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Thread: Covid 19 Sci/med discussions only

  1. #21
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    Must read, and ties in with doc in the OP, etc:

    April 7, 2020 -- As doctors treat more patients who are severely ill from COVID-19, they’re noticing differences in how their lungs are damaged.

    Some patients coming to the hospital have very low oxygen levels in their blood, but you wouldn’t necessarily know it from talking to them. They don’t seem starved of oxygen. They may be a little confused. But they aren’t struggling to breathe.

    When doctors take pictures of their lungs -- either with a CT scanner or an X-ray machine -- those also look fairly healthy. The lungs may have a few areas of cloudiness and crazing, indicating spots of damage from their infection, but most of the lung is black, indicating that it is filled with air.

    https://www.webmd.com/lung/news/2020...-lung-problems
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  2. #22
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    Quote Originally Posted by WillBrink View Post
    Must read, and ties in with doc in the OP, etc:

    April 7, 2020 -- As doctors treat more patients who are severely ill from COVID-19, they’re noticing differences in how their lungs are damaged.

    Some patients coming to the hospital have very low oxygen levels in their blood, but you wouldn’t necessarily know it from talking to them. They don’t seem starved of oxygen. They may be a little confused. But they aren’t struggling to breathe.

    When doctors take pictures of their lungs -- either with a CT scanner or an X-ray machine -- those also look fairly healthy. The lungs may have a few areas of cloudiness and crazing, indicating spots of damage from their infection, but most of the lung is black, indicating that it is filled with air.

    https://www.webmd.com/lung/news/2020...-lung-problems
    Well if blood flow to places like the kidneys can be restricted with covid-19 it would stand to reason that blood flow to the lungs could also be affected.
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  3. #23
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    Quote Originally Posted by Arik View Post
    So far doesn't seem to be. People have been tested positive after recovering but there is a rather large failure rate for the tests and it seems that those who really did test positive again we're not reinfected but instead the virus was dormant
    Yeah the error on testing seems to be a real issue adding noise to this. I don’t envy those trying to make sense of all this.

  4. #24
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    Quote Originally Posted by ABNAK View Post
    Well if blood flow to places like the kidneys can be restricted with covid-19 it would stand to reason that blood flow to the lungs could also be affected.
    The lungs are especially sensitive to oxidative stress and damage likely manifests itself and multi organ involvement and failure via cytokine storm follows. That's my working hypothesis and I feel the real missing opportunity in treatment is to address that aspect and prevent the type L phenotype -> type H transition. Some docs are figuring that out and seeing real clinical success, most are not and unable or unwilling to buck the system.

    His small series of vids are worth viewing:

    https://www.youtube.com/channel/UCNg...NwKdfGiXp8WILg

    He decided he could not in good consciousness continue to intubate people who clearly didn't need it, and he explains what happened after that.

    While it's clear he realizes what they are seeing is not classic ARDS, he does not appear to have made the leap in terms of what I'm talking about as it pertains to type L -> type H transition and avoiding that.
    Last edited by WillBrink; 04-16-20 at 20:16.
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  5. #25
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    The L type phenotype seems to closely resemble HAPE:

    Cureus. 2020 Mar; 12(3): e7343.

    Acetazolamide, Nifedipine and Phosphodiesterase Inhibitors: Rationale for Their Utilization as Adjunctive Countermeasures in the Treatment of Coronavirus Disease 2019 (COVID-19)

    "Effective treatments for Coronavirus Disease 2019 (COVID-19) outbreak are urgently needed. While anti-viral approaches and vaccines are being considered immediate countermeasures are unavailable. The aim of this article is to outline a perspective on the pathophysiology of COVID-19 in the context of the currently available clinical data published in the literature. This article appreciates clinical data published on COVID-19 in the context of another respiratory illness - high altitude pulmonary edema (HAPE). Both conditions have significant similarities that portend pathophysiologic trajectories. Following this potential treatment options emerge."

    Full paper:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096066/
    Last edited by WillBrink; 04-16-20 at 14:39.
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  6. #26
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    This excellent doc has been updated:

    EVMS CRITICAL CARECOVID-19 MANAGEMENT PROTOCOL by Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School:

    https://www.evms.edu/media/evms_publ...9_Protocol.pdf
    - Will

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  7. #27
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    I like Will’s idea of a decent thread that won’t go immediately tinfoil.

    Journal of American Medical Association published a small study that found 21% of the COVID-positive folks had co-incident respiratory infections. The study occurred last month in Northern California and gives an idea on how the disease may act in flu season.

    This is bad news for testing efficacy. COVID did not crowd out other infections, as was rumored by early Chinese information. When everything else was ruled out, a presumptive was more likely COVID or at least a COVID test would be easier to justify. The 20% co-incident infection findings muddy the clinician’s role.

    It also seems to effectively undermine the General CDC direction to clinicians. It appears that clinician guidance was last updated by the CDC in February.
    https://jamanetwork.com/journals/jam...rticle/2764787

  8. #28
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    Quote Originally Posted by WillBrink View Post
    This excellent doc has been updated:

    EVMS CRITICAL CARECOVID-19 MANAGEMENT PROTOCOL by Paul Marik, MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School:

    https://www.evms.edu/media/evms_publ...9_Protocol.pdf
    Thank you. I've been struggling to keep current with what is what and that was very useful.
    It's hard to be a ACLU hating, philosophically Libertarian, socially liberal, fiscally conservative, scientifically grounded, agnostic, porn admiring gun owner who believes in self determination.

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  9. #29
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    Quote Originally Posted by HardToHandle View Post
    I like Will’s idea of a decent thread that won’t go immediately tinfoil.

    Journal of American Medical Association published a small study that found 21% of the COVID-positive folks had co-incident respiratory infections. The study occurred last month in Northern California and gives an idea on how the disease may act in flu season.

    This is bad news for testing efficacy. COVID did not crowd out other infections, as was rumored by early Chinese information. When everything else was ruled out, a presumptive was more likely COVID or at least a COVID test would be easier to justify. The 20% co-incident infection findings muddy the clinician’s role.

    It also seems to effectively undermine the General CDC direction to clinicians. It appears that clinician guidance was last updated by the CDC in February.
    https://jamanetwork.com/journals/jam...rticle/2764787
    The problem with the Wuhan thread wasn’t the free flow of ideas and information, it was the maturity and civility of some of the member posting in it.

  10. #30
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    Quote Originally Posted by VARIABLE9 View Post
    The problem with the Wuhan thread wasn’t the free flow of ideas and information, it was the maturity and civility of some of the member posting in it.
    Been nice had they just been given a vacation and kept all the info within one location but that’s just my OCD speaking. Sorry for the sidetrack, carry on.

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