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SLU & NCAA Corona Virus Discussion


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58 minutes ago, courtside said:

If anyone on this board is interested in Chloroquine, Colchicine, its effectiveness or not, shortages, (which means indicated patients taking it for approved reasons aren't getting it) important side effects, recent FDA approval for emergency use of COVID-19, ...etc...this is a good detailed article that covers it. 

https://www.washingtonpost.com/business/2020/03/30/coronavirus-drugs-hydroxychloroquin-chloroquine/

 

Michael Ackerman from the Mayo Clinic is concerned with cardiac death with its usage.

The France trial only had 14 patients. China found no improvement with it.

Anthony Fauci is skeptical of its paucity of evidence.

Lewis Schrager, Chief Medical reviewer at the FDA from 2002-2013 is skeptical.

Keep in mind Zpaks used to treat pneumonia etc..prolong heart intervals already as do these anti-malaria drugs 

All hands on deck. Many things are being tried and used to help people.

Interesting choice of words from Old Guy calling the demand and use of ventilators a "Hullabaloo" or fuss.....England (ICNARC) has reported 34% survival rate with ventilators thus far with COVID-19. (64% overall)

Medications, treatments, and vaccines are in the development process now. Until then a wide variety of treatments are being used. Whatever it takes.

 

Great article.

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41 minutes ago, rgbilliken said:

🎶 Covid-19 too-loo-rah

Covid-19 too-loo-rah

Covid-19 too-loo-rah 🎶

I'm sorry. Mods, please ban me from the board.

I’m going to need to see your song writing credentials!

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 Just because I find this interesting I will report it. Don't feel any need to read this it is boring and factual. I was reading an article last night comparing mortality among Covid-19 patients that required ventilation. The data reported went up and down widely varying from a mortality of 30% or so of all ventilated Covid patients at certain hospitals, to 86% at other facilities. This proves a point, which is not anecdotal but valid even if it varies a lot. Hospitals use different criteria to place patients on ventilators, they also vary in their ability to handle the demands produced by having mutliple ventilation cases at the same time.

The whole idea of concentrating the attention on the number of ventilators available is idiotic, counting the number of machines does not in any way indicate the people handling the machines are uniformly good and have expertise in this field. When the number of ARDS patients increase, ventilation or not, the number of deaths will also increase. It is a LOT better to try to prevent progression of the disease to the terminal respiratory failure stage. This is the best way available to keep deaths of hospitalized Covid patients at a low level.

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13 hours ago, Old guy said:I am going to bring up a topic about infectious disease that interests me and probably no one else, so please stop reading now if your eyes have begun glazing. The topic is the role the immune system may possibly play in causing damage to the body when it responds to an infectious disease. There is ample documentation that the paralysis and death caused by polio is due to the fact that the immune system over-reacts, causing widespread inflammatory reactions, and even turning against perfectly normal parts of the body which the immune system identifies, erroneously, as being part of the infectious process and attacking these normal tissues. The later option is what causes the paralysis associated with polio.

How about Covid? The terminal event with this virus generally occurs through ARDS with respiratory failure and death. This explains the whole hullaballo about ventilators, which is not a totally reasonable therapeutic measure, it is just a life support measure. By the time a patient gets to ventilation, they are pretty well on the way out. This is why a number of clinical studies have been started on the use of anti-inflammatories (chloroquine being one of them) in the treatment of this disease. There is another study starting now using colchicine as the anti inflammatory agent. It must be pointed out that extensive inflammation of tissues can provide a suitable area for secondary infections. Therefore the combination of antibiotics and anti-inflammatories that appear entering the testing stage.

The press release of this new study using colchicine follows. The idea behind this use of anti inflammatories is described in the following paragraph which is written in what could be called "popular immunology" terms:

"If you become infected with coronavirus, your immune system sends useful immune chemicals to the affected areas of the lungs to help fight the infection, which is good because this is how you recover from an infection.  However in some people there is an overreaction by the immune system called a “cytokine storm” causing too many immune messengers to be made. This means major parts of the body become very inflamed and they can not work properly.  The lungs become congested which causes severe breathing problems and pneumonia. The heart, liver and kidneys can also become very inflamed which can lead to serious complications, even organ failure and death.

Colchicine will be used for its anti inflammatory effects when treating COVID-19.  By reducing the excessive inflammation, it is hoped that the body’s immune system will be able to fight coronavirus, and reduce the complications of pneumonia, organ failure and death"

Yes, neither chloroquine, nor colchicine, nor antibiotics will kill the virus directly but, by reducing the inflammation and secondary infections, therapy using these agents may provide a way to allow the patient's immune system to do its work and let the body heal itself."

Comparing this therapeutic approach with the use of ventilation is interesting. Therapy with anti-inflammatories seeks to prevent the ARDS before it happens, and allow the body to heal itself in the process. None of these anti-inflammatory therapies will kill the virus but they may well allow the immune system to kill the virus. By the time you reach ARDS and require ventilation, your lungs are clogged, and possibly infected with other organisms as well, and the patient's immune system is already unable to keep the viral load down.

If you were a patient going down this road, which of the two approaches would you prefer? Mind you, if the anti-inflammatory therapy does not to work in your particular case, and the disease starts to spiral downwards you may end up receiving ventilation and life support. The use of anti-inflammatories does not rule out ventilation if and when needed. However, once the ARDS stage is reached, the prognosis is not a good one.

 

Would earlier use of non-invasive ventilation when possible make a difference? After Gov. Cuomo mentioned today that 80% of people who get put on a ventilators won’t make it, the CEO of a company that produces them was asked about it on CNBC.  His response was that if that’s the case he must have been speaking of invasive ventilation and that limits on available machines must be preventing them from being ventilated sooner.   
 

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58 minutes ago, ARon said:

Would earlier use of non-invasive ventilation when possible make a difference? After Gov. Cuomo mentioned today that 80% of people who get put on a ventilators won’t make it, the CEO of a company that produces them was asked about it on CNBC.  His response was that if that’s the case he must have been speaking of invasive ventilation and that limits on available machines must be preventing them from being ventilated sooner.   
 

Ventilation is always forced, invasive, and mechanical. You get an endotracheal tube in through your mouth which is sealed inside the trachea by an inflatable balloon (built into  the tube) and get connected to the machine that makes sure you inhale and exhale a measured amount of air (or air with oxygen added or even nebulized sprays of specific meds) until you do not need ventilatory support any longer. While you are ventilated you are heavily sedated so you can tolerate the process. This is not a nice or gentle process. Getting the patient off the machine has to be done gradually.

There is no such a thing as non invasive ventilation, sure you can use CPAP at times, but if the lungs are full of fluids and crud you are not going to do well with this, you will also not do well with a simple oxygen mask. ARDS is not a mild condition in any way imaginable. Cuomo's figure is basically what the Chinese reported, you can do better than that but it depends on the skill and experience of those handling the ventilators. Oh, and after each patient gets off the machine, it must be thoroughly cleaned and disinfected before the next guy in line is hooked up to it.

I have no idea who CNBC was interviewing or what kind of equipment his company made. CNBC may be a satisfactory source for market news but NOT for clinical or therapeutic opinion.

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1 hour ago, RiseAndGrind said:

5,100 dead now. Doubled in two days 

The good news is hot spots like NY have seemed to peaked with confirmed cases, which means the deaths will peak very soon hopefully. In nearly 95% of these deaths the individual had underlying medical issues, most commonly diabetes, which makes sense with the immune system being weakened in those. Looks like May will be the transitional period back to normality, as well as the time when a treatment will be available for the virus. Lets hope people continue distancing themselves from each other through this next month, so things continue to move in the right direction.

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That is nice JohnyJumpUP. As you are saying there is no reason to expect that all areas of the country will peak at the same time, or even that they will have a similar % of death among those infected. Let's hope NY starts trending down soon, followed by the rest of the country.

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10 hours ago, Old guy said:

 Just because I find this interesting I will report it. Don't feel any need to read this it is boring and factual. I was reading an article last night comparing mortality among Covid-19 patients that required ventilation. The data reported went up and down widely varying from a mortality of 30% or so of all ventilated Covid patients at certain hospitals, to 86% at other facilities. This proves a point, which is not anecdotal but valid even if it varies a lot. Hospitals use different criteria to place patients on ventilators, they also vary in their ability to handle the demands produced by having mutliple ventilation cases at the same time.

The whole idea of concentrating the attention on the number of ventilators available is idiotic, counting the number of machines does not in any way indicate the people handling the machines are uniformly good and have expertise in this field. When the number of ARDS patients increase, ventilation or not, the number of deaths will also increase. It is a LOT better to try to prevent progression of the disease to the terminal respiratory failure stage. This is the best way available to keep deaths of hospitalized Covid patients at a low level.

Listened to the NPR report yesterday on the use of ventilators to treat covid-19. From the healthcare staff interviewed, the disease so inflames and ravages the lungs that way north of 50% of patients don’t survive.

Just the insertion of the tube usually causes lung damage. It’s a brutal, ugly illness that in NO way resembles the flu, so you clowns who made this comparison citing your flu statistics, can  return to wearing your red noses and floppy shoes.

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We’ve arranged a society based on science and technology, in which nobody understands anything about science and technology. And this combustible mixture of ignorance and power, sooner or later, is going to blow up in our faces. Who is running the science and technology in a democracy if the people don’t know anything about it?

- Carl Sagan, 1996

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1 hour ago, billikenbill said:

Listened to the NPR report yesterday on the use of ventilators to treat covid-19. From the healthcare staff interviewed, the disease so inflames and ravages the lungs that way north of 50% of patients don’t survive.

Just the insertion of the tube usually causes lung damage. It’s a brutal, ugly illness that in NO way resembles the flu, so you clowns who made this comparison citing your flu statistics, can  return to wearing your red noses and floppy shoes.

https://ccforum.biomedcentral.com/articles/10.1186/cc8122 flu patients can also end up on ventilators, there was a shortage of ventilators during the swine flu epidemic, just a clown with an opinion

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2 hours ago, billikenbill said:

Big Bill Fan, my question for you is can you view your Faux News propagandists while wearing that big red nose?

TDS is a debilitating and progressive disease....stunning, that some are gloating over tragedy and death.....this forum has truly exposed the character of some....

 

oh, and since we loved to critique our President, how about taking a closer look at the guy you want running the country....must make you proud!

 

 

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36 minutes ago, BIG BILL FAN said:

TDS is a debilitating and progressive disease....stunning, that some are gloating over tragedy and death.....this forum has truly exposed the character of some....

No one is gloating. Absolutely no one is happy about thousands of deaths. 

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8 hours ago, JohnnyJumpUp said:

The good news is hot spots like NY have seemed to peaked with confirmed cases, which means the deaths will peak very soon hopefully. In nearly 95% of these deaths the individual had underlying medical issues, most commonly diabetes, which makes sense with the immune system being weakened in those. Looks like May will be the transitional period back to normality, as well as the time when a treatment will be available for the virus. Lets hope people continue distancing themselves from each other through this next month, so things continue to move in the right direction.

I hope you're right re: the number of cases in NY.  Although, I'm curious as to whether the actual cases have peaked or if testing has leveled off. I recall a chart from yesterday that showed the aggregate number of nationwide tests have been roughly the same the past few days. Also, this story states "New York City's Department of Health limits testing to hospital patients even as hospitals struggle to quickly turn around tests." 

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