Marcus - I have been just following this thread and haven't commented yet. Very happy to hear this news!

I have to admit I was a little nervous when I saw this thread near the top. Feared the worst. Relieved.

I think it's amazing people are invested in this patient's status. I know I was because a fellow Ag was treating him.

Good job, Doc. Thanks for all you're doing, too. You're living some of the hardest days most wouldn't be able to stomach. Grateful for your dedication.

Keep up the good fight! Continue to give the virus hell!

Marcus Aurelius said:

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

10-14 days now.

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https://patch.com/california/paloalto/coronavirus-testing-california-whats-taking-so-long

It may not be this way in all states. And I don't know where Marcus is located, just using California as an example.

Player To Be Named Later said:

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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.

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While it may not change anything for the patient, it's important to know who has it or who doesn't. A doctor can either say, "a patient that presented as Covid responded to this" or "a patient with Covid responded this way." One can be added to the sample group while the other may not be because it is uncertain. I am no doctor but I think certainty will help us understand how to beat this thing quicker.

If a test isn't likely to help me, I wouldn't be excited to leave my house for a lengthy car ride, put up with people, and get a swab stuck up my nose.... all while feeling like hamnered dog crap.

My wife and I have felt that we are going to have to dodge this thing until testing is standard and protocols are well established. That will probably be late May early June. We are 71.

If you are barely symptomatic, I agree. I was talking about people in the hospital where different treatments are being tested and tracked. For these folks, I think they need to be tested regardless of the results' affect on patient care.

However, if the determine you get immunity after having the virus, it will be important for everyone to know whether they had it or not. It could mean the difference between sheltering in place for a month or being able to go back to a job. That why I think the antibody test is so important.

I've been checking this thread every day for news! Thanks for the update.

Mark Fairchild said:

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My wife and I have felt that we are going to have to dodge this thing until testing is standard and protocols are well established. That will probably be late May early June. We are 71.

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That's exactly the way to be thinking about this!
The longer you can postpone exposure and infection, the better the treatment will be once you do.

chris1515 said:

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Mark Fairchild said:

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My wife and I have felt that we are going to have to dodge this thing until testing is standard and protocols are well established. That will probably be late May early June. We are 71.

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That's exactly the way to be thinking about this!
The longer you can postpone exposure and infection, the better the treatment will be once you do.

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Or you catch it while this epidemic is at its peak and medical resources are scarce.

Player To Be Named Later said:

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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.

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Our turn around time is less than 24 hours now, but we also have in house testing

What part of the country are you? That seems like the exception rather than the norm?

An interesting finding in post-mortem analysis from China is that bacterial superinfection rates are unusually low in those disease (as opposed to most other viral pneumonias) and they are finding occasional cases of secondary pulmonary aspergillosis. An interesting consideration for patients not improving on maximal therapy.

Marcus:

I assume the neutrophilia you observe clinically is just a "symptom" of the dramatically increased IL-6 production... does it track the cytokine storm progression over the course of disease? Are there specific clinical outcomes as a result of the neutrophilia or is it just a useful biomarker?

I'm scientifically curious about the pathogenesis/immunology of the disease.

https://www.sciencedirect.com/science/article/pii/S0924857920301047

IL-6 is markedly elevated in the COVID-19 cytokine storm. It drives numerous inflammatory mediators and I would assume it is causing the neutrophilia. IL-6, CRP and ferritin correlate with disease severity. As I mentioned earlier China autopsy studies show marked splenomegaly with lymphocyte engorgement probably worsening lymphopenia and thrombocytopenia.

Would be curious to get your take on this paper / twitter thread:

Theory is the high ferritin levels are due to the virus hijacking red blood cells, which is the actual mechanism that's wreaking havoc.

Kudos to those participating on this thread; Power is in the information... and you guys are sharing and helping many indirectly here.

Interesting. Yes ferritin could rise if iron was dissociated from Hgb by the virus. But, as you know, ferritin is also an acute phase reactant and may be elevated by the cytokine storm like CRP. I'm not seeing terrible anemia in these pts FWIW.

Have to be really careful with that paper. I agree good for hypothesis development....but that is it

Ranger222 said:

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Have to be really careful with that paper. I agree good for hypothesis development....but that is it

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That paper is 100% in silico molecular modeling. No laboratory science whatsoever. It's a jumping off point for study.

They also make several statements that are false...granted its was submitted to the preprint server over a month ago and our knowledge has since changed. I believe the preprint paper that showed direct binding partners of these proteins by strep tagging, purification and MS/MS ID is a better starting to understand what they might be doing, at least in vitro