OtherGround Forums OG doc. AMA on COVID-19

3/14/20 8:56 PM
1/7/09
Posts: 15785
John Cable -

 

 

you did not answer my q. 

 

remdesivar? does it work?

No one knows yet. clinical trials are currently underway.  Anecdotal evidence says it might work, but that doesnt mean much until the clinical trials conclude.

3/14/20 9:16 PM
3/17/02
Posts: 623

Good stuff!!

Edited: 3/14/20 9:31 PM
2/4/09
Posts: 10434

Should be reposted here. A conference in Boston. Good info 

 

https://externalmediasite.partners.org/Mediasite/Play/45a9a74f18ec45deb338e00ac4cf4e281d

 

Start at 38 minutes for emerging antivirals. 

 

Start at 29 minutes for general COVID information and I believe she's the speaker that brings up Women VS Men with soluble ACE2

3/14/20 9:29 PM
12/13/11
Posts: 9091

hey doc, I am on the immune suppressant drug entyvio for ulcerative colitis. other than than I am a healthy 30 year old male in professional athlete kinda shape. how big is the risk of dying for me? since taking the drug I have routinely gotten sick fairly frequently throughout the winter each year when previously I probably did not get sick for 10 years. 

3/14/20 9:33 PM
10/23/05
Posts: 2876
used2wrestle - 

What are your thoughts on the veracity of the coronavirus numbers in Quebec? On one hand they seem to be reassuring that there's no community spread as every single case is tied to international travel but on the other hand it seems that they simply won't test you if you haven't travelled. It seems Ontario's new testing approach is the complete opposite and they're specifically looking for community spread now. In any case, I'm worried Quebecers are getting a false sense of security when they're out fighting for TP at Costco.

Thanks for the AMA and if you do a nephrology AMA I'd like to ask about your awareness of roxadustat and if approved, you'd use it. Also curious about bardoxalone and it's ability to improve eGFR in CKD.


I know cases of direct transmissions in Montreal. I believe it's also acknowledged in the news. Only 24 positive cases in Quebec as far as I can tell, but you're right we haven't offered widespread testing.

As for roxadustat, I have no personal experience. I read the NEJM paper but I'm not sure why it would be better than EPO.

As for bardoxalone, no experience either. I read the Chertow paper. I'm not a big fan of post-hoc papers, especially from a study that was stopped because of high cardiac events.

Edited: 3/14/20 9:36 PM
10/23/05
Posts: 2877
John Cable - 

 

 

you did not answer my q. 

 

remdesivar? does it work?


We'll know soon hopefully. Trial ongoing. Too soon to tell

Here is some prelim info: https://mbio.asm.org/content/9/2/e00221-18
3/14/20 9:37 PM
10/23/05
Posts: 2878
SpunQ - 

Hey Doc.

 

https://www.justice.gov/opa/pr/harvard-university-professor-and-two-chinese-nationals-charged-three-separate-china-related


Yes, and?

Edited: 3/14/20 9:47 PM
10/23/05
Posts: 2879
Neil McCauley - 

hey doc, I am on the immune suppressant drug entyvio for ulcerative colitis. other than than I am a healthy 30 year old male in professional athlete kinda shape. how big is the risk of dying for me? since taking the drug I have routinely gotten sick fairly frequently throughout the winter each year when previously I probably did not get sick for 10 years. 


Risk of contracting the virus?
-Depends where you live. Might be significant, as for many of us.

Risk of getting pretty sick if you contract it?
-Higher than someone of the same age.

Risk of death?
-Very very low. There are very few cases of young adults dying, even in those with severe immunosuppression. Be careful and don't wait if you get sick.
3/14/20 9:44 PM
4/19/09
Posts: 33005
mataleo1 -
acai - 

Based on the information that's out there, i don't think it's necessary nor a good idea to wear a mask.  It also causes you to fidget with it, which brings your hands on your face or close to it...Peter Attia MD mentioned the same thing in one of his recent videos on the subject.  

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

 

>>>If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.

 

>>Wear a mask if you are coughing or sneezing.

 

What to do:

 

(1.) Get a thermometer, fever is 100.4 or higher

(2.) Purchase a Pulse Oximeter to measure your oxygen levels at home.  Since COVID-19 causes a slow decrease in Oxygen levels before someone actually feels the effects, that's why you would measure your levels at home.  If you notice it go below 95% contact your doctor right away.


n95 masks do reduce transmission but they have limitations (not full proof) but early data is promising in very endemic areas.

Your suggestions for diagnosis (fever and low sat) is helpful but not fullproof. Fever only has a sensitivity as marker of 80-85% meaning there are quite a few false negatives. And low sat is a bad prognostic factor but not a diagnostic one.

Foolproof

3/14/20 9:50 PM
12/1/12
Posts: 2368
mataleo1 -
used2wrestle - 

What are your thoughts on the veracity of the coronavirus numbers in Quebec? On one hand they seem to be reassuring that there's no community spread as every single case is tied to international travel but on the other hand it seems that they simply won't test you if you haven't travelled. It seems Ontario's new testing approach is the complete opposite and they're specifically looking for community spread now. In any case, I'm worried Quebecers are getting a false sense of security when they're out fighting for TP at Costco.

Thanks for the AMA and if you do a nephrology AMA I'd like to ask about your awareness of roxadustat and if approved, you'd use it. Also curious about bardoxalone and it's ability to improve eGFR in CKD.


I know cases of direct transmissions in Montreal. I believe it's also acknowledged in the news. Only 24 positive cases in Quebec as far as I can tell, but you're right we haven't offered widespread testing.

As for roxadustat, I have no personal experience. I read the NEJM paper but I'm not sure why it would be better than EPO.

As for bardoxalone, no experience either. I read the Chertow paper. I'm not a big fan of post-hoc papers, especially from a study that was stopped because of high cardiac events.

Thanks Doc!

what about tenapenor for hypophsphatemia? Is pill burden and compliance a big issue?

roxadustat was superior on MACE vs. EPO in patients starting on dialysis (superior on efficacy too I think), doesn't require IV iron, works in inflamed patients so no need for high doses of EPO and is a pill. Not sure if those points would be meaningful enough to drive a change in practice.

3/14/20 9:50 PM
6/30/07
Posts: 60015

Good thread, thanks everyone

3/14/20 9:51 PM
3/18/14
Posts: 2249

Sub

3/14/20 9:56 PM
10/23/05
Posts: 2880
used2wrestle - 
mataleo1 -
used2wrestle - 

What are your thoughts on the veracity of the coronavirus numbers in Quebec? On one hand they seem to be reassuring that there's no community spread as every single case is tied to international travel but on the other hand it seems that they simply won't test you if you haven't travelled. It seems Ontario's new testing approach is the complete opposite and they're specifically looking for community spread now. In any case, I'm worried Quebecers are getting a false sense of security when they're out fighting for TP at Costco.

Thanks for the AMA and if you do a nephrology AMA I'd like to ask about your awareness of roxadustat and if approved, you'd use it. Also curious about bardoxalone and it's ability to improve eGFR in CKD.


I know cases of direct transmissions in Montreal. I believe it's also acknowledged in the news. Only 24 positive cases in Quebec as far as I can tell, but you're right we haven't offered widespread testing.

As for roxadustat, I have no personal experience. I read the NEJM paper but I'm not sure why it would be better than EPO.

As for bardoxalone, no experience either. I read the Chertow paper. I'm not a big fan of post-hoc papers, especially from a study that was stopped because of high cardiac events.

Thanks Doc!

what about tenapenor for hypophsphatemia? Is pill burden and compliance a big issue?

roxadustat was superior on MACE vs. EPO in patients starting on dialysis (superior on efficacy too I think), doesn't require IV iron, works in inflamed patients so no need for high doses of EPO and is a pill. Not sure if those points would be meaningful enough to drive a change in practice.


Thx I'll look into it. I mostly focus my practice in acute dialysis but this is relevant.

I'm assuming you meant hyperPO4. Since we've had fosrenol, fewer pills are already administered. But I like the fact that there's no calcium and no metal (aluminum or lanthanum). Diarrhea seems like a problematic side-effect.

3/14/20 9:57 PM
12/2/05
Posts: 14350

In

Edited: 3/15/20 2:20 PM
9/24/10
Posts: 2163

 

3/14/20 10:50 PM
1/1/01
Posts: 53308

It seems that the virus induces pneumonia and that's where the danger lies. Yet I had heard that anti-virals weren't working, but antibiotics were. Is it possible that the covid19 virus somehow induces a bacterial pneumonia?

3/14/20 10:53 PM
12/1/12
Posts: 6634


3/14/20 11:01 PM
5/19/17
Posts: 696
mataleo1 -

Trying to be useful in this time of crisis and uncertainty.

MD here working in both the US and Canada. Have seen and treated a few cases so far. My wife is an epidemiologist and ID doc working for the IDSA and CDC so she's right in the middle of this.

I'll answer any mindful and respectful question unless I'm busy on call.

For the record, I thought that Trump behaved irresponsibly when this came out and we are now lagging behind. However, I entirely support his decision to close the borders from Europe and I think he's behaved like a responsible leader these last 2 weeks.

Ask away

Let's keep this civil.

Edited: A big shout out to fellow MDs RahjaiMD, sage77, NoNeed4aScreenName for their input!

Sorry if this question has been asked already, you are on the frontline dealing with this. Is it really as bad as media is been making it. I mean are you scared lf what will happen the next couple of weeks?

3/14/20 11:10 PM
8/19/06
Posts: 10030
Thanks to all the Doctors and medical staff for posting.
3/14/20 11:12 PM
12/1/12
Posts: 2369

How long will the virus survive on a surface in Montreal winter weather? If this isn't known would it be shorter or longer than warmer weather?

3/14/20 11:12 PM
5/19/17
Posts: 698
Hessian - Thanks to all the Doctors and medical staff for posting.

+1, been reading stories from docs here in the Netherlands, this shit is for real. 

Edited: 3/15/20 12:13 AM
1/27/20
Posts: 194

Trobinson is a homosexual who passed his homosexual genes down to his homosexual son, who happens to be a D1 homosexual. Him, and his son, absolutely love to have unnatural sexual relations with humans of the same gender. He is also not tough, and is likely prone to flash knockouts. Trobinsons wife is a mouthy, skinny chick who miraculously also has love handles. She has short hair that is heavily dyed , and spits all the time. He has a great truck, and his wife has a great car - but he doesn’t understand how car payments work, which means that he’s a half million dollars in debt due to him having a Silverado and his wife having a CRV. He has multiple subscriptions to Disney plus, amazon prime, Netflix and HBO. He regards these subscriptions cumulatively as less than five dollars per month. His entire family are homosexuals. He sucks at video games and does not understand them. His credit card is dangerously close to its limit. He’s great at computers and has a wicked computer chair, but his computer room is very cluttered. He is unable to retort this post without vulgarity. I win and he loses - the end.

3/15/20 12:10 AM
11/15/11
Posts: 174

Thank you for the thread.

3/15/20 12:33 AM
4/26/13
Posts: 8272

Awesome info. Thank you

3/15/20 12:33 AM
1/1/01
Posts: 21658

Has there been some type of correlation found between incubation period and severity of the infection?

You show signs in 5 days then you'll have a bad case / you show signs in 14 days and its a mild case...