Question for the doc.

If mild symptoms develop but not serious enough to warrant going to hospital, is there any benefit or danger to taking Atovaquone-Proguanil? I have a 15 pack from a cancelled west Africa trip.

Reveille - this falls under "do you think this is worth worrying about":

I typically wear contacts about half of the day but in the last 10 days or so have just been wearing my glasses. Had some tightness in the chest a few days ago but 99% sure it was just anxiety. No fever.

Went out on a walk 4 days ago and my eyes just started burning. Could not get them to stop. Everything else felt fine but I almost had to walk with my eyes closed. It passed, but then this morning they were burning a bit when I woke up and then were just on fire while taking the dog out -- I was in tears by the time I made it back inside with the dog. Never had anything like it before.

I've never had allergies, or if I have they have never been significant enough for me to notice. But I read a few reports about some soccer players and they mentioned burning eyes as one of their symptoms.

Is it worth isolating over? As it stands it's just been my girlfriend and I the last week or so... and she has felt fine save for Wednesday night she had unexpected diarrhea (she'll love I'm sharing) that came on hard and quick, and then she was nauseous most of the day yesterday. Originally fever/dry-cough had been what I'd been looking out for, but again did some research and found that diarrhea/nausea now seemed to be a symptom and that typically 48 hours later the respiratory issues start -- so I haven't freaked her out but I'm keeping an eye on her.

Worth doing any kind of isolation, or at this point is there just as good a chance we both have it (or both don't) and there's no sense?

Proposition Joe said:

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Reveille - this falls under "do you think this is worth worrying about":

I typically wear contacts about half of the day but in the last 10 days or so have just been wearing my glasses. Had some tightness in the chest a few days ago but 99% sure it was just anxiety. No fever.

Went out on a walk 4 days ago and my eyes just started burning. Could not get them to stop. Everything else felt fine but I almost had to walk with my eyes closed. It passed, but then this morning they were burning a bit when I woke up and then were just on fire while taking the dog out -- I was in tears by the time I made it back inside with the dog. Never had anything like it before.

I've never had allergies, or if I have they have never been significant enough for me to notice. But I read a few reports about some soccer players and they mentioned burning eyes as one of their symptoms.

Is it worth isolating over? As it stands it's just been my girlfriend and I the last week or so... and she has felt fine save for Wednesday night she had unexpected diarrhea (she'll love I'm sharing) that came on hard and quick, and then she was nauseous most of the day yesterday. Originally fever/dry-cough had been what I'd been looking out for, but again did some research and found that diarrhea/nausea now seemed to be a symptom and that typically 48 hours later the respiratory issues start -- so I haven't freaked her out but I'm keeping an eye on her.

Worth doing any kind of isolation, or at this point is there just as good a chance we both have it (or both don't) and there's no sense?

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Before the rain we just had, oak pollen levels were astronomically high. Given that walking outside seemed to worsen it and that oak is so high that people who usually don't have much issue with it had been showing symptoms, I believe the most likely reason for your eye symptoms is oak/tree pollen.

However, at this point if you can isolate you should. Even without symptoms of any kind, we should all be avoiding any unnecessary actions where we are likely to come in contact with others right now.

Diarrhea is sometimes seen with this virus, possibly up to 20 or more percent of the time, and has been documented as the only presenting symptoms in Covid-19 positive patients. Anyone who has any typical viral symptoms at all (fever, cough, nausea/vomiting, diarrhea, body aches, chills, sore throat, etc.) should be considered a possible Covid-19 case and act accordingly.

Probably a dumb question but can someone explain exactly what "required hospitalization" is in the latest CDC report? The report categorizes age groups by hospitalization, ICU, and mortality. The 20-44 age group has a high "hospitalization" rate 20% (up to 29% without accurate numbers) compared to other age groups and I'm curious what defines requiring hospitalization, i.e.: getting an IV, an overnight/multi-day stay, breathing machine for assisted breathing (would this be ICU), or a combination of all? I don't understand where you swap from being admitted (and what causes this) to requiring ICU care.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

I'm not in the medial field but have stayed at a Holiday Inn before so I will venture that distressed breathing and reduced O2 stats = hospitalization while the need for a vent = ICU.

AW Aggie said:

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Probably a dumb question but can someone explain exactly what "required hospitalization" is in the latest CDC report? The report categorizes age groups by hospitalization, ICU, and mortality. The 20-44 age group has a high "hospitalization" rate 20% (up to 29% without accurate numbers) compared to other age groups and I'm curious what defines requiring hospitalization, i.e.: getting an IV, an overnight/multi-day stay, breathing machine for assisted breathing (would this be ICU), or a combination of all? I don't understand where you swap from being admitted (and what causes this) to requiring ICU care.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

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"Required hospitalization" means they were admitted to the hospital.

This can be done either by a primary care physician who directly admits someone from their clinic or practice, or by an ER physician and hospitalist/specialist who after the patient was seen in the ER both agree the patient will need additional care and cannot be discharged home from the ER.

There are different levels of admission. Patients who will need no more than 24 hours care in general are admitted to "Observation" status, then there are general admissions who are going to require more care but not so much care they will need to be in the intensive care unit (aka ICU).

General admission patients are typically rounded on once or twice a day and their nurses have higher numbers of patients they are responsible for.

ICU patients are monitored more closely by the physicians and their nurses are responsible for fewer patients. Anyone on a ventilator will be in the ICU but there are some non-ventilated patients in ICUs for a variety of different reasons .

Badace52 said:

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AW Aggie said:

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Probably a dumb question but can someone explain exactly what "required hospitalization" is in the latest CDC report? The report categorizes age groups by hospitalization, ICU, and mortality. The 20-44 age group has a high "hospitalization" rate 20% (up to 29% without accurate numbers) compared to other age groups and I'm curious what defines requiring hospitalization, i.e.: getting an IV, an overnight/multi-day stay, breathing machine for assisted breathing (would this be ICU), or a combination of all? I don't understand where you swap from being admitted (and what causes this) to requiring ICU care.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm6912e2_w

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"Required hospitalization" means they were admitted to the hospital.

This can be done either by a primary care physician who directly admits someone from their clinic or practice, or by an ER physician and hospitalist/specialist who after the patient was seen in the ER both agree the patient will need additional care and cannot be discharged home from the ER.

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Thank you Dr. To be more clear on my question though, what is the seperation from requiring additional care to being sent to the ICU. I understand were learning everyday about this but I thought persons under 60 or so were in the category of being able to ride it out without hospitalization but this report seems to contradict that.

Please don't take this as questioning you, I'm genuinely curious and trying to understand why this age group has a low mortality rate but requires more people to be hospitalized.

30 yr old son was very sick about a month ago in Cali...he had business trips to Seattle and San Jose the same week...101+ fever, exhausted, chesty cough, not much congestion, bedridden for 4 days then better...now we know why Teledoc asked if he'd traveled to China...is there any way a month later to confirm he had Covid 19 and is now immune?

OMR

Any chance that dihydroartemisinin/quinine might also have anti-viral activity??

I know this sounds like a bit strange. But I do remember my grandparents utilizing quinine
in its herbal (grass form) as a makeshift flu medication in 2010 for a family member with the flu. I asked them recently and to their recollection was surprisingly effective (Almost mediate reduction of fever permanently within 5 hours). Unfortunately my grandparrents do not remember if it was quinine or dihydroartemisinin (Or both mixed in).

I'm sorry I cannot give more info. My grandparrents are that crossover first/second generation medical staff in China (post 1949) and without much formal education and tools; they had to learn by experience and guesstimating via statistics..

I am sure that we have much more capable brains than me in the medical field so I wondered if you had toyed with the idea.

I will say, having tasted quinine in its grass for it IS BITTER AS ALL HELL

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Thank you Dr. To be more clear on my question though, what is the seperation from requiring additional care to being sent to the ICU. I understand were learning everyday about this but I thought persons under 60 or so were in the category of being able to ride it out without hospitalization but this report seems to contradict that.

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Correct me if I read it wrong, but I read it as saying the age group from 20 - 44 makes up 20% OF hospitalizations, not 20% in that age range are hospitalized. Also, that's a 24 year age range whereas the others are 10-year age ranges. I think the report does confirm the older you are to more at risk you are.

Oldmanriver said:

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30 yr old son was very sick about a month ago in Cali...he had business trips to Seattle and San Jose the same week...101+ fever, exhausted, chesty cough, not much congestion, bedridden for 4 days then better...now we know why Teledoc asked if he'd traveled to China...is there any way a month later to confirm he had Covid 19 and is now immune?

OMR

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Not at this point. Later on there will be lab tests developed to test for titers and previous exposure. It will be one of the ways researchers track how far this actually spread. Unless there is some future medical need to know or taking part in a research study, would likely have to pay for test out of pocket.

Had one of those in December..... holy hell that was awful

What's the story with takeout and/or delivery of food? We're under full shut down. However, still want to try and help some businesses any way we can. Ordering takeout or delivery is a way to do that and have some family fun. If someone is sick making or delivering food can they transfer the virus through food contamination?

Doc(s),

Would it be prudent to get pneumonia shots even under age 65?.

OMR

AggieDawg12 said:

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What's the story with takeout and/or delivery of food? We're under full shut down. However, still want to try and help some businesses any way we can. Ordering takeout or delivery is a way to do that and have some family fun. If someone is sick making or delivering food can they transfer the virus through food contamination?

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I'm not a doctor, and I didn't sleep at a Holiday Inn Express last night, but I did just read this article about this issue.

https://www.seriouseats.com/2020/03/food-safety-and-coronavirus-a-comprehensive-guide.html

Why is Germany having so many fewer deaths than the US even though the total cases are similar? Also the US serious cases seems to not change much yet the new deaths goes up significantly daily. What gives?

https://www.worldometers.info/coronavirus/

Supposedly if a person has a preexisting condition / comorbidity they are not being attributed to covid19. Similar to china's reporting system for what it's worth.

And US cases lagging where they should be based on deaths indicates we're testing less than everyone else.

LongLurking Ag said:

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Just an idea to ponder.

With expected hospital shortages and the hotel industry not doing well, would it not be possible to convert some near to medical centers (which there are usually several) to makeshift hospitals? If so, this is too late for NY but might be possible if we move quickly to prepare for the worst?

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I think princess was doing this with some of their cruise ships, since they won't be going anywhere anytime soon. Hotel might not have emergency power for med equipment if the power went out which wouldn't be good.

cdouglas said:

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Why is Germany having so many fewer deaths than the US even though the total cases are similar? Also the US serious cases seems to not change much yet the new deaths goes up significantly daily. What gives?

https://www.worldometers.info/coronavirus/

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Maybe our population is older? I'm betting Germany had much less Baby Boom in the forties.

Any more info on elderberries? Semi preppers and hypochondriacs like me had been using to boost immune system but now hear they may actually produce the cytokines storm responsible for sudden cardiac arrest in SARS MERS and possibly Covid 19. Thanks Doc for all you're doing on the front lines and also keeping us informed.

Adding to WL

Big Al 1992 said:

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Any more info on elderberries? Semi preppers and hypochondriacs like me had been using to boost immune system but now hear they may actually produce the cytokines storm responsible for sudden cardiac arrest in SARS MERS and possibly Covid 19. Thanks Doc for all you're doing on the front lines and also keeping us informed.

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It's been addressed a few times. No evidence that they are effective at this point. So kind of at use at your risk message.

Sorry not sure how that imoj got there

Doc, I have a question regarding taking vitamins. I started taking them in fairly high doses about 3 weeks ago. Vit D 10,000 -15000 + plus units a day, 1000 % daily Vit C also, 1 selenium and 1 zinc a day. Anyway, I'm having issues w the pollen and my lower back (kidneys I believe) have been really starting to bother me. I increased my water intake and it has helped, but I can still feel some pain. I get some fever w my allergies also (who knows maybe Covid)

Can you give a guideline as to what's a safe but healthy limit on taking some of these vitamins so that I don't cause other bodily harm? Should I be taking a lower quantity?

The article below is an statistical look at the positive folks on the cruise ship. It is a neat data set because I think everyone was tested .
The most interesting tidbit here is the level of asymptotic cases were higher in the middle older age groups. Preexisting immunity to other Coronaviruses or waining immunomonitor production (cytokines)? Thoughts?
Take care!
https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v2.full.pdf

Reveille said:

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AggieDawg12 said:

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What's the story with takeout and/or delivery of food? We're under full shut down. However, still want to try and help some businesses any way we can. Ordering takeout or delivery is a way to do that and have some family fun. If someone is sick making or delivering food can they transfer the virus through food contamination?

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Not sure about this one because if the food is covered it should be ok. But the virus can live on paper and cardboard for some time so probably a small possibly. Someone else may know more about this. I don't think it is a huge risk but I would guess there could be a small possibly of transmission.

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The news last night gave some good tips for getting delivery. They suggest it will minimize your risk of exposure if you do the following:

1) Have the delivery driver leave food outside your door without interaction.
2) Transfer the food to your own dishes
3) Reheat the food just to be safe
4) Throw away any plastic tupperware, bags, or cardboard boxes immediately and wipe down any surfaces they were on.
5) ETA: and wash you hands before eating!

When it comes to take out, they recommended to only go places where they walk the food out to you in your car so you don't have to go inside.

Reveille said:

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AggieDawg12 said:

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What's the story with takeout and/or delivery of food? We're under full shut down. However, still want to try and help some businesses any way we can. Ordering takeout or delivery is a way to do that and have some family fun. If someone is sick making or delivering food can they transfer the virus through food contamination?

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Not sure about this one because if the food is covered it should be ok. But the virus can live on paper and cardboard for some time so probably a small possibly. Someone else may know more about this. I don't think it is a huge risk but I would guess there could be a small possibly of transmission.

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The studies showed 90% reduction in steel/plastic (nonporous surface) in 12 hrs, and 4-8 hours for cardboard (porous). However, the tests were conducted by drying the sample on the surface and then applying a liquid cell culture medium... this would be similar to licking the surface. Obviously licking the surface (or touching with wet hands) would transfer more of the dried sample than a dry touch.

Also, heat kills. Studies on SARS-CoV show 10 fold reduction of virus survival for every 10F. Given the similarities between SARS-CoV2 (the one that causes COVID19), it should be very similar.

If the food preparer is making the food, hot food would be better, allowing the heat to kill the virus.
Social distancing at delivery, and wash hands after opening the food container would be best practice to protect against sick delivery person.