Covid-19 Update Aggie Physician

1,294,400 Views | 3660 Replies | Last: 2 yr ago by tamc91
Reveille
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Pahdz said:

probably should make it free to view for non-subscribers as well
Sorry that was my mistake for posting here. Have been running on little sleep but I agree and feel bad that I didn't think of that prior to posting. I posted here because that is where I come the most.
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Reveille
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Alta said:

If somebody had the virus but is now recovered is there a way to ever determine if they did in fact have the virus?
Not sure but I think they have developed titers that they could run but focus right now is more on active cases, treatments and prevention of new cases.
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Reveille
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MediAg13 said:

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.
This is very true!! Everyone should could the FLU vaccine every year. The FLU has many strains which is why we have to re-vaccinate annually.
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Reveille
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Badace52 said:

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.


Well said very accurate.
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Reveille
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Mantis Toboggan MD said:

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.
Another good piece of advice.
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MediAg13
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Legalize-It-Ags said:

Hey Dr. Rev,

I have a question about the mortality rate of COVID-19 and the Flu. Both are bad for the elderly and those with underlying medical conditions, but which one is more deadly for those that are considered at high risk? I know the normal Flu has kills tens of thousands of people per year. But there has only been a couple thousand deaths world wide out of maybe 120,000 total cases. I just have a hard time seeing this being deadlier than the normal flu. I understand that it is 10-15x more infectious than the flu and if it gets out of hand, it could create a real problem. I'm no expert by any means, I'm just a dude trying to wrap my head around this.

So currently you've got 4718 deaths and 127,863 cases world wide which is a 3.69% mortality (this is probably over estimated due to lack of denominator). If you extrapolate that to say 50 million infected by the flu each year (which spread is more limited due to vaccines and rapid onset of symptoms) you're looking at 1,844,943 deaths. Way way higher than the 20-50,000 deaths from the flu. There is a reason to take every precaution with so many unknowns and the potential for such a high downside. I'm not saying 1.8 million people are about to die but I am just saying this isn't as "stupid" as people keep saying it is.
highpriorityag
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The # of cases is far more than reported, the death rate is lower than 4%.
74OA
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SECDEF issues travel restrictions. If the military is concerned, I'm concerned: STANDSTILL
Governor
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I would also highly recommended the sub-Reddit:

COVID-19 Sub-Reddit

Its heavily moderated and focused only on medical research that has been published about nCoV-19.

Examples:

Case Study: 6m infant in Signapore - shows high viral loads, NO symptoms, 16 days of testing positive

Some of the studies are not for the layman but usually someone in the comments translates.
Aggie1
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Pumpkinhead said:

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/

Quote:

The Extraordinary Decisions Facing Italian Doctors

There are now simply too many patients for each one of them to receive adequate care.
Recommend reading this article.


Having provided healthcare in Italy via US Military Medicine in several locations I can provide a bit of information that might be useful for several reasons.

Italy - like other European countries - provides "socialized medicine" - which is limited to whatever the Italian government chooses to appropriate. As a result the healthcare system in Italy is grossly inadequate to begin with for many reasons - and most frequently limited and restricted based on funds available. During good times it is not uncommon to wait for months to see a provider for "normal" healthcare requirements - albeit rationed based on funds available.

There are far more M.D.'s than there are positions available and thus the Docs that have a position often have a group of other unemployed but interested Docs who have no position but who are trying to stay "available" following on their coattails. For instance, I have visited many Italian hospitals where it looks like care is being given by groups of 12-20 docs but only one is employed.

To follow, basic daily support such as clean linens, food, emptying soiled containers and cleaning for reuse, sitting nearby to call for help is needed as few nurses and often no nurse call is otherwise available.
Multiply this scenario across the entire country and you get an idea of the level of healthcare available during the good times let alone during this pandemic circumstance.

Furthermore, IF a patient is on a government waiting list but able to pay directly for care, he/she can usually be seen same day or soon thereafter by the same docs, in the same facility - after 4 PM in the afternoon and until usually 8PM or so. Those who really have serious health issues and can afford it will travel to the US (or Ireland yes that's what I said) to get their healthcare at places like Texas Medical Center/Methodist/MD Anderson, Johns-Hopkins, Cleveland Clinic, Mayo, etc.

So, you can imagine when a "pandemic" like the ongoing CoronaVirus hits what happens! It ain't pretty - and most of the world including Europe, the UK, the Middle East, Africa, Far East, even Canada, etc - any country under socialized medicine is having the same recurring problem. Not enough facilities, not enough providers, not enough funds - and "panic" is the result.

I am not saying the USA is free of worry - by any means! I'm just saying we are much better prepared than any other nation in the world to address and hopefully contain this situation. With the numbers that some forecasters are talking, even the US will not be able to house everyone - but we will be a lot better off than any other country in the world...

And that's one of the main reasons that "socialized" medicine is folly!! Especially in the USA where we are used to the best.

As a parallel, you know Germany used to laugh at the USA when we had 55 MPH speed limits. They said they would never reduce the quality of their vehicles to just meet the lower limits - and by golly they didn't and their vehicles typically are top of the line today. The US should heed that for our magnificent healthcare system.
Unfortunately Germany has socialized medicine and has the same situation described above in Italy for healthcare.

The US must not under any circumstance fall into that socialized medicine trap...
Or we will all be paying over 50% personal income tax to try to achieve rationed care based on congressional appropriations like the rest of the world And then where would be go to receive better care even for those who have the $$?
AAAAAAAAAAg - Air Force Aggie Architect and Hospital Administrator fm Amarillo, Altus, Austin, Arabia, Arkansas, Africa, Seoul, Bahrain, Amman, Kuwait, Iraq, Iran, Saudi, DFW-Fairview, Ramstein, San Antonio, Pentagon, OKC, JCAHO/JCR - '65, '69, '73 - A&M Letterman (ret).
Winston Churchill: “If you’re not a socialist in your twenties, you have no heart. But if you’re not a capitalist in your thirties, you have no mind.”
Scoopen Skwert
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You forgot about the mafia running things and the locals walking out and sitting outside the fence until someone's pocket is fattened.
Bupkis
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TexAgs knows things!
Thanks Revielle and others.
GuatemalanAg
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Hanging your t.u. diploma upside down is so redass!!!
Thanks for posting this
Scoopen Skwert
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Bupkis said:

TexAgs know things! Thanks Revielle and others.


If we can find a cooler we can find a cure!!! That's our new motto.
Pahdz
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No apologies needed, just glad you posted it
Governor
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And yet Italy has a higher life expectancy than the US (83.5 yrs vs. 78.9 yrs).

Please take the political comments to the right board.
Aggie1
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bh93 said:

You forgot about the mafia running things and the locals walking out and sitting outside the fence until someone's pocket is fattened you.
You are absolutely correct!

I knew a Hospital Administrator for a US Military Hospital rent a beautiful enormous block square villa for peanuts.
His Hold Baggage goods disappeared the day of arrival and delivery as he went to market for groceries.
After checking around he was told he had to pay the Mafia to "watch" his new villa and its contents.
He found the Mafia guy and came to agreement.
Meanwhile his Household Goods shipment was delivered and he bought some new stuff.
His Household Goods and new stuff disappeared next day.
He goes to his Mafia pay off guy - WTH?..
Who informs him he also has to pay the Cosa Nostra guy to protect his stuff as well,.
He ended up paying two groups to watch his stuff.
True story!!

Italy has many difficulties that require getting used to... Not the least of which is "pick pockets"...
Reveille
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DTP02 said:

aggierogue said:

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.


A big part of them saying that is to prevent a shortage of masks for people who really need it, such as people who are sick (to help prevent spreading) and people who work in healthcare and are constantly exposed.

The other part is that studies have shown that having a mask on your face can increase the number of times you touch your face and have the undesired impact of making it more likely that you are bringing the virus closer to your mouth and eyes. The gain in wearing a mask that might catch some airborne droplets would thus by offset by the increased risk of additional touches to your face to adjust the mask, subconsciously scratch at the elastic, etc.


Wearing a mask is not to protect you from getting sick but it is to protect a sick individual from infecting others. If you put it on a sick individual then they are not coughing and sneezing respiratory droplets containing the virus into the air.

If you put it on a healthy individual you are still sucking the air in around the gaps of the mask. We do not wear them in clinics and hospitals except around immunosuppressed patients to protect them.
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Reveille
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Illuminaggie said:

Thank you for the thread, doc. Great information and service for the community.

I have a couple of bits of information I've been unable to find. Perhaps you might be able to give so e insight.

1. The average rate of hospitalization for symptomatic patients under 60.

2. The average length of hospitalization for patients who develop serious or critical illness.

God Bless and stay strong.


I have not seen any information on length of stay. The focus is on survival rates but no one is caring how long it takes to save them yet. Over time insurance companies will for sure be analyzing that type of information.
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Bob_Ag
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Sandman98 said:

Three weeks ago, before anyone here thought much about COVID-19, my 13 yo son had a fever between 102-105 for five days. He tested negative for flu but they gave him Tamiflu anyway (said he was probably tested too early).

At a follow up with a different doctor she said it's just some random virus because Tamiflu did NOT improve his symptoms after five days. No mention whatsoever of Corona. My other son showed milder symptoms. I'm aware of several kids in our circle who had a similar experience. All have recovered albeit rather slowly.

Do you think there were many undiagnosed cases in the early stages before panic took hold?
I think when we start getting a better volume of data, we are going to find out that the number of infections is a lot more than what we currently know. I'm betting there is a significant portion of the population that has already had COVID-19 and only showed mild symptoms.
Reveille
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Harkrider 93 said:

I am pretty sure it was some Harvard Dr that talked about that Princess? cruise ship that was quarantined.

His claim was that ship was the best testing environment so far. Those people were stuck in there with people who had the virus and they know only one person brought it on. I don't think he talked about the ability to spread specifically, but if it was airborne, wouldn't practically everyone on that ship gotten the virus? Or at least one section (maybe they did).


I would agree with that assumption! A completely airborne virus would be very difficult to contain in that environment!
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74OA
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BQ MOM said:

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.
As a public service, this post should be linked and stickied for Ags over on the General and Politics boards, too, not just here on the pay board.
74OA
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JetAg said:

This is all great information! Thank you Reveille.

***STAFF*** is there anyway to sticky this on a different board so we can share with other Aggies/family members that do not have premium access?
Reveille
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Bob_Ag said:

Sandman98 said:

Three weeks ago, before anyone here thought much about COVID-19, my 13 yo son had a fever between 102-105 for five days. He tested negative for flu but they gave him Tamiflu anyway (said he was probably tested too early).

At a follow up with a different doctor she said it's just some random virus because Tamiflu did NOT improve his symptoms after five days. No mention whatsoever of Corona. My other son showed milder symptoms. I'm aware of several kids in our circle who had a similar experience. All have recovered albeit rather slowly.

Do you think there were many undiagnosed cases in the early stages before panic took hold?
I think when we start getting a better volume of data, we are going to find out that the number of infections is a lot more than what we currently know. I'm betting there is a significant portion of the population that has already had COVID-19 and only showed mild symptoms.


I absolutely agree there is a tremendous number of people walking around with virus unknown to them. That is why the cases will rise rapidly as we are seeing but the mortality rate will decline.
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Reveille
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maroonbeansnrice said:

26 of the total 39 deaths at present in the USA were at a nursing home on the west coast. Will we ever find out what happened there? Very strange. I'm guessing the patients had private or semi-private rooms. Even if they have communal areas it seems; the facility would have to be severely under-staffed (a sick employee(s) would almost have to go to every room coughing/sneezing on each and every patient), and/or have some kind of extremely unsanitary practice for this to have spread as rapidly and thoroughly as it did.

It seems like what happened there would be extremely important information to have as it pertains to the spread of this virus.

What are your thoughts on this?


Nursing homes are notorious for spreading infections! This is not really that surprising once the virus got in it would be difficult to prevent it from spreading as the patients have multiple medical problems and are immunosuppressed!
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Illuminaggie
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Reveille said:

Illuminaggie said:

Thank you for the thread, doc. Great information and service for the community.

I have a couple of bits of information I've been unable to find. Perhaps you might be able to give so e insight.

1. The average rate of hospitalization for symptomatic patients under 60.

2. The average length of hospitalization for patients who develop serious or critical illness.

God Bless and stay strong.


I have not seen any information on length of stay. The focus is on survival rates but no one is caring how long it takes to save them yet. Over time insurance companies will for sure be analyzing that type of information.
Thank you, Rev. The only numbers I've seen on it are from China and was hopeful comparative data might be available.
BubbleBoyB
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Excellent Stuff and thank you! Wish I found this sooner. Replying just to get notifications
Reveille
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Legalize-It-Ags said:

Hey Dr. Rev,

I have a question about the mortality rate of COVID-19 and the Flu. Both are bad for the elderly and those with underlying medical conditions, but which one is more deadly for those that are considered at high risk? I know the normal Flu has kills tens of thousands of people per year. But there has only been a couple thousand deaths world wide out of maybe 120,000 total cases. I just have a hard time seeing this being deadlier than the normal flu. I understand that it is 10-15x more infectious than the flu and if it gets out of hand, it could create a real problem. I'm no expert by any means, I'm just a dude trying to wrap my head around this.


In all likelihood it is almost certain this will be deadlier then the FLU. The flu has a fatality rate of around 1-2 per thousand while coronavirus is about 35 per thousand. However, as I have said the denominator is way too small for coronavirus. We expect it to drop to around 3-6 per thousand as more cases are diagnosed.

However, the total number of deaths I do not expect to surpass the FLU because of all the protective measures being employed. That could change fast though if the hoarding of antiseptics continues.
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Reveille
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YNWA_AG said:

I am 25 and have crohns and psoriatic arthritis. Am I supposed to stop taking my suppressants?


I would talk with your physician but I am recommending to my patients to stop all unnecessary immunosuppressive drugs!
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Reveille
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doctorAg13 said:

bh93 said:

"Chest CT?" On a pregnant pt? Umm is that medically necessary?

Correct

That's ~7 mSv vs .1 mSv for a chest x-ray.
It's a risk/benefit calculation any time imaging is performed on pregnant patients. The potentially deleterious effects on the fetus are largely restricted to the first trimester, which is also when the patient can easily be shielded for the exam. This is not even an issue in an immediately life-threatening situation.
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Reveille
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harrierdoc said:

But once it is in the community, given the variable presentation, you've waited too long to keep people separated.

We are a social animal. We will always find ways to get together. I don't think there is any way to really affect this, or any other viral pathogen that is in the community. I think it's better to try to come up with a vaccine, and just let the virus spread through the population until then. Otherwise, we are just trying to put a small band-aid on a huge laceration.

Teens and college kids aren't going to stop hooking up and swapping bodily fluids because they may get a cold. Heck, they do it knowing they can get STD's that can affect them for life.



There lies the problem. We don't have access to a vaccine yet and people are not going to want to isolate themselves.
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Reveille
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Sandman98 said:

Three weeks ago, before anyone here thought much about COVID-19, my 13 yo son had a fever between 102-105 for five days. He tested negative for flu but they gave him Tamiflu anyway (said he was probably tested too early).

At a follow up with a different doctor she said it's just some random virus because Tamiflu did NOT improve his symptoms after five days. No mention whatsoever of Corona. My other son showed milder symptoms. I'm aware of several kids in our circle who had a similar experience. All have recovered albeit rather slowly.

Do you think there were many undiagnosed cases in the early stages before panic took hold?


Kids get viruses like that so the time,. Coronavirus being one of them but that was not likely at all to be Covid-19 that far back. We usually call it a viral syndrome because not with the money to do a viral culture since it changes nothing.
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Reveille
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Capitol Ag said:

I am 46 years old. I take an immunosuppressant called remicade every 10 weeks for my ulcerative colitis. Been in Remission for 12-13 years. Last injection was early February. I'm also in great shape and train extremely hard mostly with barbells and I weigh about 214, low body fat (humble brag). I get that I'm "at risk" and I handle all things I have been doing for years that way. Wash hands, don't share food, avoid hands to face etc.

Given my level of physical fitness, do I still count as "at risk" and what is your advice on how to proceed, if anything? I currently am the head trainer at a local gym as well. So avoiding the gym is not an option b/c of work. Oh and the gains. Gotta make my gains.


I would talk with your gastroenterologist but yes you would be at higher risk just because of the remicaid so if you can I would likely take a short medication break.
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Reveille said:

Kydero said:

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.
Swine FLU was simply a version of Type A influenza and was treated with Tamiflu. It was rare that it progressed to a fatality since we had treatments available.
It was quite a few fatalities.

"The swine flu, or influenza A (H1N1) virus caused the 2009 global pandemic. An estimated 151,000-575,000 people worldwide died from the H1N1 virus in 2009. Of those, there were an estimated 12,400 deaths in the U.S."
“It ain’t like it used to be.”
-Jimbo Fisher
Reveille
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DTP02 said:

harrierdoc said:

But once it is in the community, given the variable presentation, you've waited too long to keep people separated.

We are a social animal. We will always find ways to get together. I don't think there is any way to really affect this, or any other viral pathogen that is in the community. I think it's better to try to come up with a vaccine, and just let the virus spread through the population until then. Otherwise, we are just trying to put a small band-aid on a huge laceration.

Teens and college kids aren't going to stop hooking up and swapping bodily fluids because they may get a cold. Heck, they do it knowing they can get STD's that can affect them for life.



The goal isn't to prevent the virus from spreading. That'd be nice, in theory, but isn't realistic. The virus is going to spread and it's almost certainly going to hit just about every community and a huge chunk of the world's population is going to be infected at some point.

The goal is to slow down the spread by taking judicious measures, so that the healthcare system doesn't get overwhelmed to the point that mortality increases due to the inability to treat all the seriously ill patients.

The question is where do the local officials draw the line on what is a judicious measure. To me, they should plan and then act only after it's hit their community. That's the balance between acting too soon, and thus likely accomplishing only prolonging the economic hardship, and acting too late and risking overloading healthcare.

An exception to this philosophy is that preemptive action should be used for high-risk places like nursing homes.

But that's the local government response (which is more important to each of us than the fed government response, although people only talk about the feds). We all need to do our own part by practicing good hygiene in terms of hand washing, coughing, and being aware of what surfaces we touch.


You are correct that is exactly the goal! The hospital system runs at over 90% capacity! We will not have enough beds and ventilators to save everyone and tough choices.

I agree that the economic impact on lower income jobs will tremendous. Hard choices are being made around the country and more will still have to made!
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