit your unnecessary exposure to others and stay safe!
Quoted from cottonm4:
OK. How widespread do YOU think it will get? Any ideas? Do you think we will get a handle on it? If so, how long do you think it will take?
Can we believe any thing we hear about a forthcoming vaccine? And what is your opinion with this off-label testing that is going on?
Without significant limitations on person to person spread it will become widespread within a month or so in the US.
Yes, we will eventually get a handle on it, the question is how many people will die before we do. If we keep our medical system from being overwhelmed we will have fewer deaths.
Vaccine is 12-18 months from being widely available from what I have seen and heard so far.
There are several drugs out there that may have some benefit based on anecdotal evidence but it remains to be seen if that effect will hold up under more widespread use. I will say that there isn’t a whole lot we have in our toolbox at the moment so most doctors are willing to try drugs that may help.
Thanks for your questions.
Quoted from wolfemaaan:
Actually it’s not. You’re cured buddy. No new strains have been detected, that’s why it’s called Covad 19. It is a derivative of SARS and originally SARS-CoV-2
If they were reporting Covad 19 and Covad 20, etc we’re developing then I’d be concerned
This is incorrect. There are at least two strains out currently in the world.
SARS-CoV-2 is the name of the virus. COVID-19 is the name given to the disease process caused by SARS-CoV-2. The name will not change based on the calendar year.
Quoted from cdnpinbacon:
This is fascinating Doctor. Thank You for trusted opinions.
You’re welcome. I’m just another pinhead trying to do what I can to help our community.
Quoted from hAbO:
I think the biggest fear is to have it bloom all at once which will overload the system which can cause more deaths than needed. Kind of a power surge that pops a breaker. The thing is just trying to get everyone on board with just laying low for a while.
This is correct. The idea of flattening the curve is to avoid overloading our medical system in the short term.
Also important to realize that many patients in China were infected by people who were not yet showing symptoms. That’s why it’s important to follow the guidelines for social distancing even if you don’t feel sick.
Thank you. Can I/we assume you are currently working in hospital? Of so, how are your PPE supplies holding up? Do you expect PPE shortages in future if you are not already experiencing them? How well is the mental state of the health care workers were you are located? Are they keeping it together or are they starting to freak out?
I worked in a hospital for 11 years and left that to open a clinic about 18 months ago. I was informed yesterday by my old hospital that I could be called back in during a surge.
PPE supplies are not great. We need more gowns and N-95 masks.
The folks I know are doing ok, here in Texas we haven’t seen a surge like what is happening in New York yet. We’re all concerned but determined to do our jobs the best we can.
What is your best Guess Doctor on the business as usual time? 1, year?
It’s not clear yet however my personal guess is that this current outbreak will extend into May/June at least. We may see a lull in the summer and I am hoping we don’t see another spike in the fall.
Not sure on business as usual. My guess is the current 15 day effort is 15 days and reassess.
Quoted from Atrain:
How many days are we (USA) behind Italy?
Hard to say, the US curve is currently closely mirroring that of Italy. We won’t know whether the social distancing is making a difference until next week sometime.
Quoted from henrydwh:
Is it true that you can be reinfected, or is once you get it and recover there is no chance of catching it again?
That’s not yet clear. Generally you will be immune to a strain of virus after recovering from it. Having said that there are two strains currently known and it’s not clear if you can get S type after recovering from L type or vice versa.
There are some reports of reinfections but it’s not clear whether these are testing anomalies or true reinfections. Stay tuned.
Are there hiv threads attached to this virus making it hide?
There is not a link between SARS-CoV-2 and HIV.
This virus has an ability to spread in the 2-3 days before symptoms appear in the patient. That’s why it appears to hide.
Quoted from sataneatscheese:
Pinball_Gizzard What steps is your random hospital in Texas taking to expand capacity in preparation for a likely patient crunch? Do you have estimates on when infections/hospitalizations/deaths will peak?
The hospital has surge plans in place. Physicians and nurses in the community may be called back into the hospital to see patients.
Case peaks will depend on whether the American people act responsibly to control the spread.
pinball_gizzard So SARS was linked to be a seasonal wintertime virus. Are you expecting the same behavior from Covid 19 meaning the warmer summertime weather will solve this on its own?
SARS was a novel coronavirus that jumped from animals to humans similar to SARS-CoV-2. It’s not a seasonal virus in the same way we think of seasonal flu.
Viral illnesses in general are less common in the summer months. This is related to people being outside more and inside less as well as the effect of UV light helping to inactivate viral particles.
I am hopeful we will see a decrease in transmission during the summer but it is possible we see another surge in the fall. It’s too early to tell. Right now we need to focus on mitigating the damage from the current outbreak.
Ok so you are expecting Covid 19 to possibly shell itself and then return when it gets cold again.
Curious why it’s impervious to hot weather? Maybe I should suntan and keep my heater on
I would encourage you to take this pandemic seriously and follow the recommendations of the medical community and your government. If not for you, then for your neighbors. If nothing else, cut my colleagues in your area a break and do your part to reduce the number of patients we have to treat in the hospital.
DOCTOR : the virus is just as active in hot weather?data says yes ...A certain strain is more active in heat ?
I haven’t seen data showing a significant difference based on ambient temperature of the area. If we saw a marked increase in transmission in southern hemisphere countries we might suspect some effect but we are not seeing that.
Doctor: should we shut down the world until 2021?
Hah, no. This virus will probably be an issue at some level for 12-18 months until the vaccine is widely available. Life will probably look different until then but I don’t think a shutdown will be needed for that long.
Quoted from Zablon:
I'm not saying anything he is saying is wrong, or that he's not a doctor...but do we KNOW he's a doctor? We've had our share of healthcare workers telling us the last 2 weeks that this was overblown and not an issue.
Well, I suppose there's not much of a way to KNOW anyone on the internet is anything they claim to be. However, I know Daditude personally and he can vouch for my identity if he likes. Also, this is what I looked like at work today (please excuse the peeling sunburn):
79A63038-95A0-4FCA-91BF-D2E12B855D7F (resized).jpeg
If that's not enough, then I guess you don't have to take my advice.
Quoted from hockeymag8:
Doctor thank you so much for being on here and allowing us to ask you questions! I work at 2 Behavior Health hospitals and we are reading and hearing from our Medical doctor there is some optimism about using Chloroquine as treatment for COVID-19. Any thoughts/insight if this is/will be effective? Thank you!
The chloroquine question is not certain at this time. There were some observational studies during the SARS outbreak in 2003 that patients on chloroquine for other conditions seemed to do better with SARS infection. There is a small study out of France that seems to show similar effects however it is a very small study and that is why Dr. Fauci is trying to throw some water on that fire.
Bottom line is it is not clear that there is a definite benefit as there have not been any large, randomized, controlled trials yet. Also, we want to protect the supply we do have and keep those for doctors and hospitals to use in cases to see if there is any benefit. There is probably concern from the administration to stop a run on chloroquine based on a small study and then not have any to use for the really sick patients.
Quoted from whthrs166:
So doctor can you tell us the latest on Remdesivir. I am hoping that this one can get through the trials ASAP. Everything I read says that it is the most promising Antiviral so far.
From what I have seen so far, Remdesivir has mixed results in the limited testing they have done and some significant possible side effects. It will certainly be looked at closer, but the jury is still out.
Fair enough, I assumed someone around here must know you personally.
I've only been into collecting pinball machines for about 18 months so I only have a couple Pinside buddies so far.
Quoted from Gryszzz:
Well now you have A LOT.
Thanks for stepping in here as the voice of reason. You docs got it rough, I feel for ya.
Thank you.
You're most welcome! Thanks for the kind words.
Quoted from jhanley:
I can understand why they want to be certain about this drug. I was reading it can kill you pretty easily if you take too much of it. Is that true?
Almost any drug can have adverse effects if you take too much. Chloroquine is no different.
That's the article I read too. I was thinking 2 grams wasn't much ,but it is. My bad.
Nothing to apologize for! There’s a lot of information flying around right now and it’s tough to make sense of it all. That’s why I decided to weigh in here, try to help clear things up a little.
2 grams is about the dose we use over the course of three days to treat malaria. Taking that much all at once could cause problems.
Quoted from pinballOsp:
Thanks for volunteering! My question:
my understanding is China, Taiwan, S. Korea took extreme measures of total isolation at home (not sure how they did food?). That makes sense. You'd think 2+ weeks of this and the illness is isolated to homes and hospitals.
what we're doing in California: we're sort of home... but freely able to go on walks, hikes. My wife is at the grocery store ~1.5 hours every few days. It's packed.
how is the California way going to prevent spreading the virus in any reasonable amount of time?
I'd rather hole up for 2+ weeks than live this shitty way for months. What am I missing ?
Thanks !!
That’s really the problem, weighing controlling the virus against the economic effects and limiting peoples liberty.
South Korea was one of the most successful and they had a massive testing program and strict isolation.
Quoted from Methos:
Thanks for everything you and your colleagues are doing. Truly you guys are the Road Warriors.
Any insight on what is breaking down in Italy? Lots of reports and rumors, but why are they struggling so bad?
Italy has one of the oldest populations in Europe and a culture where visiting your elders is a weekly thing. Recipe for disaster in this case unfortunately.
Well, here's a little positive news. New cases in the US today have been 5300 as of right now. That's compared to just about 4950 yesterday. That's the first day this week I haven't seen near logarithmic growth in cases. Just one data point but let's see how we look over the weekend.
Quoted from BobSacamano:
pinball_gizzard
1) Do you have enough masks, gloves and hand sanitizer? Are
home-made masksbetter than nothing? Here's an interesting article on
various types of materialsand how well they block virus/bacteria particles.
2) How does a BiPAP machine differ from a the "ventilator" that we're hearing about shortages of in the news? My father had ALS and used a
Trilogy BiPapwith a face mask (non-invasive), so I have some experience with that device (and 1 other brand I can't remember the name of). My understanding is that if he would have chosen invasive ventilation with a tracheostomy, he would have been kept on the same Trilogy ventilator. We returned his device to the VA Hospital because it was loaned to us, but I know that at the time you could purchase them online (I looked into buying a backup). Obviously they're not going to take them away from ALS patients, but I know some sleep apnea patients get prescribed BiPAPs (in addition to CPAPs). Could a CPAP machine be converted to a BiPAP machine? Or is the solution to just have the manufacturers ramp up production? On another note, I saw an article that showed where someone turned an
Ambu Bag into a mechanized ventilator.
Thanks for taking your time to answer questions, and thank you and all your support staff for saving lives! My sister is a nurse in Minneapolis and while I wish she could stay quarantined and safe at home, she recognizes that she's got a job to do.
1). Short answer is no. Gloves are ok and most hospitals had a pretty decent supply of sanitizer on hand so I don't see those in short supply as yet around here but my area is still in the early stages vs California or New York. N-95 masks are the big issue right now.
2). BiPAP uses a face fitting mask to add extra air pressure during inspiration and exhalation vs a ventilator that uses a tube that is inserted into the trachea and secured there with an inflatable balloon. It is used as a kind of bridge between breathing on your own and being on a ventilator. The problem is the BiPAP may end up aerosolizing the virus in the room and cause more risk for the healthcare workers so some ICU docs are recommending against using it in these patients. Ventilators have hepa filters to filter out the virus and keep it from entering the air from the machine. Again, this is all very early and people are doing the best they can with the information they have.
Pinball_Gizzard
Thanks for the reply.
Another question I had was how many people does it take to care for an average COVID-19 patient or is there no such thing as an "average" COVID-19 patient (because of all the other issues: diabetes, heart conditions, etc)? The pictures I've seen from Italy just show room upon room of patients lying in beds, hooked up to ventilators and other medical equipment. Early on, I heard about it taking multiple respiratory technicians (3 was the number I heard) to "run/manage a patient on a ventilator". Are medical professionals (nurses, doctors, technicians) the choke point or ventilators? If we come up with enough ventilators, will we be able to re-assign other medical professionals to the job or maybe use trained/trainable personnel from the armed forces?
Without sounding too morbid, what's killing those who are admitted to the hospital with COVID-19? Is it pneumonia, ARDS, or some other pre-existing condition (diabetes, heart disease, etc)?
There’s really no average patient. Based on Chinese data, 80% of patients will have mild to moderate symptoms and can recover at home. 15% will have more severe symptoms and will require hospital care but not ICU care. 5% require ICU care. A typical ICU patient has one nurse assigned to them, several doctors, a respiratory therapist, phlebotomist to draw labs, radiology tech for X-rays, etc.
Both physical ventilators and people to care for the patients can be a limiting factor. If an ICU doc gets COVID-19 and has to be home quarantined that really hurts as they are hard to replace. That’s why docs like myself who don’t normally manage vents may have to in a surge situation. Tough to say right now but that’s why there is such a focus on flattening the curve so we don’t get there.
COVID-19 patients die from viral pneumonia and ARDS which makes it impossible to get enough oxygen into their blood despite full ventilator support. Older patients, those with lung disease and other conditions that suppress their immune system (like diabetes) are more likely to get severe disease and may have less lung reserve to be able to survive the pneumonia phase.
Quoted from jlm33:
And now the reason why scientist are cautious about these results.
It usually takes months to publish a scientific paper (tell me about it!) and months as well to set up a clinical trial. You need to make sure that each group is similar (in terms of age, severity, comorbidity factors... read the criticism posted above) if you are going to compare different treatments.
Here everything was rushed, from the trial to the publication. Some standard procedures were probably abandoned, given the emergency. Peer-review was definitely lightning fast. Peer-review is a quality control process that make sure fatal errors are avoided (and still, even after a long peer review, you may find mistakes or fraudulent results but that's another story).
This does not mean these results are wrong, I am just explaining why scientists can be a bit uncomfortable.
Disclaimer: I am a biochemist, not a virologist (with a PhD, not MD).
Agree with the above. I think the bottom line on chloroquine for now is that it’s possible this drug may prove helpful in treating COVID-19 but the therapeutic window is fairly narrow and some of the side effects could be disastrous in an already critically ill patient. More data will certainly be coming on this.
Quoted from zr11990:
So now its ok for me to be a antisocial asshole?
Absolutely!
Does he change his gloves between patients?
They look taped on? He must disinfect them or have another pair on over the taped gloves?
Seems like a way to pick up the virus if you don't already have it?
That guy looks to be in a PAPR suit so he gets sprayed down between patients with disinfectant. Other sites may use disposable gowns, masks and gloves which are changed between patients.
Thanks for info.
I noticed a lot of video coming out of China and Italy with healthcare workers in full suits. At what point do you guys switch from a mask and goggles to a full protective suit? Are there different levels of suits? The look expensive, so I would imagine there aren't a ton of them just lying around. Are they single use or can you sanitize and re-use them?
Full suits are expensive and hard to come by. I'm actually a little surprised they were using them in that video. They may have better PPE supplies in that state vs Texas, not sure. Here in Texas we are using a disposable paper gown, gloves, facemask with a shield or eye goggles for swabbing coronavirus patients.
Looking at the video again, I don't see the little respirator motor on a belt with him so maybe he's just in a full suit with no respirator.
Usually PAPR suits are only used for highly contagious things like Ebola. I have heard of docs in Europe using them for intubations of COVID-19 patients due to the high amounts of virus that are aerosolized during the procedure and it puts the doc doing the procedure at risk. Several ICU docs in Europe and Asia have died of COVID-19 after intubating and caring for patients in the ICU. Not many of those suits to go around though.
Quoted from Wickerman2:
What say you to this expert analysis?
“Why aren’t we sanitizing masks?” . “You look at the masks, I’ve looked at all the different masks. Some don’t lend themselves to doing that but many do. ... We have very good liquids for doing this, sanitizing the masks, and that’s something they’re starting to do more and more of.”
I haven't seen any masks here locally that can be sanitized with a liquid and reused.
I have been using the same N-95 mask for a week because it's all I have. My brother in law is sending me a box of 9 masks that he has from a construction site. I am going to take one and give the other 8 to the local ER guys.
Quoted from Oaken:
My wife also is using paper suit, face shield, respirator method here in Minnesota.
It is comically oversized on her.[quoted image]
Hey man, if she can get it great. That's just about as safe as you can get.
OK, this increases the chances of being infected, but should not affect the death rate (?)
Two things:
1. Italy has the a high number of people over 65 in their population. That will increase the overall death rate.
2. Italy's healthcare system is being pushed to the brink. When that happens, the mortality rate will increase for not only COVID-19 patients but all patients. If there are no ICU beds available, if there are no ventilators available then patients who might have survived with proper care will die. Also patients with OTHER diseases who need ICU care will also die. That's why it's so important to flatten the curve to avoid overwhelming the healthcare system of a country.
Quoted from CrazyLevi:
I got a question doc:
Isn’t it too little, too late, and too half ass to “flatten the curve” to a point where we do better than Italy?
I live in nyc and the past two days I’ve seen sweaty guys with no shirts on playing half court basketball In groups of 10. If that’s going on here in nyc I can’t imagine how seriously the rest of the country is taking this.
Well, we are out of the window for containment so flattening the curve is really all we can do. How well we flatten the curve depends on every individual American doing their part. You will have some people ignoring the orders and spreading the virus, but short of enacting martial law it's all we can do at this point.
Quoted from SilverballSleuth:
Question for ya doc:
Is it silly to sanitize mail/packages/grocery delivery? Is this virus clinging to objects as I’ve been hearing? How should one sanitize if yes?
Thank you.
No, it's really not silly at all. SARS-CoV-2 has been shown to live on certain hard surfaces for 2-3 days. Cardboard and paper looks to be around an hour. My advice would be open the package outside or in your garage, throw away the box or wrapping, wash or sterilize whatever the item is after you remove it from the box and then do hand hygiene for yourself. Groceries are a little harder, I don't think it would be really feasible to sterilize each item but certainly you could remove the groceries from the bags, discard the bags and then wash any vegetables or fruit prior to storing them.
Quoted from Daditude:
Rick has been pretty amazing about sharing info and answering questions on here. I can't imagine how busy he is right now.
I think he meant we won't know the effects of social distancing for another few weeks. 
Quoted from statsdoc:
Are you pulling the night shift, Doc? I thought I was an early bird, but 2am?
Hah, sometimes I have trouble sleeping.
I'm seeing a lot of at-home tests for COVID-19 being announced?
Will you buy one?
How accurate do you think they are?
https://www.statnews.com/2020/03/21/fda-warns-new-home-coronavirus-tests-unauthorized/
Be careful. There's going to be a lot of people trying to make a quick buck during this. None of these at home tests have been authorized. I think they're more dangerous than helpful at this point. Let's say someone takes a home test, it's falsely negative and they go out into the public thinking they're fine and spread the virus more. Bad news.
Now, if some at home tests are verified and approved and healthcare systems have enough access to testing then great, it might be helpful in getting more people tested but not at this time.
Quoted from OLDPINGUY:
Morning Doc.. I pray for your health today.
I do have a question for you. Last week I have received emails from people I have done business
with in China. They tell me they have as many N95 Masks as needed, shipped in 3-5 days. 10,000, 100,000 etc.
Most Likely, these are not NIOSH approved.....Wouldnt these be of immediate need, with some quick approval, from Reliable sources of Manufacture?
Yes, N-95s are needed pretty much across the nation. My brother in law is actually sending me a box that he had from a construction site to use so I don't have to use the same one I did last week. Any n-95s we can get from reliable manufacturing sources is needed.
Doc, can you clear up that question ... Do we need to be concerned about coronavirus in things we ingest? I was under the impression that the virus could be caught via mouth, nose, eyes, etc.
Sure, there's no data to suggest that transmission inside the GI tract occurs, however I would be on the safe side with food you purchase because if there was a high amount of viral particles on the food it could conceivably reach your posterior pharynx (back of your throat) and set up there.
The virus can get into your body either through inhalation or access to mucus membranes. The upper part of the back of your throat (nasopharynx) is a mucus membrane. In fact it's the place we swab to test for coronavirus.
pinball_gizzard Doctor - I'm reading new things stating that they are finding an early warning might be loss of taste and smell. Any validity to this? Or would this maybe be a coincidental side effect from people taking zinc to try to stave off the sickness?
There does seem to be evidence to support loss of taste and smell as an early symptom.
Quoted from FYMF:
Not to be an insensitive prick ... you said it can bind to mucus membranes.
So what you're saying is technically I can get Covid19 via a ****** if said participant had the virus?
If you've got an insensitive prick why would you be getting that??
Hey-O!!!! Rimshot!
Hahaha.
Doc brings the heat.
But uh yea. Can it be passed like this. Insensitive prick or not
No evidence of this and I'm not sure a woman with symptoms would be up for it....
Besides if you are in close proximity to another person with COVID-19 you'll have multiple other opportunities for transmission.
I hope this becomes available soon. Could be a major help. Part of the problem with PPE supplies is we are burning through masks, gowns, etc waiting days for the current test to return. If we can get an answer in 45 minutes? SWEET!
https://www.cnn.com/2020/03/21/politics/fda-coronavirus-test/index.html
Hey Doc:
Serious question: Just got a call from a close friend who up til now thought this is all overplayed.
His wife is extremely sick with flu like symptoms out of nowhere
He says she has the exact same symptoms described by others with the VID (can we call it that?)
He said she went to the doctor and "they tested her for 2 flus." (Presumably A and B,) but not Covid19.
He says that they told her she tested negative for both flu test and "she had a virus but not Covid and go home."
My question is: with these symptoms and negative results on both flu strains and no Covid test... I feel like he should assume she has Covid for his family's sake no?
Thanks much!
Yes, I would consider her as a COVID-19 patient until a negative test is obtained. Even then a single negative test does not rule it out. Our current recommendations from our medical system here is that we are not testing low risk patients to try and preserve the number of tests we do have. Low risk patients are instructed to quarantine at home for 7 days OR 3 days after their last fever, whichever is LONGER.
Quoted from Rondogg:
Doc, can someone get Covid if they have already gotten it (one and done)? There seems to be anecdotal evidence that they can but is there a consensus on this topic?
No consensus on this. There have been anecdotal reports of people testing positive twice but it would be pretty atypical to be able to be reinfected with a particular strain of virus. It's also not clear if you can contract the S type after recovering from L type.
Quoted from RWH:
Doc is there any chance that if someone had contracted one of the other strains of corona that even though they are not identical strains it could impart some % of resistance? I'm thinking like human DNA this virus has a basic frame if you will that is common to all strains which our immune system may recognize? I'm speaking of the novel strains from animal to human.
The closest prior novel coronavirus to this one is SARS from 2003. I don't think we have any data regarding anyone who had SARS and then got SARS-CoV-2.
There is anecdotal evidence of patients being treated with serum from recovered patients and improving after this therapy.
Everything I've read or heard reported said after being tested you were to self quarantine until you got a negative result.
This is correct.
Quoted from Jaybird815:
Hey Doc, how you holding up? You guys are a special breed and just want to say thank you for all you and your colleagues are doing.
Thanks! I’m doing ok, our clinic has shifted to sick visits only. I’m expecting a surge in patients this week or early next week here in Texas.
Quoted from Utesichiban:
Are you an internist/FP or specialist? Appreciate everything you guys do and sending thoughts and prayers your way.
I am an internist here in the D/FW area. Thanks for the kind words!!
I was excited to score some goggles at Lowe’s today for myself and my medical assistants to use when seeing possible COVID-19 patients. We do have some masks that have plastic face shields on them but not many and will run out soon. Goggles can be wiped down and reused. Yeah!
This is just sad and EXACTLY why medical professionals are trying to tamp down the hysteria over this drug.
Please people, there's a reason we train for 7-12 years AFTER college.
Quoted from titanpenguin:
This is more simply people who don’t follow directions. The drug has historically been available for those traveling to areas where malaria is present. It comes with specific directions on how to use it. I’m betting people ordered it from outside the country in directions other than English.
According to the article they used some preparation that is used in fish tanks? God only knows what dosage was in that preparation.
One thing I'm confused about; they said at the start of this that the virus was passed from animal to human and then rapidly mutated where it had the capability to transfer from human to human. Just today though they said scientist are saying it isn't mutating or at such a slow rate that a vaccine would be very effective against it. What?, it mutated in a matter of days before but just simply slowed down or stopped, not making sense to me. Maybe the Doc could enlighten me on this.
So this is a good question. My understanding is the SARS-CoV-2 may have taken some time to develop the ability to infect humans. It seems the two strains were present in China during the initial outbreak so they likely have been present for some time as well in the animal population.
When they make a vaccine they are going to try and target antigens (proteins on the virus that the body’s immune system can recognize) that are common to both strains and thus likely effective against both.
Quoted from hwyhed:
Welcome back Dr. I do hope that you’re getting some rest, and doing well. I have a question/thought as I was walking my dog..if someone needed cpr, how does 1 (besides chest compressions) go about it? I like the idea of trying to potentially save/help, but wouldn’t want to potentially get them/myself exposed to a virus..
Well, current recommendations for CPR include compressions only because the mouth to mouth doesn’t add all that much to the air flow you get from compressions. I suppose if they had coronavirus they could transmit it during CPR but the risk of that is low vs the potential to save a life.
Quoted from phil-lee:
Or gloves and N-95 masks for all US Citizens who need them. With the proper PPE we can go back to sense of normalcy by Easter. I don't understand why this is so hard to understand.
Yeah, they tried to lie to us early on saying they don't work and to donate them to Pro's.
Now that lie has been discarded we can work toward everyone having these items, learning how to use them, and using them.
Instead of cussing people not at home we can cuss them for not wearing a mask and gloves.
N-95s are not needed for the average citizen and if people buy up N-95s that means there won’t be any for the healthcare workers who do need them. A simple surgical mask will do fine for the average citizen going about their day in the public.
N-95s have to be fit to the face and you have to know your size for them to be truly effective. Docs wear them when performing high risk procedures like intubations. Please don’t go out and buy N-95s. Donate them to hospitals.
Quoted from Psw757:
We will know soon, they tested all 32 on the bus. Hopefully this didn’t mutate into another human to human virus. Symptoms apparently very similar to Covid - 19 but with a 30% mortality rate.
Hantavirus does not spread human to human. They’re testing the bus because they were all in the same place and could have been exposed.
Could it not mutate into human to human?
Wasn’t this particular Covid 19 supposed to be non transmissible between humans as well?
No, COVID-19 is a new virus that leapt from animal to human. Hantavirus has been around for a long time and has never transmitted human to human. The virus is shed in mice and rat feces and urine. Humans get it when they inhale the dust from the urine and feces. It’s a very rare disease and localized to very specific areas of the world.
Quoted from No_Skill:
Luckily I took up the hobby of playfield restoration a few years ago. I bought one of these bad boys which might come in handy soon.[quoted image]
Yeah, that would work. I was planning to buy a respirator to start clear coating playfields. Fat chance of that now I guess.
Still delivering the official spiel huh? You know it would be better if everyone had access to 3m -95 masks, every case that is avoided on the street is a case that doesn't end up in the ER. I taught PPE to 120 workers at a chemical plant and it takes 30 seconds to properly don a mask.
With calls to return to normalcy as soon as possible masks and gloves are the ESSENTIAL tools to do this. People that must continue to work need masks and gloves, period.
I’m delivering the truth. This will be my last response to you.
Let me try to explain the n-95 issue a bit. I can understand why someone would question why a healthcare worker would need an n-95 yet they don’t need one for personal use. Here’s why:
N-95s are currently recommended during aerosolization procedures like intubations or bronchoscopies. This is because during these procedures air and material from inside the lungs are aerosolized into the air and put the doctors and nurses doing the procedure at high risk. PPE is a matter of degrees. You could argue that everyone being in level 4 isolation suits would be the best but that simply isn’t possible. Neither is everyone walking to the grocery store wearing an N-95. For walking around, a simple surgical mask has been shown to be effective in protecting yourself from another person who may cough or sneeze. Staying 6 feet away from others is also effective.
If you take the selfish route and decide your personal need for an N-95 with low risk of exposure is higher than an ICU doc who is swimming in virus during a procedure while trying to save someone else’s life....well I don’t know what to say to that.
Quoted from vicjw66:
Aren’t all the N-95 masks sold out to the public? Shouldn’t the manufacturers be forced to now sell all newly produced masks directly to the hospitals? Has this been mandated?
I have looked at my local stores and everything is sold out.
My brother in law works with a commercial construction firm and I received two boxes of n-95s from them via FedEx yesterday to distribute to my clinic staff and the ED guys at the hospital. This was their personal stash they had in their trucks or whatever and they didn't keep them for themselves to make a trip to Kroger. They sent them to the people who need them most. THAT'S the kind of attitude that will get our country out of this with the least life lost.
Sorry if I'm salty about this issue but the men and women I work with are putting their lives on the line to help others. If they had the same selfish attitude as some of the people in this country they would simply say "F YOU" and stay home.
Quoted from swampfire:
So I stand corrected, N95 masks do protect us better than nothing. But if you have one and your doctor’s office and hospital don’t, you’re an asshole. Do I have it right now? Just to drive it home, most of us have the luxury of standing well clear of other people, even while at work. Doctors and nurses don’t.
An n-95 would be better than nothing IF you were coughed or sneezed on. A surgical mask would also offer decent protection in that case. However, in the case where someone coughs or sneezes in close range you are also at risk for transmission through the eyes so are you going to wear goggles too?
Think of it like welding. The guy holding the torch and doing the welding needs eye protection, gloves and maybe even an apron. A guy standing 10 feet away watching only needs eye protection because he's out of the range of sparks and such. Now if the observer was an a-hole and decided HE needed the apron and gloves and left the dude doing the welding unprotected? That's what we're talking about.
Hey Doc,
I am seeing a bunch of city workers and restaurant/business owners undertaking a ton of pressure washing all over town.
If the virus can last on surfaces for days/weeks at a time. Is it not possible that blasting pressurized water at the virus could make it airborne and people nearby susceptible?
Thanks,
F
Yes, it’s possible. I would hope they are using some sort of dilute bleach solution. Even if they do aerosolize some it should be gone from the air in a few hours. They might be putting themselves at risk though.
Are the recovered US numbers really only 616? I thought it was way higher than that...if not..that's scary...
Coronavirus infection takes 7-10 days to run its course, IF you don't have complications. You won't start seeing recovered numbers start to go up until next week probably.
Quoted from JodyG:
And the FDA is telling most of these people with in-home tests to destroy them. The average american doesn't have the fortitude to stick the swab in their nose far enough, so the the test will come back negative. Then the idiots will go throw parties and spread it worse. Let the professionals do the test.
https://reason.com/2020/03/25/fda-tells-at-home-diagnostics-companies-to-stop-coronavirus-test-roll-outs/
This is my main concern with a home swab test. To get a nasopharyngeal sample the swab has to to into the nose about 4 inches or so and reach the back of the throat. This is uncomfortable and I think a lot of people aren’t going to get a good sample and you will see false negatives.
Quoted from Bublehead:
Hey, go read the link and say that again... FDA has changed its tune on this...
From what I have seen, FDA has said they will allow “at home tests” but only if the swab is obtained in a clinic by a healthcare worker who knows how to do the swab properly.
Don’t get me wrong, more tests are a good thing but tests that are likely to produce a lot of false negatives can set us up for disaster. “My at home coronavirus test was negative, I think I’ll go see grandma and see how she’s doing.” Whoops.
Is it like a Strep test?
No, a strep test is a touch swab of the throat through the mouth. This is a swab in the nose to the nasopharyngx in the back and then spun for 10-15 seconds. Repeat with the other nostril, same swab.
Quoted from Eightball88:
So unless you know what you are doing, it sounds like the possibility of false negatives is quite high. There is probably a YouTube somewhere that shows the proper procedure but still, the follow on effects of a false positive could be very unfortunate.
Doctor, did I hear correctly that it actually takes 2 consecutive results to confirm one way or another, or is that it takes 2 consecutive negative results to confirm that a person has recovered from the virus?
Thank you for the time you are taking to answer our questions and provide useful and authoritative information. I am always on the lookout for your posts here!
Previously the CDC was requiring a confirmation test to call someone positive but that was early on. I doubt they are still requiring that now.
Quoted from Luckydogg420:
I have about 20 of the n95 masks in my shop. I asked my buddy if his wife, a nurse, wanted them. He said they're not allowed to bring their own masks into the hospital and because it's an opened box the hospital cant take them; because the might not be sterile.
I guess I'll hold onto them for friends and family.
Honestly that’s a stupid move by the hospital admin if true. N-95s aren’t sterile in the first place box opened or not.
Quoted from PanzerFreak:
If people are being told to go home and self isolate for 14 days why are they not being given a test?
1. Tests are not widely available yet so we are prioritizing high risk cases.
2. For a low risk patient there is no difference in the treatment whether you test or not. Patients are presumed positive and told to self isolate and monitor their symptoms. It would be no different if they were tested. Even a negative test doesn’t completely rule it out because of possible false negatives so you still have to quarantine.
Quoted from tiltmonster:
Masks are meant to prevent your potential infected droplets spreading to others, your hand and eyes are more of a concern of contracting the virus.
While a mask does serve to prevent some of the respiratory droplets from exiting an infected patient, the primary mode of transmission here is inhalation of respiratory droplets so a surgical mask would also serve to help protect an uninfected patient. Transmission through the eyes is a secondary mode and really not much you can do about it unless you want to wear goggles around which is really overkill for just walking around.
I've given several of my high risk patients a mask from our clinic stock for them to wear when they are out at the grocery store.
A new FDA-authorized COVID-19 test doesn't need a lab and can produce results in just 5 minutes
https://www.yahoo.com/news/fda-authorized-covid-19-test-033823184.html
"Unlike the rapid tests that have been used in other countries, and that received a new type of authorization under an FDA guideline that doesn't confirm the accuracy fo the results, this rapid testing solution uses the molecular testing method, which works with saliva and mucus samples swabbed from a patient. This means that it works by identifying a portion of the virus' DNA in a patient, which means it's much better at detecting the actual presence of the virus during infection, whereas other tests that search the blood for antibodies that are used in point-of-care settings can only detect antibodies, which might be present in recovered patients who don't actively have the virus."
Interesting but bad reporting. SARS-CoV-2 is an RNA virus. It doesn’t have DNA.
Quoted from PinJim:
My mother has late stage Alzheimer’s. She hasn’t recognized me for years. She doesn’t know herself, her family, etc. Hell, if my family had a choice, we’d have euthanized her already. Don’t prioritize her over someone that has potential for useful life. Of course, every situation is different, but that’s my situation.
If I were 80 and had it, and a 30 year old also had it - prioritize them over me.
This.
In a true care rationing situation all the reserves have been used up and doctors have to make very hard triage choices. It’s about preserving the most possible quality life. The article originally cited is pretty inflammatory and strikes me as click bait journalism. It states that the policy talks about people with SEVERE mental retardation, SEVERE dementia and SEVERE traumatic brain injury. Then in the next paragraph it tries to say that people with Down’s syndrome or autism are at risk. Those conditions are not considered severe mental retardation so those patients would not be subject to the policy.
Quoted from Gunnut40:
GM making ventilators so quickly is scary. They will have to bipass a lot of quality checks to roll these out this soon. I have a question for pinball_gizzard. If we had all the machines to keep people alive. Would we have enough properly trained people to use them correctly?
Yes and no. We have enough ICU docs and respiratory therapists to manage the load I would think. The problem will be trained ICU nurses.
Quoted from mcluvin:
Until they start dropping or quitting...
Some may get ill. In general though people who devote that much time and training to help others don’t slink off in the corner and quit when the shit hits the fan. I can tell you from personal experience we’ve had multiple specialist docs asking how they can help out. Hell, we even had a neurosurgeon offer to mop the floors because he didn’t want to sit on his butt while others did the dirty work. True story.
Quoted from DS_Nadine:
For your sake I wish you‘re right but I wouldn‘t believe it. You‘d need 5% of your populations ICU beds and ventilators over 6 months, while each bed is occupied for about 3 weeks - if you don‘t „flatten the curve“.
Beds are an issue for sure but the question was people to man them.
That sounds great and all, but when you don't have the equipment to do it safely and you have a family to consider, I think your gonna see some folks rethinking that.
I don’t expect that the PPE shortage will last much longer. I also think you underestimate the caliber of people that go into healthcare. Especially in the hospital environment it really becomes a family and you stay in there for those around you.
Dreamed about a Therapy, would like to document it here first. Not recommending a medical procedure, just feel the idea may have
some credence.
Intubation with miniature UV Lights. If UV kills the virus on surfaces why could the light not be introduced deep into the trachea to
kill the clinging virus on the lungs?
This would cause severe burns in the trachea. Remember, UV light is what causes sunburns.
Good to see you back, buddy!
Needed some time away from this thread. Hopefully in the future we can avoid the amount of pointless bickering that was going on over those couple days.
I probably won't recognize you the next time we see each other, good on you for the weight loss!
Hey Doc,
A question if you have knowledge on Proteolytic Enzyme treatment for the Virus.
I use Serrapeptase to keep my lungs clear, and remove soft arterial plaque, based on my condition.
Are you aware of this being of any help with the virus, as it clear mucus in the lungs, or is this mucus helping more?
I'm not aware of any current research on this topic. The real issue with severe COVID-19 is ARDS which isn't a mucus problem. It's a lung stiffness problem. The air sacs of the lungs need to be stretchy to be able to inflate and deflate as you breathe. If they get inflamed and stiff you end up with very high airway pressures and difficulty with gas traveling across the membranes of the lungs to let CO2 out of the blood and O2 in. Eventually this problem can advance to the point we can't adequately ventilate the patient even with extreme measures like proning or high frequency oscillator vents.
And in other news:
https://happymag.tv/uranus-has-started-leaking-gas-nasa-scientists-confirm/
Not if exposure was limited. Think micro-dosing. Many treatments introduce unpleasant side effects (Chemotherapy) but through clinical trials the proper UV exposure necessary to alleviate the virus could be determined. I don't feel it could all be eliminated.
The problem is microdosing won’t hurt the virus either. Not only that but only the large airways are accessible via bronchoscope so you couldn’t even get to the smaller airways and alveoli where the infection is.
It’s a non-starter.
Sounds like the symptoms of stage 4 emphysema at an accelerated pace where the lungs loose all elasticity. Regardless of the amount of flow in it can't be pushed out, only this virus adds the extra element of disrupting oxygen absorption on a much higher scale. Is that a fair analysis doc?
Same end effect but very different mechanisms.
Emphysema is a result of cigarette smoke destroying the alveoli (tiny air sacs) in the lungs. So you lose surface area for gas exchange and become hypoxic.
ARDS is where the alveoli are still intact but the membranes themselves are thickened and inelastic, making them not usable for meaningful gas exchange and thus you lose effective surface area.
”far-UVC light cannot penetrate even the outer (non living) layers of human skin or eye; however, because bacteria and viruses are of micrometer or smaller dimensions, far-UVC can penetrate and inactivate them. We show for the frst time that far-UVC efficiently inactivates airborne aerosolized viruses, with a very low dose of 2mJ/cm2 of 222-nm light inactivating >95% of aerosolized H1N1 infuenza virus. Continuous very low dose-rate far-UVC light in indoor public locations is a promising, safe and inexpensive tool to reduce the spread of airborne mediated microbial diseases. “
From an article in Nature
This proposal does not seek to completely remediate the virus from all parts of the lungs, but could eliminate the large clusters shown in the main airway from x-rays of patients.
With all due respect, you don’t get it.
The article you cite is talking about inactivating viruses in the air. NOT inside the lungs. Bleach also inactivates viruses in the environment but no one is suggesting that you aerosolize bleach and have patients inhale it. You will KILL the patient.
The article I cite shows a type of UV light that kills the virus without harming skin that is effective in micro doses. I see no reason why this could be used to alleviate clusters in the main airway in a safe manner.
Think outside the box.
Said nothing about drinking bleach, where did that straw man come from?
You said it would cause burns Solved
You said micro doses would not work Solved
OMG. I’m done with this conversation.
Taking a form of chloroquine intended for fish tanks is a better idea than this and where did that guy end up.
Inhaling bleach isn’t a straw man, it’s a adequate analogy. Both proposed treatments would cause severe burns to the endothelial lining of the lungs and make an already life threatening situation worse.
And again, topical therapy to the lining of the trachea and major bronchi does NOTHING for the small airways and alveoli where the virus is causing the problem.
Why does a ventilator cost $24000. Is it that complicated to make?
$20,000 is about what the market cost is for a fully featured vent.
For those asking about whether to go to the doctor:
Teladoc is one Resource you can use for minor things. There are limits to what you can use Teladoc for though and the physician may still tell you that you need to see a doctor or go to the ER. I just got credentialed to work at Teladoc so I’ll be starting that this week.
If you are having serious symptoms like chest pain you should absolutely go to the doctor. The risk of an untreated heart attack or other life threatening issue is WAY more than the risk you would contract coronavirus at the office or ER.
From what I understand, the hospital ships are taking in non-COVID patients so the hospitals have more room to deal with COVID patients.
This is my understanding as well.
And in the "it's probably about to get a lot worse" category, they are handing "essential critical infrastructure worker" papers at work in case we are pulled over or it comes down to checkpoints. Gonna keep this to pass on to the grandkids (in 50 years).
Already got one of them fancy letters folded up under my sun visor.
Wow, I recognized that immediately - Jack In the Box? I remember swapping out those 10 drop targets for sure.
Ding-ding-ding!
Quoted from chad:
A nice gesture, and no speeding ticket!!
https://www.cnn.com/2020/03/30/us/minnesota-trooper-n95-masks-doctor-trnd/index.html
Fat chance of that around here. My last speeding ticket was about 6 years ago. I was driving to the hospital to see a patient who was actively coding. I sped up to pass a car and the cop was sitting right where the speed limit went from 50 to 45. He gunned me doing 53 in the 45 as I passed the car. He pulled me over, I explained I was a physician on my way to the hospital in an emergency and showed him my ID badge. His response? "License and registration sir."
What an a-hole.
Quoted from DaveH:
Boo. I was going to guess Jumping Jack. Because the two player version is better? No, because I have JJ, I moved on my Jack in the box years ago.
Well it technically it is a Jumping Jack but I gave credit because there's no way to tell by the playfield alone.
You are right though, two player is better!
Quoted from cait001:
What are those flappy things? Sinuses?
Turbinates. Basically ridges inside the nose that help to direct air flow and increase surface area for moisturizing and warming the air as it enters the nose.
Sinuses are contained inside the skull.
Quoted from rkahr:
So, if this little virus originated in bats in China, should we be worried it jumping to bats locally where it could jump back after we are done isolating? What jumps out in my mind is the bat bridge in Austin but I'm sure there are other localized areas where mankind and batkind are close.
-Rob
-visit http://www.kahr.us to get my daughterboard that helps fix WPC pinball resets or my replacement LED display boards for model H & model S Skee Ball
A jump back into animals usually doesn’t happen but I suppose it could. More common is a continued mutation cycle in the original animal host and then another jump into humans with a different strain of virus.
Pretty much Covid is doing what nature does. Seems like vast majority of healthy people are not affected and the people with underlying conditions and old age are. That’s Darwin’s theory of evolution
The only thing so far solving this issue is the uncredited human immune system.
This is wrong, AGAIN.
Evolution does not state that the young survive while the old and sick die. That’s just life.
Evolution states that an organism that can adapt to a change in environment survives while one that can’t adapt or adapts less well dies out.
So a good example of evolution would be if an organism failed to recognize the change in environment or wasn’t intelligent enough to recognize the change and then died due to the change. Examples I can think of are college kids who went to a COVID party or congregated on a beach in Florida and then contracted coronavirus. Also, someone who refuses to accept the reality of this pandemic and goes about their business without any regard for their own well being or that of others.
Agree for the most part. If I (we) can hold out long enough then there will be better, more standardized methods of treatment. That is my goal anyway, to hold out until the pharmaceuticals and doctors catch up. The whole world of scientist are working on this. #1 priority. Something good is coming. And then the vaccine a while later.
This. This initial wave of infections will have a higher mortality rate vs subsequent waves. We will figure out the optimal way to treat COVID patients to minimize the death rate. Drugs will be found that help during severe infections.
Flatten the curve now and buy our medical system some time to get their feet under them.
I think there’s a significant difference with the flu. Our “herd” sees flu every year. Yes there are different strains but the immune system has still seen that virus before in some form. You may not be immune to it and it can still make you sick but your immune system has some “memory” of flu when you get it. That’s for seasonal flu. We’ve seen those strains before.
Where flu gets scary is a novel influenza like swine flu or bird flu. Those are viruses that usually live in animal hosts and only rarely infect humans. The Netflix show Pandemic has a lot of good info on this. A new flu that was highly contagious and became uncontained like this coronavirus would possibly be worse than this current pandemic.
The reason people who say this is just another flu are wrong is because if we did not take measures to contain this coronavirus outbreak you could be looking at a few million Americans dead within a year.
See that’s the problem, if our measures work and we limit the damage then the very people who don’t understand why the measures are important now will be saying “See? Told ya so.” They can’t see the alternate reality where we don’t do what’s needed to control the virus and millions die.
Quoted from wrb1977:
Instead of being condescending and opening with your snide remark, how about you answer each of my individual questions within my post. I am NOT in any way saying this is just another flu. I realize it is more contagious and hasn’t been seen before. My point was more the lack of care for those that die from the flu each year. Why are we not being consistent with ALL deadly viruses? If we social distance for coronavirus, why not the flu each year? So, crazylevi, instead of getting frustrated with me, I ask you to answer my individual questions contained within post #5806. I am looking for answers not confrontation.
We are proactive with the flu. There is active surveillance of the animal reservoirs to monitor for new strains, there are vaccines each year to help protect us from the seasonal flu. If a novel strain emerged multiple systems would come into play to control the outbreak.
Bottom line is we can’t shut down the world every fall for the flu season. Despite all our measures some people still die from the flu each year. It’s a matter of degrees.
Thanks Doc for answering some of my questions...makes sense. The flu numbers are what they are WITHOUT preventative measures, such as social distancing, in place. So it does make sense that even WITH these measures in place the coronavirus numbers continue to climb rapidly showing the severity of what we are dealing with. I guess it’s just a numbers game and the flu deaths we experience each year is considered “acceptable” by our society.
Unfortunately medical science has not gotten to the point we can fix everything. Sometimes infections still kill people. I’ve seen patients die from severe influenza, pneumonia, skin infections, etc. These are all diseases we have good treatments for and far fewer people die from these things compared to 50 years ago but we aren’t perfect yet.
I’m waiting for the little wand they have in Star Trek that instantly fixes things.
Why do you think social distancing isn’t really discussed or practiced during the annual flu season, especially around the elderly where it often leads to pneumonia and then death or those with underlying health conditions? Seems like we could be doing a better job with lowering flu deaths.
Well I think part of it is complacency. People should be washing their hands all the time like they are now yet we don’t. You shouldn’t go to the movies if you are sick but people do it. You should eat healthy and exercise but we don’t (guilty here as well).
People do all sorts of things that aren’t good for them.
Personal experience:
We are still only testing those who are high risk.
PPE is still in short supply.
Other parts of the country may have different experiences, I can only speak for myself.
Quoted from o-din:
Isn't it a little late for that?
I think most doctors prescribe antibiotics for viral infections once they start up.
Don't know what I'm going to do when I get a serious bacterial infection.
Prescribing antibiotics for viral illnesses is a problem that doctors are trying to police. It’s really driven, in my opinion, by patients who demand antibiotics despite the doctor telling them it won’t work. I’ve seen it way too many times in my own practice. It’s not an excuse, the doctor should be able to stand up to the patient and say no but in today’s consumer satisfaction driven healthcare market that’s often a tough choice.
My wife’s number one pet peeve. She won’t do it. Patients get pissed and leave negative feedback. Then she gets called in for having sub optimal feedback numbers.
Yeah, I feel her pain. In my practice I really try to gain the trust of my patient so when I tell them they don’t need a particular medication I have a better chance of them going with my advice. I’m sure your wife does the same. It doesn’t always work.
They get pissed until they take them unnecessarily and end up with a c-diff infection. My wife got c-diff after surgery several years back and my dad last year from antibiotics due to reoccurring UTI's.
It isn't pretty and is increasingly common after use/overuse of antibiotics. My dad failed all antibiotics to treat the C-diff and had to have a fecal transplant 3 months ago. Fortunately, that last line therapy appears to be working.
Don't take antibiotics unless you need to and it is likely to work (i.e. bacterial).
Yes the overuse of antibiotics is the coming storm in healthcare. I was at a conference a year or so ago and an infectious disease guy did an entire lecture on the topic. Bacteria don’t like getting killed any more than we do and they WILL figure out a way to survive. It’s a balancing act to use the antibiotics we do have judiciously so we can buy time to develop new antibiotics and hopefully stay one step ahead of the bacteria.
So the doctor who knows best prescribes them anyway.
You guys are gods!
No we’re humans who can and do make mistakes. I’m not saying it’s right and it is something I think the medical community is really trying to correct but there are still people out there who value their own short term benefit over the long term consequences of their actions.
Isn't there a test you can do to see if it is a virus before prescribing them?
Seems they are doing a lot of testing now.
Not really. There are rapid flu tests available but the vast majority of routine viral illnesses are not flu. What you have to go on are the patients symptoms and tests like chest x-rays. Often it boils down to the color of their sputum. Once it turns green I usually will consider starting antibiotics. Also, bacterial pneumonia often piggybacks onto a prior viral illness so the lines get blurry.
The most common viruses to cause colds are rhinovirus, coronavirus, parainfluenza and RSV. I’d love it if we had a rapid, in clinic test for these but it doesn’t currently exist.
Quoted from arcademojo:
CDC May Urge All Americans To Cover Their Faces In Public
https://www.dailywire.com/news/cdc-may-urge-all-americans-to-cover-their-faces-in-public
I’m all for this. Just don’t use n-95s please!
Quoted from TheFamilyArcade:
This is interesting. “A coming storm”. As I really thought everyone realized by now that antibiotics don’t fight viruses. I mean, I’ve know this for at last 20 years, and the information wasn’t hard to locate.
Our societal fascination for anti-bacterial soap has been a big topic too, for at least a decade if I’m not mistaken. My household doesn’t use it. And why would we? If we constantly kill all the bacteria we’re exposed to, than our immune systems don’t have a chance to build up defense systems against bacteria. And when that day happens. Boom.
You’d be surprised how many people come in and demand antibiotics to cure their cold. I explain this multiple times every week.
The optimistic rates are assuming many that get on a ventilator that would not otherwise survive.
Wonder what percent of lives these ventilators are actually saving.
The data I’ve seen a shows between a 60-80% mortality rate for those that end up on the vent although the numbers in the studies are small so there’s probably a wide variability.
There will never be correct data on how many lives a ventilator saves.
A person who got on one might have survived anyway, and one who did not might have died anyway.
Put that in your statistics.
In this case I would say it’s highly unlikely that a patient with ARDS would survive without a ventilator.
No, I can't because many may have survived anyway.
How do we know when a ventilator is the difference between life and death?
Are they all put on it when they have actually stopped breathing on their own?
Because I’ve treated ARDS patients myself and I can tell you it’s hard as hell to save them WITH maximum vent support. Without it their oxygen levels are not compatible with life.
Hey Doc,
From what I am reading, it appears that individuals that are put on a ventilator are often pretty severely impacted from a life-quality standpoint if they manage to survive. I would love to hear your thoughts on this. There was an interesting article in the New York Times (https://www.nytimes.com/article/ventilator-coronavirus.html) and I am curious if your experience is consistent with the article.
Thank you
I will hit the NY times paywall so I can't read the article.
However, I will try to answer your question.
Ventilator support is a last resort measure. It's often the difference between living and dying but it does have drawbacks. The lungs are meant to be a negative pressure system, they suck air in. A ventilator turns them into a positive pressure system as it forces air in. That does damage over time to the lung tissue. Usually when patients are on a vent long term (more than a couple weeks) there are adverse effects on the lungs themselves. The patient is more susceptible to pneumonia and other infections. Pneumothoraces can occur (holes in the lung tissue and then air leaks into the chest cavity).
In the case of COVID-19 I would say the majority of the issue is the ARDS itself. This is a severe respiratory condition with a very high fatality rate. The fact that we can save anyone at all with ARDS is pretty remarkable. There may be long term lung scarring related to ARDS in a survivor.
But, it's better than the alternative in most cases.
Hey Doc,
Try opening an incognito or private browsing tab and then copying the url/link into the window.
Usually works for me.
Some sites have gotten smarter than that but most work that way still.
Thanks, I guess the Times is running a no subscription offer during this pandemic so I just had to give them an email address. More spam for me! Yay!
So the article is a decent description of how a vent is used for the average person.
The longer term effects they talk about are PTSD and the like which can occur but this also can happen with almost any severe illness.
Again, it's better than the alternative. Unless maybe you're O-din and there's a nice avocado tree nearby...
Hey man, thanks so much! Sometimes in life you are put in a position you really never wanted to be in but you have a skill set that is needed at the time. That’s kinda how I feel right now. Thank God here in Texas we aren’t in dire straits yet but it looks like it may start to hit the fan here next week if the models and predictions are correct.
I just am praying for the docs, nurses, techs and all the support staff in New York, New Jersey, Detroit and New Orleans. They’re in for a hell of a ride in the next two weeks.
Quoted from Extraballz:
Hey Doc. What do you think of that Dr David Price video? You agree with it? My main conflict is I thought COVID was mainly spread through the air and he is saying mostly spread by hand to face. Thanks in advance for any opinion.
It's an interesting video, I haven't had time to watch it all yet.
I think what he is saying is that it spreads by you touching a patient who has sneezed or coughed on themselves and then you pick up the virus on your hands by touching them and then touch your face where it gets access to a mucus membrane. I have not heard that this is the primary method of transmission but I certainly think it is a major one. I still think respiratory droplet transmission is likely.
Edit: I watched a little more and I actually agree with most of what he says. I'm not at a point where I personally would say 99% of COVID transmission is by touch and then hands to your face but I think his advice is really quite good as far as ways to prevent transmission.
Bottom line, continue using the same precautions that have been recommended and limit your exposures.
Yeah, I think a simple surgical type mask probably helps transmission rates. I have been telling my high risk patients to wear them when they go out. I've given several of ours away to folks that REALLY can't afford to get coronavirus. Just leave the N-95s and respirators for the healthcare workers.
Quoted from Trogdor:
Is Cuomo correct? Less then 20% of patients on ventilators survive? Would they have survived without the ventilator? If correct, this is shocking. They stressed importance of ventilators and how blunting the curve will not overtax limited ventilators. Less then 20% seems almost statistically insignificant. If lung cells become infected, they die- cannot oxygenate blood. Why would ventilators help? For all we know, inducing coma could be the intervention needed.
Also, the drug scene has escalated with little coverage. Apparently fentanyl laced meth is killing it- especially if you mix in a little wasp killer spray. Crazy cheap and dehabilitating. Paying people not to work and not leave home may have a larger effect on society then just boredom.
1. 20% is statistically insignificant? I disagree.
2. Go back and read my posts on ARDS.
Quoted from Who-Dey:
This Doctor tells it like it is, no bullshit or beating around the bush.
Send that to wolfemaaan.
If you have to start a post by saying “No politics”, you’re probably about to make a political post...
There are going to be a lot of leaders in this country on both sides of the aisle that are going to have some serious ‘splainin to do when this is all over.
Having said that, let’s be on the same team right now. It’s not the time for finger pointing.
Quoted from Mizzou0103:
I think you’re partly right. I agree we need to be in the same team, but that doesn’t mean that we shouldn’t be pressuring leaders to ensure:
Adequate testing gets provided quickly
The appropriate stay at home measures are taken
Healthcare workers get the PPE they need
Ensure our neighbors get financial relief if they’re laid off
Educate ourselves to be ready to hold leaders and legislators accountable, the next time they are on the ballot
Those issues are policy and government related and not political. It’s important that we make sure our leaders are accountable to the population. Of course this is regardless of party.
I agree with you however arguing on a pinball website about politics accomplishes none of those objectives.
One thing about weather forecasts I learned is that when they say 50% chance of rain, it doesn’t mean there is a 50% chance of rain in your area, it means they project 50% of the viewing area of their station will get some sort of rain that day.
What is survival rate with oxygen and sedation?
The survival rate of an ARDS patient without ventilation is basically zero.
Without mechanical ventilation I think you would see an additional 2500-5000 deaths in the next two weeks. Maybe one of the statistics guys can come up with the math.
A lot of "Empty Hospital" videos popping up, just wondered if anyone in these areas could explain or verify if they are real or bogus. The big Hospital in New York was featured by several people, they all looked like ghost towns.
I haven’t seen any of the videos and it honestly sounds like more conspiracy theories.
Here in Texas I can tell you my hospitals parking lot is about half full and that is because the hospital is limiting who can come in and has canceled elective procedures. So, all the traffic of people who are coming in to visit a patient or have an elective surgery, or have a colonoscopy, or an elective cardiac procedure, etc. all those patients are gone.
Quoted from Blitzburgh99:
I have a question for doc gizzard.
What about cigarette, cigar, and vape smoke? If the virus can live in the air for hours (per various reports), would the virus be transmitted in a cloud of smoke? If I can smell someone’s cigarettes from the next house, should I be concerned?
No. there's no evidence to support airborne transmission like that. Even a truly airborne disease like tuberculosis would have difficulty traveling from one house to another like the smell of cigarette smoke.
Now, there's plenty of reasons for people to not smoke or vape but spreading coronavirus isn't one of them.
How do you explain this?
https://www.latimes.com/world-nation/story/2020-03-29/coronavirus-choir-outbreak
I’m 4 weeks and 1 day smoke free. Damn I miss cigars...
Just because they were all singing doesn't necessarily mean the virus was transmitted airborne. Respiratory droplets can be created when coughing or clearing the throat. In addition, singing itself is a very different activity vs talking. There is much more air being forced from the lungs so you could consider the possibility that a higher amount of virus was placed into the air. There are cases of physicians contracting coronavirus from intubating a patient or doing a bronchoscopy where large amounts of virus is put into the air. Similar situation.
Also a choir is in very close proximity to each other and likely are touching each other or common surfaces intermittently which is another possible mode of transmission.
Doc, did you ever get your neutral zone switch figured out?
LOL, not yet. My STTNG playfield is still in the service position. I'm hoping to tackle that this weekend.
Today I went to Hobby Lobby and picked up a couple acrylic paints for the Jumping Jack playfield I am going to try and restore.
I guess we could go down the rabbit hole of what ifs all night if we wanted to.
Would it be theoretically possible to transmit coronavirus by standing in front of an opera singer who had it? I guess, it's possible.
I will say the amount of smoke it takes in the air to allow your nose to pick up the smell is WAY less than the probable needed amount of virus to transmit a disease.
Let's not get crazy people.
I’m just trying to understand the hard facts. People recommend six feet distance. Based on what? Or maybe we just don’t know? That’s ok too, just trying to u defat and the facts.
6 feet is based on the usual radius for respiratory droplet travel.
I understand the reasons behind your questions and they are good reasons. The reality though is that this virus has been around for about 4 months that we know of. We just don't have the data to determine exactly how likely it is to transmit one way vs the other so we go off of what other coronaviruses do and what we know of this one so far.
The best thing you can do to prevent transmission is wash your hands religiously, don't touch your face and limit your exposure to other people outside your own home.
I have a question. I know your not suppose to touch your face BUT, let's just assume that your cheek or chin or forehead is itching, is it safe to scratch your face like that occasionally? I understand you shouldnt touch your mouth, rub your eyes, or pick your nose but would you get coronavirus by scratching your cheek or forehead if it was itching?
If you touched a surface that had coronavirus on it and then touched your cheek or chin then yes it's possible you could get it.
Don't touch your face while you are out in public and wash or sanitize your hands after you touch any public surface. If you are inside your home and have washed your hands since coming in from the public then it should be ok to touch your face at that point.
It's hard, I never knew how much I touched my face during the day until now!
To add to the article I linked, the main takeaway I have is that we may be undoing ourselves by wiping down groceries, where a low dosage might reside.
On a personal note, my wife and I went to the local Costco a couple weeks ago. Five days later (about 7 days ago), my wife suddenly developed a bad cough, was very tired, and couldn’t keep warm even with multiple covers and an electric blanket. I was extremely concerned. This lasted from late in the day and all through the night. She started feeling better the next day and within a few days had no more symptoms. She does not have seasonal allergies or really ever develop a cough. I know there is more than one possible way to explain this, but the oddity is that we have been completely isolated during that time and for the week prior. There was no other means by which she could have caught something to my knowledge. it is possible that she fought through a low dosage exposure.
Doc, I would be curious to get your take on all this.
It’s possible but we are still in cold and flu season in general. I’ve seen several patients in the last week that I would have bet money they had COVID based on their symptoms and they tested negative.
Only way to tell for sure would be an antibody test which we don’t currently have.
Nurses are awesome. One of the first lessons you learn in residency is don’t piss off the nurses. They can be an amazing help to you or they can literally make your life hell. The doctors may be steering the ship but the nurses do the majority of the healing.
Quoted from iceman44:
If YOU are sick, don’t go out
If YOU are at risk don’t go out
Wash your hands
Whether anyone likes it or not we are headed to the “personal responsibility” mode of operating sooner than later
“Be careful Barbara, they are coming for you!”
If you don't have to be out, don't go out.
This virus is spread by asymptomatic carriers as well as people who are feeling ill.
You can take personal responsibility for your mother, father and older family members all you want. Stay the hell away from mine.
Tell YOURS like I tell MINE to stay the heck home!!!
That's a great idea except when they need to go get groceries. Then people like you are out there when you don't need to be and may be spreading it.
Currently, the death rate is 9 people per million in the USA.
There are 111 deaths in Texas out of 30 million people
3500 in NY due to the density of people and mass transit. California with 38 million people, not so much
The extremely HIGH likelihood is that IF you aren’t “at risk” YOU will NOT die from this virus
Sorry to give you some positive news but it’s just a fact
You're not telling us anything we don't already know.
Here's the real question, are you saying you are willing to sacrifice someone else's life to preserve your what, income? Ability to go to Lowe's?
Exactly what are you willing to sacrifice someone else's mom or grandmother for? How many people are you willing to sacrifice? 1? 10? 100? What's the line for to preserve your personal way of life? Is it too much to ask that you inconvenience yourself for 30 days to save someone's life? 60? How much inconvenience is it for you to just wear a mask in public?
Sorry, that’s irresponsible on their part
My 81 parents have grocery delivery.
THEY need to stay home. That’s the problem for “at risk” people!!!!
Still running around to grocery stores, Home Depot and Lowe’s.
Getting groceries is irresponsible? How about going to Lowe's when you don't have to and possibly continuing to spread this virus? That's not irresponsible?
Your logic is a little flawed.
Yes. When does it end? When you say it’s over? And no I don’t have a mask or toilet paper because I didn’t hoard from the people that actually need it.
There will be sacrifices made, it’s already monumental with regard to stress, anxiety, loss of jobs, suicide, alcohol and drug abuse etc
When does it end? I don't know yet.
Is it too much to ask you to stay the hell home at least until we stop exponentially increasing cases and deaths each day? How bout we start there?
You worry about taking care of yourself. How about we start there?
As long as YOU stay home you have nothing to worry about
Sorry, I can't because I have to worry about taking care of all the people who come into my office and into my hospital sick as shit because of idiots who think this is all "fake news". I have to worry about them first. I also have to worry about whether I am bringing this home to my family every night because I see patients every day who have COVID symptoms and send them for testing.
But hey, don't let any of that get in the way of your mulch buying at Lowe's.
Can you answer your own question? What’s you line? Would you sit at home, out of work, for 2 years to save a life? Or out of work for 1 day to save 1 million lives? I suspect I know the answer to both questions. But what’s the tipping point between the two?
I’ve accepted that people will die from this, and frankly, have to die so we can sustain “life as we know it”. My own father would die before accepting that he *might* live for 5 more years, only to devastate the lives of his children and grandchildren. I’m 43, and I feel the same. I’d sacrifice myself so my kids can have a better life.
I know that could be interpreted as “f your grandma, your parents, etc.”. I could interpret the opposite position as “f me and my kids”. Halting the economy for 2 months to save the lives of people who may live another few years is foolish. The end result is devastating to me financially, and thus will hurt my offspring too. It’s a shit sandwhich, I know. My parents are old. My in-laws are not in good health. It sucks. I will lose family members.
We go to war to fight for our beliefs systems, to sustain our way of life. In war we send kids in to do our “dirty work”. And yet we want to destroy our economy and way of life so we can maybe save our elderly and vulnerable? I know what I’m say is blunt. It may not be popular. But it’s what I see as reality.
And even if we distance and pause, there’s no stopping the virus. Short of a vaccine. We may slow it down and save some lives. And destroy a lot more in the process. Don’t let the cure be worse than the disease...
Yes, your position boils down to "f you and your family". Congratulations.
And my line is ZERO. I go to work every day to try and help patients. I go directly home every day after work. We go to the grocery store only when we have to. My kids haven't been outside of our front yard in 3 weeks. I try to not make ANYTHING I do harm another person. That's my line.
The bulk of what these people are really trying to say is 2 things:
1. Money over people
2. Why should I be inconvenienced because of someone elses problem
Basically, the part of the American mentality that most of the world hates.
Learn some empathy, and learn that not everything revolves around what you want.
This.
rezdog