atag said:

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My coworker is on dialysis and we work with the public. Is he at extra risk or does that have no effect? Thanks for your time!!!

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Absolutely someone on dialysis should be considered very high risk. They should stay home and reverse isolation should be done to prevent him from catching it.

Safe at Home said:

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Thank you so for taking the time to do this Dr. Coates. Being able to get authoritative information in times like this is invaluable.

I am wondering if a person can acquire immunity without contracting the disease. Say a person ingests a relatively small number of microbes (maybe a trillion vs a quadrillion?), could his immune system fight it off before he became sick? Is that what has has happened to people who are testing positive but don't show symptoms? Could a society as a whole build up immunity without most people becoming sick?

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Good question! Answer is not completely known but let's remember the Coronavirus has been around for decades causing the common cold. Well kids get colds 4 to 5 times per year. So they believe this mutation of the virus Covid-19 is not affecting kids because they may have some mild immunity built up. Remember this is a hypothesis and not proven. So to answer your question maybe.

I know you are stretched to the max, but I am worried about my granddaughter. She is a fish in the Corps and has a history of asthma. She received a DOD scholarship, so it's not too bad and she hasn't had a problem with it in several years. She couldn't breathe today and was running a fever. She was tested for the flu and it was negative. Her Mom, a practicing RN, is assuming it is Covid-19. She was told she can't be tested for it because she does not meet the criteria of being exposed to a known case or a high enough risk. Any suggestions? My daughter is going to isolate her and treat it like the flu/asthma.

buzzardb267 said:

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I know you are stretched to the max, but I am worried about my granddaughter. She is a fish in the Corps and has a history of asthma. She received a DOD scholarship, so it's not too bad and she hasn't had a problem with it in several years. She couldn't breathe today and was running a fever. She was tested for the flu and it was negative. Her Mom, a practicing RN, is assuming it is Covid-19. She was told she can't be tested for it because she does not meet the criteria of being exposed to a known case or a high enough risk. Any suggestions? My daughter is going to isolate her and treat it like the flu/asthma.

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It sounds like mom is doing the right thing and following the current recommendations regarding potential Covid-19 cases that do not meet criteria for testing. Recommendations have been changing daily regarding whom to test, when to test, and how to test. Hopefully larger scale testing will be available soon but until then you guys are doing the best you can for her. If she seems to be developing any type of respiratory distress get her evaluated at the nearest ER.

buzzardb267 said:

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I know you are stretched to the max, but I am worried about my granddaughter. She is a fish in the Corps and has a history of asthma. She received a DOD scholarship, so it's not too bad and she hasn't had a problem with it in several years. She couldn't breathe today and was running a fever. She was tested for the flu and it was negative. Her Mom, a practicing RN, is assuming it is Covid-19. She was told she can't be tested for it because she does not meet the criteria of being exposed to a known case or a high enough risk. Any suggestions? My daughter is going to isolate her and treat it like the flu/asthma.

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Oh wow did she have a chest X-ray? She needs to be evaluated for pneumonia.
With a historyy of asthma, fever and trouble breathing certainly sounds like pneumonia. But otherwise mom is doing the right thing.

Tests will be much more readily available next week but I think I would consider takint her to an ER to be evaluated for a possible pneumonia.

Old RV Ag said:

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Reveille said:

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atag said:

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My coworker is on dialysis and we work with the public. Is he at extra risk or does that have no effect? Thanks for your time!!!

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Absolutely someone on dialysis should be considered very high risk. They should stay home and reverse isolation should be done to prevent him from catching it.

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I've got a son-in-law early 50's with liver disease (MELD <9) and chronic pancreatitis. Yes, he was a heavy drinker but hasn't had a drop in over 5 years and leads a pretty active normal life. Should he go to the levels of reverse isolation or just understand he's a higher risk? He had an appointment a week ago with his doctor to renew pain meds for the pancreatitis I believe - when I asked him about all this he told me the doctor didn't even bring up the virus and nor mention added precautions. Sound okay? I wasn't there so don't know if that's the case or if he didn't want to relay what the doc said so as not to worry family. Thanks for all you've been doing here.

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This disease effects more cardiopulmonary and kidney patients other than liver. I don't know the exact answer but I would probably error in the sure of caution and just consider him higher risk. Don't think you need reverse isolation but just good hygiene and isocial distancing.

Reveille said:

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Old RV Ag said:

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Reveille said:

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atag said:

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My coworker is on dialysis and we work with the public. Is he at extra risk or does that have no effect? Thanks for your time!!!

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Absolutely someone on dialysis should be considered very high risk. They should stay home and reverse isolation should be done to prevent him from catching it.

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I've got a son-in-law early 50's with liver disease (MELD <9) and chronic pancreatitis. Yes, he was a heavy drinker but hasn't had a drop in over 5 years and leads a pretty active normal life. Should he go to the levels of reverse isolation or just understand he's a higher risk? He had an appointment a week ago with his doctor to renew pain meds for the pancreatitis I believe - when I asked him about all this he told me the doctor didn't even bring up the virus and nor mention added precautions. Sound okay? I wasn't there so don't know if that's the case or if he didn't want to relay what the doc said so as not to worry family. Thanks for all you've been doing here.

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This disease effects more cardiopulmonary and kidney patients other than liver. I don't know the exact answer but I would probably error in the sure of caution and just consider him higher risk. Don't think you need reverse isolation but just good hygiene and isocial distancing.

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Many thanks! He's like a real son to me and works with me. His father died when he was 4 and his mom never remarried. This gives me some relief - he's the type who would not want people to worry so I wasn't sure.

What you're doing here is so incredible. And a big shout out to Badace52 and the other docs on here as well.

Thanks to Reveille and Badace52! You have really set my mind at ease. My granddaughter was pushed to apply to the Air Force Academy by her LTC in high school ROTC. She was bound and determined to go to A&M and carry her granddad's saber some day. She is on her way and I could not be more proud. My daughter is taking the pneumonia advice to heart and watching her closely. Gig 'Em!

Big Al, there's suggestions in the twitter thread you posted that the tweet is unattributable, and as such, unreliable and maybe bogus. Idk, just fyi

Snap E Tom said:

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One more question - I for one am skeptical about the possibility of a vaccine given that SARS uses ADE. https://www.sciencedirect.com/science/article/pii/S0006291X14013321

Am I being paranoid and should just trust those rushing to make a vaccine right now are taking this into account?

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It's going to be awhile before a vaccine is available but definitely just trust it when it comes out. There is significant testing prior to release even in an emergency like this.

Big Al 1992 said:

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Thanks Doc Rev for all your insight and Godspeed with your patients
This was from the front lines in Seattle - sobering stuff. Can you help with some of the acronyms (WBC=white blood cell) and what it means?

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I don't if that is legit or not but worldwide there is an extremely low number if healthy people (no medical problems and a nonsmoker) getting severe disease or dying. But there are going to be some. They will likely be the ones mentioned but also remember well over 99% recover in this category.

La Bamba said:

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Hey guys, quick question - where can you go to get tested or where will the locations be? Has anything official been released on that? Sorry if already answered...

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Very difficult right now as testing is limited.
But there will be plenty of locations as soon as next week. You will be able to drive through and get tested. However, use the soon to be released online screening tool before just wasting a test.

In terms of being ready to treat symptoms at home during a self-quarantine, what OTC meds would be ideal to have on hand:

Cough syrup- dextromethorphan or other active ingredient?

Is expectorant like guaifenesin helpful or not?

fever reducers

Cough drops

Anything else?

OaklandAg06 said:

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Q for the Drs- how is information that has been coming out of Asia around treatments being put to use? I've heard a lot about remdesivir, HIV drugs, and hydroxychloroquine. I know we have a lot of red tape in our medical system and curious how we are putting lessons learned from other countries for treatment to use here.

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The world is sharing lots of information rapidly. We have not had as many critically ill yet but we will all be doing everything we can once we need to.

The amount of information is enormous and coming rapidly. Trust me doctors in the US are working hard to prepare for all possible treatment options when the time comes. I doubt the government will put up too many roadblocks in this time.

Thomas Ford 91 said:

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Quote:

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However, use the soon to be released online screening tool before just wasting a test.

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If you're referring to the online screener that was discussed in the President's news conference, that's been debunked. It is not currently in development.

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It's not been debunked. The media is doing everything they can to make Trump look bad so he will lose the end election. Technically it was not Google but a subsidiary of Google called Verify developing it. But they did say it may take longer than anticipated to get to everyone.

In the meantime the drive thru testing centers will be going up soon.

DTP02 said:

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In terms of being ready to treat symptoms at home during a self-quarantine, what OTC meds would be ideal to have on hand:

Cough syrup- dextromethorphan or other active ingredient?

Is expectorant like guaifenesin helpful or not?

fever reducers

Cough drops

Anything else?

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All of the above are exactly what you need. I have been amazed there has not really a run on these items.

Other things are likely gone but mainly Gatorade or drinks with electrolytes in them.

Food for up to 14 days

If you have no other co-morbid conditions and are currently not feeling short of breath to the point you feel you may need to be hospitalized, right now the answer is to self quarantine for at least 14 days and treat your symptoms with over the counter medicines. Also stay well hydrated with a 50:50 mix of water and electrolyte containing fluid (Gatorade, Powerade, propel, Pedialyte, etc...)

I generally recommend a regimen of Guaifensin DM, acetaminophen for fever, ibuprofen or naproxen for body aches/fever, pseudoephedrine for congestion (less common with Covid-19), and loratadine for seasonal allergy symptoms (which a lot of people are having due to all the tree pollen in the air independent of any viral infection.). Always check with your primary care physician if you take any type of daily medications or have any known medical conditions to make sure the above drugs are o.k. for you.

Soon there will be drive through testing centers you can go to where you stay in your car and they test you. These are not open yet. Once they are you could go there for testing.