Coronavirus: What questions do you have?

[cwbullet]

I'll be honest, I think these are "micro-measures," the political pressure to open the economy in light of the November election season will be the death knell of 10's of thousands, maybe 100's of thousands late Summer and this Fall.

Not so sure. The number of infections and deaths will not be reduced unless we stay at home till the vaccine is produced and used. We have flattened the curve but it will keep cycling until the vaccine. My concern is that we let off the brakes too soon. It is just a gut feeling with no evidence behind it.

 

[Speaknoevil]

Not so sure. The number of infections and deaths will not be reduced unless we stay at home till the vaccine is produced and used. We have flattened the curve but it will keep cycling until the vaccine. My concern is that we let off the brakes too soon. It is just a gut feeling with no evidence behind it.

I think we are in agreement here.

 

[Rob702Martinez]

I'm late to the party and not going to read 48 pages.
What's the deal with the antibody testing?
Can you get it again if the test shows you had it? Can you be a carrier? Any other info? How does the test know you had it?

 

[cwbullet]

I'm late to the party and not going to read 48 pages.
What's the deal with the antibody testing?
Can you get it again if the test shows you had it? Can you be a carrier? Any other info? How does the test know you had it?

Antibodies are small proteins that bind to viruses and microbes to inactivate and signal to the body to destroy invaders. They is an oversimplification but you get the point.

Antibody testing is on the near horizon. It is available and has suspect sensitivity and specificity. We to produce a lot of it and start using it. Once we have it dispersed, we have to determine how and when to use it as a scientific and medical community. We do not know how long the antibodies take to form, how long they last, and how much protection they provide. Once they are widely available and we have enough results, the answers will come.

We started testing this week. I will know more in the next couple of weeks.

 

[tim cubbedge]

Chuck (or anyone who knows), I have gotten emails from both Labcorp & Quest stating they are now offering COVID-19 antibody testing. Based on your previous reply, I assume these test results should be taken with a grain of sea salt?

 

[cwbullet]

Chuck (or anyone who knows), I have gotten emails from both Labcorp & Quest stating they are now offering COVID-19 antibody testing. Based on your previous reply, I assume these test results should be taken with a grain of sea salt?

Before I answer your question, I want to give a bottom line answer on antibody testing. It will not nor will it ever be used to diagnose COVID. That is not its purpose.

To answer your question: Yes - To be determined. I got the same emails. The problem is that the statement “they are available” does not fully indicate the degree of availability. You need more than the test. You need the test, reagents, and equipment. Not all of the items are fully available to all and test are limits.

If you had COVID-19 or thought you might have, it would be nice to know if your immune system produced infection-fighting antibodies against SARS-CoV-2. It would relieve a bunch of stress if we knew we were immune. The problem is that antibody testing may or may not do this.

Many large clinical laboratories are fighting to be the first to deliver a usable test. What “usable” means depends on the test and how we use it. Antibody testing will be used and it will have value but the degree of value is they to be know. Like hydroxycholoroquine, this is next new focus of what we need. Scientists caution that antibody testing may provide consumers false hope; that the value of testing, at least right now, is quite limited. It is not the panacea the news want you to believe it is.

 

[NateB]

We have an office, an allergist / immunologist, offering an FDA approved Covid antibody test for anyone with a referral for $50. I don't know exactly which test he has, but it is rapid and I think just uses a capillary sample like a blood sugar test.

The office didn't state an error rate up front, but did say it is only effective if the exposure has been in the past 6-8 weeks. I'm curious if I have been exposed, but I'll pass until any tests are more valid and my employer foots the bill.

 

[cwbullet]

We have an office, an allergist / immunologist, offering an FDA approved Covid antibody test for anyone with a referral for $50. I don't know exactly which test he has, but it is rapid and I think just uses a capillary sample like a blood sugar test.

The office didn't state an error rate up front, but did say it is only effective if the exposure has been in the past 6-8 weeks. I'm curious if I have been exposed, but I'll pass until any tests are more valid and my employer foots the bill.

We, too, are doing them. The value is yet to be determined. We use it currently for research purposes right now.

I would not pay for it. I was tested and I am negative for ABs.

We tested a small group that identified as bring exposed but never developed symptoms. I would have guessed they would have been positive, but they were not.

 

[Flyfalcons]

filler

Here's one for Chuck. It seems that hospitals have had good success keeping patient oxygen levels up by placing them on their sides or prone position. If one if battling this disease at home, would that be the best position for them to rest in?

 

[Peartree]

Chuck,
We know that the virus can live on solid surfaces for several days. Less when it's dry, and less when exposed to UV radiation, but more when it's damp and dark. With regular stories about widespread infections among the employees of meatpacking plants, to the extent that a great many USDA meat inspectors have become ill (with three dead), what are the odds that someone could pick up the virus from packaged meat? Particularly, as has happened recently, several hundred of the employees in a single plant tested positive for the virus? Our family has a freezer full of deer meat so we don't buy a lot of meat in the store, but this is the kind of thing that makes me wonder if we might consider buying even less.

 

[cwbullet]

Here's one for Chuck. It seems that hospitals have had good success keeping patient oxygen levels up by placing them on their sides or prone position. If one if battling this disease at home, would that be the best position for them to rest in?

I have no research to back it up, but it does lower the stress on your lungs.

 

[cwbullet]

Chuck,
We know that the virus can live on solid surfaces for several days. Less when it's dry, and less when exposed to UV radiation, but more when it's damp and dark. With regular stories about widespread infections among the employees of meatpacking plants, to the extent that a great many USDA meat inspectors have become ill (with three dead), what are the odds that someone could pick up the virus from packaged meat? Particularly, as has happened recently, several hundred of the employees in a single plant tested positive for the virus? Our family has a freezer full of deer meat so we don't buy a lot of meat in the store, but this is the kind of thing that makes me wonder if we might consider buying even less.

This is exceptionally low to no risk.

I cannot imagine anyone could catch it from meat unless you are eating it raw or not washing your hands. That being said, I will continue to buy and eat meat.

As with eating meat before COVID, cook it till it fully heated and don’t lick the wrapper, you hands, or raw meat (sad that I have to day that).

 

[Flyfalcons]

This is exceptionally low to no risk.

I cannot imagine anyone could catch it from meat unless you are eating it raw or not washing your hands. That being said, I will continue to buy and eat meat.

As with eating meat before COVID, cook it till it fully heated and don’t lick the wrapper, you hands, or raw meat (sad that I have to day that).

You wouldn't think people would need to be told to wash their hands either, but anyone who has used a public restroom has certainly noticed the"flush......door" sounds with no "sink" sounds between them.

 

[John Kemker]

This is exceptionally low to no risk.

I cannot imagine anyone could catch it from meat unless you are eating it raw or not washing your hands. That being said, I will continue to buy and eat meat.

As with eating meat before COVID, cook it till it fully heated and don’t lick the wrapper, you hands, or raw meat (sad that I have to day that).

About three years ago, I went to an all "don't handle raw meat without gloves" routine. I found that, for example, raw breakfast sausage lasted much longer in the fridge if I never let my bare skin touch it, even if I washed my hands for a full minute. Once I figured that out, I stopped touching raw meat with my bare hands altogether. I still wash them thoroughly before donning the gloves.

 

[cwbullet]

You wouldn't think people would need to be told to wash their hands either, but anyone who has used a public restroom has certainly noticed the"flush......door" sounds with no "sink" sounds between them.

You can’t fix stupid.

 

[ksaves2]

You can’t fix stupid.

You need one of these shirts Chuck: https://tinyurl.com/y9zn2ftw

I got a yellow one. Kurt

 

[Alan Whitmore]

Chuck,
I have a question about age-specific hospitalization and death rates. It may be too early in the pandemic to start compiling meaningful data of this sort, but my question would be something like this: of all the people in the x-y age range who contract SARS-2 infection, what proportion of them get sick enough to require hospitalization, and what proportion of them die?
My concern is fairly obvious: I am in the 70-80 year old range, and next to the 80 and up range, we were the people most likely to die from SARS-1. I worked in a SARS-1 hot animal lab for 2 or 3 days a week until I got to be 65, and then I started looking at the stats and just got scared. For 8 to 10 hours a day we were doing necropsies on SARS-infected mice with sharp scissors and needles just millimeters from our gloved hands. Then one day I just couldn't do it any more. Some of the mice we were dissecting had lungs that looked like little bags of blood. That is my reason for concern.
Do we have age-specific data on this virus or is it too soon in the process?
I realize that both "serious disease requiring hospitalization" and "death from infection" are profoundly social and environmental constructs. If I were a person without medical insurance living on a native-American reservation in New Mexico, my access to good medical care would be profoundly different from that which I currently enjoy, as a person with good insurance living within 20 minutes of two of the finest medical centers in the USA: Duke University Medical Center and University of North Carolina Hospital System.
I follow the stats on the CDC website and the one that John Hopkins has published on the web almost every day, so I have some notion of total numbers and death rates by state and city, but I haven't really seen any age-specific data. Do you know of any?

Alan Whitmore

 

[NateB]

We have cases and deaths broken down by age available from the Indiana CDC's website. https://www.coronavirus.in.gov/2393.htm

We don't have the number of hospital admissions, ICU admissions or vent use metrics broken down by age publically available. From what I have seen, we have had a few children, teenagers, and younger adults admitted, but most have been adults over 40. As you can see most of the deaths have been in seniors, but most of those were also nursing home residents.

 

[jsdemar]

I follow the stats on the CDC website and the one that John Hopkins has published on the web almost every day, so I have some notion of total numbers and death rates by state and city, but I haven't really seen any age-specific data. Do you know of any?

Many of the State depts of health or governor's press releases show age and if they had a preexisting condition. New Mexico does this. https://cv.nmhealth.org/newsroom/
And a dashboard (but age isn't shown for deaths):
https://cvprovider.nmhealth.org/public-dashboard.html
55% of cases in NM are Native Americans.

From browsing the reports, deaths started out to be people in their 80's and 90's. Mean age recently is more in the 60's. Here in NM.

 

[cwbullet]

Of all the people in the x-y age range who contract SARS-2 infection, what proportion of them get sick enough to require hospitalization, and what proportion of them die?
............
I follow the stats on the CDC website and the one that John Hopkins has published on the web almost every day, so I have some notion of total numbers and death rates by state and city, but I haven't really seen any age-specific data. Do you know of any?

Alan Whitmore

That is a great question and one we have been asking to be tabulated from day one. All data is a little suspect at this stage because I am not sure we have a good grasp on how many were exposed and failed to develop symptoms. Based on early antibody testing, I think we are at double or higher rates of infection. I looked for death rates and have not found a reputable source. I know the CDC is working on it.

Hospitalization rates:
The best data from the CDC is located at:
https://www.cdc.gov/coronavirus/201...ronavirus/2019-ncov/covid-data/covidview.html
This was published on 17 April: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

I will keep looking.

 

[BABAR]

Has social distancing and closure of nonessential businesses had a favorable impact on reducing other infectious diseases such as flu and STDs?

 

[ksaves2]

Good gosh Dr. Whitmore, I didn't know you were in the age range that you specified above.
Doesn't matter but I thought you were around my station in life. Anywho, I'm bailing out July 1st and retiring. It's a year and a half early but I've gone through a lot and can't do the domestic chores I want to do. I am/soon to be/was a primary care medico who tried to hammer into people good health behaviors but more often than not, failed. They went home and did the same things that took them down anyways. I admire you as I feared genetics, as I thought it, was stupid for my compatriots to "hunt for virgins" in the fruit fly lab. Breeding bugs didn't appeal to me so I was able to get away without taking the course for a Bio-chem major. Anyhow, happy mixing.
(Something I'm going to get back to in retirement.)

Kurt Savegnago

(Yeah, don't hold it against me. I have an M.D. instead of a Phd!)

 

[Flyfalcons]

Has social distancing and closure of nonessential businesses had a favorable impact on reducing other infectious diseases such as flu and STDs?

What kind of barber shops have you been frequenting?!?!









(and where are they located?)

 

[NateB]

Has social distancing and closure of nonessential businesses had a favorable impact on reducing other infectious diseases such as flu and STDs?

I don't know about STDs, that isn't an area of healthcare that usually involves a critical care paramedic. Flu cases though, at least at my hospital, fell sharply shortly after the stay at home orders were in place.

Traumatic injuries are also down. People aren't driving as much and some factories are closed.With the weather becoming nicer, they are on the rise again, which is expected. Farmers are starting to plant and people are riding motorcycles more, both which lead to more accidents.

 

[cwbullet]

Has social distancing and closure of nonessential businesses had a favorable impact on reducing other infectious diseases such as flu and STDs?

The answer is 100% yes. Part of that is reduced testing. In a lot of facilities, the equipment to run the test is the same machine.

 

[Marc_G]

I don't know about STDs, that isn't an area of healthcare that usually involves a critical care paramedic.

Arguable point. When one partner tells the other partner about an STD, the need for critical care can come into play!

 

[BDB]

Chuck...I'm intersted to hear your opinion about the Kawasaki-like symptoms that have been observed in children in NYC who have coronavirus antibodies:

https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/

Thanks so much for taking the time to manage this thread. Now more than ever, It's incredibly valuable to get answers from a trustworthy source.

 

[ksaves2]

I don't know about STDs, that isn't an area of healthcare that usually involves a critical care paramedic. Flu cases though, at least at my hospital, fell sharply shortly after the stay at home orders were in place.

Traumatic injuries are also down. People aren't driving as much and some factories are closed.With the weather becoming nicer, they are on the rise again, which is expected. Farmers are starting to plant and people are riding motorcycles more, both which lead to more accidents.

In a trauma unit we used to have a pool to predict the first date that a motorcycle accident victim is brought in. It was a sure sign of spring. One of my compatriots said they should put organ donor cards in all motorcycle shops. He also called them "graveyard ponies".

I agree that with the lockdown, flu cases are less and at the prison in town here they were on lockdown for flu prevention before the governor ordered a lockdown for the general population due to Covid. As a result, there haven't been any Covid cases in the local prison yet. Have only had a total of three cases
in the county I live in so that might have something to do with it. Yes there isn't widespread testing because we don't have many tests available but the local hospital is not being inundated with Covid sick people either so that indirectly supports the low number (3) of Covid cases.

I've joked with associates and patients that in Fulton County, we're a bunch of "hicks" that don't go anywhere! That in and of itself I think is protective along with the other features of good hygiene and masks. Kurt

 

[ksaves2]

Chuck...I'm intersted to hear your opinion about the Kawasaki-like symptoms that have been observed in children in NYC who have coronavirus antibodies:

https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/

Thanks so much for taking the time to manage this thread. Now more than ever, It's incredibly valuable to get answers from a trustworthy source.

Wow, that's interesting. I wonder if they are treating it like Kawasaki's with aspirin and gamma globulin. Kurt

 

[cwbullet]

Chuck...I'm intersted to hear your opinion about the Kawasaki-like symptoms that have been observed in children in NYC who have coronavirus antibodies:

https://www.cbsnews.com/news/kawasaki-disease-children-hospitalized-new-york-city-coronavirus-link/

Thanks so much for taking the time to manage this thread. Now more than ever, It's incredibly valuable to get answers from a trustworthy source.

We have seen a couple of cases. The Number or N is too small to determine if the antibodies are the cause or if the treatment is the same has Kawasaki disease. They did treat it with Aspirin. Not sure if they used gammaglobulin. The patient did improve. N too small to make a determination.