New study - US getting really good at treating Covid

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dermdoc
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In reply to Infection_Ag11 • 8:41a, 10/22/20
AG
Infection_Ag11 said:
I've only ever treated the ones with objective evidence of infection (fever, raging white count I can't otherwise explain, etc.) If it's just a draining PG (which is 90% of the time) I tell them to stop systemic antibiotics because they're just gonna get C. Diff with no benefit. I've only ever seen one patient with it I'm very confident actually had an infection (his blood cultures grew the same pseudomonas isolate as the skin biopsy culture and his whole leg was cellulitic).

We saw it a lot at the Dallas VA in fellowship as well as at CUH, probably 1-2 a month and yeah they were usually smokers with Hep C. Not so much at Parkland for whatever reason.
Same here. Worked at Ben Taub for years and was the Friday clinic attending and we hardly ever saw PG.

Moved to Beaumont for family reasons and it was rampant. Strange.
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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OKC~Ag
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In reply to Infection_Ag11 • 9:25p, 10/23/20
Infection_Ag11 said:
Keegan99 said:
Remember the obsession with ventilators, given the ChiCom recommendations?


Ultimately if you have to get intubated, you have to get intubated. We can't save everyone from the vent with steroids, high flow and probing. If you're saturating 70% on all the above and starting to lose consciousness/brady down you can either maybe die on a vent or definitely die in moments off of one.

Can our current strategy prevent a shortage of vents? Almost certainly barring an unforeseen (and at this point likely impossible) and tremendous spike in cases. But this emerging narrative that nobody should be intubated with COVID19 is simply a misunderstanding of how that process works.
We may run out of critical care nurses before we run out of vents...in elsewhere, Oklahoma.

DFW and metro hospitals are sucking all critical care nursing talent with major sign-on bonuses for the temporary nursing gig.

Long term nurses to our hospitals are resigning drove and becoming free agents. They are moving from OKC to DFW or elsewhere or changing to the different hospitals within the city for big sign-on bonuses.
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shalackin
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9:47a, 10/25/20
AG
That certainly doesn't help since we are spiking here in the metro. First I have heard of our critical care teams leaving. But that makes sense.
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Pelayo
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In reply to Big Al 1992 • 6:50p, 10/25/20
AG
Big Al 1992 said:
This is great news. Mortality down for hospitalized patients - even those high risk.
What American medicine does best, fix the hard things and save lives.
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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cc_ag92
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In reply to Pelayo • 6:53p, 10/25/20
AG
Very grateful for this! Thanks for all you and your peers have done and continue to do.
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94chem
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In reply to Marcus Aurelius • 8:05p, 10/26/20
Marcus Aurelius said:
Dexamethasone I believe is the key. We aren't using toci anymore. Remdesivir less. Anticoagulation and CVP. Less dying to be sure. But hospitalizations are much higher here now.


In other words, a common sense conversation with an allergist could have helped.
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94chem
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8:07p, 10/26/20
This thread is a microcosm of American health care. F- on prevention, A+ on cure.
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P.U.T.U
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In reply to 94chem • 11:41a, 10/27/20
AG
94chem said:
This thread is a microcosm of American health care. F- on prevention, A+ on cure.
That is the truth, I know a good amount of people that gained weight and drink like fish now. The good thing is I know 5 people that have stopped drinking and lost a ton of weight. Most were going down rabbit holes with drinking and realized if they did not stop it was going to kill them, that and their spouses were about to divorce them.
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AgE Doc
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5:05p, 10/31/20
AG
It will be very interesting to see if the advances that have been made in treatment (not cure) significantly affect the mortality numbers in Texas.

I've been keeping track of Tuesday through Friday daily new cases versus reported daily deaths Tuesday through Friday 3 weeks later, and thus far the percent of cases that have resulted in deaths three weeks later has been relatively stable since the late spring.

It typically fluctuates in a relatively narrow range between 2.1% to 3.1% of the cases three weeks earlier.

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cc_ag92
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In reply to AgE Doc • 5:32p, 10/31/20
AG
That would be great news!

Is there any way to track the number of hospitalizations? Have they decreased, too, or stayed the same but resulted in recovery instead of death?

Anecdotal: a friend's FIL is in the hospital in Washington. After a week and a half in the Covid unit, he was moved to ICU. After a week in ICU, they told them it was time to say goodbye because they couldn't get his oxygen levels to stabilize. Three days later, he moved out of ICU and they think he will recover. I wish I knew more about the treatment he received.
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OKC~Ag
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In reply to AgE Doc • 1:12a, 11/5/20
This data suggest that "US is Not really good at treating Covid"...

we are still muddling through.

Aside from steroids, no new breakthrough therapeutics/intervention.
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silverwings97
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In reply to OKC~Ag • 5:44a, 11/5/20
AG
Possible therapeutics ahead... hopefully soon. I would be interested in hearing the opinions about the science behind this from the experts on this board.

https://finance.yahoo.com/news/neurorx-relief-therapeutics-announce-continuation-060000268.html
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20ags08
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9:33a, 11/5/20
AG
For the doctors on here, what is the longest time you have seen somebody needing rehab to fully recover and get back to their old self?

My father first saw symptoms July 13, went into the hospital July 20th, Intubated/ICU July 23rd. He battled like hell, doctor called and told us there was nothing else they could do and it was in God's hands now. He battled back little by little.

He was taken from central Texas to Dallas Sep 1 to a ventilator weaning facility in Deep Ellum. He has now been at a PT/OT facility in Dallas learning how to be mobile again. We feel like he is slowly getting better but it's so tough to see him get so frustrated because he cannot do anything at all on his own anymore. He lost a little over 60lbs and virtually all his muscles in his legs.

He is going on Monday to the hospital for CT scans to see if he had a stroke or something while he was in his coma in ICU. Hoping that could explain some of the issues he's having with one arm and one leg, but they are opposite arm and leg.

It's been a crazy 4 months for our family and no one seems to be able to tell us if he'll ever be able to be him again.
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deadbq03
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In reply to 20ags08 • 10:17a, 11/5/20
AG
Not a doctor, but I know of a similar story.

A couple in their 60's at my parents' church in SA got Covid around the same time.

The wife was better in days.

The husband had a similar story to your father - maybe even worse. IIRC he was only finally out of hospital in early October and at that time, he couldn't functionally move any of his limbs. (I haven't gotten an update since then so no idea how he's progressed).
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20ags08
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In reply to deadbq03 • 1:05p, 11/5/20
AG
It really is amazing how it is effecting everyone differently.

On a Tuesday after a few days in ICU the nurse told us they fully expected him to recover and he was doing great, on Thursday is when everything hit the fan. His kidneys stopped working and we were pretty much told he wouldn't make it through the night.

He's battled hard and we are so extremely blessed that he is alive, it's just hard to watch him get so frustrated by trying to just lift his arm.

And to make it worse, insurance has tried to take him from his rehab place twice now and move him to another place. He's doing so well at his current place and knows all his nurses and doctors it just seems crazy to move him now. Especailly from a place where my mom can go and be with him from 8am-8pm and the place they want to move him lets one visitor for 20 minutes a day only after they test negative.
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cc_ag92
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In reply to 20ags08 • 7:50p, 11/5/20
AG
A friend's FIL has a similar story... doing well, then not going to make it through the night, then moved out of ICU three days later. It's definitely a weird illness.

Freaking insurance, though.. I hate that you have to deal with that on top of the health issues.
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20ags08
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In reply to cc_ag92 • 3:34p, 11/7/20
AG
Our appeal was granted again! So he'll get to stay at Encompass Health Rehab for at least a little bit longer.

Dad took 3 steps yesterday on the parallel bars, shaking like crazy an I believe hoisted in a belt, but still progress.

Mom mentioned today about putting all of their belongings back home in central Texas into storage, getting rid of the house and moving up to Dallas and getting an apartment for a while. Leads me to believe she might have had a conversation with the doctors that dad's stay could be a while longer.

I'm sure the insurance stuff will continue to come up!
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AgE Doc
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In reply to AgE Doc • 5:10p, 11/7/20
AG
AgE Doc said:
It will be very interesting to see if the advances that have been made in treatment (not cure) significantly affect the mortality numbers in Texas.

I've been keeping track of Tuesday through Friday daily new cases versus reported daily deaths Tuesday through Friday 3 weeks later, and thus far the percent of cases that have resulted in deaths three weeks later has been relatively stable since the late spring.

It typically fluctuates in a relatively narrow range between 2.1% to 3.1% of the cases three weeks earlier.

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cc_ag92
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In reply to AgE Doc • 5:31p, 11/7/20
AG
Wow. Spot on unfortunately. It will be interesting to see if that continues as the case numbers rise.
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cc_ag92
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In reply to 20ags08 • 5:32p, 11/7/20
AG
That's GREAT news!! Thanks for the update!
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cone
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In reply to AgE Doc • 5:48p, 11/7/20
AG
so this thing is the Spanish Flu???

I think the CDC said it was more like the 1968 Hong Kong flu
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VaultingChemist
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In reply to AgE Doc • 8:35a, 11/8/20
AG
The 2.1% to 3.1% of "reported" cases is great news.

I think there are a significant number of unreported cases, however.

For example, all members of my family became sick with a disease, and exhibited similar symptoms. I took a 20-minute COVID test within 18 hours of running a fever, and it was negative. My daughter took the same test several days later, and tested positive (after she lost her sense of taste and smell). My wife did not take a test, but she developed a cough (she only had fever for 5 days). I ran fever for 12 days, and only developed a cough on the tenth day, which quickly disappeared. My son had similar symptoms back in March, but was never tested and never got very sick.

Four people that were probably infected with COVID, and only one positive test. I am curious how many other families have unreported cases.
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AgE Doc
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11:14a, 11/8/20
AG
In my area compared to earlier this Spring/Summer there are fewer unreported/detected cases. Nursing Home employee screening and vigilant return to school policies by local school districts appear to be driving that number of unrecognized cases down.

Im interested to see how much therapeutic options currently available have changed the mortality numbers compared to the late spring and summer. So far it seems that we are in about the same ball park as earlier this year.

Prevention of large scale community spread is still key. I'm eagerly awaiting data from the phase three trials with the various vaccines and hoping people can avoid as much as possible pandemic fatigue with mitigation efforts. We are urging families to have outdoor distanced Thanksgiving get togethers if possible.
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cone
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In reply to AgE Doc • 12:50p, 11/8/20
AG
why are your numbers so different from CDC lethality?

like order of magnitude different?
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AgE Doc
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In reply to cone • 3:44p, 11/8/20
AG
cone said:
why are your numbers so different from CDC lethality?

like order of magnitude different?


This is just a case fatality percent and not an infection mortality percent. The more cases that aren't detected the higher a case fatality rate will be.


Testing in Texas has been widely available although not always timely in results dating back to the late spring. So I don't think there is a big change in undetected infections from late May to present. If anything we may be having fewer undetected cases.

Some people have insinuated that the virus is less deadly or that we in the medical field have made huge strides therapeutically, but that's not so far what the Texas numbers have shown over the last 5 months. I posts this just so people are aware they need to remain cautious to protect their families and communities.


It is super easy to have pandemic fatigue. I'm not advocating lock downs or avoiding life's pleasures but I would encourage people to follow public heath precautions to help mitigate spread of the virus and avoid unnecessary death and morbidity with a vaccine so close 3-4 months).
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cone
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In reply to AgE Doc • 4:00p, 11/8/20
AG
so the dexamethasone isn't helping?
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AgE Doc
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In reply to cone • 5:38p, 11/8/20
AG
cone said:
So the dexamethasone isn't helping?
Dexamethasone helps decrease mortality in ICU patients about 15%, but that has been the case since the late spring (May 2020). There hasn't been any further real breakthroughs since then.

In Texas we went through our first large wave in late June, July, & August. Our case numbers are starting to get back up into those ranges for daily cases, and I just want to try and combat the false messaging by some that there have been recent breakthroughs in September and October that make the weeks ahead less important in terms of public health mitigation.

Some are still pushing a herd immunity by natural infection and stating recent theraputics as justification that people shouldn't worry about mask wearing or distancing. Those things are still important and will save Texas lives in the coming weeks/months.
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cone
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In reply to AgE Doc • 5:43p, 11/8/20
AG
does it help prevent people from ending up in the ICU?

I'm trying to understand the difference between NYC April and Houston August
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Keegan99
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In reply to AgE Doc • 5:50p, 11/8/20
AG


Why haven't masks worked in New Mexico?


Or Illinois?



Both states have very strict ordinances and exceedingly high levels of compliance.


What's going on?
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AgE Doc
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In reply to cone • 6:01p, 11/8/20
AG
cone said:
does it help prevent people from ending up in the ICU?

I'm trying to understand the difference between NYC April and Houston August
The biggest difference in March/April was we were only testing people who had fever & known exposure due to lack of testing capabilities. We were not geared up to do mass testing on every cough, sore throat, runny nose, etc... and as a result there were tens of thousands of cases that were never detected in the early weeks/months of the pandemic (NYC). If you look at the case numbers in March and early April you could probably multiply the detected cases by 5 to 10 fold to get closer to the actual number of infected people.

By the late spring there were no longer boundaries or limits to testing whoever you wanted to test. No longer had to have fever or known exposure. As a result we didn't miss as many cases and the case fatality rate came way down as we identified a greater percentage of the people who were infected.

The infection fatality rate has come down some with dexamethasone between March and late May, but typically it's recommended only in people who are starting to have prolonged symptoms and getting closer to requiring oxygen. If you give dexamethasone too soon in the disease course it was actually shown to make symptoms worse because it does suppress both immune and inflammatory response. I typically don't start it until closer to Day 7 of symptoms or if people are starting to show some decline in their oxygen saturations and we are getting close to possible hospitalization.
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AgE Doc
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In reply to Keegan99 • 6:12p, 11/8/20
AG
Keegan99 said:


Why haven't masks worked in New Mexico?


Or Illinois?



Both states have very strict ordinances and exceedingly high levels of compliance.


What's going on?
Unfortunately this most likely represents a return to the classroom and inconsistent levels of compliance with distancing and proper mask wearing. I have a high school child, and I know how it is at their school. It leaves something to be desired. That said I'm not a proponent of shutting schools down, I think we need everyone on the same page with compliance with proper distancing and mask wearing to keep the schools open.

In our Texas county we had the same number of new cases in the first month that the kids were back in school as we had the entire first 4+ months of the pandemic. By the end of the second month of school we had doubled the number of cases from the first 4+ months of the pandemic.
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tysker
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In reply to AgE Doc • 6:46p, 11/8/20
AG
3-4 more months for a vaccine feels like the new 'two more weeks.' Its still going to take 3-4 months after approval for the vaccine to be produced, dispersed and actually to a statistically significant amount of the public, maybe even 6. So we're still looking at sumner or fall 2021 before reaching for any significant immunity levels

And who is paying for all of this? Will the people benefiting the most ultimately pay the least?
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cone
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In reply to tysker • 6:59p, 11/8/20
AG
Quote:
Will the people benefiting the most ultimately pay the least?
yes, of course
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aggie8182
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In reply to Keegan99 • 9:17p, 11/8/20
AG
Not exactly a response to this topic but, Is there a source that would break down the number of new cases by age group on a per month basis? So number of new cases by age group in September, number of new cases in Oct per age group, etc. per state? thanks!
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AgE Doc
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In reply to aggie8182 • 10:47p, 11/8/20
AG
aggie8182 said:
Not exactly a response to this topic but, Is there a source that would break down the number of new cases by age group on a per month basis? So number of new cases by age group in September, number of new cases in Oct per age group, etc. per state? thanks!
That would be nice data to see. I haven't seen one like that for Texas thus far. Anecdotally for me it's been about 50/50 between school age kids vs. parents/grandparents.
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