AggieAuditor said:

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Blackstreet said:

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What is everyone's vitamin D status when they are sick and admitted? Are they taking vitamin D, quercetin, NAC, Vitamin C, berberine, etc? Do the have other genetic predispositions like factor V Leiden mutation or other hypercoagulable undiagnosed states, etc? Were they treated with zpak, steroids, hydroxychloroquine, or other therapies prior to admission?

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There was a doc on here a few nights ago that laid out a pretty grim next few months. Basically said that nothing we have works. Not vitamins, not HCL, not toci, not steroids, nothing. I'm sure there was some emotion behind his post but it's sad that we're this far into this thing and, generally speaking, our treatments are useless.

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There have been many docs on here that said various treatments work. So, maybe, maybe not.

Developing a new drug to treat a disease takes years, even decades of work. So far, the only things we have really done are trying various drugs we already have to see if they help at all and using some antibodies (convalescent plasma therapy and a couple of monoclonal antibody formulations). That and we put a lot of effort into developing several potential vaccines, which isn't exactly reinventing the wheel but modifying a vaccine platform already in development to work against COVID.

All that to say it really isn't all that surprising that we don't have an effective treatment only 1 year into this virus. But being really close to having a vaccine or 4 is incredible. Probably doesn't fix the next couple of months.

Birmingham AL metro. My experience no different from many pulm/CC doc friends I know across the south.

Here at the VA in San Antonio we are supposed to get our first shipment of vaccine in December. I hope to get it as soon as it's offered. I am finally ready to fight back at this virus. I feel I've dodged a bullet by working for 4 months on a covid floor and working in a hospital period. I've had 5 covid tests all neg and 2 antibody tests negative.

Marcus Aurelius said:

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Healthy. No comorbidities.

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Hope they can pull through, that's horrible.

Ethnicity a factor, blood type still an indicator, viral load? Sucks

Thanks for everything you do. After this is all done, I'll gladly buy you some rounds at the Chicken.

Marcus Aurelius said:

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Fenrir said:

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Who do you want making those decisions?

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Reasonable families. Doctors not empowered to make those decisions in the US. I guess for good reasons. But these are desperate times. This is not the case in other countries. America litigious.

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It may sound cold, but we really should allow medical professionals to make the call not to intubate a 100 year old with dementia and respiratory failure. That's not only cruel for the patient, but wasteful to the healthcare industry and puts other lives that could actually be saved at risk. It's obscene the futile care we are forced to provide and the unnecessary pain and suffering and wasted resources it leads to.

Fenrir said:

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Most families are going to be emotional in such circumstances. Do you think that the government or a panel of professionals at the hospital should be making these decisions? Your line about "Doctors not empowered to make those decisions in the US. I guess for good reasons." seems facetious.

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I think there are cases in which it is so overwhelmingly obvious to the medically literate that a patient is going to die that we should allow those with that knowledge to prevent unnecessary pain and suffering, yes.

What we do to people to try and "save" them at the request of families is often so much worse than death.

bigtruckguy3500 said:

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Marcus Aurelius said:

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Fenrir said:

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Who do you want making those decisions?

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Reasonable families. Doctors not empowered to make those decisions in the US. I guess for good reasons. But these are desperate times. This is not the case in other countries. America litigious.

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Well, when doctors were going to get paid for their time to educate patients on end of life decisions, it was called a death panel. And the topic continues to remain a taboo in this country. For some reason if you aren't doing everything possible to keep that heart beating, you're a bad doctor.

I think if a patient, 100 years old or not, decides he wants to be full code, that's his right. But more often than not, the elderly are ready to go, it is the families that come in and say "you have to do everything, that's what he wanted."

I think everyone needs to watch Extremis on Netflix. Recommend watching it now, before you have a family member or loved on on life support to give perspective that might be too hard to watch at a later time.

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Yep, and it's our job as doctors to start those conversations early. I can't tell you how many times I've seen a patient in the hospital with treatment refractory leukemia on some 8th line experimental salvage therapy with no hope of survival and now with invasive fungal disease, and I'm literally the first doctor to ever tell that patient that they are going to succumb to their illness without qualifier. It is MADDENING how far we as doctors allow terminal illness to advance before we have these conversations.

Fenrir said:

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I don't disagree that the person in question is best served being putting on hospice. That's a pretty extreme case. Where do you draw the line? When does your ability as doctor to be the arbiter end?

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I think it should be reserved for the most obvious cases and should be a rare occurrence. And even if we had that power, it should be a last line of defense. We always want patients/families to come to those realizations themselves if possible.

For example, doctors do have the authority to withdraw care on a patient we can prove is brain dead without family consent. Now that's not the same thing because such a patient is very literally already dead and we're just stopping the illusion of life, but from a patients family perspective it's not that different. This is RARELY invoked however as most people will come to realization that we can't do anything after we explain it to them.

No doctor is ever going to invoke such power on a patient they believe has any chance of meaningful recovery, and in fact doctors going to bat for patients when hospital admin wants to get them out of the hospital or take them off life support is a far more common occurrence than what we're talking about here. If a doctor is telling you that you or your family member is going to die, without any qualifiers, it's because they are extremely certain of that outcome. That isn't something we do lightly or on a regular basis. I understand people want to invoke miracles and the supernatural, and that's fine, but you can't base immediate real world decisions in our physical reality on those notions. If we withdraw care and the patient miraculously survives, that's wonderful. We just know from experience that they probably aren't going to.

Fenrir said:

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I'm pro hospice in general. I've seen 3 grandparents pass in a far less difficult manner thanks to hospice. My wife used to be a hospice nurse and I have seen her go through many "bad weekends". It is unfortunate that some will suffer needlessly. I am just not convinced that it is a call doctors should be expected to or relied upon to make, and I'm not convinced we are to the point of needing to ration healthcare yet.

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It depends on what your goals are. We always talk about healthcare costs in this country and how to reduce them, but the reality is 80% of healthcare dollars are spent on patients in the hospital during the last two weeks of their lives and a LARGE percentage of that care is futile. The problem is that is the one aspect of healthcare spending nobody is willing to talk about because people start screaming about death panels and killing meemaw.

So I guess my point is, there's no point in discussing the 20% we form legislation around if we aren't willing to have tough conversations about the 80% nobody wants to touch. The reason healthcare is so much more expensive here is in part due to the nature of private healthcare insurance in America, but how we administer end of life care is a HUGE part of the equation. Not providing prolonged ICU care to advanced dementia patients alone would do more for healthcare costs in America than any piece of legislation ever passed in Washington or at any state level.

It's concerning to me how much you seem to want control of end of life decisions regarding patients.

I'm glad doctors don't have that level of control.

Like I said, it's a conversation nobody is willing to have. And until we are ready to have it, everyone screaming at politicians to fix the problem is entirely pointless and a waste of everyone's time.

Capitol Ag said:

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bay fan said:

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Capitol Ag said:

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bay fan said:

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B/CS Dreaming said:

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DThanks, Marcus. This stuff sucks.

Aggie95 said:

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That's very strange. Curious on test results. 2 days would be about the quickest covid death I've heard of.

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Yeah...I thought the same. Maybe just a coincidence?

I was talking with a doc friend about it and they weren't surprised. Has anyone else heard of heart issues just a day after showing symptoms?

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Back in April my friend lost her 30 year old nurse daughter very quickly. She was a healthy marathon runner. Got sick and died in the ICU of heart complications associated with COVID. It has framed they way I look at this pandemic. Little respect for those who pretend it's nothing.

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I think we will find that situations like your friend's daughter, who was athletic and part of a demographic that would on the surface appear most safe, had an underlying condition that wasn't known about and diagnosed or the treatment wasn't given in enough time before it was too late. Many younger athletic people could very well figure that they can just push through things when ill and do not seek treatment in time. Again, I understand the emotional side of this, no doubt. It is terrible. But her situation is an outlier for sure and would need to be studied in depth to see why she would die from this when it's so, so very rare for a person in her condition.

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You have a way to brush everything off. Please stop. This young woman was a nurse and well aware of what was happening to her. You need to stop trying to explain away everything. It's offensive.

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Sorry. Not at all trying to offend or brush off anything. She represents an extreme outlier. That is just a fact. The only thing where I could see her being more likely to die would be if she cared for Covid patients and had exposure to way more of the virus than normal given her situation.

Not sure why you're offended. Not trying to start a fight. You're the one who brought the situation to this thread. I found it interesting and was just speculating on the situation. There have been extremely rare situations where healthy people with no known preexisting conditions under 55 have died. Why? It's important we find out no doubt.

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Perhaps you are not aware but you show up on every single thread and make it clear you dismiss this virus. Sometimes you don't need to act as if you know when it's quite clear you just force your opinion without any real situational knowledge. Outlier or no, she was a young valuable life lost. Please don't respond. Let's see if you can be respectful.

What he is saying is, technically, true. A 40 year old with no risk factors whatsoever dying of COVID is a statistical outlier. Where I disagree with him is the obvious intent of his posts, which is to parlay that fact into a conclusion about the pandemic that is unwarranted.

A healthy 40 year old dying of COVID is an outlier, but a healthy 40 year old experiencing varying degrees of ongoing morbidity associated with their infection is not. And that is where, in the younger populations, this really differs from influenza. Influenza does not regularly lead to previously healthy young people being unable to return to baseline levels of function months after their initial infection.

BiochemAg97 said:

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AggieAuditor said:

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Blackstreet said:

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What is everyone's vitamin D status when they are sick and admitted? Are they taking vitamin D, quercetin, NAC, Vitamin C, berberine, etc? Do the have other genetic predispositions like factor V Leiden mutation or other hypercoagulable undiagnosed states, etc? Were they treated with zpak, steroids, hydroxychloroquine, or other therapies prior to admission?

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There was a doc on here a few nights ago that laid out a pretty grim next few months. Basically said that nothing we have works. Not vitamins, not HCL, not toci, not steroids, nothing. I'm sure there was some emotion behind his post but it's sad that we're this far into this thing and, generally speaking, our treatments are useless.

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There have been many docs on here that said various treatments work. So, maybe, maybe not.

Developing a new drug to treat a disease takes years, even decades of work. So far, the only things we have really done are trying various drugs we already have to see if they help at all and using some antibodies (convalescent plasma therapy and a couple of monoclonal antibody formulations). That and we put a lot of effort into developing several potential vaccines, which isn't exactly reinventing the wheel but modifying a vaccine platform already in development to work against COVID.

All that to say it really isn't all that surprising that we don't have an effective treatment only 1 year into this virus. But being really close to having a vaccine or 4 is incredible. Probably doesn't fix the next couple of months.

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And we were told - by some on this very board - that there was NO WAY there could be a vaccine in under 18-24 months.

I see both sides of it,

That being said, on Friday we had a doctor tell my wife that her mother didn't have a stroke but had a frozen shoulder at a hospital in Central Texas.

This was when they though she only had medicare and they wanted her out of the hospital. When they found out she had Tri Care, suddenly they wanted to run a battery of tests and dig on on the cause. She was brought into the ER with a locked up shoulder, flacid left arm and weakness in her left leg.

As much as I want to trust science, I'm skeptical of those who might use it cynically for their own base ends. Or rather I trust the base science, I trust some individual docstors, I don't trust the healthcare system as a whole.

Infection_Ag11 said:

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What he is saying is, technically, true. A 40 year old with no risk factors whatsoever dying of COVID is a statistical outlier. Where I disagree with him is the obvious intent of his posts, which is to parlay that fact into a conclusion about the pandemic that is unwarranted.

A healthy 40 year old dying of COVID is an outlier, but a healthy 40 year old experiencing varying degrees of ongoing morbidity associated with their infection is not. And that is where, in the younger populations, this really differs from influenza. Influenza does not regularly lead to previously healthy young people being unable to return to baseline levels of function months after their initial infection.

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I am not trying to parlay anything. I am tired of the overuse of statistical anomalies by many whether its the media or whoever. It would be essentially the same as using the threat of a plane crash to scare people into not flying. I believe the American people are being essentially lied to in many ways. By both sides at times. I want facts to set policy and to quell panic. Nothing more. This is worse than the flu. No doubt. But we cannot shut down again either, which too much of the country is still trying to or has done. That just causes more harm than good. And we just do not know the extent of severe long term issues. There are some. As there are with the flu. How that coincides with the flu would be interesting to study as well. Most still do not report long term effects, yet there are some, no doubt. Heck, there really are younger, very healthy people who die from complications due to influenza every year too. Just a fact. Not diminishing Covid, statistically for those under 50, the flu really is more dangerous. That is not debatable. It's how we use that data and information that really matters.

None of this is to take away from what the Doc is posting about in the OP and subsequent posts on this thread and that is not my intention. It was Bay Fan who hijacked what I was trying to say and totally misrepresented it. Not sure why. I had no beef with her on any of this. I hope this thread can proceed forward without much more debate as there are plenty of other threads available for that. These are just my opinions.

In the end, what we need is to get to a vaccine soon. It's the only way to quell most of this.