Coronavirus thread

[Caballoflaco]

I wonder if we'd be better off vaccinating high schoolers and college-age people to drive down community transmission. If community transmission dropped off a cliff, then the nursing home residents would be much safer regardless of their health and immune status.

In any case, I'm glad you're back to just regular paranoia. That's no too bad for 2020!

I saw tonight that they’re about to start trials on kids 12-17.

[pangloss]

Question for the scientists on whether the following claim/logic appears to be accurate, and whether that means we should still be cautious around others who may have received the vaccine prior to getting vaccinated ourselves.

The best way for getting herd immunity is first to get the vaccine, then second get exposed to it in your nose so that the IgG plasma cells in the armpit lymph nodes migrate to your nose. Downside being that 2nd step half of that process takes 3-10 days, so until then you're basically an asymptomatic spreader. After both steps have taken place, though, your nose and throat will have enough COVID neutralizing IgA to block transmission. So post vaccination there may be 1-2 months of silent spread which would not be good for those without the vaccine yet.

I'm behind on this thread and should have just done a multi-quote response, but this should be my last catch up post for the night.

Regarding the immunology, you get vaccinated in the arm, and the vaccine drains through the lymph vessels to the nearby lymph nodes. Once in the lymph node, antigen presenting cells process the vaccine and present it to T lymphocytes. Simultaneously, B cell recognize the vaccine and are activated and start to make IgM. In the case of the mRNA vaccines, cell in the body have to take up the vaccine, make the protein, and then eventually the T cells and B cells each get to see it. After 3-4 days, the T cells that recognize the vaccine have multiplied and are recirculating to other parts of the body. By about day 7 many of the responding B cells have become plasmablasts are also recirculating. At this point some B cells are making IgG and are in germinal centers in the draining lymph nodes where they basically figure out how to make better antibodies. Some of these B cells go on to become long-lived plasma cells that live in the bone marrow and spleen. The antibodies made by these plasma cells are what will protect people months to years after vaccination. When a person is vaccinated via injection, you usually don't see much of a mucosal (e.g. nose/respiratory) immune response, which would be IgA. There are some experimental injectable vaccines in animals that manage to stimulate IgA production in the respiratory tract, but I don't know what these SARS-CoV-2 mRNA vaccines will do. Regardless, if you have good IgG levels, that will protect the lung against COVID pneumonia even if it doesn't protect against mild upper respiratory infection. You'd still probably be a risk to others, but the amount of viral shedding and the duration of shedding would likely be less. Consequently, the window of time in which you could transmit infection would likely be lower.

[YVK]

College athletes.

I've volunteered my expertise to a medical team for local Div 1 college teams. Apparently NCAA has required, at least several months ago, that every collegiate athlete who's covid19 positive to get cardiac injury markers and, if abnormal, cardiac testing. Or so I was told. I haven't been busy with that task at all but the notion that this likely healthiest and fittest group of population gets away from covid without consequences has been quickly refuted.

[pangloss]

I saw tonight that they’re about to start trials on kids 12-17.

My older daughter is eight years old and honestly I'd want a few hundred thousand more people to get the vaccine before she does. I'm glad they are working down the age range though. I bet in a few months they'll get to the 8-12 year olds. I'd take any of the front runner vaccines for myself tonight if I had the chance.

[TGS]

As I've offered to do multiple times, I am quite happy to walk you through this point by point, but you will have to start by being open to an alternative conclusion than the one you've decided upon in advance

I think that's a no.

Now let me deflect that by asking you to prove the sky is blue.

[45dotACP]

Roger that. Your response was what I expected, and I almost didn't post it. However I wanted to be fair and I do appreciate you investigating the site.


If you have evidence, that HCQ and Zinc (together), given in the early stages of the virus don't work, then I am opening to listening. I am not interested in zinc doesn't work, hcq doesn't work, or it doesn't work but it was given when the patient was very sick in the hospital. Again, I am talking about what most people who advocate it are talking about. Together and in the early stages.

Roger that. Your response was what I expected, and I almost didn't post it. However I wanted to be fair and I do appreciate you investigating the site.


If you have evidence, that HCQ and Zinc (together), given in the early stages of the virus don't work, then I am opening to listening. I am not interested in zinc doesn't work, hcq doesn't work, or it doesn't work but it was given when the patient was very sick in the hospital. Again, I am talking about what most people who advocate it are talking about. Together and in the early stages.

I'm actually a bit more interested in finding out what DOES work for patients in the hospital. Regardless of how early it's given.

There is a medication that's the same age as plaquenil and is proven by studies to help patients with COVID....it's called Dexamethasone, or Decadron.

These conspiracy theories that some shadowy cabal is trying to keep people from accessing the most effective treatment or that doctors are being stifled seems to fly in the face of the fact that a metric crapton of meds were granted emergency use authorization for treating COVID. Antibiotics, Antivirals, Blood products, IL-6 inhibitors, Monoclonal antibodies...I wouldn't be surprised if they would have been all about green tea if someone said it would help.

But the scientific process weeds these out and those who still think Chloroform is the best anaesthesia are ignored. Not stifled.

Another problem with meds that are given for "early cases" is a lot of confirmation bias.

Yeah, the majority of COVID patients don't become severely ill. You could have them taking doses of human feces and they'd probably still recover from COVID.

But the 2,000 people doomed to die today because they were the 1% fatality of the 200,000+ cases that dropped today? The speed with which some of those people will sicken is mind boggling. I've seen patients dead within 12 hours of a positive test. Let alone go from early stage ARDS to late stage ARDS.

You'd have to be giving them a dose of HCQ/zinc so early that they wouldn't even know they had symptoms. It would have to practically be in the water.

It's not a viable strategy from a public health strategy for those most likely to die, even if it did work. Maybe that's the reason it doesn't.

The main reason is the process of ARDS, the most common mechanism of death for these patients and the common thread in all of the severe cases. It's also a reason that skilled ICU management is an important component of hospitals that see higher than normal COVID survival rates.

I could (and actually do) teach a class to new nurses that is all about respiratory illnesses and ARDS is a huge part of that, as it is not actually a single disease process, but a collection of symptoms that can be caused by several different pathologies. I can only cover it generally here.

Often times severe COVID patients are actually ARDS patients.

Once you begin the process of ARDS, the primary pathology that causes it (COVID for instance, but it can be trauma, toxins, pneumonia, septic shock, cancer, HIV, or even just choking on a quail egg) is largely irrelevant. And ARDS can develop on 24-72 hours from the original insult to the body. The body is convinced the lungs are under assault and begins its own inflammatory response, tearing the lungs apart in hopes of getting the attacker...the scarring in the lungs causes decreased oxygen levels...which causes more inflammation...which kills more lung tissue, which dies and becomes scar tissue.

This is a very general explanation...I realize I'm leaving out extremely important aspects of the proliferative, exudative and fibrotic stages...but this is largely to teach a concept map to nurses for whom such intense detail as type 1 vs type 2 alveolar, ventilation and surfactant production etc...

Anyways, the only way to arrest the process is support. Supplement the oxygen by giving more than the healthy lung requires so the hypoxia doesn't kill lung tissue. Give a potent anti inflammatory agent (like a corticosteroid...of which dexamethasone is one) provide fluids to support blood pressure (if they're shocky), flip the patient prone to get the bases of the lungs less affected by gravity...because a great deal of oxygen exchange takes place there and you can keep the patient hanging on. You do all this in hopes their bodies chill and turn off the self destruct sequence, and the lungs begin to shunt blood away from damaged areas and towards areas that can participate in getting oxygen in the blood.

If all else fails, bypass the damaged lungs with Extra Corporeal Membrane Oxygenation (ECMO)

All this to say, the best option for surviving COVID until an effective vaccine is widespread is the same as it has always been: eat right, take your vitamins, stay in shape, do your cardio.

If you wind up in the hospital, the meds we have are to keep your body from ripping your lungs to pieces trying to fight your infection. DO YOUR INCENTIVE SPIROMETER and get up in your chair. Keep your lungs open and inflated and you'll exchange oxygen more effectively.



Sent from my moto g(6) using Tapatalk

[MickAK]

Roger that. Your response was what I expected, and I almost didn't post it. However I wanted to be fair and I do appreciate you investigating the site.


If you have evidence, that HCQ and Zinc (together), given in the early stages of the virus don't work, then I am opening to listening. I am not interested in zinc doesn't work, hcq doesn't work, or it doesn't work but it was given when the patient was very sick in the hospital. Again, I am talking about what most people who advocate it are talking about. Together and in the early stages.

You keep doing this, to the point where even to somebody that celebrates independent thought and research and thinks it's essential is getting annoyed. So how about this. You can go back in the thread to May/June and watch me and Nephrology get in a big internet fight about a study that showed HCQ had a negative effect on outcomes. Maybe that will raise my credibility in your eyes. If you won't take it from someone who went to medical school, maybe you will from another independent thinker.

Think about this:

1. At this point in the pandemic, there is too much money at stake for medical establishment inertia to block an effective treatment. Money talks. Bureaucracy and hidebound establishments can do a lot of harm, but money will move mountains and has.

2. This is a virus with a very wide range of outcomes across every conceivable age range, pre-existing condition status and comorbidity. That makes it extremely difficult to conduct an effective study on a prophylactic.

3. HCQ has very well established side effects. It has been in use for decades and those side effects are not up for debate. The data is widely available and easily analyzed.

4. Using HCQ/Zinc as a prophylactic at the scale you are suggesting would cause more negative outcomes than positive ones. That data wasn't available in May/June but it is now.

5. There's nothing wrong with being excited about the potential research into HCQ/Chloroquine having an effect on virus replication. The developments in mRNA vaccines are exciting but any novel virus is going to have a major effect even with a quicker pathway to an effective vaccine. The fact that nobody knows how it works is a good thing. It means there may be something to learn, and something good may come of it.

6. You can't say the majority of doctors are full of shit then use the fact that the people that support your point of view are doctors as a talking point. If the majority of doctors/medical professionals are full of shit, your doctors might be too.

[Caballoflaco]

[TheNewbie]

I'm actually a bit more interested in finding out what DOES work for patients in the hospital. Regardless of how early it's given.

There is a medication that's the same age as plaquenil and is proven by studies to help patients with COVID....it's called Dexamethasone, or Decadron.

These conspiracy theories that some shadowy cabal is trying to keep people from accessing the most effective treatment or that doctors are being stifled seems to fly in the face of the fact that a metric crapton of meds were granted emergency use authorization for treating COVID. Antibiotics, Antivirals, Blood products, IL-6 inhibitors, Monoclonal antibodies...I wouldn't be surprised if they would have been all about green tea if someone said it would help.

But the scientific process weeds these out and those who still think Chloroform is the best anaesthesia are ignored. Not stifled.

Another problem with meds that are given for "early cases" is a lot of confirmation bias.

Yeah, the majority of COVID patients don't become severely ill. You could have them taking doses of human feces and they'd probably still recover from COVID.

But the 2,000 people doomed to die today because they were the 1% fatality of the 200,000+ cases that dropped today? The speed with which some of those people will sicken is mind boggling. I've seen patients dead within 12 hours of a positive test. Let alone go from early stage ARDS to late stage ARDS.

You'd have to be giving them a dose of HCQ/zinc so early that they wouldn't even know they had symptoms. It would have to practically be in the water.

It's not a viable strategy from a public health strategy for those most likely to die, even if it did work. Maybe that's the reason it doesn't.

The main reason is the process of ARDS, the most common mechanism of death for these patients and the common thread in all of the severe cases. It's also a reason that skilled ICU management is an important component of hospitals that see higher than normal COVID survival rates.

I could (and actually do) teach a class to new nurses that is all about respiratory illnesses and ARDS is a huge part of that, as it is not actually a single disease process, but a collection of symptoms that can be caused by several different pathologies. I can only cover it generally here.

Often times severe COVID patients are actually ARDS patients.

Once you begin the process of ARDS, the primary pathology that causes it (COVID for instance, but it can be trauma, toxins, pneumonia, septic shock, cancer, HIV, or even just choking on a quail egg) is largely irrelevant. And ARDS can develop on 24-72 hours from the original insult to the body. The body is convinced the lungs are under assault and begins its own inflammatory response, tearing the lungs apart in hopes of getting the attacker...the scarring in the lungs causes decreased oxygen levels...which causes more inflammation...which kills more lung tissue, which dies and becomes scar tissue.

This is a very general explanation...I realize I'm leaving out extremely important aspects of the proliferative, exudative and fibrotic stages...but this is largely to teach a concept map to nurses for whom such intense detail as type 1 vs type 2 alveolar, ventilation and surfactant production etc...

Anyways, the only way to arrest the process is support. Supplement the oxygen by giving more than the healthy lung requires so the hypoxia doesn't kill lung tissue. Give a potent anti inflammatory agent (like a corticosteroid...of which dexamethasone is one) provide fluids to support blood pressure (if they're shocky), flip the patient prone to get the bases of the lungs less affected by gravity...because a great deal of oxygen exchange takes place there and you can keep the patient hanging on. You do all this in hopes their bodies chill and turn off the self destruct sequence, and the lungs begin to shunt blood away from damaged areas and towards areas that can participate in getting oxygen in the blood.

If all else fails, bypass the damaged lungs with Extra Corporeal Membrane Oxygenation (ECMO)

All this to say, the best option for surviving COVID until an effective vaccine is widespread is the same as it has always been: eat right, take your vitamins, stay in shape, do your cardio.

If you wind up in the hospital, the meds we have are to keep your body from ripping your lungs to pieces trying to fight your infection. DO YOUR INCENTIVE SPIROMETER and get up in your chair. Keep your lungs open and inflated and you'll exchange oxygen more effectively.



Sent from my moto g(6) using Tapatalk

Thank you for this.


Obviously no cure is going to work for all, simply not going to happen. It is refreshing to hear that there are multiple medicines being used in an effort to treat the sick. Still, numerous doctors have had success with HCQ and Zinc. Maybe it was just dumb luck, or maybe there is something to it.


We seem to be talking about two different sets of patients. Those with early detection and treatment, and those who you are caring for in the ER in a more advanced stage of the disease.


Do you think if everyone was taking HCQ and Zinc, it would have no meaningful effect on the virus?

As to conspiracy theories, I am not into those either.

[TheNewbie]

You keep doing this, to the point where even to somebody that celebrates independent thought and research and thinks it's essential is getting annoyed. So how about this. You can go back in the thread to May/June and watch me and Nephrology get in a big internet fight about a study that showed HCQ had a negative effect on outcomes. Maybe that will raise my credibility in your eyes. If you won't take it from someone who went to medical school, maybe you will from another independent thinker.

Think about this:

1. At this point in the pandemic, there is too much money at stake for medical establishment inertia to block an effective treatment. Money talks. Bureaucracy and hidebound establishments can do a lot of harm, but money will move mountains and has.

2. This is a virus with a very wide range of outcomes across every conceivable age range, pre-existing condition status and comorbidity. That makes it extremely difficult to conduct an effective study on a prophylactic.

3. HCQ has very well established side effects. It has been in use for decades and those side effects are not up for debate. The data is widely available and easily analyzed.

4. Using HCQ/Zinc as a prophylactic at the scale you are suggesting would cause more negative outcomes than positive ones. That data wasn't available in May/June but it is now.

5. There's nothing wrong with being excited about the potential research into HCQ/Chloroquine having an effect on virus replication. The developments in mRNA vaccines are exciting but any novel virus is going to have a major effect even with a quicker pathway to an effective vaccine. The fact that nobody knows how it works is a good thing. It means there may be something to learn, and something good may come of it.

6. You can't say the majority of doctors are full of shit then use the fact that the people that support your point of view are doctors as a talking point. If the majority of doctors/medical professionals are full of shit, your doctors might be too.

Well I think we are all independent thinkers in this thread. Medical school doesn't make you all knowing (despite what my wife says!), but it obviously has infinitely more weight than anything I might say or post does. As it probably should.


My interest in solely in what works. It seems HCQ and Zinc has worked well for many, but there may be a better overall solution.


I don't think the majority of doctors are full of shit.


Annoyance is strong on all sides, I am sure.







Anyway, I am going to attempt to bow out this thread for a while. My concern is that my disagreements are taking away from the quality of the discussion, even if I believe the concerns I have are valid.