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Thread: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

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    Moderator (on Sabbatical) Pam's Avatar
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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by David Trd1 (here)
    Quote Posted by Bill Ryan (here)

    If you want me to post my real suspicions, I can. But that's a different topic.

    Regardless of how this started, or any agenda behind it, real people are suffering and will suffer. This is not a Truman Show mirage.
    Bill I would be extremely interested to hear what your thoughts/suspicions are regarding this...?
    I second that, Bill we would like to hear your suspicions.

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Bill Ryan (here)
    Quote Posted by Franny (here)
    This tweet is important. It's the same in other countries, too.

    Many politicians and sports personalities worldwide ó and even celebrities like Tom Hanks and his wife ó are getting tested and turning out positive.

    That means something: of course, they're getting tested because they have influence and no-one's going to say 'No' to them if they ask for a test. But that's not the real point.

    The number turning out positive is the thing to look at. This group of publicly high-profile people is a TINY TINY % of the population. Yet look at the numbers of positives.

    What this means is that the numbers of actual positives in the whole population ó if they were all to be tested, which isn't happening ó is maybe 100x or even 1000x the currently reported numbers. We all have to confront the fact that this thing is just everywhere.

    I'd predict with high confidence (but some reluctance!) that many more politicians and celebrities will report being infected in the next few weeks. At some point, regular people will start to realize what this means for them.
    They are already realizing it. It is DIRE in the US.

    In complete callousness, companies are laying off their workers, throwing them out in the cold.

    Many, MANY people in the US are without Health Insurance as they are part-time casual workers. A full-time job with Health Care is a luxury in the US, most companies have split their jobs into part-time work to avoid paying benefits to people.

    People not only cannot afford to get tested or treated, now with mass layoffs of vulnerable low-paid workers, they will not even be able to afford to eat or even keep healthy.

    But never mind, for the lawmakers all is fine, business as usual:

    Quote Weíre kind of in a self-contained environment here, in some sense disconnected from whatís going on in the real world,Ē said Rep. Bruce Antone, D-Orlando. ďItís a disconnect and Iím not sure I can describe it.
    So never mind, lawmakers will still be hard at work making laws - at least they have their priorities right.

    Clinically insane, is the most polite thing I can say.
    Last edited by arwen; 13th March 2020 at 13:32.

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by carnavas (here)
    For someone who lives in Tehran, Iran I havenít gone outside the house for more than 20 days and thatís why I canít give anyone any insights about whatís happening outside Iím having fun and watching movies and have been following this thread since the beginning while appreciating everyone sharing their knowledge here, itís so far so good. I found all the elderberry and oregano and vitamin c and many other spices mentioned here. I donít see a full blown ghost town yet though the spread of the virus varies depending on which part of town and of course our people have always been ignorant as the only thing we have ran out of is masks. Some canít quit their jobs or work from home and my heart goes to them but there are still many unnecessary roaming as I hear, even many laughter and talkings outside our house in the street! Government lying? Of course even their own people are dead or maybe lying to escape but thats cause their all illiterate and donít know how to take care of themselves or the people. I bet we will and do have the worst case scenario but that wonít affect you much if you can self isolate and merge yourself in positive vibes (Iíve been making funny videos about the virus in my spare time). There are claims of many bank workers and nurses dying and thatís so sad I wish they knew more about vitamin c and these stuff going around and Iím trying my best to share. We order food and chicken for my rescue cats maybe once or twice a week and still didnít welcomed the bug and hopefully not. Well, take care and Iím here if anyone has any questions about things that I maybe know.
    carnavas. thank you so much for your post. It is so interesting to get your on the ground perspective from Tehran. I hope you will continue to keep us posted about your observations there. I so appreciate the international perspective we are getting on this thread.

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  7. Link to Post #1704
    Canada Avalon Member TomKat's Avatar
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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Franny (here)
    I must admit this was rather humorous.
    I think people are worried about being quarantined and running out of TP. That's all the sense I can make of it.

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Bill Ryan (here)
    Many politicians and sports personalities worldwide ó and even celebrities like Tom Hanks and his wife ó are getting tested and turning out positive.

    That means something: of course, they're getting tested because they have influence and no-one's going to say 'No' to them if they ask for a test. But that's not the real point.

    The number turning out positive is the thing to look at. This group of publicly high-profile people is a TINY TINY % of the population. Yet look at the numbers of positives.

    What this means is that the numbers of actual positives in the whole population ó if they were all to be tested, which isn't happening ó is maybe 100x or even 1000x the currently reported numbers. We all have to confront the fact that this thing is just everywhere.

    I'd predict with high confidence (but some reluctance!) that many more politicians and celebrities will report being infected in the next few weeks. At some point, regular people will start to realize what this means for them.
    I wonder how much of this has to do with how much these people travel, and hobnob around?

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Very sobering news indeed, from Italy



    Link: https://twitter.com/Freedoc_be/statu...88013789138945
    ďIf a man does not keep pace with [fall into line with] his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.Ē - Thoreau

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Tintin (here)
    Very sobering news indeed, from Italy



    Link: https://twitter.com/Freedoc_be/statu...88013789138945
    I heard this news on Tuesday, are they just getting word of this in Italy today?

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Default Re: The Wuhan Coronavirus [Covid-19]
    I confess this made me smile. Nepal has just closed Mount Everest.

    Bill, and that in turn reminded me of a humorous quote from WC Fields. " I went to Jersey City over the weekend. It was closed. "

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by TomKat (here)
    Quote Posted by Franny (here)
    I must admit this was rather humorous.
    I think people are worried about being quarantined and running out of TP. That's all the sense I can make of it.
    At the end of the day, there are alternatives to TP in a pinch. Running out of TP or paper towels is not life threatening. I think that a couple of videos of people hoarding TP led to the masses automatically following the lead without reasoning it out. I think it is a shining example of how easy we humans can be influenced and led.

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by thepainterdoug (here)
    Default Re: The Wuhan Coronavirus [Covid-19]
    I confess this made me smile. Nepal has just closed Mount Everest.

    Bill, and that in turn reminded me of a humorous quote from WC Fields. " I went to Jersey City over the weekend. It was closed. "
    Of course no normal people would go there in this weather , honestly ⛈

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    The list of drugs that may increase issues includes Ibuprofen....

    Quote Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
    Lei Fang
    George Karakiulakis
    Michael Roth
    Published:March 11, 2020




    .............Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs).4
    Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

    If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarising this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism.

    We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs. Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    This is a interesting presentation of viral mechanisms and differences about the novel corona virus.


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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    They just closed all schools in the state of michigan k thru 12 starting on monday for 3 weeks and maybe more. Also my relative works for one of the big insurance carriers , they told everyone to start working from home yesterday. Just an update here .

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Geophyz (here)
    Quote Posted by Tintin (here)
    Very sobering news indeed, from Italy



    Link: https://twitter.com/Freedoc_be/statu...88013789138945
    I heard this news on Tuesday, are they just getting word of this in Italy today?
    I've not long ago picked this up from our Avalon twitter feed, today. The doctor who tweeted this appears to be based in Belgium (_be being a clue there). Perhaps they've only, within their professional network, just received confirmation on who died. (Actually, Mar 12th according to the tweet).
    ďIf a man does not keep pace with [fall into line with] his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away.Ē - Thoreau

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    Avalon Member Delight's Avatar
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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Looks like UK may incline to let the epidemic peak in around 10-14 weeks? The bell curve described also has significant infection 3-4 weeks on either side.


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    UK Moderator/Librarian/Administrator Tintin's Avatar
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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Delight (here)
    The list of drugs that may increase issues includes Ibuprofen....

    Quote Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
    Lei Fang
    George Karakiulakis
    Michael Roth
    Published:March 11, 2020


    .............Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs).4
    Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

    If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarising this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism.

    We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs. Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.
    Very interesting article Delight. Thank you

    There's some good looking and helpful information there, for sure.

    I've popped it in the library now as a possible essential research piece.
    Last edited by Tintin; 13th March 2020 at 17:05.
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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Madrid is closed , my city too. Streets empty. People asked to stay at home. Long lines, not inside supermarkets, but to just come in. no fear, much love
    honoring White Feather: SHIFT HAPPENED

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    I am very disheartened by a number of my friends and family members...

    I started preparing for this outbreak back in mid January. I am now basically completely done preparing. I've got everything I need for a few months at home. Still, in my mind, this probably isn't enough. I just don't want to have to keep going out every few days to get groceries, etc (any exposing myself to possibly getting infected).

    Anyway, I live in the southeastern United States today I told a number of friends and family members that I am now always wearing an N100 mask and that I am fully stocked up on food, supplies, medicine, etc.

    My very good friend, who lives in New York City, absolutely crushed me with his response to what I was doing in preparation. First of all, he's 36 and lived in Bosnia during the Bosnian wars (in his backyard) and moved to the United States literally on 9/11. So, he's been through a lot. Anyway, he told me I was a typical dumbass American and that "hoarding" supplies and food is astronomically stupid. "Your a typical over-privileged white middle class American who has never been through a crisis in your life. I am not doing anything to prepare and I'm fine with it. If I die, I die."

    OK, that's fine. But, I grew up very poor (helping my mother walk up and down the neighboring roads looking for bottles to cash in for dinner everyday). My parents both lost their jobs at the same time in the early 1990s. My brother broke his neck the same exact day (almost ended up paralyzed). So, I have seen my own version of struggle. No, it wasn't a war. I didn't grow up in a war zone, but it was still an immense struggle. Luckily, through that struggle, I grew to absolutely love very basic food (spaghetti and sauce, etc, since we were so poor).

    Anyway, I feel very let down... I feel very bad about myself now because of these comments by my friend. I am actually very depressed about this. I feel like I am supposed to hate myself because I am white / middle class or something. My family struggled with money for close to a decade. Anyway... just venting here.

    I've prepped quite well. But when I started wearing my mask everyone started making fun of me... "Oh, you realize that only protects other people from getting infected BY YOU. It doesn't protect you from GETTING INFECTED. You know that right? You dumbass American."

    This makes no sense. If an N100 mask can protect from infecting others it surely can protect you from getting infected. Maybe not the eyes, but the nose and mouth at the very least.

    Anyway, I'm a bit heartbroken and sad right now that nobody I know is taking this seriously except for myself. I have 2 little kids and a wife that I am trying to keep safe. I am by no means rich. Sure, I am white but what does that have to do with anything?

    Would just love some words of support. I am really having a tough time with this reaction by my "friends"

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    Quote Posted by Delight (here)
    The list of drugs that may increase issues includes Ibuprofen....

    Quote Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
    Lei Fang
    George Karakiulakis
    Michael Roth
    Published:March 11, 2020


    .............Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARS-CoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels.4 The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs).4
    Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2.5 ACE2 can also be increased by thiazolidinediones and ibuprofen. These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.

    If this hypothesis were to be confirmed, it could lead to a conflict regarding treatment because ACE2 reduces inflammation and has been suggested as a potential new therapy for inflammatory lung diseases, cancer, diabetes, and hypertension. A further aspect that should be investigated is the genetic predisposition for an increased risk of SARS-CoV-2 infection, which might be due to ACE2 polymorphisms that have been linked to diabetes mellitus, cerebral stroke, and hypertension, specifically in Asian populations. Summarising this information, the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism.

    We suggest that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs. Based on a PubMed search on Feb 28, 2020, we did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.
    Great find, Delight!
    I was able to find 3 articles that may be relevant as far as natural Ace Inhibitors and ARBs (Angiotensin II receptor blockers).

    The first link has a table with a list of natural substances that are readily available. Many have already been mentioned here at PA. Be sure to click the table, and maybe download it.
    Hypertension: Is It Time to Replace Drugs With Nutrition and Nutraceuticals?

    The second link is about berberine. (also readily available). I thought of this, and searched it, as it has allowed my husband to come off his BP meds. (that, and Hawthorne Berry)
    Effects of berberine on angiotensin-converting enzyme and NO/cGMP system in vessels.
    Hawthorn: The Three-in-One Natural Remedy for High Blood Pressure
    "We're all bozos on this bus"

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    Default Re: The Wuhan Coronavirus [Covid-19, the Honey Badger virus]

    From the front line in Seattle, appears things are already pretty desperate:



    "Information from an Intensivist (ICU doctor) front line Seattle

    * we have 21 pts and 11 deaths since 2/28.
    * we are seeing pts who are young (20s), fit, no comorbidities, critically ill. It does happen.
    * US has been past containment since January
    * Currently, all of ICU is for critically ill COVIDs, all of floor medsurg for stable COVIDs and EOL care, half of PCU, half of ER. New resp-sx pts Pulmonary Clinic offshoot is open

    * CDC is no longer imposing home quarantine on providers who were wearing only droplet iso PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne iso PPE for aerosol-generating procedures in ANY pt in whom you suspect COVID, just to prevent the mass quarantines.

    * we ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs, which is not the manufacturer's recommendation. Not surprised on N95s as we use mostly CAPRs anyway, but still.

    *terminal cleans (inc UV light) for ER COVID rooms are taking forever, Enviro Services is overwhelmed. Bad as pts are stuck coughing in the waiting room. Rec planning now for Enviro upstaffing, or having a plan for sick pts to wait in their cars (that is not legal here, sadly).

    * CLINICAL INFO based on our cases and info from CDC conf call today with other COVID providers in US:

    * the Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data very skewed by late and very limited testing, and the number of our elderly pts going to comfort care.

    - being young & healthy (zero medical problems) does not rule out becoming vented or dead - probably the time course to developing significant lower resp sx is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb).

    - based on our hospitalized cases (including the not formally diagnosed ones who are obviously COVID

    - it is quite clinically unique) about 1/3 have mild lower resp sx, need 1-5L NC. 1/3 are sicker, FM or NRB. 1/3 tubed with ARDS.

    Thus far, everyone is seeing:
    - nl WBC. Almost always lymphopenic, occasionally poly-predominant but with nl total WBC. Doesn't change, even 10days in.

    - BAL lymphocytic despite blood lymphopenic (try not to bronch these pts; this data is from pre-testing time when we had several idiopathic ARDS cases)

    - fevers, often high, may be intermittent; persistently febrile, often for >10d. It isn't the dexmed, it's the SARS2.
    - low ProCalc; may be useful to check initially for later trending if later concern for VAP etc.

    - up AST/ALT, sometimes alk phos. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis at admit (150-200) correlates with clinical deterioration and progression to ARDS. LFTs typically begin to bump in 2nd week of clinical course. - mild AKI (Cr <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.

    * characteristic CXR always bilateral patchy or reticular infiltrates, sometimes perihilar despite nl EF and volume down at presentation. At time of presentation may be subtle, but always present, even in our pts on chronic high dose steroids. NO effusions. CT is as expected, rarely mild mediastinal LAD, occ small effusions late in course which might be related to volume status/cap leak.

    * Note - China is CT'ing everyone, even outpts, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs. Etc. 2 of our pts had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than CXR. - when resp failure occurs, it is RAPID (likely 7-10d out from sx onset, but rapid progression from hospital admit). Common scenario for our pts is, admit 1L NC. Next 12hrs -> NPPV. Next 12-24hrs -> vent/proned/Flolan.

    - interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you'd notice and say hmmm.

    - thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate.

    - given the inevitable rapid progression to ETT once resp decompensation begins, we and other hosps, including Wuhan, are doing early intubation. Facemask is fine, but if needing HFNC or NPPV just tube them. They definitely will need a tube anyway, & no point risking the aerosols.

    - no MOSF. There's the mild AST/ALT elevation, maybe a small Cr bump, but no florid failure. except cardiomyopathy.

    - multiple pts here have had nl EF on formal Echo or POCUS at time of admit (or in a couple of cases EF 40ish, chronically). Also nl Tpn from ED. Then they get the horrible resp failure, sans sepsis or shock. Then they turn the corner, off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less, then either VT->VF-> dead or PEA-> asystole in less than a day.

    Needless to say this is awful for families who had started to have hope.

    - We have actually had more asystole than VT, other facilities report more VT/VF, but same time course, a few days or a week after admit, around the time they're turning the corner. This occurs on med-surg pts too; one today who is elderly and chronically ill but baseline EF preserved, newly hypoTN overnight, EF<10. Already no escalation, has since passed, So presumably there is a viral CM aspect, which presents later in the course of dz.

    - of note, no WMAs on Echo, RV preserved, Tpns don't bump. Could be unrelated, but I've never seen anything like it before, esp in a pt who had been HD stable without sepsis.

    Treatment -

    *Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS.

    *Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting then rapidly back to normal - suggests not a primary toxic hepatitis.

    *unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID pts. Also CrCl>30, which is fine. CDC is working with Gilead to get LFT reqs changed now that we know this is a mild viral hepatitis.

    -currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin can't remember where.

    *steroids are up in the air. In China usual clinical practice for all ARDS is high dose methylpred. Thus, ALL of their pts have had high dose methylpred. Some question whether this practice increases mortality.

    *it is likely that it increases seconday VAP/HAP. China has had a high rate of drug resistant GNR HAP/VAP and fungal pna in these pts, with resulting increases mortality. We have seen none, even in the earlier pts who were vented for >10d before being bronched (prior to test availability, again it is not a great idea to bronch these pts now).

    - unclear whether VAP-prevention strategies are also different, but wouldn't think so?

    - Hong Kong is currently running an uncontrolled trial of HC 100IV Q8.

    - general consensus here (in US among docs who have cared for COVID pts) is that steroids will do more harm than good, unless needed for other indications.

    - many of our pts have COPD on ICS. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far pts are tolerating that, no major issues with ventilating them that can't be managed with vent changes. We also have quite a few on AE-COPD/asthma doses of methylpred, so will be interesting to see how they do."
    we have subcontracted the business of healing people to Companies who profit from sickness.

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