KidDoc said:

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Philip J Fry said:

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What makes it attack the lungs? I went to the corner clinic the other day because of a soar throat. I was told it was likely viral, but not to worry about it. Chest has been feeling tight since then. Not difficult to breathe, but have the desire to cough if I take a deep breath.

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That really sounds like COVID assume you have it and be safe.

infectious answered your lung question accurately as usual.

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Should I expect to have a fever? My soar throat has gone away....general fatigue has stayed. But I've never run even a low grade fever.

He remains on 100% NRB mask. Afebrile. LFTs normal now. RR 30s. Sats mid 90s. WBC 13 K. PLTs normal. He is being diuresed to see if that will help. BNP up to 1,600. Eating more. So maybe a hair better? Hardly sleeping however.

Philip J Fry said:

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KidDoc said:

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Philip J Fry said:

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What makes it attack the lungs? I went to the corner clinic the other day because of a soar throat. I was told it was likely viral, but not to worry about it. Chest has been feeling tight since then. Not difficult to breathe, but have the desire to cough if I take a deep breath.

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That really sounds like COVID assume you have it and be safe.

infectious answered your lung question accurately as usual.

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Should I expect to have a fever? My soar throat has gone away....general fatigue has stayed. But I've never run even a low grade fever.

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Impossible to tell. Virologists think many people get mild illness without fever even. So it is nearly impossible to give advise for this situation without testing.

Wanted to get the physicians thoughts on this (we live in Houston)...on Monday, March 9th wife wakes up with an excruciating sore throat and swollen lymph nodes (negative for strep). Monday night turns into severe chills and body ache and then on Dr re-visit Tuesday positive on Flu A rapid test (should have tested both on Monday but our Dr was out of office and there was some miscommunication with RN staff...no biggie). Never had a fever but these symptoms lasted for approx 4 days and the gradually got better. Intermittent cough.

I've read that you guys are seeing some cases where they test positive for Flu A and COVID19. I just found the no fever part odd and of course the timing of when the first community cases started showing up here made me wonder. No one else in our family got it (me or our 8 and 4 year old - I might have felt a little off for a day max) and everyone had the flu shot in the fall (I know that doesn't preclude us from getting the Flu).

Probably over thinking this.

Approximately 10% of COVID-19 co tracks with Flu A. I assume she's not elderly? Virtually impossible from my read/experience to be afebrile with active symptomatic COVID-19 (cough, aches etc.)

We are in our early 40s. I would hate to be elderly with an 8 and 4 year old at home!

Thanks doc!

I got sick in February worse than I have in a while. Aches, high fever, dry cough. Wife got me fajitas from Chuy's one night and I was really excited to eat it. Barely touched it because it didn't have much taste. I wound up going to the doctor on the tail end of it and tested positive for the flu. I had also gotten a flu shot and just assumed that the vaccine hadn't worked. About a week after symptoms I had my annual checkup and my liver enzymes were slightly elevated. Doctor wants me to redo labs in April for another look at the liver enzymes.

At the time, joked that I had the Wuhan but knew that was unlikely and that it was probably the flu. Hearing about the taste and liver enzyme symptoms of Covid-19, I have started to wonder. If my April labs are normal, I may really start to wonder.

He is doing a little better. Exhausted. Little appetite. Afebrile. Labs essentially normal except low albumin. Still lymphopenic. CXR slightly better. O2 sats high 90s now on 100% NRB. I worry about the possibility of post-inflammatory fibrosis with long term decrements in lung function in these patients. Some reports of this coming out of China.

Seems like that would be quite a bit better than two or so days ago, right? High O2, no fever? Or am I just being overly optimistic?

Yes. But I am amazed this man has avoided intubation. Very high respiratory demand day after day.

Nm

Marcus Aurelius said:

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He remains on 100% NRB mask. Afebrile. LFTs normal now. RR 30s. Sats mid 90s. WBC 13 K. PLTs normal. He is being diuresed to see if that will help. BNP up to 1,600. Eating more. So maybe a hair better? Hardly sleeping however.

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I know you're trying to educate people but I suspect your compliance officer would freak out at you posting that level of detail with so few patients it could be in your place of work.

Marcus Aurelius said:

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He is doing a little better. Exhausted. Little appetite. Afebrile. Labs essentially normal except low albumin. Still lymphopenic. CXR slightly better. O2 sats high 90s now on 100% NRB. I worry about the possibility of post-inflammatory fibrosis with long term decrements in lung function in these patients. Some reports of this coming out of China.

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Statistically don't patients who survive more than 10-12 days from the start of symptom onset tend to survive?

Yeah. I get it. No names or location. Far from TX.

Marcus Aurelius said:

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Yeah. I get it. No names or location. Far from TX.

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Docs in your field with an A&M undergrad can be doxed in minutes. Your compliance dept can figure out shortly who you are discussing.

I love the inside experience angle but don't get yourself in privacy trouble. Might even want the mods to delete this thread.

longeryak said:

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Marcus Aurelius said:

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Yeah. I get it. No names or location. Far from TX.

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Docs in your field with an A&M undergrad can be doxed in minutes. Your compliance dept can figure out shortly who you are discussing.

I love the inside experience angle but don't get yourself in privacy trouble. Might even want the mods to delete this thread.

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Nah

For those interested - happy to update my pt is on NC O2 now and moving out of ICU. N/L (neutrophil/lymphocyte) ratio 3 (excellent prognostic predictor). He will recover barring disaster.

what drugs did he get? the HCQ cocktail?

Great to hear for those of us that have been following along with your patient's progress! And good work on your part getting him through it. I know his family must be so grateful!

See earlier posts. HCQ/Zinc. Azithro for several days. (our ID docs anti azithro). Day 4 from symptom onset. So earlier than than some of mine who have arrived at day 7+ and have/are not doing well. Take it for FWIW - purely anecdotal, small N. But my opinion is earlier the better. Trials are ongoing and will tell the truth.

Great news!

Was the N/L tracked while he was in ICU?

any other treatments available?

interferon?

Ranger222 said:

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Was the N/L tracked while he was in ICU?

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His peak - at day 7!!! (Ominous day for COVID-19) was 20!. China data says zero survival if any patient reaches > N/L > 20.

Marcus Aurelius said:

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See earlier posts. HCQ/Zinc. Azithro for several days. (our ID docs anti azithro). Day 4 from symptom onset. So earlier than than some of mine who have arrived at day 7+ and have/are not doing well. Take it for FWIW - purely anecdotal, small N. But my opinion is earlier the better. Trials are ongoing and will tell the truth.

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Did your ID docs recently turn away from Azithromycin? Our guys were still using it as of two days ago

Marcus Aurelius said:

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For those interested - happy to update my pt is on NC O2 now and moving out of ICU. N/L (neutrophil/lymphocyte) ratio 3 (excellent prognostic predictor). He will recover barring disaster

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F() k yeah!

Edited to quote the correct post

Chinese COVID-19 autopsy studies show spleens are markedly enlarged, engorged with lymphocytes. Seems this disease is almost an "HIV" like situation in which CD4 cells are wiped out, making immune response more challenging. Scary.

Kool said:

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Marcus Aurelius said:

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See earlier posts. HCQ/Zinc. Azithro for several days. (our ID docs anti azithro). Day 4 from symptom onset. So earlier than than some of mine who have arrived at day 7+ and have/are not doing well. Take it for FWIW - purely anecdotal, small N. But my opinion is earlier the better. Trials are ongoing and will tell the truth.

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Did your ID docs recently turn away from Azithromycin? Our guys were still using it as of two days ago

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They have. Not sure why other than QT issues.

Posted a thread re this drug FDA trial. I will use it compassionately if I can get it.

How on earth did that guy get into the hospital and have a positive test by day 4?

Just from following things, that seems like a small miracle.

"COVID-19 test returns positive 7 days after swab."

10-14 days now.

Lord. Is it even worth going for a test now? Seems like the testing is purely for the benefit of the stats geeks/bean counters while offering zero benefit to the patient.

Marcus Aurelius said:

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Chinese COVID-19 autopsy studies show spleens are markedly enlarged, engorged with lymphocytes. Seems this disease is almost an "HIV" like situation in which CD4 cells are wiped out, making immune response more challenging. Scary.

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What happens if you don't have a spleen? Asking for a friend

It won't get enlarged.