Cancel Order? Because of Corona Virus Fallout?
03-22-2020, 10:53 PM
#196
The Apple Watch, as I understand it, can do a single lead EKG. In theory, this can check what is called the QT interval. If this gets too long, you can have ventricular tachycardia. However, as far as I know the software is really only set up to measure rates of rhythm, and irregular rhythms like atrial fibrillation or what is called supra ventricular tachycardia (VT), and not really this QT interval. It may detect what are called PVCs, which may be a premonition of VT, but again, this may or not indicate issues with the QT interval.
Let's be clear right now. For now, let's use these drugs to treat people with COVID pneumonia in the hospital only, if we are going to use them at all. In the hospital we can do a full EKG. If we give these as prophylaxis to health care workers as a start, at least they will be followed.
The incidence of QT prolongation is rare, as many on this forum will tell you, but I would not use these drugs just now for prevention and especially not only use an Apple Watch to monitor for QT prolongation.
I'd love to hear a cardiologist on this (which I am not).
Let's be clear right now. For now, let's use these drugs to treat people with COVID pneumonia in the hospital only, if we are going to use them at all. In the hospital we can do a full EKG. If we give these as prophylaxis to health care workers as a start, at least they will be followed.
The incidence of QT prolongation is rare, as many on this forum will tell you, but I would not use these drugs just now for prevention and especially not only use an Apple Watch to monitor for QT prolongation.
I'd love to hear a cardiologist on this (which I am not).
I was actually thinking about the use of plaquenil as prophylaxis for health care workers today.
Asymptomatic carriage of this virus is high. Another issue - delineating between minimally symptomatic COVID-19 and seasonal allergies may be next to impossible without testing, which will not be available for low yield cases like this for quite some time. How do we protect patients from exposure?
Personally, I'm maintaining 6 ft airspace and I'm wearing gloves and a mask when I broach that space to physically examine them. I'm bringing patients directly into the room as soon as they check in (no sitting in the waiting room) and if my rooms are full, they'll wait in the car and we'll call their cellphone to bring them up when the room is ready.
03-22-2020, 11:11 PM
#197
Not a cardiologist, but an Apple Watch would not settle the question for me.
I was actually thinking about the use of plaquenil as prophylaxis for health care workers today.
Asymptomatic carriage of this virus is high. Another issue - delineating between minimally symptomatic COVID-19 and seasonal allergies may be next to impossible without testing, which will not be available for low yield cases like this for quite some time. How do we protect patients from exposure?
Personally, I'm maintaining 6 ft airspace and I'm wearing gloves and a mask when I broach that space to physically examine them. I'm bringing patients directly into the room as soon as they check in (no sitting in the waiting room) and if my rooms are full, they'll wait in the car and we'll call their cellphone to bring them up when the room is ready.
I was actually thinking about the use of plaquenil as prophylaxis for health care workers today.
Asymptomatic carriage of this virus is high. Another issue - delineating between minimally symptomatic COVID-19 and seasonal allergies may be next to impossible without testing, which will not be available for low yield cases like this for quite some time. How do we protect patients from exposure?
Personally, I'm maintaining 6 ft airspace and I'm wearing gloves and a mask when I broach that space to physically examine them. I'm bringing patients directly into the room as soon as they check in (no sitting in the waiting room) and if my rooms are full, they'll wait in the car and we'll call their cellphone to bring them up when the room is ready.
This is such a tough, tough decision in the absence of firm data. I cringe as I write this, and I hope beyond hope we have data--any data--to guide us on prophylaxis, and I hope we get it soon.
For me, what I do is assume people are negative if they have no fever with/without dry cough (not sure endemic travel is a criterion any more) and use the standard precautions as you are doing.
My health system here in Pittsburgh provides daily guidance on this, which changes daily. I assume health systems and local authorities are providing local guidance on precautions for anyone who asks for them, usually posted online. Nobody just now, as far as I know, is providing suggestions recommending anti-viral prophylaxis.
To all those non-MDs reading this, I apologize for hijacking this 992 thread.
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hamerans (03-23-2020)
03-22-2020, 11:21 PM
#198
Banned
https://news.sky.com/story/coronavir...smell-11961439
03-23-2020, 12:23 AM
#199
This is such a tough, tough decision in the absence of firm data. I cringe as I write this, and I hope beyond hope we have data--any data--to guide us on prophylaxis, and I hope we get it soon.
For me, what I do is assume people are negative if they have no fever with/without dry cough (not sure endemic travel is a criterion any more) and use the standard precautions as you are doing.
My health system here in Pittsburgh provides daily guidance on this, which changes daily. I assume health systems and local authorities are providing local guidance on precautions for anyone who asks for them, usually posted online. Nobody just now, as far as I know, is providing suggestions recommending anti-viral prophylaxis.
To all those non-MDs reading this, I apologize for hijacking this 992 thread.
For me, what I do is assume people are negative if they have no fever with/without dry cough (not sure endemic travel is a criterion any more) and use the standard precautions as you are doing.
My health system here in Pittsburgh provides daily guidance on this, which changes daily. I assume health systems and local authorities are providing local guidance on precautions for anyone who asks for them, usually posted online. Nobody just now, as far as I know, is providing suggestions recommending anti-viral prophylaxis.
To all those non-MDs reading this, I apologize for hijacking this 992 thread.
03-23-2020, 07:26 AM
#200
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hamerans (03-23-2020)
03-23-2020, 07:42 AM
#202
I happened to stumble on "Explained" on Netflix which hand a pandemic episode. It was very informative and explained how a lot of these virus originate in China due to their wet market and mixing of animal blood. For example they said bird flu could not infect humans and the common cold could not infect birds but when a bird infected a pig and a human consumed the pig it created H1N1. What really was scary was they went into detail about SARS and how a person whom had diarrhea flushed their toilets and it transmitted to other apartments through the vents. I don't know how accurate that is, but if that's true for this virus i fear for NYC Residents
03-23-2020, 11:13 AM
#203
Have you noticed anyone complaining about loss of taste or smell? I've heard that could be the very first sign of infection with this virus.
https://news.sky.com/story/coronavir...smell-11961439
https://news.sky.com/story/coronavir...smell-11961439
03-23-2020, 11:46 AM
#204
I am extremely far away from being a doctor, and I definitely underestimated this outbreak before it exploded here, but I've had a few thoughts on this the past few days:
1) We are being told to listen to the experts, listen to the experts. If you had listened to the WHO, seemingly the biggest experts on this that exist, they said on February 27th, that the evidence they had did not show a lot of human to human transmission. So listening to the experts about 11 days before the outbreak really started here would have meant being fairly dismissive of the potential for this to explode the way that it has. Doesn't mean that you should ignore advice from experts, but this kinda stuff just drives me nuts...there's an excessive amount of appealing to authority and authority is often wrong...not necessarily maliciously so, but wrong.
2) Criticism of our response to this feels a bit ridiculous...who exactly has responded well? South Korea is the one example everyone points to, but as pointed out elsewhere, they were prepared because their response was so bad to previous outbreaks. The entire European continent, which is the shining standard of life for people of a certain political persuasion who have most vociferously criticized the US response, has done a horrifically bad job of responding to this, moving much more slowly and doing less than we did. No one is prepared for this, because it would be a dramatic waste of resources for governments and private companies to stockpile enough resources for tens of millions of people to get sick all at once. Even after this outbreak there are many, many countries that have seen it explode and done absolutely nothing to prepare for it coming there. Human inertia is incredibly hard to defeat, it's extremely extremely hard to tell people that something is going to destroy their lives when they're seeing zero effects of it in front of their face. If anything, the remarkable speed that things happened here is fairly impressive, things went from normal to sports and entertainment and businesses closing in 2 days. Maybe we could have shut everything down February 28th, but again, listening to the World Health Organization the day before you'd have thought this wouldn't be a big problem. Hard to shut down the US economy without a lot of human transmission happening.
3) How much longer until we reach a breaking point where it's worth people getting sick to re-open stores and other parts of the economy with social distancing measures because if we don't there won't be much of a world for everyone to return to when things go back to normal?
My extremely uneducated hope is that the cases level out over the next 7 days...the outbreak really started to grow significantly here on March 12th, so the majority of people sick now would likely have gotten the virus before the more stringent distancing and isolating measures came into place. Theoretically that should start paying dividends by the end of the month, at least that's my hope...who knows.
1) We are being told to listen to the experts, listen to the experts. If you had listened to the WHO, seemingly the biggest experts on this that exist, they said on February 27th, that the evidence they had did not show a lot of human to human transmission. So listening to the experts about 11 days before the outbreak really started here would have meant being fairly dismissive of the potential for this to explode the way that it has. Doesn't mean that you should ignore advice from experts, but this kinda stuff just drives me nuts...there's an excessive amount of appealing to authority and authority is often wrong...not necessarily maliciously so, but wrong.
2) Criticism of our response to this feels a bit ridiculous...who exactly has responded well? South Korea is the one example everyone points to, but as pointed out elsewhere, they were prepared because their response was so bad to previous outbreaks. The entire European continent, which is the shining standard of life for people of a certain political persuasion who have most vociferously criticized the US response, has done a horrifically bad job of responding to this, moving much more slowly and doing less than we did. No one is prepared for this, because it would be a dramatic waste of resources for governments and private companies to stockpile enough resources for tens of millions of people to get sick all at once. Even after this outbreak there are many, many countries that have seen it explode and done absolutely nothing to prepare for it coming there. Human inertia is incredibly hard to defeat, it's extremely extremely hard to tell people that something is going to destroy their lives when they're seeing zero effects of it in front of their face. If anything, the remarkable speed that things happened here is fairly impressive, things went from normal to sports and entertainment and businesses closing in 2 days. Maybe we could have shut everything down February 28th, but again, listening to the World Health Organization the day before you'd have thought this wouldn't be a big problem. Hard to shut down the US economy without a lot of human transmission happening.
3) How much longer until we reach a breaking point where it's worth people getting sick to re-open stores and other parts of the economy with social distancing measures because if we don't there won't be much of a world for everyone to return to when things go back to normal?
My extremely uneducated hope is that the cases level out over the next 7 days...the outbreak really started to grow significantly here on March 12th, so the majority of people sick now would likely have gotten the virus before the more stringent distancing and isolating measures came into place. Theoretically that should start paying dividends by the end of the month, at least that's my hope...who knows.
I do see CDC or the so called experts putting press release on January 30th confirming first human to human spread in the US https://www.cdc.gov/media/releases/2...us-spread.html
This lady who visited Wuhan in mid or early January infected bunch of people in Chicago.
2. Coming to our response which has been terrible. Our multi-billion dollar intelligence agencies have been warning since January that Chinese are lying about the disease but this administration ignored it https://www.washingtonpost.com/natio...597_story.html
.Also testing was an utter failure - https://www.wsj.com/articles/how-was...em-11584552147
Japan has Corona under control.
Italy is an outlier due to demographics (50% of the dead had more than 2 underlying heath conditions) and Italian mentality for not following rules as more than 50,000 people are charged with breaking quarantine rules.
Germany has more cases than the US but far lower fatality rate
Canada's cases are declining
Testing availability is still low in NY
3. Hard to say but 15%-25% hit to Q2 GDP is likely unless government spends 1.5-2 trillion (The issue is how to design in a short period without corruption or goof up's). Also, eCommerce is crushing and big retailers are changing their model (Best Buy, Dick's, etc) provide contact-less delivery on curbside. Even car retailers are changing the model as I saw email from my Range Rover dealer willing to do whole paperwork via email and sending car home for test drive with sales guy wearing gloves and mask. The biggest issue is economic divide where some people can easily work from home while people who work at low income jobs lost their jobs and have no money to pay for rent, food, etc.I am still paying my nanny and cleaning lady even though we told them not to come for work anymore.
In the end, I have faith in human spirit that something would work out
03-23-2020, 12:16 PM
#205
Maybe someone who is in the medical field - may be able to comment further on the link below. Apparently the drug has been used for a long time. The study starts today. If they can find a drug that mitigates how lethal the virus is as opposed to prevention or having to wait so long for a vaccination may allow a return to some economic normality. Antiviral is obviously something that scientists around the world are working on. The antiviral may be more appealing as it contracts the time line. Here is the link.
https://www.cbc.ca/player/play/1714643523946
https://www.cbc.ca/player/play/1714643523946
Last edited by ISPYA718; 03-23-2020 at 01:05 PM. Reason: Grammar
03-23-2020, 12:57 PM
#208
Rennlist Member
Lei Pan, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study
03-23-2020, 01:26 PM
#209
Rennlist Member
Colchicine is a medication I have used for thirty years and in low doses is fairly benign , and it has been used for a variety of diseases including gout, pseudo gout, pericarditis and other conditions like FMF" familial Mediterranean fever plus others
can't predict if it helps or not , but with this pandemic a lot of people are trying a lot of things and ultimately we will have few winners
can't predict if it helps or not , but with this pandemic a lot of people are trying a lot of things and ultimately we will have few winners
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ISPYA718 (03-23-2020)
03-23-2020, 01:34 PM
#210
I am totally appreciating the input on the crisis in this thread. Seems we are running out of non censored platforms to have smart conversations around this. Hope to see the dialog continue. "Porsche people" have to stick together through this!