Covid-19 Update Aggie Physician

1,276,253 Views | 3660 Replies | Last: 2 yr ago by tamc91
Not a Bot
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Because of the time to test turn around, all patients coming in with potential symptoms are being placed in droplet isolation as a precaution. This means surgical mask, gown, gloves for staff. If they need to be admitted, the patients can go in regular rooms and we are trying to cohort them, meaning a separate area with minimal staff crossover with other patients. We are also requiring patients to wear a mask whenever staff is in the room to minimize droplet spray if they can tolerate it.

We are using our N95/airborne precautions for patient treatment that causes aerosolization, like BiPAP and nebs. Nebulizer treatment is proving a bit problematic as many people with lung disease need nebulizers. Are trying to use inhalers instead whenever possible. Most hospitals do not have enough negative flow isolation rooms to keep all of these patients on strict airborne precautions. The key will be to minimalize aerosolization procedures.
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Also are isolating them from non patient care staff. Phlebotomists, food delivery, etc are not being allowed in those rooms at all.
MarlinChaser11
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What's your thoughts on asthma meds such as albuterol or symbicort if your showing signs.
dermdoc
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Stay safe brother
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Big Al 1992
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Any thought of the articles going around - legit or not - of the virus living in the throat before entering the lower respiratory system so gargling with salt water may help "wash away or kill virus"
HowdyTXAggie
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Reveille -

I have read this whole thread, however, with the information changing so quickly, please forgive me, if this has already been discussed.

1) Let's say hypothetically, warmer temps do help out and make it harder to spread. If that is the case, I assume we're going to be under a false sense of relief until this winter? Also assuming that the vaccines don't hit before the winter and/or other treatments to assist.

2) Is South Korea successfully fighting covid-19? They've one a lot more testing than we are. Are they premature in re-opening places? Do you think we'll be more like Italy vs South Korea?
gooberhead
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Would it be advisable or not for a 66 yr old to get the fllu shot and pneumonia vaccine at this time?

Thanks for what you're doing, doc!!!
MRB10
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Im generally not a hypochondriac but I've had a tightness in my chest today and have been needing to take extra deep breaths since it started. Early 30s. Good general health.

Worth noting that I had a physical Friday and nurse practitioner didn't comment on lung exam. Flu and TBAP adminiatered(I posted on the thread Saturday about that). Lab results were fine. LDL barely above optimal. White blood count a little low. Creatinine slightly elevated.

Slight cough/congestion that I've attributed to seasonal allergies. Needing to clear throat and the like.

Breathing/tightness has not prevented me from ADL but it's there. Any chance this could also be allergy related? At what point would you become worried and to call someone?

I generally get allergies this time of year but not asthmatic responses.
Reveille
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MarlinChaser11 said:

What's your thoughts on asthma meds such as albuterol or symbicort if your showing signs.


Those medications should be fine as there is not much systematic absorbtion of steroid with inhalers. Albuterol should be fine as it is a beta agonist and not a steroid.

I would recommend taking your asthma medications regularly because you want your lungs as healthy as possible!
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Not a Bot
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Big Al 1992 said:

Any thought of the articles going around - legit or not - of the virus living in the throat before entering the lower respiratory system so gargling with salt water may help "wash away or kill virus"


Others may be better suited to answer this question, but saltwater gargling has been used as a home remedy for a long time for throat infections such as strep. We know that many infectious bacteria, includng strep, have a hard time reproducing in a salty environment. Anecdotally, I've done this myself and it seems to help, along with the course of antibiotics. I don't have a study in front of me saying it works, but a lot of people swear by it for minor throat infections.

In terms of a virus, I'm not sure how this would be helpful. Viruses use your own cells to replicate so the salty environment would likely not affect it unless there is some sort of other salt action I'm not aware of.
hatchback
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You and me both with the chest tightness. I think it's stress related since I don't have a fever. Usually I keep my stress in my shoulders, but since Wednesday/Thursday my chest has been tight. Not noticeable at night or in the morning.
canadianAg
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Curious about our situation. My medication for my HT includes an ace inhibitor (hyzaar and amlodipine). I've seen a few things about this possibly increasing my risk of becoming infected. Any truth to that or still unknown?

Also have a 3 month old with a large VSD with surgery in about a month who I have to assume is high risk just line with almost any respiratory virus?

Not so much a question but my mom mom is 65 and been in and out of the hospital the last two weeks with pneumonia. Seems like she's really had all the symptoms for this (cough, difficulty breathing, sore throat, fever, I think you mentioned liver function being a symptom and that was flagged on blood work). They haven't tested but I wouldn't be terribly surprised if she had it.
MRB10
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It's very odd, that's for sure. I had a big presentation today at work so stress may be a factor. I just took my temp and I'm not currently running fever either.
chief1999
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I've seen where this virus doesn't do well with heat? First off is this accurate? If it is accurate would it make sense to run the heater at public places/ buildings when they are closed, and should this go down as temperatures rise towards summer?
Jet Black
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Probably stress/anxiety related. Would definitely make sense with every thing going on.
MadDog73
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I use Spiriva and Advair for COPD. Any concerns about continuing to use these two inhalers?
74Ag1
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chief1999 said:

I've seen where this virus doesn't do well with heat? First off is this accurate? If it is accurate would it make sense to run the heater at public places/ buildings when they are closed, and should this go down as temperatures rise towards summer?

Makes since. Colds and flu are less in summer
Irwin M. Fletcher
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MadDog73 said:

I use Spiriva and Advair for COPD. Any concerns about continuing to use these two inhalers?
I am not a doc but my guess is you need to stay onany inhaler for COPD. It would be very wise for you to stay in your home as much as you possibly can. You would be at very high risk.
Reveille
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BoilerAg10 said:

Im generally not a hypochondriac but I've had a tightness in my chest today and have been needing to take extra deep breaths since it started. Early 30s. Good general health.

Worth noting that I had a physical Friday and nurse practitioner didn't comment on lung exam. Flu and TBAP adminiatered(I posted on the thread Saturday about that). Lab results were fine. LDL barely above optimal. White blood count a little low. Creatinine slightly elevated.

Slight cough/congestion that I've attributed to seasonal allergies. Needing to clear throat and the like.

Breathing/tightness has not prevented me from ADL but it's there. Any chance this could also be allergy related? At what point would you become worried and to call someone?

I generally get allergies this time of year but not asthmatic responses.


A combination of stress and allergies is the most likely cause. With all of the talk of COVID-19 it is not uncommon to think you may have it.
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OldArmy71
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Your question is dealt with in this thread:

https://texags.com/forums/84/topics/3100014


Short answer is that there is no evidence to stop ACE inhibitors. (I am on one too.)
Reveille
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MadDog73 said:

I use Spiriva and Advair for COPD. Any concerns about continuing to use these two inhalers?
No concerns. Spiriva is a long acting Muscarinic Antagonist (LAMA) while advair is an inhaled steroid not much at all is systemically absorbed. Like the other person I answered you want your lungs to function as well as possible just in case you do get ill you have more reserve available.
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Reveille
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chief1999 said:

I've seen where this virus doesn't do well with heat? First off is this accurate? If it is accurate would it make sense to run the heater at public places/ buildings when they are closed, and should this go down as temperatures rise towards summer?
If you look at my facebook I addressed this last week. We don't know for sure but it is encouraging that it will slow down.
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Reveille
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canadianAg said:

Curious about our situation. My medication for my HT includes an ace inhibitor (hyzaar and amlodipine). I've seen a few things about this possibly increasing my risk of becoming infected. Any truth to that or still unknown?

Also have a 3 month old with a large VSD with surgery in about a month who I have to assume is high risk just line with almost any respiratory virus?

Not so much a question but my mom mom is 65 and been in and out of the hospital the last two weeks with pneumonia. Seems like she's really had all the symptoms for this (cough, difficulty breathing, sore throat, fever, I think you mentioned liver function being a symptom and that was flagged on blood work). They haven't tested but I wouldn't be terribly surprised if she had it.
Your BP meds are fine. Continue with them.

Your 3 month old and mother should both be considered high risk and precautions should be taken with them. I would shower and change clothes when you get home before holding or feeding the infant.
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BwdAg
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Dr Rev and others. Thanks very much.

My mom is 81 and her best friend is 85. The friend is checking on her since she lives alone and has early dementia.

The friend has 2 doctor appointments this week and feels they are necessary to make. I told him to social distance and take hand sanitizer with him. I asked him to immediately wash his cloths and bathe when he got home from his appointment.

I asked them to take time off church but they still attend, and will until the church stops service. The church is still passing the offering plate and does not seem to understand the seriousness to date. This is Waller county, so no real internet church service alternatives.

Should I advise the 85 year old to do anything specific if he has to go to the appointment other than what I told him?

I am worried the less sophisticated church services may not consider timely alternatives and risk the health of their older parishioners. My mom and friend are not listening to me on avoiding the services.

Thanks.


88planoAg
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BwdAg said:

Dr Rev and others. Thanks very much.

My mom is 81 and her best friend is 85. The friend is checking on her since she lives alone and has early dementia.

The friend has 2 doctor appointments this week and feels they are necessary to make. I told him to social distance and take hand sanitizer with him. I asked him to immediately wash his cloths and bathe when he got home from his appointment.

I asked them to take time off church but they still attend, and will until the church stops service. The church is still passing the offering plate and does not seem to understand the seriousness to date. This is Waller county, so no real internet church service alternatives.

Should I advise the 85 year old to do anything specific if he has to go to the appointment other than what I told him?

I am worried the less sophisticated church services may not consider timely alternatives and risk the health of their older parishioners. My mom and friend are not listening to me on avoiding the services.

Thanks.



Can he stay in the car until they call him back into his appointment?
Badace52
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BwdAg said:

Dr Rev and others. Thanks very much.

My mom is 81 and her best friend is 85. The friend is checking on her since she lives alone and has early dementia.

The friend has 2 doctor appointments this week and feels they are necessary to make. I told him to social distance and take hand sanitizer with him. I asked him to immediately wash his cloths and bathe when he got home from his appointment.

I asked them to take time off church but they still attend, and will until the church stops service. The church is still passing the offering plate and does not seem to understand the seriousness to date. This is Waller county, so no real internet church service alternatives.

Should I advise the 85 year old to do anything specific if he has to go to the appointment other than what I told him?

I am worried the less sophisticated church services may not consider timely alternatives and risk the health of their older parishioners. My mom and friend are not listening to me on avoiding the services.

Thanks.





Waiting in the car and having them call or come get him is a good idea.

My parents are only in their sixties. Even as a doctor, it was everything I could do to convince them to stay home and watch service on t.v. last week. They said since they were still having church they were going to go. If there wasn't the option of watching on t.v. they would have gone for sure. Some of these churches are being very irresponsible with their parishioners.
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74Ag1
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Rev
Just found out that anti-malaria medication may be effective in battling this
Use to have to start taking it for a period of time prior to traveling to Africa and after I returned.

Why isn't this being used worldwide to arrest the virus until we have a vaccine?
https://www.google.com/amp/s/kfor.com/health/coronavirus/drug-used-to-originally-fight-malaria-showing-promise-in-treating-coronavirus-oklahoma-medical-research-foundation-says/amp/
Badace52
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74Ag1 said:

Rev
Just found out that anti-malaria medication may be effective in battling this
Use to have to start taking it for a period of time prior to traveling to Africa and after I returned.

Why isn't this being used worldwide to arrest the virus until we have a vaccine?
https://www.google.com/amp/s/kfor.com/health/coronavirus/drug-used-to-originally-fight-malaria-showing-promise-in-treating-coronavirus-oklahoma-medical-research-foundation-says/amp/


This has been discussed earlier in the thread. Chloroquine has pretty terrible side effects and is reserved for those who are very ill.
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74Ag1
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Yep it does have side effects from personal experience
And I haven't read whole thread
Leggo My Elko
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Rev,

Thank you so much for this thread. What do you know about obesity in terms of being a risk factor? I assume it is, but are there any numbers in terms of how much?

Also, it's been a few days since you sorta addressed the estimated total fatalities when this is all over and I understand there so much we don't know yet. But, if you were forced to put $10K on an over/under of 500,000 USA COVID related deaths, which way would you bet?
Not a Bot
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Given the extreme measures we've taken of the last few days, I will go with the under by far.
Badace52
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TexjbA&M said:

Rev,

Thank you so much for this thread. What do you know about obesity in terms of being a risk factor? I assume it is, but are there any numbers in terms of how much?

Also, it's been a few days since you sorta addressed the estimated total fatalities when this is all over and I understand there so much we don't know yet. But, if you were forced to put $10K on an over/under of 500,000 USA COVID related deaths, which way would you bet?


Obesity is likely a minor risk factor, but it does not put you into the high risk category unless you have other conditions stemming from that obesity. In fact, other health conditions caused by or made worse by obesity are usually why obesity is a risk factor in the first place.

I don't have a set number per se, but I have run the numbers based on current best estimates. The current thought is that 40-70% of the population will eventually contract the virus (it is unlikely all of those people will get it during the initial outbreak). With the current U.S. population of 330 million, conservatively we are looking at 120 million infected (40%). When the dust settles, we are probably looking at around a 1% death rate for those infected so that would be 1.2 million deaths in the U.S. alone.

Hopefully social isolation works.
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Reveille
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Most current update

https://www.facebook.com/1998386763777604/posts/2642464439369830/?sfnsn=mo
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aggie67,74&76
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Thanks Reveille for all of the great information.
Indignitas
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I've got 2 questions for any doctors or medical personnel:

1) Do you see any opportunity for lay people with low health and spread risks (e.g. lives alone, recovered COVID-positive) to volunteer and support overloaded hospitals?

2) What is the general opinion of field-expedient workarounds (for resource shortages) like the Italian 3D printed respirator valve? Are you aware of any concerted planning or centralized information along those lines that carries some credibility with medical professionals?
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