STAFF - can we get Dr Marcus a Red Cross badge. Thanks doc for all of the info you're providing and your work on the front lines.

This thread is the most depressing thing I've read today. So much hope being crushed. I pray this man recovers, for him and the people looking for hope.

The evidence strongly suggests immunity.

Well I have now seen my first confirmed case, and it was a two-fer, as well. One of them lab confirmed, the other strongly assumed. Both are presumed to be community spread. One of them had been having symptoms off and on for 1.5 months, numerous ER presentations (around 10 total to my knowledge in a 1.5 month span), consistently normal vitals outside of fever. It's tough to say whether that individual might have had a couple different viral illnesses over that time span or whether this all might be related to CV. I actually saw both of them the day prior and discharged both with instructions to self-quarantine for the next two weeks. Both came back to the ER, although neither stated that they felt any worse, they just didn't feel better. One got discharged again, the other got lab work as their vitals were slightly abnormal. Ended up having some slight lab abnormalities necessitating an observation stay. Rapid test came back positive within 2 hrs. Their symptoms are impossible to differentiate from your typical viral syndrome. The one who was admitted did have the peripheral ground-glass opacity pattern on CT as well as several of the typical lab patterns, however.

THX for interest. He is about the same. PO2 70 on 100%NRB. He has battled to avoid vent. WBC up to 11K. IMO this is good sign. Still tenuous. Having disagreements with ID doc who DCd azithro. We are trying to get on same page. Benign drug - not sure why he is reticent to Rx it. The French paper - though small - showed synergism with HCQ. Day to day. Wife was DCd yesterday - well.

Backlog. I assume. Testing is biggest failure of this crisis.

I'm seeing more and more severe presentations in young relatively healthy patients. Three today alone under 40, one intubated in the ICU and probably won't make it.

Marcus Aurelius said:

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Several pediatric under 10 cases here and a teenager in dire condition.

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Based on what I'm hearing from colleagues in peds ID it seems like asthma is the theme of severe presentations under 20. Kids with asthma are the ones getting intubated, but thankfully this is more related to reactive airway disease and less so parenchymal lung disease. It basically causes a severe asthma exacerbation which is easy enough to fix once they're intubated.

meatsweats said:

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Why such the difference? On Fox they had a story of a 20 something male in excellent health now in a medically incuced coma with COVID-19. Then I hear stories of a 90 year olds making it. There has to be some common denominator? Blood type? Genetics?, What makes a small percentage of young healthy people to really struggle with this virus?

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We don't know, but most diseases have outliers with regards to outcomes. For any illness there will be younger people who unexpectedly do poorly and older patients who do surprisingly well.

DFWTLR said:

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From what's being reported (or at least from what I've read) the US has more younger patients requiring critical care. How many of your younger patients have other issues, such as obesity or heavy smokers/vapers?

Keep fighting, cant imagine what it's like every day for you all!

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The US has very high rates of childhood asthma and obesity which appears to be playing a role.