Covid-19 Update Aggie Physician

1,294,180 Views | 3660 Replies | Last: 2 yr ago by tamc91
Badace52
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This link has some real data to look at. The sources are listed below the data. Death rate by age is definitely good to look at as is death rate by co-morbidity.

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/?fbclid=IwAR1C1bY03zSB590OjEhEfAOohqM8WKDp9HG5go_7BEyRzjJHKgrQRFFtLmQ
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coastalaggie
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What are your thoughts on repatriating back to the US if you live or work abroad in country with little known cases? Don't want to get stuck on the wrong side of the wall if this thing goes sideways worst then it already is.
Fair Winds and Following Seas
Reveille
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Not sure how to answer this question. But I do think part of the hysteria is because to the public coronavirus is a new term. Definitely not trying to understate it. It is very serious and potentially deadly, but what if the influenza virus had significantly mutated.where the vaccine and medications did not work. What if we had a novel influenza-19 virus would people be as nervous? It would be almost the same situation. A new virus with no vaccine and treatment putting a lot of people at significant risk. High risk of overloading the healthcare system causing significant loss of lives. I seriously doubt you would see this type of reaction because i fight with patients every year to get the vaccine.
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agdidastech11
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Are those that have recovered from COVID-19 essentially immune from the disease, or is there still a risk of being re-infected?
aggie59
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Thanks Doc,after reading your post it reminded me to contact my Rheumatoid Arthritis Dr to see if he wanted to suspend my medication which suppresses my immune system,which we have done before when treating an infection.Like many other Ags just want to make it to see us win a National Championship in football.
Redassag94
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Is it possible to have the Coronavirus and only show minor symptoms like cough and sore throat (normal cold like symptoms) and NO fever?
Jet Black
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Redassag94 said:

Is it possible to have the Coronavirus and only show minor symptoms like cough and sore throat (normal cold like symptoms) and NO fever?
Yes.
Badace52
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If you read the OP's link you would know the answer to that is yes. This disease has minimal or no symptoms in many patients for an extended period and may or may not progress to shortness of breath over a number of days.

Edit: also check out the link I posted at the top of this page. It gives good perspective of what to worry about, what not to worry about, and really who should be the most worried. Spoiler alert: a lot of people who are worrying right now likely shouldn't be quite so concerned.
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Ag12thman
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Thanks for sharing this, Doctor. Would be a great sticky for at least a few days, IMO.
trident91
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Some of you should read all the blue posts, including the link posted in the very first post of this thread, before you post. There are a number of questions that probably won't get a response from Dr Coates because he has already answered it.
JDL 96
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Thanks for posting this Reville!
cc_ag92
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Thanks for the information. I smiled when I realized that my parents live across Murphy Road from your office.
Reveille
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If you can find one you should get one but luckily FLU season is almost over. You don't want to get the FLU and put more unnecessary burden on the healthcare system.
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Reveille
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That is exactly what you need to do until this thing clears or a viable vaccine is developed. Anyone on immunosupressive drugs that is not being prescribed for a life threatening disorder would be advised to hold them for a little while.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
MediAg13
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This is a great post. From one Aggie doc to another this is some of the most level headed information out there and I hope everyone takes it to heart.

I would like to add/emphasize one point for everyone and that is to NOT present to your local urgent care or ER for minor symptoms just to get tested. We are still for the most part taking direction from the public health department as to who we are allowed to test and there is a high chance you will not get tested with minor symptoms unless you have been around someone who has already tested positive. DO go if you are feeling severely short of breath or otherwise have concerning symptoms. If you are just wanting to be tested for epidemiological purposes call your local public health department for guidance. The ER is already a Petri dish and we're doing as much as possible to protect our patients from each other.
Reveille
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Redassag94 said:

Is it possible to have the Coronavirus and only show minor symptoms like cough and sore throat (normal cold like symptoms) and NO fever?
Oh finally, figured out how to respond with question in post! LOL

Yes you can which is one of the main factors why the denominator is off. This makes the virus hard to control because they don't they are sick. Up to 80% of patients have mild low grade or even sometimes no fever.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
CSTXAg92
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Reveille said:

For texags forum critics (football related as I have name in Kyle Field as Eppright donor) lol

If I have time I will try to answer any serious question you have here.
Great post Doc. Thank you for the information.

My laughing emoji is because you knew - even with a post as obviously serious and important as yours - on TexAgs there would be critics and huckster/jokester/sarcastic responses. I applaud your attempt to head those off at the pass.
Harkrider 93
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I have read that some studies think taking vitamin D would help. Of course some studies show it doesn't.

Should we take vitamin D that is still on the shelves vs vitamin C that isn't?
Mantis Toboggan MD
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PJYoung said:

Here's a TexAgs post from another thread:

Quote:

Marcus Aurelius
8:09p, 3/11/20

AG


I have a surgeon buddy who works at a hospital in Arkansas. Tells me they had a 30 y/o admitted with ARDS/respiratory failure. Long hospital course. Eventually expired. Family requested autopsy. Path report - ARDS due to, you guessed it, coronavirus. Not tested because lack of "travel hx/exposures." Egregious to me. Innumerable exposed there.

Healthy, no comorbidity. Died last week, autopsy posted yesterday. Not in the news or US statistics yet.
While this is unfortunate and certainly a sad case, in my mind, at this time it is more the exception than the rule, especially with the data gathered thus far. ARDS is not a unique consequence of COVID-19, in fact it has a multitude of potential inciting events, most commonly are bacterial pneumonias, viral pneumonias, medications, or environmental toxins, just to name a few. I recently had a healthy, 30-something year old female with no past medical history quickly progress to respiratory failure due to influenza, which she had contracted from her significant other who recently completed Tamiflu maybe a week earlier. Within 72 hours of presentation to the hospital she was intubated and eventually died due to ARDS stemming from influenza.

Generally in ARDS, following an inciting event, there is widespread inflammation that targets the thin membrane in our lungs that facilitates gas exchange. This leads to profound hypoxia and quickly progresses to respiratory failure requiring intubation. The unfortunate part about ARDS is that although these patients require mechanical ventilation to maintain oxygen levels, mechanical ventilators can actually worsen the hypoxia and possibly kill these patients. This is because ARDS causes changes that make our lung tissue very heterogenous, with certain areas very fragile that are damaged by positive airway pressure utilized in ventilators. Honestly, medicine does not understand ARDS very well, and when someone progresses to it providers usually will end up throwing the kitchen sink at them, regardless of it is COVID-19 related or not. ARDS carries a grim prognosis, regardless of how healthy you are. Quickly referencing some of my old lecture materials, roughly 80% of patients who meet ARDS criteria require intubation and it carries a high mortality rate (~30-45%).

So, although unfortunate and scary, I am not surprised that there are cases of young patients dying from COVID-19 due to progression to ARDS. ARDS is scary because it can affect anyone, and the treatment for it (which is primarily supportive and treating the underlying cause) can actually cause you to worsen. But whenever I hear of a younger/health patient with COVID-19 who dies, I immediately assume it was likely due to ARDS, or some other type of organ failure (either sepsis or particularly a viral-induced cardiomyopathy). I suspect that as the virus continues to spread throughout the world there will be a coinciding proportional increase in young/healthy patients that may progress to ARDS. Overall I hope this remains the exception, but what would be more concerning to me is if we started to see increasing numbers of severe cases/death of COVID-19 in young/health patients.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
3rd Generation Ag
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I keep my flu season immunity vitamins and have started them back up. D3, E, Zinc, C. Not sure they will help but don't wee how they can hurt. And B12.
Kydero
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Why was the swine flu, which also was a pandemic, not treated as seriously as Covid-19?

Universities didn't close, athletic events weren't cancelled.
BQ MOM
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Staff
S
Thank you so very much for doing this, Reveille. I have "stickied" this thread so that it will remain at the top of the forum. If ever a post needed to be viewed, this is it.

And...also love that you hang that tu diploma upside down.
Pahdz
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probably should make it free to view for non-subscribers as well
aggiewilliford
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Thanks Doc and Gig Me!
Gig Em Ags, God Bless Old Army and Marching in Behind the Band! Whooooopppp
cr0wbar
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Pahdz said:

probably should make it free to view for non-subscribers as well
I think the thread should be moved to a more transparent forum
aggierogue
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"This virus is not airborne but is spread through respiratory droplets."

Is this actually known?

The "expert" on Rogan's podcast, who has an impressive resume in infection disease epidemiology, stated definitely that it IS airborne.

The CDC is very noncommittal on transmission. As far as I can find, the CDC says NOTHING about whether it is airborne. I can't believe they won't even say it's unknown, if that's the case. They say "COVID-19 is a new disease and we are still learning how it spreads" and "The virus is thought to spread mainly from person-to-person' and "It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their [face]"

Seems pretty crazy there's so much uncertainty on the transmission basics.




Frisco86
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You noted that you fight (aggressively urge) your patients to get flu shot.

I have never received one. Luckily, I guess, I have never got the flu (knock on wood). Question: You noted that if you get a bug your body develops antibodies that then can be deployed if the bug reoccurs and thus you don't get sick - ie build an immunity to it. So if you get a flu shot, does that build these antibodies? If so, then do you need to get flu shot every year? Seems like it is pushed to get your annual flu shot. Or does the shot just reduce the severity of the flu if and when you do get it?

I will hang up and listen. Thanks.
aggierogue
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Also don't understand why the CDC says "CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19."

They clearly don't fully understand how it's transmitted, but they advise against wearing a mask. Why? Seems like there's only an upside, and no downside.
harrierdoc
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Something to think about -

if all of this "social distancing" was really important, where would you think the very first area should be to implement this? Think of a location that people are in close quarters, don't practice hygiene very well, and the population isn't isolated, like in boot camp...

K-12 schools.

Sure, these kids may not get really sick from this, like the majority of us, but they are going back home to their families, many with pregnant mothers, or going to see grandparents or other family members.

If we, as a society, were serious about this, we would stop all schools. But, can you imagine the outcry from the people that have to have their kids in school for work? What about money for the school districts? I guess you could just close schools now for a month or 2, then go to school over summer. More outcry.

So, the fact that our leaders aren't willing to do this simple step tells me that all this hand ringing is nothing more than fear and legal posturing, rather than good population medicine.
AggieBaseball06
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Frisco86 said:

You noted that you fight (aggressively urge) your patients to get flu shot.

I have never received one. Luckily, I guess, I have never got the flu (knock on wood). Question: You noted that if you get a bug your body develops antibodies that then can be deployed if the bug reoccurs and thus you don't get sick - ie build an immunity to it. So if you get a flu shot, does that build these antibodies? If so, then do you need to get flu shot every year? Seems like it is pushed to get your annual flu shot. Or does the shot just reduce the severity of the flu if and when you do get it?

I will hang up and listen. Thanks.


I'm not a doctor but as I understand it, it's a different strain of flu every year. So Elko can teach his defense thr fundamentals of defense but he still has to install a different game plan when he's playing Texas State vs when he's playing Alabama. The flu shot is designed for the specific strains that they are predicting each year.

Alta
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If somebody had the virus but is now recovered is there a way to ever determine if they did in fact have the virus?
Lemmys Rickenbacker
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aggierogue said:

"This virus is not airborne but is spread through respiratory droplets."

Is this actually known?

The "expert" on Rogan's podcast, who has an impressive resume in infection disease epidemiology, stated definitely that it IS airborne.

The CDC is very noncommittal on transmission. As far as I can find, the CDC says NOTHING about whether it is airborne. I can't believe they won't even say it's unknown, if that's the case. They say "COVID-19 is a new disease and we are still learning how it spreads" and "The virus is thought to spread mainly from person-to-person' and "It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their [face]"

Seems pretty crazy there's so much uncertainty on the transmission basics.





The expert on Rogan's podcast was going by his opinion on most of what he is saying and not fact. There is just not enough data yet.
MediAg13
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The flu vaccine provides some immunity beyond just the one year so by stacking vaccines every year you're doing yourself a favor. Even if this years vaccines "isn't perfect" you may get some protection from last years vaccine.

An anecdotal example would be all the doctors at the hospital. We all are forced to have the vaccine every year. Sometimes I see dozens of flu positive patients daily for weeks and weeks during peak flu season. Everyone in the household has the flu. None of them are vaccinated. Yet after seeing hundreds of these patients I still do not have the flu.
Badace52
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Well it is a new virus and studies are lacking, but viruses in the coronavirus family all have relatively large viral particles and so far all the human coronaviruses have been spread by droplet. It is therefore highly unlikely to be spread by airborne transmission.

It is also worth noting that airborne transmission likely doesn't mean what the lay person thinks it means. To be considered an airborne transmission the virus has to have the ability to aerosolize and hang around in the air floating on small particles for extended periods of time so that if someone were to cough in a room and then leave and another person came into that same room several minutes later, the viral particles would still be floating in the air in sufficient quantity to spread infection.

If someone coughs directly onto you or within six feet and you catch the virus "through the air" that is not airborne transmission. It is droplet transmission.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Mantis Toboggan MD
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AggieBaseball06 said:

Frisco86 said:

You noted that you fight (aggressively urge) your patients to get flu shot.

I have never received one. Luckily, I guess, I have never got the flu (knock on wood). Question: You noted that if you get a bug your body develops antibodies that then can be deployed if the bug reoccurs and thus you don't get sick - ie build an immunity to it. So if you get a flu shot, does that build these antibodies? If so, then do you need to get flu shot every year? Seems like it is pushed to get your annual flu shot. Or does the shot just reduce the severity of the flu if and when you do get it?

I will hang up and listen. Thanks.


I'm not a doctor but as I understand it, it's a different strain of flu every year. So Elko can teach his defense thr fundamentals of defense but he still has to install a different game plan when he's playing Texas State vs when he's playing Alabama. The flu shot is designed for the specific strains that they are predicting each year.


More or less correct, the influenza vaccine is developed based on the year prior's most prevalent strains of influenza (e.g. H1N1, H3N2 etc). Influenza mutates quickly through a process called antigenic drift, so the vaccines can be hit or miss some years. Anecdotally my guess is this years vaccine was not very efficacious.

Regardless of how effective it is, I encourage all patients to receive the flu shot, unless contraindicated, with the caveat that although it does not guarantee that you won't contract the flu, it likely will reduce symptom severity and possibly symptom duration. Putting it another way, I rarely hear patient's tell me, "I wish I didn't get that flu shot". Instead, more often than not I usually hear, "I should have gotten the flu shot" when someone comes in with flu-like symptoms.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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