Coronavirus thread

[Nephrology]

Israeli doctor in Italy says new, innovative treatments ‘flattening the curve’

"In Padua, the autoimmune medicine Tocilizumab has proven effective, but can only be used once it is established that no other viruses or bacteria are present in the patients’ bodies, he said. The hospital where he works has also seen positive results from the antiviral drug Remdesivir, he added."

"He said medics have been forced to be creative, giving an example from the city of Parma where patients who couldn’t be put on a respirator using a tube were attached to it using a snorkeling mask, with a part that connects it to the machine being printed in a 3D printer."

"While at first, doctors viewed the new coronavirus as an extremely infectious flu, they have since learned that the disease is highly unpredictable and that patients’ conditions can change drastically several times during a day, while a medication can take hours to show an effect."

"One technique he said had yielded dramatic results was to have patients lie on their stomach instead of on their back while on a ventilator. “Suddenly the oxygen level in the blood jumped by hundreds of percents,” he said."

That last bit seems counter intuitive, but I'll let our medical professionals judge it and the whole article for accuracy.

re: Toculizumab and Remdesivir, both are drugs that are currently being studied. I've also heard anecdotal reports of patients improving with both drugs and am hopeful that they work, but I will reserve my judgment until we have better data.

re: having patients lie on their stomach (aka "proning"), that is a well-studied, evidence-based intervention for mechanically ventilated patients with ARDS (iirc most effective in patients with severe ARDS). The reason this works is semi complicated, but the short version is that it optimizes the distribution of air in your lungs so you maximize the extraction of oxygen and disposal of CO2. There's even evidence this works on patients who are not intubated, but on other forms of airway support (HFNC, CPAP, etc).

[BN]

I just remembered the Iron Lungs for TB treatment. Could they be used?

[Nephrology]

I just remembered the Iron Lungs for TB treatment. Could they be used?

Those are kind of a poor man's endotracheal tube/mechanical ventilator. They were historically most used for poliovirus - not TB. I'll explain why this is important momentarily.

Essentially, a mechanical ventilator forces air in and out of your lungs using a bellows. Somewhat intuitive how that works.

the iron lung does the opposite - it generates negative pressure around your chest cavity, which makes it easier for your lungs to expand. Imagine blowing up a balloon under water vs. blowing up a balloon on air - it's easier to force air into the balloon when there is less pressure pushing against you. The iron lung generates enough negative pressure that it helps people who have trouble drawing breath because the muscles they use to breathe are either too weak or paralyzed.

This gets at why the iron lung was used for polio. Polio causes an ascending weakness/paralysis of your skeletal muscles, including the ones that you use to breathe. However, their lungs themselves were otherwise healthy. In COVID19/other causes of ARDS, the problem is the lung tissue itself. We use mechanical ventilation to force 100% pure oxygen into their lungs to compensate for damaged lung function - not because the cannot draw air in and out of their lungs on their own.

Let me know if this makes sense...

[blues]

I remember when I volunteered at a hospital for a few years during high school back in the dark ages...when Bennett and Bird respirators / resuscitators were what I'd see in the pulmonary unit.

[Wondering Beard]

If correct, this sounds good, but I think local conditions affect national numbers in the short term and it's too early to see a real trend. Then again, statistics and math are from my strong suit, and there may be more reason to hope.

The Current Trajectory Of Confirmed Covid-19 Cases In America

"Currently, the doubling time is 4.1 days, versus the value of 2.32 days computed not too many days ago. The correlation coefficient is very high, and the curve is stable and well-behaved."

[pangloss]

At the end of the day, we just need quality evidence, and while clinical studies can be expedited there is a necessary amount of time and effort that goes in to getting this information. Think of it this way: many medical scientists will spend their entire career trying to understand a basic scientific phenomenon and turn it into a treatment for human disease. It would be crazy to think we can figure it all out inside a few months.

One morning last week I drove from my garage to campus in 16 minutes. My previous record has been something like 21 minutes. A month ago, if anyone had told me that I could make it from my garage to work in 16 minutes, I would have told them that they were absolutely crazy. My hope is that a number of things that were impossible last month will come to pass next month.

We have three of four clinical trials starting here, one of which is a multicenter study that we are lead on. Some of the others involve chloroquine. I'm not involved in any of those studies, but if we have three or four ready to go, larger places will certainly have even more planned. As of right now, clinicaltrials.gov returns 202 hits for "COVID-19." Eighty-eight of these trials are already recruiting. For off-label use of approved drugs, the toxicity/pharmacology/safety is already known from previous trials. All we need is to show efficacy, and for a disease that lasts less than three weeks, efficacy, or the lack thereof, will be determined very very quickly. Solving this problem is not something that "will" happen but rather "is" happening. We're in present tense now.

[BN]

Let me know if this makes sense...

Yes, thanks. And thanks for keeping us (PF) informed. I trust you way more than Main Stream Media. I'm getting much more good information from Pistol Forum than from any other source.

[Maple Syrup Actual]

Interesting. Yeah, the UW projections have it peaking here around May 1. So far Denver is OK, but we have a young and stupid demographic in this city so who knows.

While NY isn't doing great, I am also pretty worried about other growing hotspots - in particular, Florida and Louisiana. I can't really say those states have done a better job with social distancing, either, and they have a lot less in the way of healthcare infrastructure and a lot more poor (LA) and elderly (FL) residents than NY. Their only hope is that lower population density buys them some time.

There was an article recently that suggested COVID had made its way into the Villages. That seems like a recipe for disaster.

I would expect Florida to take a beating.

The biggest outbreak in Canada right now is in Quebec; that's almost certainly returned snowbirds.

[Borderland]

Interesting. Yeah, the UW projections have it peaking here around May 1. So far Denver is OK, but we have a young and stupid demographic in this city so who knows.

While NY isn't doing great, I am also pretty worried about other growing hotspots - in particular, Florida and Louisiana. I can't really say those states have done a better job with social distancing, either, and they have a lot less in the way of healthcare infrastructure and a lot more poor (LA) and elderly (FL) residents than NY. Their only hope is that lower population density buys them some time.

There was an article recently that suggested COVID had made its way into the Villages. That seems like a recipe for disaster.

AZ has some large retirement communities also. Most are near Phoenix I think, at least they were when I lived there. I just looked at Maricopa Co. and they seem to have relatively low case numbers, <600. But we had low case numbers also when it first started. Now we're like #5 on the hit parade.

https://en.wikipedia.org/wiki/Sun_City,_Arizona

[Balisong]

AZ has some large retirement communities also. Most are near Phoenix I think, at least they were when I lived there. I just looked at Maricopa Co. and they seem to have relatively low case numbers, <600. But we had low case numbers also when it first started. Now we're like #5 on the hit parade.

https://en.wikipedia.org/wiki/Sun_City,_Arizona

I'm frankly astonished Sun City (10 minutes north of me) hasn't been wiped off the map by this already