Coronavirus: What questions do you have?

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cwbullet

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Nitric oxide as a treatment for gas exchange always amuses me. Pretty much a poison but also a great little broncodialator. My wife was an ICU nurse so I learnt a lot of her stuff while she was studying and working there 🙂.
I would not call it a poison, our bodies produce it. It is a natural vasodilator. Our bodies synthesize nitric oxide from the amino acid L-arginine by means of the enzyme nitric oxide synthase. The main site of the molecule's synthesis is the inner layer of blood vessels, the endothelium, though the molecule is also produced by other types of cells. Sildenafil, the little blue pill, is a specific phosphodiesterase type 5 inhibitor that enhances nitric oxide-mediated vasodilation.
 

OverTheTop

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Great info. Thanks. Do they still administer the NO as a gas or is the medication sufficient? I seem to remember the half-life of the NO was ridiculously short, around 1/4 second.
 

Peartree

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To be infectious, you have to shed or release the whole and active virus. The test digests the virus and tests for viral RNA. It can not test for "active viruses". We believe that many of these shedders are shedding "dead' viruses for months after recovery. Sure, they could also be producing a low level of live virus but not enough to infect. This may take months to figure out, but we there is significant evidence that some folks shed dead or complete virus for weeks to months after "cure".
Thanks.
 

cwbullet

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Great info. Thanks. Do they still administer the NO as a gas or is the medication sufficient? I seem to remember the half-life of the NO was ridiculously short, around 1/4 second.
We still give NO gas. It has had a resurgence in COVID.
 

John Kemker

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I had NO for my tooth extraction just last year. Didn't have a care in the world until it wore off. (About 0.125 seconds after they turned it off!)
 

BABAR

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Is there any “science” behind the 14 day quarantine rule, or is that just a number someone pulled out if the a——ir.
 

OverTheTop

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I had NO for my tooth extraction just last year.
You would have had N2O2, nitrous oxide. aka laughing gas. I used to get the giggles at the dentist when I had it. I had it when I was having a dislocated shoulder reduced last year. Worked well.

NO is dangerous in (not much) quantity. To quote wikipedia " At levels of 100 ppm, nitric oxide is immediately dangerous to life and health". That's why in a hospital setting where it is typically administered there is a "scrubber" system to protect nearby health workers from any that gets away from the patient.
 

John Kemker

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You would have had N2O2, nitrous oxide. aka laughing gas. I used to get the giggles at the dentist when I had it. I had it when I was having a dislocated shoulder reduced last year. Worked well.

NO is dangerous in (not much) quantity. To quote wikipedia " At levels of 100 ppm, nitric oxide is immediately dangerous to life and health". That's why in a hospital setting where it is typically administered there is a "scrubber" system to protect nearby health workers from any that gets away from the patient.
You're absolutely right. I forgot about the difference. Isn't NO the one that fumes off of RFNA?
 

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You're absolutely right. I forgot about the difference. Isn't NO the one that fumes off of RFNA?
I think in a medical setting that we use very small amounts mixed with medical air or oxygen. I know we use it, but I personally have never written for it. I would guess it is a concentration issue. The compound is created by you body so I definitely would not call it a poison. I would not even say it is necessarily toxic (in low levels) as it is produce in you body.

The safe dose is 1.25 to 80 ppm according to the medical literature.

In large amounts, NO is an irritant and can cause some serious symptoms and death. There is no doubt about that.



I suspect in high amounts it is extremely toxic but so is Carbon Dioxide. We breath in quiet a bit of it with each breath but increase it to higher percentages and it will absolutely kill you.
 

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What states are on an upward trend?
This question is a great query. Ten states are on an upward trend. North Carolina, Virginia, and Arkansas concern me. I am also seeing a trend upward in Wyoming and North Dakota, but need a few more days to decide how concerning they are. Alaska, Oklahoma, Nevada, Louisianna, and Michigan have my attention but I am not sure if the increase will last.

If I lived in those states, I would continue to social distance and be ver diligent with my hygiene.
 

dhbarr

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This question is a great query. Ten states are on an upward trend. North Carolina, Virginia, and Arkansas concern me. I am also seeing a trend upward in Wyoming and North Dakota, but need a few more days to decide how concerning they are. Alaska, Oklahoma, Nevada, Louisianna, and Michigan have my attention but I am not sure if the increase will last.

If I lived in those states, I would continue to social distance and be ver diligent with my hygiene.
Yup, living in NEOK people keep looking at me like I'm taking crazy pills when I say I'm wait-and-see through early June.

I want two weeks continuous day-over-day flat-or-lower from Joplin to OKC to Ft. Smith before I change up my routine.
 

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Yup, living in NEOK people keep looking at me like I'm taking crazy pills when I say I'm wait-and-see through early June.

I want two weeks continuous day-over-day flat-or-lower from Joplin to OKC to Ft. Smith before I change up my routine.
Stay safe. Man that pushing hard for us to reopen. We have another bump in GA as a whole. It is only slight.
 

cwbullet

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I posted this on the vaccine thread:

The first result of a small but significant human vaccine trial are in:

This one is on the Moderna RNA COVID Vaccine. Moderna is a company based in Cambridge, Massachusetts. All 45 participants in a trial developed blood levels of COVID-19 antibodies 15 days after receiving their first injection and incredibly, within two weeks after receiving their second injection, blood levels of the protective antibodies were the same as in patients who had recovered from an active COVID-19 infection. No harmful effects of the vaccine were reported. It is a small trial but very impressive results.

If passes scrutiny, I predict that the COVID-19 pandemic will be over in less than a year.
 
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John Kemker

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I posted this on the vaccine thread:

The first result of a small but significant human vaccine trial are in:

This one is on the Moderna RANA COVID Vaccine. Moderna is a company based in Cambridge, Massachusetts. All 45 participants in a trial developed blood levels of COVID-19 antibodies 15 days after receiving their first injection and incredibly, within two weeks after receiving their second injection, blood levels of the protective antibodies were the same as in patients who had recovered from an active COVID-19 infection. No harmful effects of the vaccine were reported. It is a small trial but very impressive results.

If passes scrutiny, I predict that the COVID-19 pandemic will be over in less than a year.
That is GREAT news!
 

cwbullet

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Tragedy during this difficult time is not limited to COVID. I had to attend a memorial for a Service Member who was killed in a motor cycle incident. The human head does not respond well to sudden stops cause by hard surfaces.

Today‘s focus is returning to readiness. We are focusing on returning our unit back to the new normal and maintain readiness to do what our commanders order us to do. I am concerned the move is premature with all of these states have small to medium clusters of infections. I hear all the local politicians (both parties) lauding the reopening as a success. I sure hope this is not a gotcha in the future. I would be happy to be wrong.
 

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Sorry to hear about the memorial service.

The worse part (for me) about this pandemic has been knowing that family cannot come to the hospital to be with their loved one. I think the physical connection and emotional support of family and friends is important for ones recovery, and we are taking that away right now.
 

cwbullet

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Sorry to hear about the memorial service.

The worse part (for me) about this pandemic has been knowing that family cannot come to the hospital to be with their loved one. I think the physical connection and emotional support of family and friends is important for ones recovery, and we are taking that away right now.
Concur 100%. I often wonder if my years of being a physician in combat might have blunted my emotion. I saw a teenager crying about the loss of her parent. I felt terrible that it no longer brings me to tears. Emotional distancing in medicine destroys our humanity.
 

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So it has been found that having patients in a prone position helps with this virus. Will this "proning" continue into regular nursing? Have there been any upsides for this position in the hospital setting for other diseases? Does it make anything more diffucult to do from a medical point of view?
 

Steve Shannon

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Concur 100%. I often wonder if my years of being a physician in combat might have blunted my emotion. I saw a teenager crying about the loss of her parent. I felt terrible that it no longer brings me to tears. Emotional distancing in medicine destroys our humanity.
I bet your emotions are fine, just necessarily in reserve so you can function more effectively. As you get older those emotions live closer to the surface. I find that things that never phased me when I was younger, such as on the news, bring me to tears, both for happy as well as sad things. Taps really gets to me.
 

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I bet your emotions are fine, just necessarily in reserve so you can function more effectively. As you get older those emotions live closer to the surface. I find that things that never phased me when I was younger, such as on the news, bring me to tears, both for happy as well as sad things. Taps really gets to me.
Isn't that the truth. Taps, to me, puts me back at doing ramp ceremonies in combat zones. Watching or loading an aircraft is not something most ever have to do. The loss of youth is such a tragedy.
 

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Is the virus mutating? I read news stories on this.
I think you are referring to news out of China: https://www.foxnews.com/health/coro...er-exhibiting-symptoms-differently-than-wuhan

First of all, you can't trust Chinese news, and second, there is still no evidence that we are dealing with a mutation. It absolutely could mutate. About a month ago, they were using the anosmia (loss of smell) to indicate mutation. In fact, patients were showing up with this for months around the globe and we never connected the two. Second, an alarming number of patients with anosmia also use high dose of zinc or zinc nasal spray which can also cause it. I think the ansomia is real, I just do not have a mechanism and it absolutely is not a mutation. The same could be true in these cases. We need more time to investigate the new cases and the virus.

I recommend that everyone remain calm and not play into the fury of news induce panic. The best part is if there is a mutation, it could just as easily weaken the virus as make it more deadly and there is not a darn thing we can do about.
 

John Kemker

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I recommend that everyone remain calm and not play into the fury of news induce panic. The best part is if there is a mutation, it could just as easily weaken the virus as make it more deadly and there is not a darn thing we can do about.
I agree, especially the first sentence.

Second sentence reminds me that a parasite that kills its host is not a success in the evolutionary scheme of things. Therefore, non-lethal mutations should, theoretically, have a greater chance of becoming dominant. No guarantees, though.
 

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When I was in junior high and high school, the local VFW asked me to play taps at funerals for veterans. It always came right after the gun salute and as they handed the flag to a family member. I was always far enough away that I didn’t get to see it up close. When my father died, my youngest son played taps and I got teary eyed as the VFW handed the flag to my mother. I love the tune. For me, it’s a reminder of our humanity.
 

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Isn't that the truth. Taps, to me, puts me back at doing ramp ceremonies in combat zones. Watching or loading an aircraft is not something most ever have to do. The loss of youth is such a tragedy.
Did body escort once upon a time. Tough duty trying to keep it all together for the family, especially since I knew him.
 

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Sorry to hear of everyone’s losses. Will HPR activities resume in the fall or winter of this year if cases of corona continue to decline? Work has been very busy. I need rocketry or some hobby like fishing back in my life to de-stress.
 

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Did body escort once upon a time. Tough duty trying to keep it all together for the family, especially since I knew him.
Thank you for your service. I am exempt from that duty as a doctor. For some reason, they don’t want the pronouncer escorting. It is always harder when you have a personal connection with the person.
 
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