Coronavirus thread

[the Schwartz]

This guy apparently has a fairly large following. My mom, a retired ER nurse, keeps sending me links to his stuff. He's doing daily updates on the spread, and has done some discussion along the lines of there are thoughts that the use of fever-reducing NSAIDs may be partly behind the apparent high mortality in Italy.

https://www.youtube.com/watch?v=nt2CBtukxtE

Any of our medical pros here familiar with him or have comments?

Not an M.D., but the NSAIDs apparently interfere with the inflamation response pathways, production of cytokines, leukotrienes, etc. which is why NSAIDs are supposed to be avoided in favor of a strict "Tylenol-only" regimen.

[RevolverRob]

What about those taking CCBs (Calcium channel blockers) for hypertension? There'd be no ACE inhibition occurring so CCBs might be a better Rx option in such cases where those requiring an antihypertension drug contract the COVID19 virus?

Wrong guy, maybe one of our docs can say.

But of course when in doubt, you can forward the Science blog post to your primary care doc and inquire.

—

It’s worth it - for all of those with pre-existing conditions that appear to be correlated with high(er) chance of hospitalization (e.g., diabetes, immuno-compromised, hard core cardio-vascular issues, respiratory issues, and/or hypertension) - to call their docs and talk with them. Of course not everyone can do everything, but in particular if you have immune system issues and/or respiratory issues - make a plan NOW.

That way you hopefully won’t ever need it.

[YVK]

For a while there, people were throwing everything

That is what I got from reading it, some patients on vent, some proned, some ECMO, etc. They clearly used what they had but in times like these I wouldn't expect anything beyond case reports like these.

[the Schwartz]

Wrong guy, maybe one of our docs can say.

But of course when in doubt, you can forward the Science blog post to your primary care doc and inquire.

I hope that you know that I wasn't trying to put you on the spot, Rob. Just tossed it out there for the consideration of any P-F members who are taking ACEs/ARBs for hypertension and wanna check with their physicians for alternative therapies that take a different route to reduce vascular rigidity. I have several friends who take either ACEs/ARBs or CCBs...perhaps some of the doctors here can weigh in.

[XXXsilverXXX]

Not an M.D., but the NSAIDs apparently interfere with the inflamation response pathways, production of cytokines, leukotrienes, etc. which is why NSAIDs are supposed to be avoided in favor of a strict "Tylenol-only" regimen.

Any alternative to Tylenol that those of us who are told to stay away from it? Due to a medical condition

[the Schwartz]

Any alternative to Tylenol that those of us who are told to stay away from it? Due to a medical condition

Like I said earlier- I am not an M.D., but the only other option outside of acetominophen would be aspirin. Just the same, run it past your doctor for his/her opinion first before taking my opinion on it.

Take care of yourself snd good luck, brother.

[JPC]

More testing option may be coming. This was announced today in my county:

https://www.kktv.com/content/news/Sa...568914371.html

[YVK]

ACEI/ARBs: there is no data that proves this theory. There are multiple possible confounders. There are apparently animal studies that show a totally opposite effect but I've not seen that data. The societies have said to stay on your current pill until the data is clear.

A practical point of switching meds: I'll be staying home tomorrow even though I feel fine. Program-wide decision to reduce staff presence at the hospital by 50%; protecting human resources for when it really hits the fan. I assume most systems are doing something like this, and docs are only seeing patients that must be seen. I doubt that desire to switch a pill because of an unproven theory will make a cut for a legit appointment.

Calcium channel blockers: as we've discussed in this thread, there have been reports of people developing acute heart failure with this virus. Calcium channel blockers are generally contraindicated in heart failure. I wouldn't switch away just because something might happen but it makes the point that you can always find something concerning about any drug.

Ibuprofen: same as ARBs, the data is sketchy. That said, I hate the drug, the entire group, for other reasons so just take tylenol or aspirin.

[the Schwartz]

ACEI/ARBs: there is no data that proves this theory. There are multiple possible confounders. There are apparently animal studies that show a totally opposite effect but I've not seen that data. The societies have said to stay on your current pill until the data is clear.

A practical point of switching meds: I'll be staying home tomorrow even though I feel fine. Program-wide decision to reduce staff presence at the hospital by 50%; protecting human resources for when it really hits the fan. I assume most systems are doing something like this, and docs are only seeing patients that must be seen. I doubt that desire to switch a pill because of an unproven theory will make a cut for a legit appointment.

Calcium channel blockers: as we've discussed in this thread, there have been reports of people developing acute heart failure with this virus. Calcium channel blockers are generally contraindicated in heart failure. I wouldn't switch away just because something might happen but it makes the point that you can always find something concerning about any drug.

Ibuprofen: same as ARBs, the data is sketchy. That said, I hate the drug, the entire group, for other reasons so just take tylenol or aspirin.

Thanks for the insight and clarity, YVK. I am hopeful that with all of this perhaps, maybe, some folks can be spared some pain and inconvenience in these troubling times.

[Mark D]

This guy apparently has a fairly large following. My mom, a retired ER nurse, keeps sending me links to his stuff. He's doing daily updates on the spread, and has done some discussion along the lines of there are thoughts that the use of fever-reducing NSAIDs may be partly behind the apparent high mortality in Italy.

https://www.youtube.com/watch?v=nt2CBtukxtE

Any of our medical pros here familiar with him or have comments?

Not a med pro, but I've been watching Dr. John Campbell's daily updates for a couple of weeks. He is career nurse and a PHD, and seems to have a pretty good grasp of the situation. He's been talking about COVID since January, and most of the stuff he predicted has come to pass. He also stays up to date with emerging research. He was the first to mention the China bus study referenced earlier in this thread. And I think it was his video where I first heard about the possible issues with ibuprophen.