Treating it like the flu, basically.
Covid-19 Update Aggie Physician
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It apparent wasn't as highly contagious and easily transmissible as this version. They use a bit different infectious mechanism.
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MouthBQ98 said:
Treating it like the flu, basically.
We are seeing which doctors vapor lock and not be able to do anything because there's no established protocol and which doctors are willing to get into the fight and try things, even if they aren't proven protocols.
The latter are the ones who will solve this thing and be remembered.
Just because SARS- CoV isn't as contagious as SARS-CoV2 doesn't explain why it went away. It explains why this one became a pandemic worldwide as opposed to SARS but not the other.
If I recall, it didn't have a large asymptomatic period where it was infectious and it was harder to transmit. That leads to a lower R0 value. It was harder to spread undetected, so it could be traced and people isolated.
As the vector was also likely Asian bats through an intermediary species, once IG was isolated, it died off except in whatever the reservoir species was.
As the vector was also likely Asian bats through an intermediary species, once IG was isolated, it died off except in whatever the reservoir species was.
Irwin M. Fletcher said:
Just because SARS- CoV isn't as contagious as SARS-CoV2 doesn't explain why it went away. It explains why this one became a pandemic worldwide as opposed to SARS but not the other.
Sure it does. Less contagious = easier to contain. And of you can contain it before it spreads worldwide, you can eradicate it.
It's also generally easier to contain faster acting and more lethal viruses like Ebola. Not a lot of people get infected woth Ebola and manage to jet set around the world for a week while contagious with it. They get it, they get sick, and they either die or recover in pretty much the same place they got it. Not much time to infect others unless they're the ones taking care of the sick. Which brings us back to the conclusion above: easier to contain = easier to eradicate.
The answer is we don't know, but it is likely that immunity to SARS-CoV-2 will be longer lasting than the flu which mutates and sort of interbreeds with other strains of flu much more quickly than coronaviruses have been known to do. An infection and recovery from SARS-CoV-2 will likely give immunity for at least a year and likely much longer than that. Possibly permanently.Irwin M. Fletcher said:
Have a question for the docs and researchers on this thread. I have seen a lot of thought leaders stating that this could become a seasonal issue, with an uptick in cases come in the fall. Thus reservations about getting back to a true normal for a while. My question is why did SARS- CoV that caused SARS go away after its first outbreak? Also the same for MERS, these were also coronavirus'. I just want someone on here with knowledge of all these viruses explain why they expect this virus to behave differently once the first wave is put down. Not doubting that that will be the case, I just wanted some clarification. Thank you for your work!
And if the answer is we don't really know at this point, then my question is why did SARS-CoV just die off to never return after its initial outbreak?
MERS is really hard to transmit and will probably never make for a true pandemic (worldwide spread) but will cause small epidemics (regional) until/if they ever come up with a vaccine for it.
SARS CoV was easier to contain because people didn't become contagious until they had significant symptoms unlike SARS-CoV-2 which can be spread by both asymptomatic carriers and people who have yet to develop their symptoms.
They didn't do anything really special to stop the original SARS outbreak. It was the same stuff we are trying for Covid-19, but it was easier to identify and isolate those who were sick with the disease. The main problem with SARS-CoV-2 is the asymptomatic carriers and how long people remain contagious.
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Once again it does not explain why it went away. You have explained what kept it from becoming a worldwide pandemic. You used Ebola as an example, but Ebola still exists, it did not go away, although it is fairly easy to contain. SARS-CoV does not exist right now.John Francis Donaghy said:Irwin M. Fletcher said:
Just because SARS- CoV isn't as contagious as SARS-CoV2 doesn't explain why it went away. It explains why this one became a pandemic worldwide as opposed to SARS but not the other.
Sure it does. Less contagious = easier to contain. And of you can contain it before it spreads worldwide, you can eradicate it.
It's also generally easier to contain faster acting and more lethal viruses like Ebola. Not a lot of people get infected woth Ebola and manage to jet set around the world for a week while contagious with it. They get it, they get sick, and they either die or recover in pretty much the same place they got it. Not much time to infect others unless they're the ones taking care of the sick. Which brings us back to the conclusion above: easier to contain = easier to eradicate.
See my post above yours. Also it didn't go away. It could still jump back to people from animals and cause another outbreak, but we will probably be able to contain it again using the same strategies.Irwin M. Fletcher said:Once again it does not explain why it went away. You have explained what kept it from becoming a worldwide pandemic. You used Ebola as an example, but Ebola still exists, it did not go away, although it is fairly easy to contain. SARS-CoV does not exist right now.John Francis Donaghy said:Irwin M. Fletcher said:
Just because SARS- CoV isn't as contagious as SARS-CoV2 doesn't explain why it went away. It explains why this one became a pandemic worldwide as opposed to SARS but not the other.
Sure it does. Less contagious = easier to contain. And of you can contain it before it spreads worldwide, you can eradicate it.
It's also generally easier to contain faster acting and more lethal viruses like Ebola. Not a lot of people get infected woth Ebola and manage to jet set around the world for a week while contagious with it. They get it, they get sick, and they either die or recover in pretty much the same place they got it. Not much time to infect others unless they're the ones taking care of the sick. Which brings us back to the conclusion above: easier to contain = easier to eradicate.
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Being in the hemorrhagic fever family of diseases I'm pretty sure Ebola is not asymptomatic. Bleeding from all your orifices is usually a sure sign something is wrong.John Francis Donaghy said:Irwin M. Fletcher said:
Just because SARS- CoV isn't as contagious as SARS-CoV2 doesn't explain why it went away. It explains why this one became a pandemic worldwide as opposed to SARS but not the other.
Sure it does. Less contagious = easier to contain. And of you can contain it before it spreads worldwide, you can eradicate it.
It's also generally easier to contain faster acting and more lethal viruses like Ebola. Not a lot of people get infected woth Ebola and manage to jet set around the world for a week while contagious with it. They get it, they get sick, and they either die or recover in pretty much the same place they got it. Not much time to infect others unless they're the ones taking care of the sick. Which brings us back to the conclusion above: easier to contain = easier to eradicate.
“It ain’t like it used to be.”
-Jimbo Fisher
-Jimbo Fisher
Thank you. That makes some reasonable sense.
MouthBQ98 said:
It apparent wasn't as highly contagious and easily transmissible as this version. They use a bit different infectious mechanism.
There where cases of SARS where one individual infected an entire floor of a hotel. Other cases where gas leaks from sewer pipes were suspected of how SARS was spread. That sounds like a lot more transmissible than CoV2.
Here's a question for the doctors on here. I had severe asthma as a child but haven't had any issues or attacks since I was in probably 5th or 6th grade. I'm 34 now. My parents and siblings are all wanting to get together for Easter (mainly cause they want to see our Kids) but we're hesitant out of concern for our health and theirs. We've been in lockdown with our young family for Almost a month. Am I considered high risk if I had asthma as a child but asymptomatic since? Does asthma stay present in your lungs even with no symptoms?
Thanks in advance!
Thanks in advance!
AggiePeeps06 said:
Here's a question for the doctors on here. I had severe asthma as a child but haven't had any issues or attacks since I was in probably 5th or 6th grade. I'm 34 now. My parents and siblings are all wanting to get together for Easter, but we're hesitant out of concern for our health and theirs. We've been in lockdown with our young family for Almost a month. Am I considered high risk if I had asthma as a child but asymptomatic since? Does asthma stay present in your lungs even with no symptoms?
Thanks in advance!
You probably have sensitive lungs but I would not call you high risk! Now your parents may be so that is something to consider!
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Doc, what have you heard on the seasonality of this bug?
No one really knows the answer, but the virus is known experimentally (in the lab) to thrive at cooler temperatures and lower humidity. Most other coronaviruses typically peak in incidence during the fall/winter cold and flu season and it is likely this virus will behave similarly. However, since this particular disease is new to science, we can't really say anything with certainty.Lester Freamon said:
Doc, what have you heard on the seasonality of this bug?
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doc- you are my go to guy on this, in fact we chatted earlier this week.
what do you think about this?
https://www.wnd.com/2020/04/epidemiologist-coronavirus-exterminated-lockdowns-lifted/
what do you think about this?
https://www.wnd.com/2020/04/epidemiologist-coronavirus-exterminated-lockdowns-lifted/
Today's post!
Sorry just fixed the link! Thank you!
https://www.facebook.com/story.php?story_fbid=2663674250582182&id=1998386763777604N
Sorry just fixed the link! Thank you!
https://www.facebook.com/story.php?story_fbid=2663674250582182&id=1998386763777604N
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Reveille said:
Today's post!
https://m.facebook.com/story.php?
story_fbid=2663674250582182&id=1998386763777604
Your link is broken
I'm not Doc Rev, but I'll tell you this guy is missing the forest for the trees. He is right that this disease will eventually spread throughout the population without a vaccine and we are prolonging the spread by "flattening the curve," but we are doing it so as to not overwhelm the medical capacity of our health care system and allow those who need critical care to have the opportunity to receive it during the entire course of the pandemic.aggiepaintrain said:
doc- you are my go to guy on this, in fact we chatted earlier this week.
what do you think about this?
https://www.wnd.com/2020/04/epidemiologist-coronavirus-exterminated-lockdowns-lifted/
Italy, Spain, and to a lesser extent New York are examples of what happens if you let this disease run rampant and everyone gets it at once. Now imagine how bad those places would have been if once the disease hit they hadn't locked down. That would have led to the millions of deaths nationwide that were projected early on in the course of this virus. As it stands we may hold deaths to the tens of thousands.
Social distancing is working. If people had listened to this guys advice at the beginning, the toll of this disease would have been astronomical and many in the health care community would have died along with the at risk and elderly. Looking at his picture, I'm not sure he would have fared all that well either.
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Is Germany really doing poorly? Their per capita numbers seem better than oursBadace52 said:I'm not Doc Rev, but I'll tell you this guy is missing the forest for the trees. He is right that this disease will eventually spread throughout the population without a vaccine and we are prolonging the spread by "flattening the curve," but we are doing it so as to not overwhelm the medical capacity of our health care system and allow those who need critical care to have the opportunity to receive it during the entire course of the pandemic.aggiepaintrain said:
doc- you are my go to guy on this, in fact we chatted earlier this week.
what do you think about this?
https://www.wnd.com/2020/04/epidemiologist-coronavirus-exterminated-lockdowns-lifted/
Italy, Germany, and to a lesser extent New York are examples of what happens if you let this disease run rampant and everyone gets it at once. Now imagine how bad those places would have been if once the disease hit they hadn't locked down. That would have led to the millions of deaths nationwide that were projected early on in the course of this virus. As it stands we may hold deaths to the tens of thousands.
Social distancing is working. If people had listened to this guys advice at the beginning, the toll of this disease would have been astronomical and many in the health care community would have died along with the at risk and elderly. Looking at his picture, I'm not sure he would have fared all that well either.
Per capita, their confirmed cases are about equal to the US. Their death rate is lower, but there's also reports that there may be differences with what Germany is calling a Covid death compared to other countries. Also, their death rate has been increasing, almost at 2% now. It was much lower a few days ago,
Sorry... I meant Spain. It is late and I'm currently working day 4 of the last 5.
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I kind of think they are cooking the books by doing the reverse of what other countries are accused of doing. I think hey are blaming comorbidities as the cause of death whenever possible to bring their fatality rate down but that's purely a guess on my part. They have an older demographic than Italy but seem to practice better hygiene in general so I would have guessed their numbers would have been worse than ours but better than Italy.
RE: The original SARS of 2003 -
The reason that this disease was essentially wiped out is that the Chinese government aggressively isolated people that had it, and then traced the virus to the original animal that was transmitting it to humans. Bats were thought to be the reservoir, but civets were the ones transmitting it to humans via food markets. They ended up slaughtering 10,000 civets from what they thought was the original infected colony to effectively stop any further transmission. This, of course, in addition to aggressively isolating anyone with symptoms. It is thought that there was much less asymptomatic transmission with the original SARS. SARS also was never actually a pandemic, in that there were only isolated outbreaks in a few provinces in China, as well as Toronto, Hong Kong, and Singapore. They were able to effectively isolate the people who had it until there were basically no active viral particles remaining. If the virus can't transmit to new hosts, it can't survive. Still, they have figured out that bats are actually the reservoir, so there is potential for a re-emergence at any time.
The reason that this disease was essentially wiped out is that the Chinese government aggressively isolated people that had it, and then traced the virus to the original animal that was transmitting it to humans. Bats were thought to be the reservoir, but civets were the ones transmitting it to humans via food markets. They ended up slaughtering 10,000 civets from what they thought was the original infected colony to effectively stop any further transmission. This, of course, in addition to aggressively isolating anyone with symptoms. It is thought that there was much less asymptomatic transmission with the original SARS. SARS also was never actually a pandemic, in that there were only isolated outbreaks in a few provinces in China, as well as Toronto, Hong Kong, and Singapore. They were able to effectively isolate the people who had it until there were basically no active viral particles remaining. If the virus can't transmit to new hosts, it can't survive. Still, they have figured out that bats are actually the reservoir, so there is potential for a re-emergence at any time.
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I also wanted to add to the potential treatments discussion:
I'm an ER doc in Iowa in one of the major hospitals. We are definitely not recommending outpatient treatment of coronavirus at this time, and that is mostly because we don't know the safety or efficacy of the treatments. As you guys have noted, there are several possibilities out there. The chloroquine and hydroxychloroquine are particularly problematic for several reasons. One is that these are very potent immunosuppressive medications, so while it may be a good idea to suppress the crazy inflammatory reaction that COVID causes, it also may present worse outcomes for patients who are already immunosuppressed. These medications are also very toxic. It only takes 1-2 pills for a child to accidentally overdose on them. So while it does seem that these meds may be effective (and hopefully safe) in a certain population, we need to know exactly who population that is, because there are significant risks associated with it.
Beyond that, we worry about medication shortages. We are already seeing shortages in azithromycin, which is one of our main go-to antibiotics for any atypical pneumonia, among other things.
With all of that said - and this may be the most important thing I want to tell you guys - in the ICU, my hospital is using EVERY one of these treatments. Hydroxychloroquine, azithromycin, remdesivir, and tocilizumab or sarilumab, are all being used in our ICU. I think you can rest assured that doctors are, in practice, doing everything we can when it comes to aggressively treating sick patients. No one wants to sit and watch patients die with our hands tied behind our backs. That's just simply not in our nature.
TL;DR - In the mildly symptomatic patient, risk of poorly-studied but known-to-be-potentially-dangerous-treatment outweighs potential but unproven benefit. However, in the very sick patient, the unproven potential benefit outweighs the risk, because the patient can't get too much work from the possible dangers of the treatment.
I'm an ER doc in Iowa in one of the major hospitals. We are definitely not recommending outpatient treatment of coronavirus at this time, and that is mostly because we don't know the safety or efficacy of the treatments. As you guys have noted, there are several possibilities out there. The chloroquine and hydroxychloroquine are particularly problematic for several reasons. One is that these are very potent immunosuppressive medications, so while it may be a good idea to suppress the crazy inflammatory reaction that COVID causes, it also may present worse outcomes for patients who are already immunosuppressed. These medications are also very toxic. It only takes 1-2 pills for a child to accidentally overdose on them. So while it does seem that these meds may be effective (and hopefully safe) in a certain population, we need to know exactly who population that is, because there are significant risks associated with it.
Beyond that, we worry about medication shortages. We are already seeing shortages in azithromycin, which is one of our main go-to antibiotics for any atypical pneumonia, among other things.
With all of that said - and this may be the most important thing I want to tell you guys - in the ICU, my hospital is using EVERY one of these treatments. Hydroxychloroquine, azithromycin, remdesivir, and tocilizumab or sarilumab, are all being used in our ICU. I think you can rest assured that doctors are, in practice, doing everything we can when it comes to aggressively treating sick patients. No one wants to sit and watch patients die with our hands tied behind our backs. That's just simply not in our nature.
TL;DR - In the mildly symptomatic patient, risk of poorly-studied but known-to-be-potentially-dangerous-treatment outweighs potential but unproven benefit. However, in the very sick patient, the unproven potential benefit outweighs the risk, because the patient can't get too much work from the possible dangers of the treatment.
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Thanks for what you do doc. I'm curious to ask...How are those treatments working?AggieMD04 said:
With all of that said - and this may be the most important thing I want to tell you guys - in the ICU, my hospital is using EVERY one of these treatments. Hydroxychloroquine, azithromycin, remdesivir, and tocilizumab or sarilumab, are all being used in our ICU. I think you can rest assured that doctors are, in practice, doing everything we can when it comes to aggressively treating sick patients. No one wants to sit and watch patients die with our hands tied behind our backs. That's just simply not in our nature.
I think it's a bit too soon to tell. Iowa, being a rural state, is kind of late to the COVID party. Our peak/surge is supposed to be around April 26th. We have only had a handful of deaths in the county where my hospital is, and our ICU just hit capacity this week. I only see the patients on the ER side of things, so I'll have to ask our intensivists if they've seen any real progress/improvement with these treatments. Like I said, we are so early into this, that I'm not sure patients have even been on the treatments long enough to know. I'll ask around next week and get back to you. But I guess the up side is that we haven't had many deaths yet.
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I'm in Iowa too and wanted to get your opinion on something. I'm not sure which area you are in but I live in Cedar Falls and my child has her 2 year well check this coming up Tuesday. It was originally scheduled for 3/24 and they called me a week before to reschedule.
I'm a little nervous to take her. Based on your knowledge of what's going on in Iowa, should I consider rescheduling again or is this totally fine to go to? It's a morning appointment.
I'm a little nervous to take her. Based on your knowledge of what's going on in Iowa, should I consider rescheduling again or is this totally fine to go to? It's a morning appointment.
"These medications are also very toxic. It only takes 1-2 pills for a child to accidentally overdose on them. So while it does seem that these meds may be effective (and hopefully safe) in a certain population, we need to know exactly who population that is, because there are significant risks associated with it."
I respect your position as a Dr, but all the research I have seen, which is a whole lot, HCQ for an adult on a 5-10 day dose has almost no side effects for most people at the doses they are referring. And by most people it seems to be safe for over 95% or more of the population. Many patients have been taking HCQ for years upon years. We are only talking 5-10 days here.
Plus who gives medicine to a child? Many medicines are dangerous for children that you have In Your cabinet at home.
Not trying to be disrespectful so please don't take it that way. More curious as someone who does testing for chemicals danger levels to humans to produce SDS's.
It looks like there are only 19 cases in that county at the moment, so it would seem pretty safe to me. My hospital is in Davenport, but one of my friends is an ER doc much closer to where you are. I'm going to reach out to her as a second opinion and get back to you. But my first inclination is to say that it should be fine; if your pediatrician feels comfortable enough to keep the appointment, that says a lot, too. I would just maintain the six foot distance from anyone around and make sure you and your kiddo use hand sanitizer or wash hands before you leave the office and after you get home.
I would also add that, at least in our medical system, people with any COVID-type symptoms are being diverted AWAY from family outpatient settings in order to protect against infection of folks like you guys who just need routine care. They are also going to be extremely careful about sanitizing the rooms between visits. So if all is going properly, that doctor's office setting should be one of the safer places you can go in town.
Edited to add: My colleague agrees with me that it should be one of the safest places you could go. She also adds to just shower and change both your clothes when you get home for good measure.
I would also add that, at least in our medical system, people with any COVID-type symptoms are being diverted AWAY from family outpatient settings in order to protect against infection of folks like you guys who just need routine care. They are also going to be extremely careful about sanitizing the rooms between visits. So if all is going properly, that doctor's office setting should be one of the safer places you can go in town.
Edited to add: My colleague agrees with me that it should be one of the safest places you could go. She also adds to just shower and change both your clothes when you get home for good measure.
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Of course, no one would be intentionally giving this medication to a child. But remember, in my setting, I'm seeing kids who accidentally get into family medications not infrequently.
With regards to potential dangers, while many people can take hydroxychloroquine with no serious danger, there are specific patient populations that could have major problems with it. For example, it is a QT prolonging drug, which basically means that it keeps your heart from resetting between beats as quickly as it usually would. In most people, that probably isn't a problem, but if you are already taking another medication that also prolongs your QT interval (of which there are more than a few), or if you're a person that already has a genetic prolonged QT, the effects are additive. Once someone's QT interval gets too long, the heart freaks out and goes into a deadly dysthymia. This can kill you before you even make it to a hospital. I know this sounds extreme, but it is a real risk to consider. To top it all off, azithromycin, the other drug they are combing with hydroxychloroquine, is ALSO a QT prolonging medication. So I see why there is hesitation here to just prescribe it as a prophylactic, especially to a mildly symptomatic or symptomatic patient who statistically is likely to get better on their own anyway.
Besides that, it is an immunosuppressive drug, and, again, in a patient that already has some form of immunosuppression, this could cause major problems. The worst part of this, is that COVID-19 already reeks havoc on your immune system anyway, so no one is quite sure if adding this to the mix is the best plan.
There are also a multitude of bad side effects. Talk to anyone who has had to take malaria prophylaxis for travel.
Don't get me wrong. I want this stuff to work as much as any other doctor, but there is this whole pesky "First, do not harm" thing that we all have to abide by, and I think we owe it to our patients to make sure what we are doing isn't harmful first. And again, I mean that for asymptomatic or mildly symptomatic patients where proven benefit has not been seen yet.
With regards to potential dangers, while many people can take hydroxychloroquine with no serious danger, there are specific patient populations that could have major problems with it. For example, it is a QT prolonging drug, which basically means that it keeps your heart from resetting between beats as quickly as it usually would. In most people, that probably isn't a problem, but if you are already taking another medication that also prolongs your QT interval (of which there are more than a few), or if you're a person that already has a genetic prolonged QT, the effects are additive. Once someone's QT interval gets too long, the heart freaks out and goes into a deadly dysthymia. This can kill you before you even make it to a hospital. I know this sounds extreme, but it is a real risk to consider. To top it all off, azithromycin, the other drug they are combing with hydroxychloroquine, is ALSO a QT prolonging medication. So I see why there is hesitation here to just prescribe it as a prophylactic, especially to a mildly symptomatic or symptomatic patient who statistically is likely to get better on their own anyway.
Besides that, it is an immunosuppressive drug, and, again, in a patient that already has some form of immunosuppression, this could cause major problems. The worst part of this, is that COVID-19 already reeks havoc on your immune system anyway, so no one is quite sure if adding this to the mix is the best plan.
There are also a multitude of bad side effects. Talk to anyone who has had to take malaria prophylaxis for travel.
Don't get me wrong. I want this stuff to work as much as any other doctor, but there is this whole pesky "First, do not harm" thing that we all have to abide by, and I think we owe it to our patients to make sure what we are doing isn't harmful first. And again, I mean that for asymptomatic or mildly symptomatic patients where proven benefit has not been seen yet.
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I actually just came across this news today, which echoes my point:
https://www.newsweek.com/hydroxychloroquine-coronavirus-france-heart-cardiac-1496810
One of my colleagues at University of Michigan says they have stopped using this drug combination there as well, due to bad outcomes and no clear benefit.
https://www.newsweek.com/hydroxychloroquine-coronavirus-france-heart-cardiac-1496810
One of my colleagues at University of Michigan says they have stopped using this drug combination there as well, due to bad outcomes and no clear benefit.
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Actually rheum gives plaquenil to kids all the time. Not sure how many children are dying but I'm pretty sure they'd have a low threshold for that. Personally, I've never seen rheum even check an EKG before starting this med and I've specifically asked my rheum referral docs about this. We're not talking about an immunosuppresive to the extent that we think of MTX. Essentially, the evidence and use of HCQ should be commiserate to the risk (and cost) at this point.
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