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Re: COVID-19: The Science is NOT Settled [Re: Angus1895] #14720565 03/29/20
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DocRocket Offline OP
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Originally Posted by Angus1895
Excellent post, thank you.

Are they going to develop serology and a type of testing to assimilate prevelance?

What is the survival rate of ventilation therapy? Is there cross protection of other corona viruses?

Thanks again.


I haven’t seen any updates lately that I trust, but previous numbers showed fewer than 20% of COVID test-positive patients requiring hospital care, and about 2-4% requiring mechanical ventilation. Most of those on the vents survive. The 80% death rate on ventilators being reported by some hospitals is NOT representative as I understand.

Serological testing for antibodies to COVID-19 is being worked on. It should be coming on stream within a couple of months if not sooner. That will give us a better grasp of the prevalence and rate of asymotomatic vs minimally symptomatic infections.

Yes, immunity to other corona viruses confers some protective effect, but this hasn’t been measured yet. If that didn’t exist, the death rate would be much, much higher.


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Re: COVID-19: The Science is NOT Settled [Re: djs] #14720572 03/29/20
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djs, no worries, I didn’t read your post as argumentative. I appreciate the discussion.


"I'm gonna have to science the schit out of this." Mark Watney, Sol 59, Mars
Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14720592 03/29/20
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Doc what are the chances of getting Covid a second time if someone has already had it? If this has been asked and answered I apologize. I don’t personally know anyone who has had it but it has been a topic of conversation more than once.

Thank you for what you do.

Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14720620 03/29/20
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God bless you DocRocket...thank you for helping us fellas on the fire.


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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14721871 03/29/20
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Is there a way to find strains in the covid 19 family, or another corona virus to devolop a MLV if you will, to get immunity sooner without the lag time required with killed vaccine?

Last edited by Angus1895; 03/29/20.

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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14721926 03/29/20
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Hey Doc! Thank you for doing what you do. I am going to send prayers for you.
Question: Do you have access to Facebook Group BAFERD?
Do they have better medical insights on the nature of viral loads and high population communities?

May you find the "hands" of the Lord, helping you during this dangerous time.

Sincerely,
Thomas

Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14721979 03/29/20
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Dr.

Maybe it was a sales pitch for the particular brand of PAPR mentioned toward the end.

Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14721987 03/29/20
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Re: COVID-19: The Science is NOT Settled [Re: kingston] #14724139 03/30/20
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kingston, the worldometers website is one of the ones I've been watching with fairly high confidence in their numbers.


"I'm gonna have to science the schit out of this." Mark Watney, Sol 59, Mars
Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14726910 03/30/20
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Originally Posted by DocRocket
Originally Posted by CharlieFoxtrot
Doc, I appreciate your giving clarity to this thing. I know you're beyond busy. I have a question and am hoping if you see this post you can shed a little light on it.

I'm reading where tPA has shown some promise in those with advanced COVID-19 by breaking up pulmonary clots and also small clots in the aveoli. Apparently COVID pts are hypercoagulable and are clotting off their IVs, as well as having kidney and heart failure. A 2001 study showed promise in this area and I believe there is a compassionate use study underway. As an ER doc, I assume you've had experience with lytics for MI and stroke. I know it's damned expensive, but nearly every ER should have it on hand. Any thoughts regarding tPA as advanced COVID therapy?

Thanks again.

cf



cf... as far as I am aware, this question is low on the list of priorities for clinicians dealing with COVID patients. Adult Respiratory Distress Syndrome (ARDS) is our biggest worry, and once it sets in we don't have any tools to fight it, other than changing our ventilator settings. lt's a fancy term to denote the end-of-life process for any lung disease or injury... a few people survive it, most don't.

Anticoagulants and thrombolytic meds do not have a significant role in treatment of COVID at this point, to my knowledge.


Thank you. After further reading it seems mostly geared towards salvage therapy. The one human trial (N=20) showed a 30% reduction in mortality, but it was given to pts. who were in severe distress with ARDs and not expected to live. Folks at MIT and UofCO are looking at it.

https://journals.lww.com/jtrauma/Ci..._Tissue_Plasminogen_Activator.97967.aspx

https://www.sciencedaily.com/releases/2020/03/200325120845.htm

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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14727060 03/30/20
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Originally Posted by DocRocket

I haven’t seen any updates lately that I trust, but previous numbers showed fewer than 20% of COVID test-positive patients requiring hospital care, and about 2-4% requiring mechanical ventilation. Most of those on the vents survive. The 80% death rate on ventilators being reported by some hospitals is NOT representative as I understand.


Hope you don't mind Doc. Here's some info I printed a few weeks back, for you to see a study showing death rates on vents.

Re-posting here, to try to help save some lives:

Of the people who go onto a ventilator, under any medical condition, only 50% survive to come off it. Only 30% of the total that are put on survive a year. There was a study in the medical industry that created those statistics.

https://www.ncbi.nlm.nih.gov/pubmed/8404197

Quote
We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge.



With the Covid-19, and it being a virus that “directly” attacks the lungs, that 50% that come off it above, could fall quite a bit. It could be extremely low, and they aren’t reporting those numbers. Wonder why.

Bottom line, if your lung capacity is low from the start, before you even get the virus, you’re in a bad situation right off the bat, because the virus will diminish your lung capacity by about 5 MET, so you’ll need an extra tank of gas (additional lung capacity above 5 MET) to be able to breath and supply oxygen to your body.

A normal person with zero health issues: No smoking, no COPD, diabetes, no severe over weight, etc. consumes the following MET:

1 - MET – sitting
2/3 - MET walking around, working
8 – MET working out on a stair stepper, fast walk sustained 30 minutes, or casual jog 10-12 min./mile for 2.5 – 3 miles.

So you see, if you start with 8 MET and the virus robs you of 5 MET, you’ll have 3 MET reserve capacity left to just lay in bed, and breath or get up and walk to eat, etc.

That is why it is critical for people to start doing a cardio work-out, however they can RIGHT NOW, to build up their lung capacity, so they’ll have a chance to fight it. It takes about 2 months normally, some faster. Just depends where you’re starting from capacity wise.

You can see, if you start off with a diminished capacity, you’re cooked right off the bat. A ventilator can not make up that capacity.

Even if the elderly have leg joint issues, et al., they can give their lungs a workout just doing deep breathing, slow so they don’t hyperventilate, for an extended period, to build up.

https://www.healthline.com/health/how-to-increase-lung-capacity

Or get a Spirometer. Several different brands on the market, $6-$10:

https://www.healthykin.com//p-5364-...Zha3E6AIVDYiGCh2SOQZvEAQYAiABEgKSdvD_BwE

The reason it isn’t killing kids, is the fact they have good lungs: run around all day. As people get older, they stop staying in shape (low lung capacity), thus the death rate climbs as the age goes up.

It’s a bad deal all around with the way it attacks the lungs.

** I wrote the above back on March 19, 2020 to help you guys in another thread.

Re-posting here to help who I can, to encourage you to get your lung capacity up, if you are not in shape.

https://www.24hourcampfire.com/ubbt...14678921/re-total-shut-down#Post14678921


Last edited by ElkSlayer91; 03/31/20.

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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14727099 03/31/20
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Originally Posted by DocRocket
Originally Posted by sse
From ER doc in New Orleans, little technical.


"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know..."



So please don't give this bull s h i t story any credence whatsoever.


Thanks for the info. Do you know of any website that has debunked that story? The reason I ask is my wife sent me the story from her work. She is the JAG for a ANG wing and asked me what I thought as it had been circulated by the med staff to read. As a clinical hospital pharmacist I saw enough things that matched info on up-to-date but also had numbers I could not find or verify anywhere, like ventilator mortality rates. I'll pass on what you said. Best I can tell this is where the original story came from on 3/25: https://texags.com/forums/84/topics/3102444/1
This is the disclaimer he has now added:
Quote
My first expanded lost draft (thanks again MacBook Touch Bar) contained the appropriate hedging, disclaimers, and uncertainty the current understanding of this pandemic deserves. Some of the more concise, unproofread, hastily rewritten original post (OP) presents itself as more definitive instead of "what I think I know". For this, my apologies. I am not performing clinical trials. I am not involved in cohorting and analyzing data. The academic physicians involved in ER, Infectious Disease and Pulmonary Critical Care are likely (hopefully) way beyond my understanding of Covid 19. Furthermore, I fail to appreciate any additional benefit I could provide to Hospital Administrators who have been preparing and communicating with each other for months; or for some already combating this daily.


I'm currently fighting with the powers that be at my hospital just to have a safe place to work. Our ICU is designed to be negative pressure, but does not have an anteroom or any passthrough to get meds/labs/etc. in and out other than be exposed to the ICU air. They built a false wall 10 feet inside the door and put a large door in it, and called that an ante room. Of course both doors can be opened at the same time and the design allows that room air to mix with the ICU air the instant it's open, etc. I've pointed out the only safe way to use it is to be in full PPE before entering, but they put the PPE inside the room. Sometime it feels that getting it as a health care worker is inevitable.

On the plus side, we have a ton of Plaquenil and Zithromax to throw at everyone in hope it helps somebody, while we barely have enough propofol, levophed, versed, etc.


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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14727784 03/31/20
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Angus1895 Offline
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Elk slayer 91.

What does MET stand for?

Thanks!


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Re: COVID-19: The Science is NOT Settled [Re: Angus1895] #14728242 03/31/20
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Originally Posted by Angus1895
Elk slayer 91.

What does MET stand for?

Thanks!

1 MET = 3.5 ml/kg/min or VO2

https://assets.firstbeat.com/firstbeat/uploads/2017/06/white_paper_VO2max_30.6.2017.pdf

A good running watch will have a VO2MAX measuring ability. Once you know your VO2MAX reading, you can Convert that to MET, and know where you are.


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Re: COVID-19: The Science is NOT Settled [Re: ElkSlayer91] #14728351 03/31/20
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Originally Posted by ElkSlayer91
Originally Posted by DocRocket

I haven’t seen any updates lately that I trust, but previous numbers showed fewer than 20% of COVID test-positive patients requiring hospital care, and about 2-4% requiring mechanical ventilation. Most of those on the vents survive. The 80% death rate on ventilators being reported by some hospitals is NOT representative as I understand.


Hope you don't mind Doc. Here's some info I printed a few weeks back, for you to see a study showing death rates on vents.

Re-posting here, to try to help save some lives:

Of the people who go onto a ventilator, under any medical condition, only 50% survive to come off it. Only 30% of the total that are put on survive a year. There was a study in the medical industry that created those statistics.

https://www.ncbi.nlm.nih.gov/pubmed/8404197

Quote
We reviewed a 5-year experience with mechanical ventilation in 383 men with acute respiratory failure and studied the impact of patient age, cause of acute respiratory failure, and duration of mechanical ventilation on survival. Survival rates were 66.6 percent to weaning, 61.1 percent to ICU discharge, 49.6 percent to hospital discharge, and 30.1 percent to 1 year after hospital discharge.



With the Covid-19, and it being a virus that “directly” attacks the lungs, that 50% that come off it above, could fall quite a bit. It could be extremely low, and they aren’t reporting those numbers. Wonder why.

Bottom line, if your lung capacity is low from the start, before you even get the virus, you’re in a bad situation right off the bat, because the virus will diminish your lung capacity by about 5 MET, so you’ll need an extra tank of gas (additional lung capacity above 5 MET) to be able to breath and supply oxygen to your body.

A normal person with zero health issues: No smoking, no COPD, diabetes, no severe over weight, etc. consumes the following MET:

1 - MET – sitting
2/3 - MET walking around, working
8 – MET working out on a stair stepper, fast walk sustained 30 minutes, or casual jog 10-12 min./mile for 2.5 – 3 miles.

So you see, if you start with 8 MET and the virus robs you of 5 MET, you’ll have 3 MET reserve capacity left to just lay in bed, and breath or get up and walk to eat, etc.

That is why it is critical for people to start doing a cardio work-out, however they can RIGHT NOW, to build up their lung capacity, so they’ll have a chance to fight it. It takes about 2 months normally, some faster. Just depends where you’re starting from capacity wise.

You can see, if you start off with a diminished capacity, you’re cooked right off the bat. A ventilator can not make up that capacity.

Even if the elderly have leg joint issues, et al., they can give their lungs a workout just doing deep breathing, slow so they don’t hyperventilate, for an extended period, to build up.

https://www.healthline.com/health/how-to-increase-lung-capacity

Or get a Spirometer. Several different brands on the market, $6-$10:

https://www.healthykin.com//p-5364-...Zha3E6AIVDYiGCh2SOQZvEAQYAiABEgKSdvD_BwE

The reason it isn’t killing kids, is the fact they have good lungs: run around all day. As people get older, they stop staying in shape (low lung capacity), thus the death rate climbs as the age goes up.

It’s a bad deal all around with the way it attacks the lungs.

** I wrote the above back on March 19, 2020 to help you guys in another thread.

Re-posting here to help who I can, to encourage you to get your lung capacity up, if you are not in shape.

https://www.24hourcampfire.com/ubbt...14678921/re-total-shut-down#Post14678921


Good info


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Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14731182 04/01/20
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New Zealand is in TOTAL lock down to try to eliminate the virus. The USA looks like it is in big trouble. Any comments DocRocket (and this is not a nasty question, it's just a question as to what the US situation looks from your point of view). Thanks.

Re: COVID-19: The Science is NOT Settled [Re: DocRocket] #14731188 04/01/20
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I believe there may have been cases in the US a few months earlier than the virus was reported in China. The week before Thanksgiving I was deer hunting in KY, my guide had a really bad cough and upper respiratory infection that was kicking his azz. Before departing for my trip my wife had a moderately severe cough too, she did her best to socially distance herself from me so I wouldn't come down with a cough. About a week after returning from KY you guessed it I came down with a nasty cough that took longer to get rid of that usual. These examples lead me to believe that the virus was present in a weaker form prior to being recognized for being what it was.

Re: COVID-19: The Science is NOT Settled [Re: gunswizard] #14731192 04/01/20
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Originally Posted by gunswizard
I believe there may have been cases in the US a few months earlier than the virus was reported in China. The week before Thanksgiving I was deer hunting in KY, my guide had a really bad cough and upper respiratory infection that was kicking his azz. Before departing for my trip my wife had a moderately severe cough too, she did her best to socially distance herself from me so I wouldn't come down with a cough. About a week after returning from KY you guessed it I came down with a nasty cough that took longer to get rid of that usual. These examples lead me to believe that the virus was present in a weaker form prior to being recognized for being what it was.


It seems everywhere I look I see people wanting to be one of the first to have this virus. I guess we should all be thankful all those people who had corona Nov through Jan here in the US stayed out of the hospitals and didn't need any care other than fluids and rest. Who knows, maybe it was here for months and only affected younger, healthy people until it kicked things up a notch in Feb.


Don't just be a survivor, be a competitor.
Re: COVID-19: The Science is NOT Settled [Re: Kodiakisland] #14731193 04/01/20
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Sitka deer Offline
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Originally Posted by Kodiakisland
Originally Posted by gunswizard
I believe there may have been cases in the US a few months earlier than the virus was reported in China. The week before Thanksgiving I was deer hunting in KY, my guide had a really bad cough and upper respiratory infection that was kicking his azz. Before departing for my trip my wife had a moderately severe cough too, she did her best to socially distance herself from me so I wouldn't come down with a cough. About a week after returning from KY you guessed it I came down with a nasty cough that took longer to get rid of that usual. These examples lead me to believe that the virus was present in a weaker form prior to being recognized for being what it was.


It seems everywhere I look I see people wanting to be one of the first to have this virus. I guess we should all be thankful all those people who had corona Nov through Jan here in the US stayed out of the hospitals and didn't need any care other than fluids and rest. Who knows, maybe it was here for months and only affected younger, healthy people until it kicked things up a notch in Feb.


Yeah... that's the way it works...

huh?


Mark Begich, Joaquin Jackson, and Heller resistance... Three huge reasons to worry about the NRA.
Re: COVID-19: The Science is NOT Settled [Re: Sitka deer] #14731198 04/01/20
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19352012 Offline
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Originally Posted by Sitka deer
Originally Posted by Kodiakisland
Originally Posted by gunswizard
I believe there may have been cases in the US a few months earlier than the virus was reported in China. The week before Thanksgiving I was deer hunting in KY, my guide had a really bad cough and upper respiratory infection that was kicking his azz. Before departing for my trip my wife had a moderately severe cough too, she did her best to socially distance herself from me so I wouldn't come down with a cough. About a week after returning from KY you guessed it I came down with a nasty cough that took longer to get rid of that usual. These examples lead me to believe that the virus was present in a weaker form prior to being recognized for being what it was.


It seems everywhere I look I see people wanting to be one of the first to have this virus. I guess we should all be thankful all those people who had corona Nov through Jan here in the US stayed out of the hospitals and didn't need any care other than fluids and rest. Who knows, maybe it was here for months and only affected younger, healthy people until it kicked things up a notch in Feb.


Yeah... that's the way it works...

huh?

Whatever happened with that stock thing?


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