COVID 19 - Thoughts from a frontline doc

Discussion in 'Cop Talk' started by PicardMD, Mar 28, 2020.

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  1. 1L26

    1L26

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    ^^^^^^^^^

    This!
     
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  2. Sgt127

    Sgt127

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    I have a new BFF over at MedCram. Dr. Seheult. Been watching his updates since this started.

    Early on he was talking about the anti viral benefits of Vitamin D. Quercetin, zinc, magnesium and Black Elderberry.

    Anytime I hear info from a medical doctor that’s also mentioned by the homeopathic crowd, it kind of gets my attention.

    I’m not going the Dr Linus Pauling mega dosing on every supplement I can find route. But, I’m fairly sure they are relatively harmless in reasonable doses.

    But, what are your thoughts on toughening up the immune system a little?

    Also, he mentioned the quinine derivative and Zinc early on. The zinc can interfere with the RNA of the virus, the quinine acts as a key to allow entry into the cell. Anything to that?

    And, thanks for being a sounding board and answering our questions!
     
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  3. PicardMD

    PicardMD Make It So!!

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    In general, I have no problem with reasonable vitamin supplementations. In fact, I do believe we probably under-recognize vitamin D deficiency in general (although primary care is getting better at this in recent years). So yes, I think proper vitamin supplementation in general is prudent. However, vitamin D's role in boosting immune system is controversial and not well understood in vivo (yes, there are many molecular pathways in theory.) The overall positive immune effect in vivo is probably negligible in the big picture (despite what homeopathic folks would like to peddle). Our immune system is very complex.

    Also, keep in mind that Vitamin D is toxic in large doses (or, overdoses), and can have unpleasant neurological side effects, some may be permanent. Fatal overdoses have been reported.

    I do believe in Zinc, specifically zinc lozenges in use for coronavirus in general. Keep in mind that coronaviruses in general are not new. In fact, various human coronaviruses (not talking about this novel-COVID-19) have been causing the common cold probably as far back as human civilization goes. Zinc has been shown to inhibit viral replication in mouth and pharynx against various human coronaviruses (not all). So, there is a decent chance that it will inhibit viral replication of COVID-19 as well. Keep in mind, it is NOT a magic bullet. Viral pathophysiology is much more complicated than that. But is it better than nothing? Yes it is.
    Keep in mind that too much zinc is also toxic.
    This is a good laypeople's article on Zinc from University of Colorado:
    https://www.uchealth.org/today/zinc-could-help-diminish-extent-of-covid-19/

    Role of quinine is very controversial. No, I am NOT in favor of routinely taking quinine to facilitate zinc effect. Quinine is not a benign drug. It has some pretty significant and potentially fatal side effects, including QT prolongation that can cause sudden cardiac deaths.

    Oral magnesium is generally safe, as your kidneys tend to dump the extras that you don't need. However, too much magnesium is also a bad thing. There are several common conditions or illnesses that can increase your body's absorption of magnesium to the point where your kidneys are overwhelmed and cannot effectively dump excess magnesium. Magnesium supplement can also be dangerous in people with existing kidney diseases, as the ability to dump extra magnesium can be impaired.

    Hypermagnesemia (high blood magnesium level) can cause many unpleasant neurological effects such as paralysis, and even sudden cardiac deaths. Yes, these are rare, but we do see them in people who think "more is better" and take **** tons of magnesium supplements.
     
    Last edited: Mar 31, 2020
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  4. PicardMD

    PicardMD Make It So!!

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    New England Journal of Medicine (I think that's where I read it from today, can't remember... could be JAMA, read too many things today) just published a new article on a more updated prognosis in COVID patients who end up on ventilators.

    Our most recent "batting average" is around 50% - meaning, we are able to save roughly 50% of people who end up on ventilators due to COVID. That is a much improved batting average from the worldwide ventilator death rate of 86%, and much improved from our initial Seattle ventilator death rate of around 70%. COVID patients who need ICU care are still needing them for a very prolong period of time compared to the flu.

    Like I said, we are getting better at this everyday. We are learning and sharing across the country and we are getting better with each patient we treat.... provided that the overall healthcare system doesn't get completely overrun by the rate of patient influx. Again, goes back to how critically important social distancing and flattening the curve are. We will continue to improve as long as we are able to drink from a water fountain and not get drowned by a firehose.
     
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  5. 1L26

    1L26

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    As I said earlier I appreciate you taking the time and providing a bit of the inside baseball that's going on. Once again, I'm glad my Patrol days are behind me and that although banged up from the job I'm still pretty healthy.

    I've sent a prayer for your safety and I want to thank you and the people you work with for giving us a reason to exhale a bit.

    Thanks again!
     
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  6. merlynusn

    merlynusn

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    A couple questions:

    1) Is the incubation period still 14 days or has that shortened some?
    2) Any advice for pregnant women outside of social distancing? Do they have an increased risk?
    3) If the whole point is to slow the spread, why didn’t they just do a mandatory lock down (a real one, not this halfway attempt) for 3 weeks? Wouldn’t that have been more beneficial?
     
  7. pblanc

    pblanc

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    Indiana is not among the US states that has been hardest hit, but it is now seeing a surge in both new cases and deaths. Indiana's case fatality rate currently stands at 2.26% which is above the national average, and that has been increasing in recent days, not decreasing. Per capita death rate now stands at 7.26/million population.

    Indiana has not been able to do extensive testing but that is improving. So far 13,373 tests have been administered but that accounts for only about 0.2% of the population, so testing has been largely restricted to those with symptoms or a history of close personal contact with an infected individual. Of those tests, a little over 15% have returned positive.

    Indiana's Health Commissioner says current expectations are that 20% of those who test positive will become seriously ill requiring hospitalization, and of those 5% will require intensive care. Contingency plans are currently being drawn up for the Army Corps of Engineers to set up field hospitals, if necessary. Eleven thousand "medical volunteers" not including students, have offered their services if needed.

    A large number of medical volunteers could certainly be beneficial, but I expect few would be able to take on the roles of those responsible for the care of the sickest individuals such as hospital intensivists, anesthesiologists, pulmonologists, and ICU nurses should their ranks need to be dramatically increased, or their numbers become depleted through attrition.
     
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  8. PicardMD

    PicardMD Make It So!!

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    We are seeing an average of around 5 days before symptoms start (fever, cough, muscle aches, fatigue... etc). And for most people these symptoms are it and they gradually get better over the next week or two. However, for those who will get really sick, we are seeing that the real bad shortness of breath starts around the second week, and gets really bad really quickly, sometimes over a few hours.

    There is very little data on pregnancy. We don't know how COVID affects the fetus. We are re-assigning our pregnant doctors and nurses away from the frontline and have them do telemedicine or other tasks that have minimal face-to-face contact with patients.

    Yes, mandatory lockdown would slow down the spread. This is where medicine/science/politics and civil liberty intersect.
     
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  9. seanmac45

    seanmac45 CLM

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    I am encapsulating the information in this thread into a WORD document. If anyone is interested in a copy PM me.
     
  10. Triple Taps

    Triple Taps

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    Coronavirus live updates: 1,400 members of NYPD have tested positive
    9:45 a.m.: 1,400 NYPD members test positive for coronavirus
    In hard-hit New York City, 1,400 members of the police department have tested positive for the coronavirus, says New York City Police Commissioner Dermot Shea.

    Protect yourselves along with protecting others!!
     
  11. GeorgiaGlocker

    GeorgiaGlocker Romans 10:9

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    Just an update on my friend who is in an ICU and on a vent:

    Basically there is no change in his condition from a few days ago although his fever is normal this morning which is a good sign. He is still being sedated.
     
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  12. Paul53

    Paul53 MAKE HATE WRONG AGAIN!

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    Saw this, might be helpful. Good health and good luck all.

    Useful information about covid from a microbiologist. Longish but a good read!

    Here to correct these misconceptions is Donald Schaffner, a faculty member in Rutgers University’s Department of Food Science.
    Schaffner’s advice for us is drawn from his experience as a food microbiologist.

    First and foremost, that terrifying report from the CDC that indicates the virus remained detectable on surfaces for as long as 17 days is based on finding viral RNA—not exactly the same as finding an infectious viral particle. The presence of fragments of a virus isn’t necessarily the same as an intact viral particle capable of infecting a person. Beyond that, the CDC does not provide the methods used to arrive at this 17 day figure, but instead cites personal communication—the scientific equivalent of passing off gossip as fact. Maybe it’s right, maybe it’s wrong, but you won’t know until you’ve gotten the full details from the original source.

    When it comes to making sure your groceries are safe, then, it’s not necessary to keep them on the porch or in the garage for three days. For perishable items like milk or ice cream, that’s actually a good way to end up with spoiled or rotting food, which is its safety issue. It’s also a really bad idea to wash fruits and veggies with soap, as ingesting soap can cause nausea, vomiting and diarrhea. And we don’t need anything else to worry about right now, do we?
     
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  13. ray9898

    ray9898

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    Dang.
     
  14. PuroMexicano

    PuroMexicano VIVA MEXICO !!!

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    Stay safe guys.
     
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  15. PicardMD

    PicardMD Make It So!!

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    Updates on several treatment options under investigation:

    I am eagerly watching the studies on hydroxychloroquine and ivermectin. There are some very quick turn around RCT's in progress on these two drugs.

    Other promising treatments on the horizon are the convalescent serum (serum from people who have recovered from the infection, for their antibodies), and several bioengineered antibodies to neutralize the virus.

    Tocilizumab, an engineered monoclonal antibody used to treat rheumatoid arthritis is also showing promise in turning off the cytokine storm that leads to ARDS (Acute Respiratory Distress Syndrome), the overactive inflammatory reaction that kills most COVID patients.
     
  16. PicardMD

    PicardMD Make It So!!

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    On a more somber note. Someone sent me this picture, painted by a physician artist:

    [​IMG]

    It's named, "The Last Shift" - in memoriam of healthcare workers who have died due to COVID.

    One of the medical websites is compiling a list, sort of like ODMP, and within a short few days, more than 100 names across the world have been submitted. US numbers are hard to get due to HIPAA regulations and no centralized tracking mechanisms.

    Locally, we have two doctors currently intubated in ICU. A primary care physician and an OBGYN.
     
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  17. seanmac45

    seanmac45 CLM

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    Picard,

    Thank you for a smack in the face realization of the cost of this pandemic to the health care providers. Their (your) sacrifices will not be forgotten any time soon.

    Sean
     
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  18. PicardMD

    PicardMD Make It So!!

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    Thank you. I've attended my share of LODD funerals as an LEO. Never thought I'd need to think about that as a physician.

    One of the most dangerous procedures to do on COVID patients is intubation - the one procedure they needed the most. It puts the procedurist in direct close-contact with the patient's aerosolization. Videoscopes and such helps, but they don't always work like what they show on the sales pitch videos in real life, especially when the procedure is urgent/emergent. Emergent trach or cricoidectomy are even worse.

    And while the media and politicians worry about running out of ventilators, what they don't talk about is running out of disposable ventilator circuits (tubings) and viral filters that keep the room safe. Without the filters working properly, a ventilated patient is essentially spraying the room with viral particles with each breath.
     
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  19. seanmac45

    seanmac45 CLM

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    Holy crap. Add that to the list of vital information that we laymen do not have a clue about.
     
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  20. BL33D 4 M3

    BL33D 4 M3

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    Great thread. Thanks so much for all the information. My question relates to reliable timeline for this thing. I have seen various estimates about when it was first detected here. My reason for asking is two-fold.

    1. I had a 2 week flu. I was exposed on Thanksgiving to a relative who was hacking non stop and sick. I spent the first 2 weeks of December with it. It may have been influenza A or B but it was the sickest I have ever been in my life. I have significant suspicions I had this virus but my illness is earlier than what we seem to think the timeline for covid-19 is. I did go to my PCP a couple weeks later for lingering dyspnea. This was just starting to be covered by the media and they asked me about recent travel etc. Chest xrays and ekg were all normal at that time.

    2. I have seen different information regarding re-infection. Do we know if once infected and resolved, people can become re-infected? Can testing determine that a person had the virus or just that they have it currently?

    Thank you.
     
    Last edited: Apr 5, 2020