Just my experience. Not aware of studies of "controlled vs uncontrolled" HTN and covid. Seems "HTN" diagnosis more prevalent in covid affected in RPCTs etc.
Covid explosion
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Last: 3 yr ago by JJMt
Marcus Aurelius said:https://www.al.com/news/2020/11/covid-vaccine-wont-stop-current-wave-of-alabama-cases-hospitalizations-soar.htmlGumby said:
Also if OP is in Alabama, hospitalizations there are down 33% from the summer peak.
"The number of patients hospitalized statewide with coronavirus has been rising for the last month. In Jefferson County, that number has increased by 76 percent since Oct. 1."
That from UAB today.
Definitely increasing in Alabama but not yet at the level of the summer peak. County level story may be different than the state. Sounds like the 3rd wave is well under way. Hopefully it peaks at or less than the summer wave.
Fitch said:I'm confused - the chart in the link shows today as a new daily record of total hospitalized, having passed through the previous peak count two days ago.Gumby said:
Nationwide, hospitalizations are still below the summer peak. Our ICUs in VA are at their lowest levels since the start of the pandemic. Seems like some regional outbreaks are occurring.
Definitely something to keep an eye on. Regional restrictions may be necessary but in VA we are down over 33% since the summer peak and we've been open the whole time. Lockdown makes no sense here.
https://covidtracking.com/data/charts/us-currently-hospitalized
Agreed on the regional outbreaks.
Hmmm, looks different on mobile. If you look at some of their other hospitalization data only ND and SD are above the summer peak.
I'm ready for Missouri to get over this damn peak. Every other day is a new record.
https://academic.oup.com/eurheartj/article/41/22/2058/5851436Marcus Aurelius said:
Just my experience. Not aware of studies of "controlled vs uncontrolled" HTN and covid. Seems "HTN" diagnosis more prevalent in covid affected in RPCTs etc.
This retrospective observational study was designed to look at the safety of hypertension medications. They stated they were safe. However, they also, concluded that the controlled HTN patients did much better than the uncontrolled HTN patients. Thus they recommended to have patients stay on RAAS inhibitors as it was shown to be possibly be associated with a lower risk of mortality.
Not a randomized controlled placebo trial but some good evidence that controlling blood pressure matters as would be expected. Unfortunately risk factors in studies just list HTN, Diabetes, cholesterol etc. They never specify if controlled or not.
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VKint said:
4 of my patients tested + this afternoon. So far all doing well but one is old and one obese so we will stay in close touch. (Actually all are old but in my practice old is a relative thing)
I would love to give them something that actually prevents hospitalization. Vitamin D evidence is sketchy at best. Sure, advise it but no evidence it actually prevents hospitalization. HCQ is finally no longer a discussion point. So many wasted hours. Zpack early? No evidence. Steroids? RECOVERY trial to my reading showed steroids early were not beneficial, maybe a detriment. They definitely help when Marcus and company are seeing you.
Correction - while typing this got another notification of a +test result. (Now 6 since 1:30 and it is now 4:30)
Anyway, fortunately the majority of these people that have tested + today will be fine and have no significant issues long term.
Vaccine is the real answer to keeping people out of the hospital. For many reasons a huge percentage of the population has given up on any mitigation efforts.
I am now seeing a big increase in Covid-19 cases and up to around 6-8 Covid+ patients per day. Since the start of the pandemic I have probably treated well over 300 COVID patients maybe close to 400 now and kept them all out of the hospital. KNOCK ON WOOD Might be all anecdotal results but I throw the book at them. First start with Zinc, Quercetin or Green Tea to act as a zinc ionophore. To hopefully inhibit replicase and slow viral replication.
Next I do use Vitamin D up to 50,000IU at the time of diagnosis. In a recent hospital trial they gave 22,000IU on admission then 11,000IU on day 3 and day 6 then weekly. In that trial there was 50 in treatment group and only 1 went to the ICU in nontreatment group there was 26 and 13 went to ICU and 2 died. Since vitamin D toxicity is very very rare I have everyone take high dose Vit D. In addition another retrospective study of over 190,000 patients of Vit D showed over a 50% reduction in contracting the SARS-COV2 virus.
Next I use famotidine 20mg (pepcid AC) BID. In a retrospective analysis posted on medRxiv of roughly I1,300 hospitalized COVID-19 patients, they found that individuals taking proton-pump inhibitors had a two- to three-fold higher risk of death compared with hospitalized patients not taking those drugs. Another study published in late August in the American Journal of Gastroenterology by doctors in the US that also found people taking a proton-pump inhibitor twice a day for acid reflux had higher odds of testing positive for SARS-CoV-2 compared with individuals taking that type of drug once a day or individuals who took a histamine-2 receptor blocker such as Pepcid AC. Another retrospective analysis published online in Gastroenterology in May found that in a cohort of 1,620 hospitalized patients, proton-pump inhibitors had no relationship to the patients' outcomes. Meanwhile, famotidine, which blocks the histamine-2 receptor on cells, correlated with a reduced risk of patients being intubated or dying from COVID-19.
Next I have them take melatonin at night. Analysis of patient data from Cleveland Clinic's COVID-19 registry also revealed that melatonin usage was associated with a nearly 30 percent reduced likelihood of testing positive for SARS-CoV-2. Notably, the reduced likelihood of testing positive for the virus increased from 30 to 52 percent for African Americans.
https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000970
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405774/
Next I use a baby aspirin as long as they have no contraindication. A recent retrospective paper found that people taking aspirin were 44 percent less likely to be put on a ventilator and 43 percent less likely to be admitted to the intensive care unit (ICU). The researchers also reported that those who took aspirin had a 47 percent decrease in risk of dying from COVID-19 when compared with those studied who were not taking a daily dose of aspirin. "Our analysis suggests that aspirin use may have beneficial effects in patients with COVID-19," the study authors wrote in their study.
https://journals.lww.com/anesthesia-analgesia/Abstract/9000/Aspirin_Use_is_Associated_with_Decreased.95423.aspx\
Next I have them take either NAC 600mg BID or Coenzyme Q 10 200mg per day to decrease the oxidative stress in their blood vessels. I personally think NAC is likely better as it also has some anticoagulant and platelet-inhibiting properties. Usually CoQ10 is easier to find but NAC readily available on amazon prime.
Finally, I use steroids in patients with risk factors. I use oral prednisone or inhaled budesonide. I have them all get a pulse ox meter and watch for readings <92%. If that occurs I for sure add inhaled budesonide and albuterol. If <90% I tell them they will have to go to the hospital.
https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/#:~:text=Other%20Clinical%20Studies%20of%20Corticosteroid%20Use%20in%20COVID%2D19&text=Several%20studies%20demonstrated%20the%20clinical,transfers%2C%20and%20shorter%20hospital%20stays.
I agree we don't have proven treatments yet but outside of steroids and aspirin these things have very little risk and all have some potential benefits. I inform the patient that they are not FDA approved or proven treatments but I have seen good results with them. Also lots of data on secondary bacterial infections with Covid-19. So watch for this and I consider doxycycline use if patients look bad or call back and are not doing good. Hopefully this helps some.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Marcus Aurelius said:No. Sorry misread your question. We've had 3 spikes of it here. March. July. Nov. Nov seems to be the worst.Aggie95 said:
are you saying someone had covid 3 times?
I have not seen a repeat infection pt so far.
I have seen 3 legitimate reinfections, all requiring hospitalizations. When I say legitimate, I mean confirmed with testing initially, resolution of symptoms in between followed by a reoccurrence of symptoms and positive test months later. Two of them actually had a more severe course on re-occurrence where they did not require hospitalization during the initial infection.
Also saw my first COVID/Influenza A co-infection of the season yesterday...along with a severely infected toe due to a diabetic foot ulcer. Poor guy.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
It would seem like a wake up call to take general health more seriously. I've seen the idea of it being more of a syndemic than a pandemic being thrown around. I've no evidence either way but it makes a bit of sense to me. Obesity was a problem before this thing showed up and it seems to prey on it and the underlying effects of it. A bit off target(is it?) maybe butour processed food industry is one of the most dangerous things we have going and it seems to just skate right along. Anyway, there is way more complexity here than just this virus showing up is what I'm getting at I guess.
So why is your area being hit multiple times, with multiple rounds of spikes and places like Collin County here in TX where I live hasn't had 1 spike? Serious question. What are your thoughts on that Doctor? Is it population density? Average education level of population? Income level? Population demo (Collin with younger residents as an example)? Is there an underlying reason some populations see major spikes multiple times while other haven't seen one yet if ever (God willing of course)?Marcus Aurelius said:
Yeah. 3. March. July. Now.
Gotcha. Yeah, that's strange it would be different across platforms.
Collin county is mostly suburban with white collar jobs where a large majority can work from home and socially distance.
Honestly, as a personal trainer, it's boils down to our decisions we make. In terms of what we decide to eat, choosing not to train at all (walking a great start but NOT the end game-you don't have to train for a marathon or a powerlifting contest or be a tri athlete or body builder but you MUST add intensity and have a training program that is measurable and is designed to help you reach your ultimate goal and they are cheap and readily available as is online coaching and even very good resources on plate forms such as youtube). It's amazed me that more people who are obese haven't tried hard to get control of their health since March. I get it. It's not easy and we all have an attitude of "it won't get me, it'll get someone else, I'm fine" but seriously, if we focused a lot harder on getting ourselves into better shape and eating either a little bit less or eating more of the good stuff we need, a lot of this issue with the virus would be significantly eliminated.merc said:
It would seem like a wake up call to take general health more seriously. I've seen the idea of it being more of a syndemic than a pandemic being thrown around. I've no evidence either way but it makes a bit of sense to me. Obesity was a problem before this thing showed up and it seems to prey on it and the underlying effects of it. A bit off target(is it?) maybe butour processed food industry is one of the most dangerous things we have going and it seems to just skate right along. Anyway, there is way more complexity here than just this virus showing up is what I'm getting at I guess.
P.U.T.U said:
Collin county is mostly suburban with white collar jobs where a large majority can work from home and socially distance.
True, however Collin Co has had less restrictions than Dallas, the resteraunts, bars, and gyms seem to be operating relatively normal and have been for quite some time.
This. And we gather quite often. As in our neighborhood, birthday parties for the kids, inside and out, and never with masks. Not just me. Most that I know in the area. You'd think there would be a few mini spikes and yet, no. Most gyms don't require masks and few wear them. Movie theaters and restaurants may require entry but you can take them off once sitting. Soccer is maskless as are most kids sports I have seen. So are there other factors at play. Given the demographics of the area, are people in Collin County just more "healthy" overall, better able to afford better nutrition and counter measures like zinc or Vit D rich food and vitamins? There are a good mix racially too. Whites, AA, Hispanics and Asians/Indian. It could very well boil down to income, no doubt, but honestly, I do not feel our income level (not that high at all mind you) has afforded us a way to avoid the virus. Maybe my health insurance is better, don't know. But that would only take effect once I got the virus. I do think that a lot of stories we hear of those who are healthy passing away are people who just didn't get the proper treatment early enough. It's understandable that a healthy younger person might think they can just fight this off and not seek help. But those cases are rear and are situations of already being positive. But its the lack of positive cases or at least lack of reported cases in Collin and other communities around the country vs other places and is intriguing to me personally. Maybe we are just overall younger and healthier and just get it and fight through it or don't even know we have it. Honestly, I had a sinus/head cold last week. Biggest issue was drainage and a stopped up nose. No sore throat. Energy levels high or normal and even my lifts at the gym were great (biggest sign that I am ill is fatigue while training and a performance drop). Probably wasn't Covid but I never went to get tested. Maybe many around me don't either?DFWTLR said:P.U.T.U said:
Collin county is mostly suburban with white collar jobs where a large majority can work from home and socially distance.
True, however Collin Co has had less restrictions than Dallas, the resteraunts, bars, and gyms seem to be operating relatively normal and have been for quite some time.
I recall seeing studies saying our care of hospitalized patients has improved, but that means people staying in the hospital rather than dying and could and will exacerbate in capacity shortages.culdeus said:This narrative seems a little stretched. Seems like younger people are getting it making it appear the death rate is falling on a broad level. It's hard to gather if let's say 65+ rate of hospital/death is better. Certainly it looked that way for awhile, but what could also be true is that it wasn't enough of an improvement to avoid over-run of hospitals which is by and large what is happening in the mid-size regional hospital districts in Texas.Capitol Ag said:We don't know that they are having to make a live/die call at this point. It sounds like overall, the treatment currently given has reduced the likelihood of death significantly. Obviously, this is very regional and local the way things pop up. One area can be exploding and a close area near there can have no issues at all. Hopefully a vaccine is introduced soon enough to help those most at risk.culdeus said:
It's crazy how the attitudes for this changed so quickly.
Went from people sort of caring, to people literally not giving a single crap.
I don't have any idea what a world looks like with full hospitals and this bearing down, I would hate to think we are denying care and I would hate to think a Dr. has to make a live/die call. What a mess.
Good luck Doc. We are all thinking and praying for you and your staff.
This. This was what I was referring to. Not trying to start a "narrative" as was suggested in the prior reply, just stating what even doctors on this board and reports have stated. We are better at treating this and fewer are dying b/c of it.BiochemAg97 said:I recall seeing studies saying our care of hospitalized patients has improved, but that means people staying in the hospital rather than dying and could and will exacerbate in capacity shortages.culdeus said:This narrative seems a little stretched. Seems like younger people are getting it making it appear the death rate is falling on a broad level. It's hard to gather if let's say 65+ rate of hospital/death is better. Certainly it looked that way for awhile, but what could also be true is that it wasn't enough of an improvement to avoid over-run of hospitals which is by and large what is happening in the mid-size regional hospital districts in Texas.Capitol Ag said:We don't know that they are having to make a live/die call at this point. It sounds like overall, the treatment currently given has reduced the likelihood of death significantly. Obviously, this is very regional and local the way things pop up. One area can be exploding and a close area near there can have no issues at all. Hopefully a vaccine is introduced soon enough to help those most at risk.culdeus said:
It's crazy how the attitudes for this changed so quickly.
Went from people sort of caring, to people literally not giving a single crap.
I don't have any idea what a world looks like with full hospitals and this bearing down, I would hate to think we are denying care and I would hate to think a Dr. has to make a live/die call. What a mess.
Good luck Doc. We are all thinking and praying for you and your staff.
https://www.nature.com/articles/d41586-020-03132-4VKint said:
4 of my patients tested + this afternoon. So far all doing well but one is old and one obese so we will stay in close touch. (Actually all are old but in my practice old is a relative thing)
I would love to give them something that actually prevents hospitalization. Vitamin D evidence is sketchy at best. Sure, advise it but no evidence it actually prevents hospitalization. HCQ is finally no longer a discussion point. So many wasted hours. Zpack early? No evidence. Steroids? RECOVERY trial to my reading showed steroids early were not beneficial, maybe a detriment. They definitely help when Marcus and company are seeing you.
Correction - while typing this got another notification of a +test result. (Now 6 since 1:30 and it is now 4:30)
Anyway, fortunately the majority of these people that have tested + today will be fine and have no significant issues long term.
Vaccine is the real answer to keeping people out of the hospital. For many reasons a huge percentage of the population has given up on any mitigation efforts.
This article talks about the evidence regarding when to use steroids.
Thanks for posting this. My wife and i have been taking everything you suggested since it was first posted and have been COVID free. We are currently taking 5,000 IU of Vitamin D. Should we increase that level as a normal daily dose?
Dr. Rev, are you no longer prescribing Hydroxy? Thanks.
No that is fine. Just take some extra at the time of diagnosis. Get your level checked next blood draw and shoot for a level over 55.Gumby said:
Thanks for posting this. My wife and i have been taking everything you suggested since it was first posted and have been COVID free. We are currently taking 5,000 IU of Vitamin D. Should we increase that level as a normal daily dose?
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I still write it some but not as much as previously.OldArmy71 said:
Dr. Rev, are you no longer prescribing Hydroxy? Thanks.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Thank you, sir.
We're seeing it here in rural North Texas in a big way. It's just been scattered cases until November. We've shut down schools and have a steady trickly of hospitalized COVID patients. The scariest thing for us is the difficulty to transfer. We can handle basic stuff, but we don't have an ICU or respiratory therapists. So anyone that gets sicker should be somewhere else. All the regional centers are refusing COVID patients. Some idiot in Austin decided that having >15% COVID on a hospital census means they have to shut down elective procedures. So all the big hospitals are holding that line to keep revenue coming in. I can't blame them, but that leaves small rural hospitals and patients in the lurch when someone really needs an ICU
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That's a pretty stupid policy decision.ramblin_ag02 said:
We're seeing it here in rural North Texas in a big way. It's just been scattered cases until November. We've shut down schools and have a steady trickly of hospitalized COVID patients. The scariest thing for us is the difficulty to transfer. We can handle basic stuff, but we don't have an ICU or respiratory therapists. So anyone that gets sicker should be somewhere else. All the regional centers are refusing COVID patients. Some idiot in Austin decided that having >15% COVID on a hospital census means they have to shut down elective procedures. So all the big hospitals are holding that line to keep revenue coming in. I can't blame them, but that leaves small rural hospitals and patients in the lurch when someone really needs an ICU
My daily capacity to see these patients has been saturated for over a week now.
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Aggie95 said:
so even controlled HTN (with medication) is still a significant risk factor for hospitalization/sever infection?
Controlled HTN, generally speaking, is preceded by a long period of uncontrolled HTN. The average patient with HTN goes something like 7 years before it is formally diagnosed by a physician. In many cases there has already been some underlying end organ damage.
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Yes. We are trying to change the hospital covid protocol. Now it is "mandatory pulm consult" for every one. We can't do it. Just too many. You do what you can. I am on this weekend. Dreading it.
Ugh. Hate to hear this. Bad decision for their education. Do you think it would do much to lesson the numbers?ramblin_ag02 said:
We're seeing it here in rural North Texas in a big way. It's just been scattered cases until November. We've shut down schools and have a steady trickly of hospitalized COVID patients. The scariest thing for us is the difficulty to transfer. We can handle basic stuff, but we don't have an ICU or respiratory therapists. So anyone that gets sicker should be somewhere else. All the regional centers are refusing COVID patients. Some idiot in Austin decided that having >15% COVID on a hospital census means they have to shut down elective procedures. So all the big hospitals are holding that line to keep revenue coming in. I can't blame them, but that leaves small rural hospitals and patients in the lurch when someone really needs an ICU
No clue. Whole grades were under quarantine, so at some point it just didn't make sense to have school open. And this is super Red, Trump-loving rural Texas
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After looking more at the state by state data, it looks like the Midwest states + MT, ND, SD, OK, AR are the ones that are currently experiencing record hospitalizations. East Coast, West Coast, and South are well below the peak hospitalization levels.Fitch said:
Gotcha. Yeah, that's strange it would be different across platforms.
Nationwide we are now at peak hospitalization due to the increase in the Midwest, however many other states appear to be in good shape relative to earlier hospitalization levels. I found the below chart to be really helpful - if you hover over each state you can see the history of hospitalizations. Look at the data per million instead of absolute. NJ / NY got up to 1,000 hospitalizations per Million and the highest state is currently SD at 614 per Million.
https://covidtracking.com/data/charts/currently-hospitalized-by-state
Were the schools driving the spread of COVID or was there some other source? Halloween?ramblin_ag02 said:
No clue. Whole grades were under quarantine, so at some point it just didn't make sense to have school open. And this is super Red, Trump-loving rural Texas
Half the teaching staff tested positive along with a couple dozen kids. So there was really no way to minimize exposures at school. I don't know what got the whole thing rolling
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ID neighbor of mine is getting ground down. Numbers are horrifying. Is your hospital requiring ID for all COVID cases or getting called for a lot more VAP in addition to usual nosocomial infections?
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VKint said:
ID neighbor of mine is getting ground down. Numbers are horrifying. Is your hospital requiring ID for all COVID cases or getting called for a lot more VAP in addition to usual nosocomial infections?
Usually just the ones requiring more than 4 L of oxygen, but we get a ton of occupational health/infection prevention type calls as well
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What is your COVID census at Parkland? Curious. We're at 40. UAB at 80-90.
I miss Parkland BTW. Was hell training there but fond memories.
I miss Parkland BTW. Was hell training there but fond memories.
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