As some of you are aware, I'm an infectious diseases physician in the Dallas area. I wanted to provide some clinical information compiled from US patient populations based on discussions with my colleagues around the state and country in ID, EM and pulm crit. Much of this is from the cases in Washington. If you find anything over your head and want further clarification please ask, I know we forget what constitutes professional shop talk sometimes.
This is a very unique virus, it behaves very differently from the more common coronaviruses which cause the common cold and from most respiratory viruses in general. It's actually quite different than influenza in its clinical characteristics. Even compared to the original SARS it's a little unique. Once you see a couple it's actually not too hard to recognize because of this.
Runny nose, congestion and GI symptoms are uncommon (no more than 5-10%) and any of these combined with the absence of or only short lived fever effectively excludes the diagnosis. These people fever consistently for days, often high fevers.
The myalgias are less intense than with influenza.
Everyone has a cough at some point
Kids aren't really becoming ill very often, and symptoms are very rare under age 12 or so. They are possibly serving as asymptomatic carriers however.
Almost all of these patients are lymphopenic (low lymphocyte counts, a type of white blood cell).
Most have mild to moderate liver function test elevations (AST/ALT 3-5x the upper limit of normal)
They all have chest imaging abnormalities and essentially everyone has at least a mild (maybe even sub clinical) viral pneumonia by imaging. The findings are generally bilateral. This is in contrast to influenza which more often results in a post viral bacterial pneumonia, rather than primary viral pneumonia (though both do happen).
We are seeing some young healthy patients do poorly. It's not the norm, but it happens. We will have some 20s-40s die in Texas.
If respiratory failure happens it will occur at day 7-8 almost like clockwork. And it happens FAST, mild hypoxia to full blown ARDS usually in only hours. The critical care guys are saying you can literally watch it happen in front of you some times.
A lot of these patients are dying not of persistently poor oxygenation on a ventilator, but due to cardiac arrhythmias. It's believed to be related to viral myocarditis and many are going into full blown cardiogenic shock. Lots of Vfib/Vtach.
Remdesivir looks promising, it was developed for viral hemorrhagic fevers (think Ebola) but seems to have good activity against many RNA viruses. It's leading to much more rapid improvement of the respiratory failure in our small sample sizes. A few loopholes and exclusion criteria to get through, though.
I'll post more tomorrow, gonna try and get some rest while the pager is silent lol
This is a very unique virus, it behaves very differently from the more common coronaviruses which cause the common cold and from most respiratory viruses in general. It's actually quite different than influenza in its clinical characteristics. Even compared to the original SARS it's a little unique. Once you see a couple it's actually not too hard to recognize because of this.
Runny nose, congestion and GI symptoms are uncommon (no more than 5-10%) and any of these combined with the absence of or only short lived fever effectively excludes the diagnosis. These people fever consistently for days, often high fevers.
The myalgias are less intense than with influenza.
Everyone has a cough at some point
Kids aren't really becoming ill very often, and symptoms are very rare under age 12 or so. They are possibly serving as asymptomatic carriers however.
Almost all of these patients are lymphopenic (low lymphocyte counts, a type of white blood cell).
Most have mild to moderate liver function test elevations (AST/ALT 3-5x the upper limit of normal)
They all have chest imaging abnormalities and essentially everyone has at least a mild (maybe even sub clinical) viral pneumonia by imaging. The findings are generally bilateral. This is in contrast to influenza which more often results in a post viral bacterial pneumonia, rather than primary viral pneumonia (though both do happen).
We are seeing some young healthy patients do poorly. It's not the norm, but it happens. We will have some 20s-40s die in Texas.
If respiratory failure happens it will occur at day 7-8 almost like clockwork. And it happens FAST, mild hypoxia to full blown ARDS usually in only hours. The critical care guys are saying you can literally watch it happen in front of you some times.
A lot of these patients are dying not of persistently poor oxygenation on a ventilator, but due to cardiac arrhythmias. It's believed to be related to viral myocarditis and many are going into full blown cardiogenic shock. Lots of Vfib/Vtach.
Remdesivir looks promising, it was developed for viral hemorrhagic fevers (think Ebola) but seems to have good activity against many RNA viruses. It's leading to much more rapid improvement of the respiratory failure in our small sample sizes. A few loopholes and exclusion criteria to get through, though.
I'll post more tomorrow, gonna try and get some rest while the pager is silent lol
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