COVID 19 - Thoughts from a frontline doc

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

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  1. Jon_R

    Jon_R

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    I don’t know the answer and I am not medical but FL state numbers for testing is 155k people tested and only 16k positive. Test have also been focused on people with symptoms. We have been 80s-95 degrees for a while.

    Having said that the projection is 4300 deaths in FL we are at 354 now. The news talks about hotspots of Michigan, Louisiana, and Illinois. There projections added together are about the same for FL. I just don’t understand how FL is going to get so bad so fast.

    Orange and Osceola counties which are home of the theme parks and massive conventions only have 15 deaths total 170 total hospitalized some have been discharged. All those crowds, foreigners, etc. at the parks and they are in pretty good shape. The out of town visitors went home but locals run these things and there are a lot of them.

    We also had baseball spring training. Around 5k people in 8 stadiums a day for ended up being 3 weeks.

    I am also not a modeler just looking at the data I hope the models are way high.

     
  2. steveksux

    steveksux Massive Member

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    Looks like from that if you correct for some other variables the apparent advantage to adding the z in the first place pretty much evaporated anyway, so no reason to take the extra risk of the potential arrhythmias.

    Randy


    Sent from my iPad using Tapatalk
     
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  3. PicardMD

    PicardMD Make It So!!

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    I have absolutely no problem with reasonable vitamin supplementation, as long as people realize that many of the vitamins do have toxic side effects if too much is taken.

    As for zinc- there is actually decent data on zinc and other common human coronaviruses (that have been causing the common cold for as long as the human civilization). No, it's not miracle shield or a magic bullet. But it is certainly in the camp of "better than nothing." I take zinc lozenges twice a day when I'm seeing patients during this pandemic.
     
  4. PicardMD

    PicardMD Make It So!!

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    When it comes to the US healthcare system and the current COVID outbreak, we cannot generalize it as a single entity.

    We are seeing hot spots around the nation where the local or regional system is overwhelmed, while other areas are still doing OK, or not busy at all.

    In areas where the local systems are overwhelmed, we are not talking about the situation in China where patients are warehoused and left to die without any care. We are talking about situations where we don't have the resources (material or manpower) to deliver the best possible standard of care to everyone. Overworked doc's and nurses may make mistakes because they are too tired. Taking short cuts and cutting corners because there are not enough XYZ material or XYZ specialists to go around... etc. And yes, there are places where PPE's are being re-used when we wouldn't think about doing that 2 months ago. I've seen this first hand, so I know this is happening.

    Another hidden concern no one is talking about is, due to COVID scare, many non-COVID patients are now afraid to seek medical care when they need it. They are staying home trying to "tough it out." Well, as some of my colleagues have eloquently put it, appendicitis or infected diabetic foot ulcers don't heal themselves and cannot be treated with chicken soup. So at some point, these patients will need to come in much sicker than they normally would, creating another layer of acute/peak demands on healthcare resources. This is another reason why flattening the curve is important.
     
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  5. PicardMD

    PicardMD Make It So!!

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    Most respiratory viruses drop their R value in hotter weather. It may happen with COVID, or it may not. We don't know that yet. I do suspect that COVID will become endemic across the world, like the flu virus, with seasonal variations in outbreaks.
     
    Last edited: Apr 9, 2020
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  6. PicardMD

    PicardMD Make It So!!

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    Zithromax is thought to have some anti-inflammatory effect. That's why it is the preferred antibiotics in COPD exacerbation when it is used alongside Prednisone, while not being used to treat an actual pneumonia.

    In the US, Zithromax is not an appropriate single agent to treat bacterial pneumonia empirically because there is too much resistance in streptococcus (the most common bacteria to cause bacterial pneumonia).

    Doctors probably reach for Zithromax as a prophylaxis because it is easy to dose (very long acting compared to other antibiotics), and commonly used in various conditions to prevent bacterial infections.
     
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  7. Newcop761

    Newcop761 CLM

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    Picard, I don't know if this guy is legit or a quack.

    His theory is that the general population should carry on and only the elderly and those with compromised immune systems/underlying health issues should shelter in place. He said that once 80+% of the population has developed antibodies we will have achieved herd immunity.

    So, is this legit? Does social distancing extend the duration of the pandemic?

    Here is the link to the article:
    https://www.thecollegefix.com/epide...nd6Hd9z7Xf6tY3PLENBj4DTdOXEpY1MDKcxfBL-0MTEFY

    Here is the video:
    View: https://youtu.be/lGC5sGdz4kg
     
  8. PicardMD

    PicardMD Make It So!!

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    Biostatisticians are very good a providing statistical models. But most of them lack clinical background to decide what is clinically relevant. That's why biostatisticians don't decide clinical relevance of their analyzed statistical results, and often don't even pick the actual model used in studies without input from clinicians and principle investigators.

    The problem with only isolating elderly and comorbid patients is, COVID seems to have a large percentage of asymptomatic folks who can spread infection. So these younger and mobile folks can bring outbreaks to their elderly relatives and friends and cause outbreaks.

    The New Orleans experience also seems to contradict his assertion. New Orleans became a hot spot after Mardi Gras, attended by primarily young, healthy people.

    And while it is true that herd immunity is an important tool in protecting population from future outbreaks, being exposed to the disease itself is not the best way to achieve immunity. Vaccine immunization is. Two reasons - not all respiratory virus infections lead to immunity afterwards. We currently don't know if recovery from COVID infection provides you with long lasting immunity against future infections. Secondly, vaccine is a much safer way to provide herd immunity. And COVID seems to have a stable enough genome for the development of an effective vaccine.
     
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  9. Newcop761

    Newcop761 CLM

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    Thanks for the response. That makes a lot of sense.
     
  10. flyover

    flyover

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    Some of the deniers should come and read this thread. Probably would not change their minds but hope springs eternal.
     
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  11. dano1427

    dano1427

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    Q: In NY, Ventilator usage has an approx. 80% mortality rate with Covid patients, far higher than average. Is ECMO going to become more common treating these cases, and has the panacea of the Ventilator been a tragic mistake?
     
  12. DocCasualty

    DocCasualty Wolverine

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    There are ~ 260 ECMO centers in the country. It is there to bridge somebody to the next step. Question is, in multi-system failure, a bridge to where? I see it having some use but it is no panacea.
     
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  13. Speleothem

    Speleothem

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    How much zinc is "just right?"
    I'm getting 30mg in my Super Beta Prostate.
    I've read that more that 40mg is too much.
     
  14. PicardMD

    PicardMD Make It So!!

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    Obviously I cannot give you medical advices over the internet.
    With that said, from an educational standpoint, we think around 70mg of zinc per day is probably reasonable in otherwise healthy adults. More than 150mg a day is probably harmful in otherwise healthy adults.

    Also, personally I like to target where the zinc goes - in my oropharynx where its a "target rich" environment for the virus. So, I use melt-in-my-mouth zinc lozenges rather than swallowing zinc in pill forms.
     
  15. PicardMD

    PicardMD Make It So!!

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    Problem with NY is, there is probably not enough staff to properly manage the ventilators. Ventilators is not a "set it and forget it" type of treatment, especially in COVID patients. It actually takes very careful monitoring by both the critical care docs AND critical care nurses. Settings need to be adjusted as needed. AND, one of the most helpful things we have found is to prone the patient on the ventilator a few times a day. Proning actually is very, very labor intensive. It takes 5 to 6 trained ICU nurses plus an experiences respiratory therapist to do it properly and safely.

    And, currently there is no readily available alternative to ventilators when someone is hypoxic enough that regular oxygen canula is insufficient, or when someone is in respiratory distress. ECMO is very labor intensive, takes a specialist to operate, and survival is probably even worse. ECMO is a very short term bridge to some other definitive therapy.
     
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  16. steveksux

    steveksux Massive Member

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    There was a lot of problems with young people having major lung issues from vaping lately, haven’t seen any reports of that being a factor in covid 19 deaths in young people, wouldn’t that be he a huge risk factor/underlying condition for someone who’s contracted covid 19? Talking about outcomes, not susceptibility. Surprised I haven’t seen that mentioned, did I just miss it or hasn’t that been widespread enough to overlap with covid patients much yet? While it was sensationalized, didn’t seem to be very common yet.

    Randy


    Sent from my iPad using Tapatalk
     
  17. Garweh

    Garweh CLM

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    The free standing surgery centers where I normally practice are all closed in NYS per Cuomo’s executive order. I occasionally provide critical care coverage at a local medical center; I deal with COVID positive patients and unknowns mostly (very, very few “normal” patients in the ICU). I provide my own PAPR and I insist that the hospital provide unused PPE, otherwise I will walk out. I am not confident that N95 masks should be sterilized after 3 days usage. So far, the hospital has provided the needed equipment.

    My days are spend intubating, inserting central venous catheters, arterial lines and managing the vents, etc. Very LONG days.
     
    Last edited: Apr 12, 2020
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  18. Tvov

    Tvov

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    Your work is appreciated!
     
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  19. Garweh

    Garweh CLM

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    Spoke with one of our perfusionists, Columbia-Presbyterian Medical Center has supposedly (unconfirmed) said “No” to ECMO. Extremely resource/time/staff intensive and risky to the staff. Unless ECMO is done early in the course of the illness, there is no data to support ECMO dramatically increasing survival once the patient requires mechanical ventilation.
     
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  20. PicardMD

    PicardMD Make It So!!

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    Yes, vaping is a risk factor.