Coronavirus thread

[Borderland]

Everyone just calm down. I hear Trump will be back in the office tomorrow.

[YVK]

It’s no secret that “VIPs” are often over diagnosed and over treated because of their social status. Very often, this is not the VIPs doing, but done at the request of the “team” physicians that accompany the VIP to protect the organization’s investment. As a resident, I had the opportunity to care for one of professional sports’ best known athletes in the emergency department - for about 10 minutes.

VIP medicine is a shit show. I've been in on a couple of cases that I won't post on the web about but it is a shit show.

[Sensei]

That was the rationale?

The RECOVERY Trial that put dexamethasone on the map for COVID found that only patients requiring mechanical ventilation or supplemental oxygen benefited from the steroid (figure 2; https://www.nejm.org/doi/full/10.1056/NEJMoa2021436). The kicker being that the trial did not set a threshold for administering oxygen or require a certain FiO2. Having said that, I suspect that most of us are not putting oxygen onto people who transiently desaturate down to 93%. Moreover, the dexamethasone was given at the hospital which suggests that the hypoxia was more severe and persistent than a few moments at 90-93%.

[MickAK]

The doc could have said no, and in 30 seconds Trump would have had a new doc who said yes.

I remember looking into this back when Trump first said he was on Plaquenil. Some of the details have grown a bit fuzzy since then, but essentially the White House Physician seems to be a role where a background suitable to hold and maintain a high security clearance is a major part of the qualifications. Trump can, of course, get a new doctor but he would have the Secret Service and a whole host of intelligence folks to fight, not just his Physician.

His current doctor is the first DO to hold the position. I don't know enough about DOs vs. MDs to know if that is a factor in his decisions about Covid therapies.

[ccmdfd]

Having said that, I suspect that most of us are not putting oxygen onto people who transiently desaturate down to 93%. Moreover, the dexamethasone was given at the hospital which suggests that the hypoxia was more severe and persistent than a few moments at 90-93%.

I sure hope not.

Is that what happened to Trump?(desat to 93)
I haven't paid enough attention to the specifics.

[YVK]

The kicker being that the trial did not set a threshold for administering oxygen or require a certain FiO2.

I think that most institutions set their own thresholds for all treatments. Our system, for example, sets a new 4L O2 requirement as a threshold for remdesivir.

[David S.]

I need help from the medical professionals, please.

Michelle is concerned that she may be showing Covid symptoms and her primary care doc wants her to get tested in the community right away.

Is there a huge difference in accuracy between the rapid and “normal” tests? What test should she look for?

BTT

[Sensei]

I sure hope not.

Is that what happened to Trump?(desat to 93)
I haven't paid enough attention to the specifics.

93% was the number that Conley mentioned in his press briefing. He also specifically denied desaturation events into the low 80s which was a rumor.

https://www.google.com/amp/s/www.nyt...l%3f0p19G=0232

However, there is some ambiguity since he would only comment on the period before Trump left for Walter Reed.

[Glenn E. Meyer]

The model for any spokesperson today is Baghdad Bob, sad to say. Even physicians. I note that one Reed doc came out and said the SUV ride was a pretty dumb thing to do. Guess his career will go far.

I also note that DJT is getting calls to why he isn't taken HCQ? I guess the 1984-ish propaganda switch technique hasn't completely taken hold.

[HeavyDuty]

BTT

Thanks, David - at this point it’s moot. They wouldn’t give her the rapid test due to the number of days since the possible symptoms began, but they did use the rapid for her youngest son. They did normal tests on her and the other boy. The youngest did come back negative. I’m not sure which specific tests were used.