Coronavirus thread

[Sensei]

Damn.

Been a long time since I worked at a transplant center, but when I did they made us do lavages on all donor lungs prior to transplant. Even with completely normal chest x-ray, CT scans.

They not do that anymore?

They BAL donor lungs but it is not standard to run the COVID on the BAL. Generally, they run the COVID on a NP swab before our procurement team arrives due to time constraints as it takes hours for it to come back. This will get published because we are trying to change the recommendations for the COVID to be run on the BAL. Some more research reveals this is the second person to have this happen to them - infected donor lungs. The first was back in late Winter before we were running COVIDs on everyone, and limited testing based on travel history. That one died.

My lady is overall doing better: off vasopressin and only on inotropic dose epi (0.02 mcg/kg/min) and milrinone for severe RV dysfunction. I also have her on nitric because her PA pressure were in that 40/20 zone. However, she is on 100 mg/hr lasix + metolazone to offload her RV and keep her negative...with rising creatinine. I’ll probably put in the trialysis line tomorrow to start CRRT.

[peterb]

Encouraging news on the vaccine front:
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Pfizer's experimental COVID-19 vaccine appears to be working. The vaccine was found to be more than 90% effective, according to clinical results released by the company Monday.

That news comes from an interim analysis of a study involving 43,538 volunteers, 42% of whom had "diverse backgrounds."

Each participant got two injections spaced 21 days apart. The analysis compared the number of cases of COVID-19 among the volunteers getting the vaccine, with an approximately equal sized group of volunteers who got an injection of a liquid that didn't contain the vaccine.

In a news release from Pfizer and its partner BioNTech, the company said results from 94 evaluable cases of COVID-19 among study participants indicated the vaccine is more than 90% effective in preventing COVID-19. The Food and Drug Administration set a minimum effectiveness bar at 50%.

This is the first COVID-19 vaccine in development to have data showing that it exceeded that mark.

While promising, this analysis alone does not provide enough information about the vaccine for Pfizer to ask the FDA for permission to distribute it.

https://www.npr.org/sections/health-...n-90-effective

[peterb]

Interesting note from a SI article on the NFL:
—————————-
Games aren’t spreading the virus. And that’s games, believe it or not, in just about any sport. I’ve been saying for a while that I couldn’t think of a single example of the virus being transmitted on the field, and Sills confirmed that for me.

“We have seen zero evidence of transmission player-to-player on the field, either during games or practices, which I think is an important and powerful statement,” Sills said. “And it also confirms what other sports leagues have found around the world. We regularly communicate with World Rugby, Australian rules football, European soccer leagues. To date, no one has documented a case of player-to-player transmission in a field sporting environment.

“Obviously, I don’t think we’re at the point where we’d say it cannot occur, but none of us have seen yet, and that’s certainly encouraging.”

Conversely, three areas have been nailed down as problems. The first thing Sills pointed out is that, as he sees it, the great majority of NFL cases of late have been a result of, well, the fact that the players live in the same country as the rest of us, and things have gotten worse in some communities. But he did acknowledge a few trouble spots.

“As far as when you do have a positive individual in the team environment, there are three things that create high-risk contact, and that’s meeting, eating and greeting,” Sills said. “Meeting, being the team meetings that happen. Eating together, that’s obvious, because people are unmasked and if you’re sitting together with someone eating that can create a high risk. And when I say greeting, what I mean by that is social activity outside the building, people hanging out together doing things.

https://www.si.com/nfl/2020/11/09/mm...-giants-saints

[Old Man Winter]

Round 2! Minnesota's governor is gonna drop the hammer today on bars, restaurants, weddings, funerals, and more.


https://twitter.com/@twitter/status/1326198774012633088

[Nephrology]

Here are Colorado's numbers as of this morning. We are back at the same peak inpatient volumes that we reached in April. Not sure what that looks like for our hospital system specifically at the moment but probably not great. Given the extremely high % of positive tests we are getting back I think it is pretty safe to assume this number will continue to rise.



edit:

Worth noting that significant number of these inpatients are under 50 years old:

[DocGKR]

Our daughter is seeing lots of very sick 20-40 yo's with COVID in her major East Coast Med Center ICU....

Most got it by violating the 4S's (ie. doing stupid things, with stupid people, in stupid places, at stupid time of the day)

[Sensei]

Our daughter is seeing lots of very sick 20-40 yo's with COVID in her major East Coast Med Center ICU....

Most got it by violating the 4S's (ie. doing stupid things, with stupid people, in stupid places, at stupid time of the day)

I’m taking care of a 47 yr old with COVID in our CVICU with an open chest because his right ventricle got punctured by a guide wire while cannulating him for VV ECMO. His wife is a bit younger - just graduated from our MICU with COVID. Their child is still intubated in our PICU with covid.

[Maple Syrup Actual]

Are we getting any closer to understanding why most people seem to skate on this thing, but a fraction of people even without obvious comorbidities get absolutely wrecked by it?

Is it purely a viral load thing, or an accumulated partial immunity from exposure to other coronaviruses, or some other factor that hasn't been worked out yet?

[ccmdfd]

I’m taking care of a 47 yr old with COVID in our CVICU with an open chest because his right ventricle got punctured by a guide wire while cannulating him for VV ECMO. His wife is a bit younger - just graduated from our MICU with COVID. Their child is still intubated in our PICU with covid.

Damn.

How's the post-transplant doing?

[YVK]

I’m taking care of a 47 yr old with COVID in our CVICU with an open chest because his right ventricle got punctured by a guide wire while cannulating him for VV ECMO. His wife is a bit younger - just graduated from our MICU with COVID. Their child is still intubated in our PICU with covid.

There is always something positive: at least your dude got ecmo. We just got a text not to initiate MCS for ANY patients. We've no remaining resources for them within the system. We're now de facto in crisis standards of care mode for all critical care patients.
I saw a long standing patient yesterday who is wills and trusts attorney. He said he has never been busier in his life. Older folks putting things in order. Pretty smart for them to do so.