I already have a dog said:

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Reveille said:

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As for vaccine one has been developed right here in Texas already. It is currently being tested on dogs, but as to when it will be available to the general public who knows. It will have to be proven to be effective and safe in dogs. After that they will start human testing. All of these things take time and it is anyone's guess as to when it will be done. Normally this is a 5+ year process. Trump wants it done within 18 months which sounded extremely optimistic at the time. But now, I suspect everything will be expedited and it could be available in a little of over a year. Maybe even sooner because the usual liberal roadblocks are not being vocal about stopping it right now.

There are also at least 8 other companies working on vaccines that I know of probably way more than that. All of these are racing to get a working vaccine to the world as soon as possible.

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I don't understand this. If the virus is so bad that we have to shut down society I would think there would be a way to fast track this vaccine. 18 months seems like a long time.

Also, if our health care system is so broken that getting a large number of people sick at once will break it then I get it, do what has to be done to flatten the curve. Then, once we get past the crisis fix the damn system so that we are prepared for the next pandemic. As bad as this one is, it could be so much worse, we need to be prepared for a true worst case pandemic.

Just wanted to clarify that I am not directing this at Reveille. I appreciate you taking the time to provide information, just frustrated that the wealthiest, most scientifically capable country in the world seems so ill-prepared to deal with an issue that everyone knew would eventually happen and that could have been much worse.

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The system is just not made to handle everyone needing care at the same time. I don't have the answer but hospitals have to also make money so having half empty hospitals waiting for the next pandemic is not the answer either.

And I am guessing in the vaccine timeframe. With the attention of this virus it would not surprise me for them to jump to human testing very rapidly.

What have learned?

First and foremost we need to stop worrying as much about everyone's freedom and as soon as a new disease appears immediately start restricting travel to that area so it has a hard time getting over here. It should have been contained in Wuhan

Secondly, the government should immediately restrict the amount of supplies an individual can purchase as soon as we believe a problem could occur.

I haven't thought about other issues but there is going to be more we learn from this.

Aggie1 said:

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Pumpkinhead said:

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https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

Quote:

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The Extraordinary Decisions Facing Italian Doctors

There are now simply too many patients for each one of them to receive adequate care.

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Recommend reading this article.

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Having provided healthcare in Italy via US Military Medicine in several locations I can provide a bit of information that might be useful for several reasons.

Italy - like other European countries - provides "socialized medicine" - which is limited to whatever the Italian government chooses to appropriate. As a result the healthcare system in Italy is grossly inadequate to begin with for many reasons - and most frequently limited and restricted based on funds available. During good times it is not uncommon to wait for months to see a provider for "normal" healthcare requirements - albeit rationed based on funds available.

There are far more M.D.'s than there are positions available and thus the Docs that have a position often have a group of other unemployed but interested Docs who have no position but who are trying to stay "available" following on their coattails. For instance, I have visited many Italian hospitals where it looks like care is being given by groups of 12-20 docs but only one is employed.

To follow, basic daily support such as clean linens, food, emptying soiled containers and cleaning for reuse, sitting nearby to call for help is needed as few nurses and often no nurse call is otherwise available.
Multiply this scenario across the entire country and you get an idea of the level of healthcare available during the good times let alone during this pandemic circumstance.

Furthermore, IF a patient is on a government waiting list but able to pay directly for care, he/she can usually be seen same day or soon thereafter by the same docs, in the same facility - after 4 PM in the afternoon and until usually 8PM or so. Those who really have serious health issues and can afford it will travel to the US (or Ireland yes that's what I said) to get their healthcare at places like Texas Medical Center/Methodist/MD Anderson, Johns-Hopkins, Cleveland Clinic, Mayo, etc.

So, you can imagine when a "pandemic" like the ongoing CoronaVirus hits what happens! It ain't pretty - and most of the world including Europe, the UK, the Middle East, Africa, Far East, even Canada, etc - any country under socialized medicine is having the same recurring problem. Not enough facilities, not enough providers, not enough funds - and "panic" is the result.

I am not saying the USA is free of worry - by any means! I'm just saying we are much better prepared than any other nation in the world to address and hopefully contain this situation. With the numbers that some forecasters are talking, even the US will not be able to house everyone - but we will be a lot better off than any other country in the world...

And that's one of the main reasons that "socialized" medicine is folly!! Especially in the USA where we are used to the best.

As a parallel, you know Germany used to laugh at the USA when we had 55 MPH speed limits. They said they would never reduce the quality of their vehicles to just meet the lower limits - and by golly they didn't and their vehicles typically are top of the line today. The US should heed that for our magnificent healthcare system.
Unfortunately Germany has socialized medicine and has the same situation described above in Italy for healthcare.

The US must not under any circumstance fall into that socialized medicine trap...
Or we will all be paying over 50% personal income tax to try to achieve rationed care based on congressional appropriations like the rest of the world And then where would be go to receive better care even for those who have the $$?

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I completely agree! We are much better prepared then people are giving us credit for!

My biggest fear is socialized medicine and having this your of crisis. It's not surprising for those of in healthcare to see the higher fatality rates in countries with socialized medicine.

I am confident that the United States rates will drop significantly as the denominator grows.

God bless you Doc for doing this. My question is about my wife. She is two years cancer free from Non Hodgkins Lymphoma. Went through chemo and immunotherapy at MD Anderson. Is she still in the more at risk category? We are both early 50's age. Thanks again for all your insights and advice.

rcb said:

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God bless you Doc for doing this. My question is about my wife. She is two years cancer free from Non Hodgkins Lymphoma. Went through chemo and immunotherapy at MD Anderson. Is she still in the more at risk category? We are both early 50's age. Thanks again for all your insights and advice.

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No she since she is off all treatment she should be at high risk anymore.

Capitol Ag said:

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I am 46 years old. I take an immunosuppressant called remicade every 10 weeks for my ulcerative colitis. Been in Remission for 12-13 years. Last injection was early February. I'm also in great shape and train extremely hard mostly with barbells and I weigh about 214, low body fat (humble brag). I get that I'm "at risk" and I handle all things I have been doing for years that way. Wash hands, don't share food, avoid hands to face etc.

Given my level of physical fitness, do I still count as "at risk" and what is your advice on how to proceed, if anything? I currently am the head trainer at a local gym as well. So avoiding the gym is not an option b/c of work. Oh and the gains. Gotta make my gains.

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The only correct answer to this is to speak with your GI doctor or PCP to answer your questions on risk, activity limitations, and continuing use of Remicaide. Luckily you received your last dose a few weeks ago so you have at least a month to re-evaluate whether you should continue it or not, and hopefully by then COVID's trajectory will be more clear.

But just my two cents, Remicaide specifically blocks a protein called TNF-alpha (i.e. a TNF-a inhibitor), which is more commonly involved in the immune response to bacterial and fungal infections. Which is why you probably had to get a PPD or Quantiferon Gold to screen for TB prior to initiating therapy (among other blood work to ensure your immune system was competent). Besides being associated with reactivating hep B or C, to my knowledge there is not much evidence that demonstrates that TNF-a inhibitors significantly impair the viral immune response. So in theory, someone in your situation who recently received a dose of a TNF-a inhibitor in the midst of a viral pandemic wouldn't necessarily have to make significant changes other than the usual standard precautions, which they probably should have been practicing beforehand.

Aggie1 said:

---

Pumpkinhead said:

---

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

Quote:

---

The Extraordinary Decisions Facing Italian Doctors

There are now simply too many patients for each one of them to receive adequate care.

---

Recommend reading this article.

---

Having provided healthcare in Italy via US Military Medicine in several locations I can provide a bit of information that might be useful for several reasons.

Italy - like other European countries - provides "socialized medicine" - which is limited to whatever the Italian government chooses to appropriate. As a result the healthcare system in Italy is grossly inadequate to begin with for many reasons - and most frequently limited and restricted based on funds available. During good times it is not uncommon to wait for months to see a provider for "normal" healthcare requirements - albeit rationed based on funds available.

There are far more M.D.'s than there are positions available and thus the Docs that have a position often have a group of other unemployed but interested Docs who have no position but who are trying to stay "available" following on their coattails. For instance, I have visited many Italian hospitals where it looks like care is being given by groups of 12-20 docs but only one is employed.

To follow, basic daily support such as clean linens, food, emptying soiled containers and cleaning for reuse, sitting nearby to call for help is needed as few nurses and often no nurse call is otherwise available.
Multiply this scenario across the entire country and you get an idea of the level of healthcare available during the good times let alone during this pandemic circumstance.

Furthermore, IF a patient is on a government waiting list but able to pay directly for care, he/she can usually be seen same day or soon thereafter by the same docs, in the same facility - after 4 PM in the afternoon and until usually 8PM or so. Those who really have serious health issues and can afford it will travel to the US (or Ireland yes that's what I said) to get their healthcare at places like Texas Medical Center/Methodist/MD Anderson, Johns-Hopkins, Cleveland Clinic, Mayo, etc.

So, you can imagine when a "pandemic" like the ongoing CoronaVirus hits what happens! It ain't pretty - and most of the world including Europe, the UK, the Middle East, Africa, Far East, even Canada, etc - any country under socialized medicine is having the same recurring problem. Not enough facilities, not enough providers, not enough funds - and "panic" is the result.

I am not saying the USA is free of worry - by any means! I'm just saying we are much better prepared than any other nation in the world to address and hopefully contain this situation. With the numbers that some forecasters are talking, even the US will not be able to house everyone - but we will be a lot better off than any other country in the world...

And that's one of the main reasons that "socialized" medicine is folly!! Especially in the USA where we are used to the best.

As a parallel, you know Germany used to laugh at the USA when we had 55 MPH speed limits. They said they would never reduce the quality of their vehicles to just meet the lower limits - and by golly they didn't and their vehicles typically are top of the line today. The US should heed that for our magnificent healthcare system.
Unfortunately Germany has socialized medicine and has the same situation described above in Italy for healthcare.

The US must not under any circumstance fall into that socialized medicine trap...
Or we will all be paying over 50% personal income tax to try to achieve rationed care based on congressional appropriations like the rest of the world And then where would be go to receive better care even for those who have the $$?

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Can't Blue Star this enough. Thank you!

Reveille said:

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DTP02 said:

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harrierdoc said:

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But once it is in the community, given the variable presentation, you've waited too long to keep people separated.

We are a social animal. We will always find ways to get together. I don't think there is any way to really affect this, or any other viral pathogen that is in the community. I think it's better to try to come up with a vaccine, and just let the virus spread through the population until then. Otherwise, we are just trying to put a small band-aid on a huge laceration.

Teens and college kids aren't going to stop hooking up and swapping bodily fluids because they may get a cold. Heck, they do it knowing they can get STD's that can affect them for life.

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The goal isn't to prevent the virus from spreading. That'd be nice, in theory, but isn't realistic. The virus is going to spread and it's almost certainly going to hit just about every community and a huge chunk of the world's population is going to be infected at some point.

The goal is to slow down the spread by taking judicious measures, so that the healthcare system doesn't get overwhelmed to the point that mortality increases due to the inability to treat all the seriously ill patients.

The question is where do the local officials draw the line on what is a judicious measure. To me, they should plan and then act only after it's hit their community. That's the balance between acting too soon, and thus likely accomplishing only prolonging the economic hardship, and acting too late and risking overloading healthcare.

An exception to this philosophy is that preemptive action should be used for high-risk places like nursing homes.

But that's the local government response (which is more important to each of us than the fed government response, although people only talk about the feds). We all need to do our own part by practicing good hygiene in terms of hand washing, coughing, and being aware of what surfaces we touch.

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You are correct that is exactly the goal! The hospital system runs at over 90% capacity! We will not have enough beds and ventilators to save everyone and tough choices.

I agree that the economic impact on lower income jobs will tremendous. Hard choices are being made around the country and more will still have to made!

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Different way of saying it - Roughly speaking, The goal is for 70% of the U.S. population to eventually get infected with this over the next 18 months, not over the next 2 months. They are trying to lower the rate of spread to give the healthcare system more time and not overwhelm the system's capacity causing unnecessary deaths. Eventually, factors like vaccines and gradual immunity built up in the population will also help out and we'll get through this.

Also, to everyone, even if you are not in a high risk category of getting seriously ill or dying from this, everybody has a role to play in not being yet another link in the virus spreading chain. Sure, you may be fine but gave it to somebody who gave it to somebody who gave it to somebody and then that was the person who got really sick or died. If most folks play their own small part in not helping the spread, we'll all get through this fine.

Illuminaggie said:

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Another quick question.

I've seen heart disease as an obvious risk factor. Would surgeries such as valve replacement or pericardiectomy necessarily increase risk in a case of serious illness with this?

Thank you so much for taking your time with this.

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More or less, "heart disease" more commonly refers to the vessels of the heart, or coronary disease, not that it doesn't include other heart related pathologies. But think of an infection like a cardiac stress test, infections place stress on the body and can increase the risk for a subsequent adverse cardiac event, which is why underlying or undiagnosed coronary disease is a big risk factor.

Regarding a prosthetic valve and history of perciardiectomy, my first question would be when you had them done? If they were remote then I wouldn't be too concerned, if you have a still healing sternotomy scar and a pericardial drain still in place then that's a different story. But I'm assuming they weren't recent.

Since you aren't on chronic immunosuppression because of these issues, your risk is similar to anyone else with a competent immune system. Also, viruses aren't your problem, prosthetic valves are more susceptible to a condition called endocarditis (infection involving the innermost layer of the heart), which is commonly bacterial in origin. The heart infection associated with COVID-19, and many other viruses, is myocarditis (infection of the muscular layer of the heart). To my knowledge, the only risk factor for viral myocarditis is immunosuppression.

So assuming you aren't immunocompromised, shooting IV drugs, or undergoing excessive dental procedures without the recommended antibiotic prophylaxis, then I would say you aren't necessarily at more risk because of a remote valve replacement and pericardiectomy. Just my two cents, hope it's useful but regardless the only right answer to your questions is speaking to your cardiologist or cardiac surgeon.

This is a great ******* thread. I love y'all.

whoopinlube04 said:

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Hi Dr. Rev,

I'm a high risk person (immunosuppressed) living in Seattle. I have GPA (wegner's) which for several years was isolated to my sinuses and treated with methotrexate. Late last year they found that it had moved to impact my kidneys and lungs (developed lung nodules and haemoptysis). They ended up pulsing me twice with methylprednisolone and began treatment with rituxan with 2 loading doses in December. I'm also currently on 15mg/day of prednisone (down from 60mg when I first started my treatment).

With all that said, would someone who is immunosuppresed exhibit the same symptoms as someone with a functioning immune system? Thanks for the help!

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I sent you a pm

78669AG said:

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Rev,

I have a trip to bali scheduled for late april. Would you cancel even knowing that in asia the virus is slowing down? I'm actually more worried about my layovers at Iah and LAX than I am of being in bali.

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It's impossible to know at this point what will happen in our country much less others. But in suspect by then the cases will be decreasing as everyone is now taking more precautions which will show down there virus.

My Dad Earl said:

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Were hospitals in Texas testing for the coronavirus last week? I have not traveled or come into contact with anybody who has (that I know of), but I was admitted into the hospital last week in Fort Worth for shortness of breath, low oxygen, and fever. My white blood cell count was astronomically high. They took blood work and tested for everything, including older strands of coronavirus, but wasn't able to pinpoint what I had. They gave me Tamiflu and every antibiotic in the book and something worked because I started feeling better within 2 days. I'm home now, but they still haven't told me what it was.

I know it a silly question to ask, but part of me can't help but wonder, is it possible I had Covid-19?

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Possible yes but not probable. With a low oxygen level and and elevated white blood cell count I doubt you had it. More than likely you had a pneumonia that responded to the antibiotics. Possibly a secondary pneumonia from influenza which can be very severe!

I have one question:

The pollen counts with the tree's and some grass's are really really high right now, should I or any of us be worried if our throat is hurting some and Im getting some fatigue, I also feel a little tightness in the chest... I believe its just allergies but now I have this coronavirus in the back of my mind... I keep checking my Oxygen content and its been 96-97%..

As a physician, this graph must have been written by an administrator. No offense to you personally, but this chart is garbage.

I'm sure you're joking, but in case you're serious.. 50% of COVID19 cases present with no fever.

Illuminaggie said:

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Another quick question.

I've seen heart disease as an obvious risk factor. Would surgeries such as valve replacement or pericardiectomy necessarily increase risk in a case of serious illness with this?

Thank you so much for taking your time with this.

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Yes that would be considered a risk factor. Since this virus has the capability of causing a cardiomyopathy!