Coronavirus thread

[ccmdfd]

I actually was recently first author on a paper about post-ARDS restrictive lung disease. Assuming that COVID ARDS is not different from regular old ARDS, then this is the deal ( @ccmdfd should jump in and correct me if I am off the mark):

Fibroproliferative ARDS - that is, the fibrotic "scarring" that occurs in, depending on who you read, something like 25% of ARDS survivors, based on evidence of restrictive lung physiology 180 days after discharge that correlates with reticular pulmonary infiltrates on HRCT scan. (source). Taken together, this is evidence of residual 'scarring' in a significant proportion of ARDS survivors.

However, if you read closely, the authors use median - not mean - % expected value. In reality, the mean is much higher, and the residual dysfunction measured by these tests are heavily weighted by an even smaller subset of survivors with significant residual scarring. Furthermore, aside from PFTs, the only other ways we have to measure lung fibrosis (not including direct biopsy) are CT scans and health questionnaires. However, 1) patient questionnaires, for lots of hopefully obvious reasons, are a fairly flawed measurement tool, and 2) imaging often does not necessarily reflect underlying organ function (the COVID Xrays are a great example - blown TF up on plain film but standing, walking, talking).

So, to put it all together, there are clearly a subset of ARDS patients (and, I imagine, also a subset of COVID ICU patients) who will develop fibroproliferative disease with significant long term consequences for lung function. However, this isn't going to be most people, and even then, for most with measurable residual deficits in lung function, it will not be an enormous change from baseline.

It's still unclear if COVID ARDS is really that different from "regular" ARDS. That is an extremely active discussion and I don't honestly know enough to weigh in. Will likely take some time for the smoke to clear.

Yeah I haven't seen anything reporting COVID ARDS as being different from plain old ARDS, but I haven't been bird dogging the literature either, since my primary focus is outpatient. It seems too early to make any conclusions though. Most of the severe cases are still recovering in the hospital or nursing home/rehabs.

This may seem strange, but one thing we really don't see in the outpatient pulmonary world is post-ICU ARDS patients. At least in the 3 institutions I trained at, taught at, and worked at in this state. I'm sure there are some academic centers which do so.

Now if they have an underlying lung condition like COPD, etc; that's a different story.

IMHO that's due to;
1. there's not a dang thing we can do for it

and

2. whatever decrement in lung function they have, it pales in comparison to the Nero/psych and musculoskeletal issues they are facing.

Someone way back in this thread responded to a post of mine, they were a post-ARDS patient. The things which still bother them are not lung related, and they are not simple/insignificant minor problems.

cc

[Nephrology]

Yeah I haven't seen anything reporting COVID ARDS as being different from plain old ARDS, but I haven't been bird dogging the literature either, since my primary focus is outpatient. It seems too early to make any conclusions though. Most of the severe cases are still recovering in the hospital or nursing home/rehabs.

This may seem strange, but one thing we really don't see in the outpatient pulmonary world is post-ICU ARDS patients. At least in the 3 institutions I trained at, taught at, and worked at in this state. I'm sure there are some academic centers which do so.

Now if they have an underlying lung condition like COPD, etc; that's a different story.

IMHO that's due to;
1. there's not a dang thing we can do for it

and

2. whatever decrement in lung function they have, it pales in comparison to the Nero/psych and musculoskeletal issues they are facing.

Someone way back in this thread responded to a post of mine, they were a post-ARDS patient. The things which still bother them are not lung related, and they are not simple/insignificant minor problems.

cc

No, no surprise at all, to be honest - this is consistent with my general impression. The papers I cite are actually from faculty that I know fairly well and that mentor and I engage with often, and he doesn't really share their point of view. He is of the opinion that it is the kind of phenomenon you might find if you go looking for, so to speak, but as you note this doesn't mean it is very clinically relevant. You should take a look at that paper I link - they use a lot of patient-reported clinical scoring systems in their analysis. The actual deficits as measured by PFTs (IC, dynamic compliance, DLCO, etc etc) aren't enormous, especially if you read between the lines.

I mostly used the phenomenon to justify a bunch of basic science stuff that really has more to do with different animal models of acute lung injury and pathophysiological factors that influence those outcomes. The fibroproliferative ARDS bit was one of a couple different 'cover stories' to tie it to a sexy clinical phenomenon. It doesn't really have much to do with the actual experiments I did beyond give me something to put in the "background" section.

[Caballoflaco]

Yeah I haven't seen anything reporting COVID ARDS as being different from plain old ARDS, but I haven't been bird dogging the literature either, since my primary focus is outpatient. It seems too early to make any conclusions though. Most of the severe cases are still recovering in the hospital or nursing home/rehabs.

This may seem strange, but one thing we really don't see in the outpatient pulmonary world is post-ICU ARDS patients. At least in the 3 institutions I trained at, taught at, and worked at in this state. I'm sure there are some academic centers which do so.

Now if they have an underlying lung condition like COPD, etc; that's a different story.

IMHO that's due to;
1. there's not a dang thing we can do for it

and

2. whatever decrement in lung function they have, it pales in comparison to the Nero/psych and musculoskeletal issues they are facing.

Someone way back in this thread responded to a post of mine, they were a post-ARDS patient. The things which still bother them are not lung related, and they are not simple/insignificant minor problems.

cc

Thanks for reminding me about that post. I remember reading it and honestly being a bit shocked by the recovery process from being under anesthesia for an extended duration especially the Nervous system problems they described.

It’s something non medical people like myself don’t really hear about unless they are or know somebody who has gone through it. We just hear Johnnny who was in an induced coma after getting smash-o’d by a tractor, covid, etc. got out of the hospital today and is “on his way to recovery”.

[blues]

Hey, you guys have had 526 pages to figure this crap out. Well, let's hear it...






(Sorry...I feel better now. )

[Nephrology]

Hey, you guys have had 526 pages to figure this crap out. Well, let's hear it...






(Sorry...I feel better now. )

In a curious twist, it turns out COVID-19 is caused by vaccines...

[Wondering Beard]

So, apparently the Lancet article was withdrawn.

Here's an article that seems to explain what went wrong: A Study Out of Thin Air

"Misinformation is bad. Misinformation in medicine is worse. Misinformation from a prestigious medical journal is the worst. Herein is a detailed look at the controversial Lancet study that resulted in the World Health Organization ending worldwide clinical trials on hydroxychloroquine in order to focus on patented therapeutics."


I have no idea if the article and author are right about everything, hopefully some you who know this sort of thing can confirm or critique.

As I wrote before, this sounds really fishy.

[Nephrology]

So, apparently the Lancet article was withdrawn.

Here's an article that seems to explain what went wrong: A Study Out of Thin Air

"Misinformation is bad. Misinformation in medicine is worse. Misinformation from a prestigious medical journal is the worst. Herein is a detailed look at the controversial Lancet study that resulted in the World Health Organization ending worldwide clinical trials on hydroxychloroquine in order to focus on patented therapeutics."


I have no idea if the article and author are right about everything, hopefully some you who know this sort of thing can confirm or critique.

As I wrote before, this sounds really fishy.

I only skimmed it, but those are definitely valid concerns, and a coherent picture is coming together. Particularly the dissection of Surgisphere. It also is consistent with what I described on the top of page 514, which stood out to me. It is very weird to have someone not correct for multiple comparisons in a study of this size.

It is beginning to smell like this was an attempt by the first author (Mandeep Mehra) to juice his career and hop on the COVID train like many of us have.

Frankly, he probably would have gotten away with it if he had aimed for a less flashy journal than the Lancet, as it would not nearly have made such a big splash in the lay media. Reading his bio, it looks like he got his MD in India and eventually finished his cardiology fellowship at Ochnser in Louisiana - not exactly a prestigious medical center. Despite this, he has 200 publications under his belt, which is quite a lot. I would bet that you will find more of this kind of shenanigans if you dig through his Pubmed bibliography (note: not all of those are his, he probably shares a last name + first initials with at least one other person)

[ccmdfd]

In a curious twist, it turns out COVID-19 is caused by vaccines...

And water fluoridation, at least according to Gen Jack D. Ripper.

[Lester Polfus]

In a curious twist, it turns out COVID-19 is caused by vaccines...

And the cure is essential oils.

[blues]

And the cure is essential oils.

No leeches or cupping?