OtherGround Forums OG doc. AMA on COVID-19

3/15/20 12:53 AM
6/16/10
Posts: 6245

In.

3/15/20 1:16 AM
1/1/01
Posts: 32231

I have had a few people ask me for my malaria drugs (trips to Africa) and willing to pay me a shitload of money for it.  What's the deal with that?

It's called primaquine and the other one is somewhere called hydro something....

3/15/20 1:51 AM
4/19/09
Posts: 33007
used2wrestle -

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?

I jave read esrly reports that 8 degrees was the optimal for longevity  outside of a person (i think 8 hours). Tropical weather was alleged to reduce the length to less thab 3 hour . Which is allegedlt why Indo hasnt been taking it super seriousl . 

Edited: 3/15/20 2:23 AM
1/7/09
Posts: 15787
Road Warrior Fin -

I have had a few people ask me for my malaria drugs (trips to Africa) and willing to pay me a shitload of money for it.  What's the deal with that?

It's called primaquine and the other one is somewhere called hydro something....

They read that chloroquine is being trialed as a treatment, without understanding anything about it beyond that headline.  Its a potentially very toxic drug and it's being used at high dosages in these trials. You have to be really dumb to want to self medicate with it. Especially since these geniuses probably want to start taking it without any diagnosis.  

3/15/20 2:55 AM
7/31/09
Posts: 6383

 

I've been listening to this video of their experience with Covid 19 in Japan and the part of the video where I have it marked to start at is very interesting.  He is a diabetic who contracted the virus on a cruise ship and didn't fully recognize he was infected even though he was cognizant of the symptoms and was taking his temperature often.  He ended up being infected with covid, common cold, flu, and viral pneumonia.  He discussed how he used breathing exercises to avoid going on a respirator when his condition was deteriorating rapidly.  I thought this video might make people feel a little more at ease to know there are exercises that can be done to help lung problems with this disease.  

Obviously, this won't help everyone, but I have to wonder how effective a combination of avoiding NSAIDs (since there is now some evidence they are causing complications with this disease), taking vitamin D daily supplements, being in the sun for vitamin D, and doing lung exercises like the one he mentions with the emotional freedom technique from Gary Craig or something much more advanced like Wim Hof's method would be with prevention and treatment.

3/15/20 3:01 AM
12/9/13
Posts: 27351

a healthy young 16 year old teenager is in the ICU due to having the Covid 19 virus

it scared the shit out of the whole country, cause the general awereness was, that only old people or people with other medical problems end up in the ICU

btw its in Dutch

https://www.rtlnieuws.nl/nieuws/nederland/artikel/5056536/sehraz-breda-coronavirus-16-intensive-care-besmet-covid19

3/15/20 3:55 AM
1/1/01
Posts: 26848
ttt
3/15/20 4:06 AM
1/1/01
Posts: 15674
mataleo1 - 
turducken - 
mataleo1 -
turducken - 

Here's my theory on a potential treatment as a total armchair scientist

 

Zinc is known to disrupt replication of RNA viruses such as this one. 

Chloroquine has shown possible efficacy as a treatment. Chloroquine is a zinc ionophore. Quercetin and epigallocatechin gallate have also been shown to be zinc ionophores. Therefore give people who are symptomatic zinc and quercetin and egcg early in the course of their illness to minimize viral load and decrease severity of infection.

 

I'll take my Nobel prize with a side of hookers please


Give this man a prize!

Lol. Do you have the ability to test the theory? Safe and cheap to try


Here's the only way to do this:
2 groups, comparable baseline characteristics, comparable disease severity, one group gets standard care, the other gets standard care + zinc

You'd need at least 150 patients to see a 20% difference in mortality. That's called a clinical trial and I can tell you that these are neither cheap, nor easy to do (I'm doing one right now...)

Good luck!


Thanks for what you're doing and this thread. Curious why the 150 patients to see a 20% difference in mortality. Can you walk me through this? thanks

Edited: 3/15/20 4:10 AM
1/1/01
Posts: 15675

Thanks for this thread and your work. I'm worried about my elderly parents.
Dad: 81, previous heart attack. In Florida.
Mom: 76, has a fib, and asthma. In Ohio. Doesn't regularly exercise.

Should my brother's family including my brother's nieces (four girls aall 5 and under) be able to visit them? Should they fly?
What is their risk?

Thanks brother.

3/15/20 4:20 AM
7/30/14
Posts: 5119

Thanks for the information. My parents are at risk (one waiting on a heart valve replacement and had chemo, the other has COPD). I’ve stopped visiting now and will only go to see them if they desperately need something. UK response to this whole thing seems a bit lacking.

3/15/20 5:44 AM
4/27/18
Posts: 2342
mataleo1 -
turducken - 

Do you have any experience with high dose IV vitamin C treating this, or other instances of ARDS or cytokine storm?  I know there are trials ongoing and some anecdotal reports of it working. And given the safety of it, why not try it first.


Great question.

We've tried EVERYTHING for ARDS: corticosteroids, vitamin C, curcuma, bioflavinoids, Vitamin E, Selenium.

Nothing seems to work. Agree with you: no risk and cheap. But benefits remain to be shown

http://www.orthomolecular.org/resources/omns/v16n16.shtml

 seems vitamin c may help with covid in general?

3/15/20 6:18 AM
10/23/05
Posts: 2883
Moke - 

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?


Many respiratory viruses cause secondary bacterial pneumonia (example staph pneumonia after influenza).

You can also develop pneumonia from the virus directly.

Pneumonia just means a lung infection. It can be caused by many pathogens.

Another problem is an aspectic lung reaction (lungs fill up with water because of the immune reaction)

There are both some promise shown by antivirals and antimalarials (chloroquine, hydroxychloroquine)

3/15/20 6:21 AM
10/23/05
Posts: 2884
Dutchemperor86 - 
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?


Not scared but definitely concerned that our system and facilities become overwhelmed and that we are faced with undesirable triage decisions (as in Italy). A lot of fragile people out there who won't be able to fight off a 2 week infection.

Edited: 3/15/20 6:24 AM
10/23/05
Posts: 2885
used2wrestle - 

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?


The virus definitely lives longer in cold weather but this also varies on plastic vs copper vs steel vs skin.
3/15/20 6:28 AM
10/23/05
Posts: 2886
jkd_guy - 

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...


Only theoretically.

A large virus load (think someone infected licking you in the face) will cause you to have a shorter incubation period and likely greater clinical severity. This also may happen if you have impaired immunity or a break in natural protective defenses (injured mucous membranes)

3/15/20 6:32 AM
10/23/05
Posts: 2887
Road Warrior Fin - 

I have had a few people ask me for my malaria drugs (trips to Africa) and willing to pay me a shitload of money for it.  What's the deal with that?

It's called primaquine and the other one is somewhere called hydro something....


Chloroquine and hydroxychloroquine (similar molecule but has a greater safety profile) have shown promise in non-randomized, uncontrolled cases. I haven't seen much on primaquine.

3/15/20 6:53 AM
10/23/05
Posts: 2888
FatBuddha - 
mataleo1 - 
turducken - 
mataleo1 -
turducken - 

Here's my theory on a potential treatment as a total armchair scientist

 

Zinc is known to disrupt replication of RNA viruses such as this one. 

Chloroquine has shown possible efficacy as a treatment. Chloroquine is a zinc ionophore. Quercetin and epigallocatechin gallate have also been shown to be zinc ionophores. Therefore give people who are symptomatic zinc and quercetin and egcg early in the course of their illness to minimize viral load and decrease severity of infection.

 

I'll take my Nobel prize with a side of hookers please


Give this man a prize!

Lol. Do you have the ability to test the theory? Safe and cheap to try


Here's the only way to do this:
2 groups, comparable baseline characteristics, comparable disease severity, one group gets standard care, the other gets standard care + zinc

You'd need at least 150 patients to see a 20% difference in mortality. That's called a clinical trial and I can tell you that these are neither cheap, nor easy to do (I'm doing one right now...)

Good luck!


Thanks for what you're doing and this thread. Curious why the 150 patients to see a 20% difference in mortality. Can you walk me through this? thanks


There are plenty of sample size calculator online.

Look for dichotomous calculator (death vs survival).

It depends on several factors including the margin of error, the estimated risk of outcome (which we really don't know could be anywhere between 1-6%), and how much of a difference you're looking for (you need more patients for lower difference). You also need at least 30% more than estimated because of either crossover (which might happen) or lost to follow-up (minimal)

3/15/20 6:55 AM
10/23/05
Posts: 2889
FatBuddha - 

Thanks for this thread and your work. I'm worried about my elderly parents.
Dad: 81, previous heart attack. In Florida.
Mom: 76, has a fib, and asthma. In Ohio. Doesn't regularly exercise.

Should my brother's family including my brother's nieces (four girls aall 5 and under) be able to visit them? Should they fly?
What is their risk?

Thanks brother.


They're likely to be all right, but there's no reason to put them at risk as they have chronic diseases and are more susceptible to be sick from this. Put off all non-essential visits for at least a month (until we know what is happening).

3/15/20 7:01 AM
10/23/05
Posts: 2890
Strangleu - 
mataleo1 -
turducken - 

Do you have any experience with high dose IV vitamin C treating this, or other instances of ARDS or cytokine storm?  I know there are trials ongoing and some anecdotal reports of it working. And given the safety of it, why not try it first.


Great question.

We've tried EVERYTHING for ARDS: corticosteroids, vitamin C, curcuma, bioflavinoids, Vitamin E, Selenium.

Nothing seems to work. Agree with you: no risk and cheap. But benefits remain to be shown

http://www.orthomolecular.org/resources/omns/v16n16.shtml

 seems vitamin c may help with covid in general?


As of today: there are no studies comparing vitamin C to placebo for COVID-19. 2 are ongoing in China but we don't have results as of yet.

Current recommendations (such as the one you posted) are based on uncontrolled data (considered very low quality of evidence).

Vitamin C makes some sense, it's cheap, and there are almost no risks associated with its use. Unfortunately, every time we've studied it, meta-analyses show no or little effect in sepsis or ARDS.

Chinese physicians are throwing everything at these patients so it's impossible to know what worked

3/15/20 7:01 AM
9/4/11
Posts: 1857

I'm still toying with going to bjj (I'm UK). Thinking its better to catch it now before our system is swamped with cases.

This sounds ridiculous, but we aren't on lock down as of yet. 

3/15/20 7:07 AM
10/23/05
Posts: 2891
Askren never lost - 

I'm still toying with going to bjj (I'm UK). Thinking its better to catch it now before our system is swamped with cases.

This sounds ridiculous, but we aren't on lock down as of yet. 


The UK has proposed a herd immunity approach, which is being very criticized at the moment: AI simulations show greater overall mortality than confinement.

Just consider that although the risk for you is minimal, you're putting some vulnerable patients more likely to get it should you be infected.

Edited: 3/15/20 7:41 AM
7/9/12
Posts: 2339

Thank you for this thread Mataleo.

I'm italian from Bari. I have friends and family currently doing it very tough over there.

I have just the one question I'm keen to hear yours or other medical professionals opinions on.

As has been noted, the Lombardy/Emilia Romagna region in Italy is one of the most modern, affluent regions in Italy if not Europe. The Italian health system is actually very good and well supported by the Govt.

So why ?..how ? Did this virus explode there of all places ??

 

3/15/20 7:44 AM
10/23/05
Posts: 2892
MMA6053 - 

Thank you for this thread Mataleo.

I'm italian from Bari. I have friends and family currently doing it very tough over there.

I have just the one question I'm keen to hear yours or other medical professionals opinions on.

As has been noted, the Lombardy/Emilia Romagna region in Italy is one of the most modern, affluent regions in Italy if not Europe. The Italian health system is actually very good and well supported by the Govt.

So why ?..how ? Did this virus explode there of all places ??

 


Sorry to hear than man. Good luck to you.

No one knows for sure, but a few hypotheses are:
-Very dense population
-Many tourists
-Genetic predisposition
-Cultural norms (kissing on cheeks)
-Damaged mucous barriers (because of smoking)

3/15/20 7:47 AM
12/13/10
Posts: 1661

So I take ramipril for blood pressure (ACE inhibitor) is it better to switch to an ARB or stay on that? Got an appointment with the Dr tomorrow to see about switching

3/15/20 7:55 AM
10/23/05
Posts: 2893
BigBadBrabs -

So I take ramipril for blood pressure (ACE inhibitor) is it better to switch to an ARB or stay on that? Got an appointment with the Dr tomorrow to see about switching

ACEi are probably not as big a concern as ARBs. Not enough evidence to stop or switch although you can consider switching to another if it's easy and riskless. We haven't stopped ARBs to our patients at the renal clinic (they benefit from ARBs more than the general population)