Coronavirus: What questions do you have?

[cwbullet]

Chuck, what are your thoughts about someone who is a mild to moderate asthmatic, triggered by heavy exercise or viruses, but young healthy.

That would be an increase risk when compared to someone without asthma, but not as much as someone immunocompromised or with chronic lung disease from smoking.

As with anything, you cannot change the disease you have, but you can limit the impact by living healthier and avoiding things that worse your disease process.

 

[cwbullet]

Thank you for the reply. She's on
Zyrtec, Prenatal vit,Sumatriptan 50mg (Imitrex), Midodrine, Nadolol, Indomethacin,
Super b complex, Magnesium &Acarbose.

She's not diabetic but the issues she has affects her blood sugar. Its to low.

Slight increased risk, but it would be much higher without the meds. I would recommend the standard precautions as with any patient. You cannot prevent all exposures, but you can reduce the odds by walking your hands and avoiding contact with people that are ill.

The one thing I would say is to talk to a provider about a flu shot if you have not had one.

 

[grouch]

My only question is does this thing warrant the hype? I mean, should people, be concerned past a basic level of hygiene?

 

[o1d_dude]

Today the internet says those who drank Boone’s Farm in their younger days are immune to the virus.

I should be relatively safe if this is true (not likely).

From the old TV commercial back in the day: “Sergeant, these men are coming with me! We’re going to Boone’s Farm!”

Right up there with Thunderbird, the cheapest wines available.

 

[cwbullet]

My only question is does this thing warrant the hype? I mean, should people, be concerned past a basic level of hygiene?

As a professional, it is important to maintain proper sanitation and hygiene at all times. I am more worried about influenza than Coronavirus, but that could change as we learn more or the pandemic changes.

 

[cwbullet]

Today the internet says those who drank Boone’s Farm in their younger days are immune to the virus.

I should be relatively safe if this is true (not likely).

From the old TV commercial back in the day: “Sergeant, these men are coming with me! We’re going to Boone’s Farm!”

Right up there with Thunderbird, the cheapest wines available.

I suspect that is not true. I would guess that was started by Mr. Boone to sell more fire water.

 

[dinoburb]

Infuenza B currently could equal or surpass 32,000 deaths (John Hopkins, Center for Health Security as of 11Feb 2020) and Corona has accounted for 11 deaths as of today in the US. Recognizing Corona is a serious problem, the current flu has significantly impacted this country already and very little is being reported about a flu virus that is, and probably will continue to infect and kill our citizens. Where’s the reality?

 

[Terri9630]

Slight increased risk, but it would be much higher without the meds. I would recommend the standard precautions as with any patient. You cannot prevent all exposures, but you can reduce the odds by walking your hands and avoiding contact with people that are ill.

The one thing I would say is to talk to a provider about a flu shot if you have not had one.

Thank you. We've all had our shots. Flu and pneumonia.

 

[Jim Hinton]

Today the internet says those who drank Boone’s Farm in their younger days are immune to the virus.

I should be relatively safe if this is true (not likely).

From the old TV commercial back in the day: “Sergeant, these men are coming with me! We’re going to Boone’s Farm!”

Right up there with Thunderbird, the cheapest wines available.

Given the levels of formaldehyde in some of the fortified wines, that might actually be possible, if drinking embalming fluid disguised as wine didn't get you first. That's why Annie Green Springs was pulled off of the market. The Springs weren't the only thing turning green in Annie's world. That has to be a hangover for the ages.

Jim

 

[Terri9630]

Infuenza B currently could equal or surpass 32,000 deaths (John Hopkins, Center for Health Security as of 11Feb 2020) and Corona has accounted for 11 deaths as of today in the US. Recognizing Corona is a serious problem, the current flu has significantly impacted this country already and very little is being reported about a flu virus that is, and probably will continue to infect and kill our citizens. Where’s the reality?

2 headlines from this morning.

WHO Announces Global Death Rate For Coronavirus Is Now 3.4%

The WHO says the coronavirus is killing people at a rate much higher than the flu

https://www.yahoo.com/lifestyle/announces-global-death-rate-coronavirus-061225297.html

 

[Speaknoevil]

Any one on immunosuppressant would be at higher risk. My recommendation to all is to avoid anyone that is ill. I general, it is an increased risk that would go up with age and other comorbid conditions.

A bummer indeed. I am on azathioprine and low dose prednisone for sarcoidosis diagnosed a year ago. I am almost back to full functioning after not being able to walk even 50ft without stopping to rest. In fact on Sunday did a 4-mile hike on a moderate-rated trail. I don't know what I'd do without immunosuppressants. It's like pick your poison, either way I have a greater chance of death.

 

[cwbullet]

A bummer indeed. I am on azathioprine and low dose prednisone for sarcoidosis diagnosed a year ago. I am almost back to full functioning after not being able to walk even 50ft without stopping to rest. In fact on Sunday did a 4-mile hike on a moderate-rated trail. I don't know what I'd do without immunosuppressants. It's like pick your poison, either way I have a greater chance of death.

I would suspect that a lack of the medication is likely a higher risk than Coronavirus.

 

[cwbullet]

2 headlines from this morning.

WHO Announces Global Death Rate For Coronavirus Is Now 3.4%

The WHO says the coronavirus is killing people at a rate much higher than the flu

https://www.yahoo.com/lifestyle/announces-global-death-rate-coronavirus-061225297.html

Maybe. This only counts positive test which is likely under representing COVID more than flu. FLU is a disease that nearly all patients like a linebacker. You are sick as heck in post patients. Coronavirus or COVID-19 hits healthy people just like the common cold and people rarely come in to see a provider.

In other words, you are comparing apples and oranges and the data likely has a reporting bias.

 

[Greg Furtman]

Chuck, thank you for doing this thread. Much appreciated.

 

[cbrarick]

I was the commander of my local medical reserve corps. We had a chair on the capital region emergency planning committee as well as south central emergency planning. Lots of fun, half the time I felt that I should be medicating some of the members...some super paranoid stuff...

however, if you want some easy reading ,
the cdc website (USA) https://www.cdc.gov/coronavirus/2019-ncov/summary.html
the who website (world health) https://www.who.int/emergencies/diseases/novel-coronavirus-2019

remember, despite all the hype, 80% of all illness is mild to moderate, you probably don't even know or get tested for it...20% are ill with only 3.4- 2% mortality.

 

[gna]

2 headlines from this morning.

WHO Announces Global Death Rate For Coronavirus Is Now 3.4%

The WHO says the coronavirus is killing people at a rate much higher than the flu

https://www.yahoo.com/lifestyle/announces-global-death-rate-coronavirus-061225297.html

Maybe. This only counts positive test which is likely under representing COVID more than flu. FLU is a disease that nearly all patients like a linebacker. You are sick as heck in post patients. Coronavirus or COVID-19 hits healthy people just like the common cold and people rarely come in to see a provider.

In other words, you are comparing apples and oranges and the data likely has a reporting bias.

Maybe, but this is where the fear is coming from--people are putting together a higher death rate with a virus that seems to be similar to the common cold, and it's not hard to extrapolate an extremely high global death toll.

 

[John Taylor]

Dr. Chuck,
I have MS and receive a monthly Iv infusion of a drug called Tysabri. It is very specific to block transfer of defensive cells thru the blood brain barrier. This leaves me with a very slight subseptibility to getting PML. I am checked often for the JVC viral load and am basically negative.
My question, will my taking Tysabri make me more susceptible to catching or having a more severe response from the Coronavirus?

 

[cwbullet]

Dr. Chuck,
I have MS and receive a monthly Iv infusion of a drug called Tysabri. It is very specific to block transfer of defensive cells thru the blood brain barrier. This leaves me with a very slight subseptibility to getting PML. I am checked often for the JVC viral load and am basically negative.
My question, will my taking Tysabri make me more susceptible to catching or having a more severe response from the Coronavirus?

Tysabri Is an immunosuppressive drug. It will reduce your ability to fight off the infection. I would say that it will likely reduce your ability to fight of any infection, but the risk fo stopping it is likely worse then the risk of Coronavirus. I have had patients who takes a similar medications. I had a long discussion with them and some were dead set on stoping it. Often these patients had a relapse some are life threatening. I would have a discussion with you primary care or speciality.

We really need to do research on some these meds and viral infections. Some medication can reduce the immune response and lower the risk, but that is rare. This happens when the immune response is causing the damage. I suspect that Tysabri would not be beneficial with Coronavirus..

 

[cwbullet]

I was the commander of my local medical reserve corps. We had a chair on the capital region emergency planning committee as well as south central emergency planning. Lots of fun, half the time I felt that I should be medicating some of the members...some super paranoid stuff...

however, if you want some easy reading ,
the cdc website (USA) https://www.cdc.gov/coronavirus/2019-ncov/summary.html
the who website (world health) https://www.who.int/emergencies/diseases/novel-coronavirus-2019

remember, despite all the hype, 80% of all illness is mild to moderate, you probably don't even know or get tested for it...20% are ill with only 3.4- 2% mortality.

Good links. Thanks for sharing.

 

[Bat-mite]

My question is: if I get a "cold" over the next couple of months, should I:

1. Stay home and treat it as usual?
2. Go to the hospital and get screened?

I am a type 1 diabetic aged 53. Thanks.

 

[cwbullet]

My question is: if I get a "cold" over the next couple of months, should I:

1. Stay home and treat it as usual?
2. Go to the hospital and get screened?

I am a type 1 diabetic aged 53. Thanks.

If it is just a cold, stay home. If you have lower respiratory symptoms suck as shortness of breath, see a medial provider and get screened. The screening criterial may change, but they are not going to screen every cold. The Coronavirus cause pneumonia in those that are susceptible and not just a “head cold”.

https://www.health.com/condition/in...utm_content=030520&cid=497466&mid=30451063828

 

[Bat-mite]

If it is just a cold, stay home. If you have lower respiratory symptoms suck as shortness of breath, see a medial provider and get screened. The screening criterial may change, but they are not going to screen every cold. The Coronavirus cause pneumonia in those that are susceptible and not just a “head cold”.

https://www.health.com/condition/in...utm_content=030520&cid=497466&mid=30451063828

What I was trying to ask was, how do I know if it is a cold or Corona? And do they want to screen everyone, or do they prefer that people who can get over it without help, do so?

 

[cwbullet]

@Bat-mite Let me clarify my answer. No they do not want to screen everyone with the cold. The key symptom is the symptoms of Pneumonia.

Symptoms of Pneumonia:

• Cough - worse than cold and deep in chest - not throat and not from post nasal drip
• Exhaustion and fatigue - you feel like you were hit with a truck
• Fever, often over 101
• Loss of appetite and potential nausea
• Shivering (you feel chilled)
• Shortness of breath with increased respiratory rate and potentially chest pain
• Rapid breathing

Symptoms of a cold:

• Fever is lower grade or nonexistent
• Nasal congestion
• Sore throats
• Body aches
• Cough from post nasal drip

If you have doubts, see a medial provider to be screened. I have screened hundreds and order one test.

 

[cwbullet]

Just to answer a question:

What does the death rate is 10% in the US tell us?
We have had 100+ positive tests and around 10 deaths.
World wide, there have been 93,090 confirmed cases and 3,198 deaths.

Why is the death rate higher in the US? I would estimate that this is from two factors: 1. People are under reporting or 2. We have had infections pocketed in a high risk population early. I think the answer is a mix of both but remember most of the deaths have been on a nursing home in WA. This patient is high risk for death.

 

[75Grandville]

@cwbullet Thanks for taking the time to do this! Appreciate your (valuable) time and effort here.

Speculating as a statistician, from what I've read, I'm going to agree with the under-reporting. The death rates we are seeing published are for those who have been tested. Who has been tested? Those with more severe cases/worse symptoms. Not that this isn't serious, and appears mortality rate is higher than seasonal flu, but I'm not buying 3.4%.

Just coming off a week of self-imposed quarantine. Entire family, myself included, had flu-like symptoms. Fever 101+, cough, chills, etc. We all followed the same pattern where the fever broke after three days, and now we're all at the "our lungs are full of crap that wants out in spectacularly disgusting ways" stage. My coughing died down to the point I felt comfortable heading back to the office. Fortunate that I have a job that provides sick days, and that I could work from home before/after.

 

[rcktnut]

@Bat-mite Let me clarify my answer. No they do not want to screen everyone with the cold. The key symptom is the symptoms of Pneumonia.

Symptoms of Pneumonia:

• Cough - worse than cold and deep in chest - not throat and not from post nasal drip
• Exhaustion and fatigue - you feel like you were hit with a truck
• Fever, often over 101
• Loss of appetite and potential nausea
• Shivering (you feel chilled)
• Shortness of breath with increased respiratory rate and potentially chest pain
• Rapid breathing

Symptoms of a cold:

• Fever is lower grade or nonexistent
• Nasal congestion
• Sore throats
• Body aches
• Cough from post nasal drip

If you have doubts, see a medial provider to be screened. I have screened hundreds and order one test.

Right on with the symptoms of pneumonia. had it about 9 years ago ( bacterial). After 1 week with symptoms went to doc, antibiotics knocked the worst symptoms out in a week, but took another 2 weeks to feel normal again. I think most people will realize they have it when they get it.
Question: Will antibiotics help combat pneumonia with this virus? I believe not.

 

[ThirstyBarbarian]

@cwbullet Thanks for taking the time to do this! Appreciate your (valuable) time and effort here.

Speculating as a statistician, from what I've read, I'm going to agree with the under-reporting. The death rates we are seeing published are for those who have been tested. Who has been tested? Those with more severe cases/worse symptoms. Not that this isn't serious, and appears mortality rate is higher than seasonal flu, but I'm not buying 3.4%.

Just coming off a week of self-imposed quarantine. Entire family, myself included, had flu-like symptoms. Fever 101+, cough, chills, etc. We all followed the same pattern where the fever broke after three days, and now we're all at the "our lungs are full of crap that wants out in spectacularly disgusting ways" stage. My coughing died down to the point I felt comfortable heading back to the office. Fortunate that I have a job that provides sick days, and that I could work from home before/after.

Regarding the 3.4% mortality rate, the WHO explicitly says that is the rate for reported cases. So it’s for cases that have been verified by testing. Realistically, what else could they report? They can’t just make a guess about the number of unreported or untested cases and report the “real” rate based on a guess.

Most likely there are a large number of unreported cases, and if you included those, the mortality rate would be lower, but the fact we don’t really know how widespread the infections are says a lot more about the shortcomings of the testing than anything else. I’m looking forward to more widespread testing so we can get better information.

 

[mpitfield]

Regarding the 3.4% mortality rate, the WHO explicitly says that is the rate for reported cases. So it’s for cases that have been verified by testing. Realistically, what else could they report? They can’t just make a guess about the number of unreported or untested cases and report the “real” rate based on a guess.

Most likely there are a large number of unreported cases, and if you included those, the mortality rate would be lower, but the fact we don’t really know how widespread the infections are says a lot more about the shortcomings of the testing than anything else. I’m looking forward to more widespread testing so we can get better information.

When was the last time any of you reported your common flu? Speaking for myself, I have never reported having the common flu, yet they have statistics on it.

 

[ThreeJsDad]

I better stock up on Pop-Tarts and Spam.....

Seriously, it is very nice to read some "Not Hyped Up" information on this subject.

 

[cwbullet]

@cwbullet Thanks for taking the time to do this! Appreciate your (valuable) time and effort here.

Speculating as a statistician, from what I've read, I'm going to agree with the under-reporting. The death rates we are seeing published are for those who have been tested. Who has been tested? Those with more severe cases/worse symptoms. Not that this isn't serious, and appears mortality rate is higher than seasonal flu, but I'm not buying 3.4%.

Just coming off a week of self-imposed quarantine. Entire family, myself included, had flu-like symptoms. Fever 101+, cough, chills, etc. We all followed the same pattern where the fever broke after three days, and now we're all at the "our lungs are full of crap that wants out in spectacularly disgusting ways" stage. My coughing died down to the point I felt comfortable heading back to the office. Fortunate that I have a job that provides sick days, and that I could work from home before/after.

Bingo