OtherGround Forums OG doc. AMA on COVID-19

3/15/20 1:55 PM
10/23/05
Posts: 2910
iclimb513 - 
mataleo1 -
jotabrav0 - 
Kirik -

Thank you for the thread of the year.

Apologies for the trobinson troll. He was of course shown the door.

I do have a question that for me is huge. I am based in Western Massachusetts. Just yesterday we had the first presumptive cases in the county. I have a fight gym, and am trying to figure out whether to close or not. We have reached out to the town board of health repeatedly for some direction, without a response so far.

Do you think fight gyms should close down? Should they move to stand up only? Stand up only with a limited size and instruction to try to maintain social distancing? Follow the lead of school officials, and close down or limit size and/or programming if K-12 are closed down in the town?

I know it's impossible to answer anything definitively, but any feedback whatsoever would be very gratefully received.

And again, sincerest apologies for the troll. He obviously leads a very miserable life, at the least internally.

I’m in the same boat Kirik. Don’t know what to do with my gym. Others in the area are adding more to spite current events. We are supposed to have a big kids party tomorrow. This whole ordeal is ridiculous. 
 

I think it’s inevitable we will have to close. But when? How long do you wait? 


No reason to wait. Everything else is closing for a reason. Better be safe. I'd think at the minimum 1 month, possibly 2 or more.

It sucks, I know most of you will lose money. For a threat that may never materialize. But this is serious.

Some of my mentors in medicine (those I trust and respect) have said this is what we should do. I defer to them for matters like this.

Damn. That sucks for the bjj gyms / guys. I stopped practicing 10 years ago but I was there 10+ hours a week for years. I'd have been way bummed and the academy owner would probably have folded if it happened in his early days. 

I'm guessing with indoor gyms of all kinds either closing or people afraid to go, outdoor sports will have a possible resurgence. Cycling, tennis, running, pretty much all the ones I can think of don't put you in proximity to others hardly at all.

Either that or people will buy home exercise equipment. There may be hoarding of thighmasters and shakeweights! Zomg! 

Great thread, Mata. Be well. 


Yeah, it sucks for a lot of people. I'm lucky in the circumstances: I'm not fearing for my job, but I know a lot are suffering. It's a time for us to support eachother. Be safe brother.

3/15/20 1:59 PM
4/12/04
Posts: 7150
mataleo1 -
kappakeen - 

Thanks for the AMA Matleo1

In your opinion what are the best practices we can do if we have to go to work? Obviously working from home is ideal but a lot of us don’t have that option.

What I’m doing is wiping my work station down with a Clorox wipe (throughout the day), wearing gloves, and practicing social distancing.  When I get home I change into clothes I have in the garage and place my work clothes in a plastic garbage bag, before I get in the house.  I then jump into the shower as soon as possible.  I work in a fairly high risk environment (corrections) but I don’t have to interact with a large number of people.
 

Do you have any other recommendations?

 

Thanks again


I'm not an expert on infectious control but from what I've read:

-Keep a safe distance from co-workers
-Wash hands often (or sanitizer)
-Don't go in if you're sick
-Don't go in if anyone else is sick
-Gloves will eventually have droplets if you keep them long enough.
-Limit contact (hand shaking)

You seem to be doing your best!

avoiding touching the face is gonna be hard as it is natural act for all of us. For what its worth, i use nitrate gloves and it actually helps in reminding me not to touch my face.

3/15/20 2:06 PM
10/23/05
Posts: 2911
Kona Silat -
mataleo1 -
kappakeen - 

Thanks for the AMA Matleo1

In your opinion what are the best practices we can do if we have to go to work? Obviously working from home is ideal but a lot of us don’t have that option.

What I’m doing is wiping my work station down with a Clorox wipe (throughout the day), wearing gloves, and practicing social distancing.  When I get home I change into clothes I have in the garage and place my work clothes in a plastic garbage bag, before I get in the house.  I then jump into the shower as soon as possible.  I work in a fairly high risk environment (corrections) but I don’t have to interact with a large number of people.
 

Do you have any other recommendations?

 

Thanks again


I'm not an expert on infectious control but from what I've read:

-Keep a safe distance from co-workers
-Wash hands often (or sanitizer)
-Don't go in if you're sick
-Don't go in if anyone else is sick
-Gloves will eventually have droplets if you keep them long enough.
-Limit contact (hand shaking)

You seem to be doing your best!

avoiding touching the face is gonna be hard as it is natural act for all of us. For what its worth, i use nitrate gloves and it actually helps in reminding me not to touch my face.

Good trick. I play chess so putting my hands on my face is a second job. Time to change this 

Edited: 3/15/20 2:06 PM
7/31/09
Posts: 6384

Thought this was an interesting twitter thread from a Harvard PhD.  Maybe you can comment on it mataleo

 

3/15/20 2:20 PM
1/18/03
Posts: 3417
MayorPirkle -

Hey Mata I'm also in Montreal. I'm immunosuppressed with infliximab and work in a job where we share a workstation (rotating shifts using the same mouses and keyboards, phones, etc..) so I've told my bosses I'm isolating. They're checking with occupational health services so I'm waiting for their response, but how long do you estimate before I can safely return to work and not worry about this virus? 2 weeks? More?

 

Thanks

Hey Mayor, not sure if it helps, but when I get into work I spray the shit out of the keyboards and mice with cleaner.  If work doesn't provide them get your own.

3/15/20 2:31 PM
11/23/10
Posts: 73

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

3/15/20 2:38 PM
10/23/05
Posts: 2912
robbie380 - 

Thought this was an interesting twitter thread from a Harvard PhD.  Maybe you can comment on it mataleo

 


I'm going to repeat myself here.

As much as I want to recommend a treatment, and as much as I've read several papers related to COVID treatment, all of these are still a guess, at best.

He mentions methylprednisone, but I'm reading conflicting data (worse outcomes).

Iron is very controversial and is associated with pro-inflammatory cascade (in fact it's been shown to increase mortality in sepsis).

Colchicine: not a benign drug!

There's a difference between lab medicine and clinical medicine. All these hypotheses need to be backed up by data (AKA a randomized trial).

Until then, it's all speculation. Clinicians need to be modest in their claims and admit so.

3/15/20 2:39 PM
10/23/05
Posts: 2913
Job Security - 

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.


Fantastic. Welcome to the party. Please join in, your expertise will help!

3/15/20 2:40 PM
7/30/14
Posts: 5120
Job Security -

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

3/15/20 2:42 PM
10/23/05
Posts: 2914

I'm going to take a break from the thread for a little while. But I'll answer questions tomorrow AM.

A lot of backlash (and now backtrack) on the Herd immunity approach of the UK.

3/15/20 2:59 PM
7/30/14
Posts: 5121
mataleo1 -

I'm going to take a break from the thread for a little while. But I'll answer questions tomorrow AM.

A lot of backlash (and now backtrack) on the Herd immunity approach of the UK.

Get some rest man. I’m in the UK. Not at all happy with the approach so far. It’s almost as if we’re waiting for it to really hit the fan before putting any significant measures in place.

3/15/20 3:26 PM
11/23/10
Posts: 74
Dragunov -
Job Security -

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.

Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:

Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).

The problems in a Covid-19-context are:

1. It won’t be effective:

No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.

2. It’s dangerous:

Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

3/15/20 3:49 PM
1/29/14
Posts: 1167

Will this affect people with Lyme disease any worse than regular folks?

3/15/20 3:51 PM
11/23/10
Posts: 75
ScreenName22 -

It's possible that COVID-19 isn’t as fatal as most people think. And stockpiling hand sanitizer and masks could hurt people who are truly at risk: the elderly and those with weak immune systems.

“Kids and adults have done extremely well in terms of recovery so far,” said Dr. Jeremy Faust, an emergency medicine doctor at Brigham and Women’s Hospital in Boston. “It’s so critical that we do not waste resources among the young and healthy and that we really focus on the areas where this might really get out of control.”

 

https://abcnews.go.com/Health/early-mortality-rates-covid-19-misleading-experts/story?id=69477312

It’s a fair point that mortality risk is dependent on case definition and case numbers. If we only look at hospitalised cases it’s going to be high, and if we look at all infected regardless of symptoms it will be low. It’s very context-dependent.

And he’s right that special care should be given to the vulnerable groups.

However, I disagree that the cruise ship cases are valid for predicting age-specific mortality. It’s just a very selected population. With no data to back up my claim and having never been on a cruise, I’m willing to bet that the average 70-year old cruise ship-goer is much fitter than the average 70-year old (perhaps even than the average 60-year old) in the general population.

3/15/20 3:56 PM
7/30/14
Posts: 5122
Job Security -
Dragunov -
Job Security -

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.

Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:

Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).

The problems in a Covid-19-context are:

1. It won’t be effective:

No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.

2. It’s dangerous:

Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

Thank you. Both of my parents are in that category. I’m planning to keep them isolated for as long as possible. They’re both retired so shouldn’t be too difficult!

3/15/20 4:02 PM
5/5/07
Posts: 11715
uber tony -

Will this affect people with Lyme disease any worse than regular folks?

Not at increased risk or will affect you any worse than general population 

3/15/20 4:22 PM
11/23/10
Posts: 76
uber tony -

Will this affect people with Lyme disease any worse than regular folks?

There’s no data available to answer this, but I would not expect Lyme’s disease in itself to be a cause of higher morbidity/mortality here. Even though it’s a chronic disease, it’s not a cardiovascular/pulmonary disease, which are the most important risk factors in this.

3/15/20 4:23 PM
1/26/08
Posts: 18045
Rambo John J -

I switched from smoking cannabis to only ingesting edibles for the time being...

Good move? or Bad Move?

me too, never can be too safe

3/15/20 4:43 PM
5/11/11
Posts: 2154
mataleo1 -
emu67 - 

How about viral dose versus severity of symptoms? Is there any information in this - the thinking is that if you’re exposed to a large number of corona virus at the same time, you’ll be sicker than if you were exposed to a smidgen but just enough to infect you. Any truth to that?


Answered this earlier but yes:
large exposure = higher virus load = overwhelming of defense mechanisms = more severe symptoms and shorter incubation

If you and a loved one both came down with symptoms would you avoid sleeping in the same bed and close contact for the above mentioned reasons? 

3/15/20 4:49 PM
11/23/10
Posts: 77
Dragunov -
Job Security -
Dragunov -
Job Security -

Great thread!

Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.

If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.

Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:

Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).

The problems in a Covid-19-context are:

1. It won’t be effective:

No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.

2. It’s dangerous:

Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

Thank you. Both of my parents are in that category. I’m planning to keep them isolated for as long as possible. They’re both retired so shouldn’t be too difficult!

Good decision. Nobody should live in fear of covid-19 forever, but at least stay safe the next 2-3 weeks until we know if this will be a repeat of Wuhan and Italy in the rest of Europe and USA.

If you plan on visiting them or doing their shopping, look out for symptoms of your own, you don’t want to be the transmission link.

3/15/20 5:16 PM
1/1/01
Posts: 26764
mataleo1 -
androb - 
mataleo1 -
androb - 
mataleo1 -
Jacks Wasted Life - 

Thank you for this AMA.

 

1) Is it true that because it is aerosol based, we are all likely to get it?  Or will preventative measures like washing hands before eating or preparing food and not touching our nose, mouth, or eyes reduce our chances of getting infected?

2) I’ve heard rumors that some states are strongly considering 2-4 week quarantines for all residents.  Have you heard anything on this?

3) If a 2-4 week quarantine were implemented, how beneficial do you think it would it be in combating the virus?  Would it potentially prevent many cases or just delay them, essentially to give health care facilities more lead time to prepare for the inevitable?


1) There remains confusion here. It doesn't seem to be airborne but can still travel because of droplets. The main risk is contact with an infected host and then touching your face. So hand washing remains paramount.

2) I don't know about that, I'll ask my wife. At my hospital, they've put EVERY health care worker that comes back from outside the country in forced quarantine.

3) It really depends on how successful we are at enforcing the quarantine. They seem to have had success in China and South Korea with this.

Can you verify this 

250 000 test were given in SK (to those with symptoms) and only 2% of the tests came back positive 

are you seeing those types of numbers as well. That most people with symptoms that are getting tested are coming back negative?


I don't know what's going on in Saskatchawan but I can find out.

More patients have been tested in Montreal than NYC as of today. More than 90% have been negative so far.

Lots of RSV and influenza infections though (which can mimic COVID)

SK=South Korea. 
they seem to have the best handle on it. 
 

lol I don’t know if 250k people total live in Saskatchewan (jokes)


Ha!

Have you read their car drive-in system for detection? That was a brilliant idea. We should do this here. SK has done an amazing job of isolating people at risk, quick detection, and quick treatments. Hope we were as good here!

actually, why aren't we doing that in canada? what canadian agencies would be responsible for implementing it? ministry of health? individual hospitals? min of transport?

 

also, you are in nyc because of your wife? i thought you were in montreal (is there a connection with your hospitals?)

general curiousity, please don't divulge anything too personal of course, i just didn't know that canadian hospitals had direct contact with us hospitals outside of research collaborations. 

 

real question: what's your view on the idea that there's an S strain and an L strain? it seems quite plausible to me as there have been varying death rates. 

 

also, why would people who recovered catch again 45 days later? My assumption would be that they caught another strain (l and s maybe)? or that the COV19 could hide in the nervous system? is there another explanation as your body should have developed antibodies and a more reactive immune system?

 

cheers mate, if this virus is done, i hope to drop by montreal. 

3/15/20 5:25 PM
1/1/01
Posts: 20296

Someone told me that there already existed about 5 CV strains in the USA prior to this and that the CV test that USA is using doesn’t differentiate this novel “deadly” strain from the pre-existing strains, so anyone who pops for this strain could just have one of the older ones. Any truth to this?

 

3/15/20 5:37 PM
5/5/07
Posts: 11716
Jump Kick -

Someone told me that there already existed about 5 CV strains in the USA prior to this and that the CV test that USA is using doesn’t differentiate this novel “deadly” strain from the pre-existing strains, so anyone who pops for this strain could just have one of the older ones. Any truth to this?

 

False.

They testing specifically for covid 19.   They have isolated it

Coronovirus is just the genre of viruses that typically cause the common cold.     Been around forever.   Usually gives u the common symptoms.

This is mutated strain similar to sars and seems to be aggressive in causing pneumonias, ards and finally cardiomyopathies which seems to be tue big killer in vulnerable populations.   Coronovirus typically doesnt do this which is why the medical community working so hard to contain this.

 

 

3/15/20 5:43 PM
5/5/07
Posts: 11717
yusul -
mataleo1 -
androb - 
mataleo1 -
androb - 
mataleo1 -
Jacks Wasted Life - 

Thank you for this AMA.

 

1) Is it true that because it is aerosol based, we are all likely to get it?  Or will preventative measures like washing hands before eating or preparing food and not touching our nose, mouth, or eyes reduce our chances of getting infected?

2) I’ve heard rumors that some states are strongly considering 2-4 week quarantines for all residents.  Have you heard anything on this?

3) If a 2-4 week quarantine were implemented, how beneficial do you think it would it be in combating the virus?  Would it potentially prevent many cases or just delay them, essentially to give health care facilities more lead time to prepare for the inevitable?


1) There remains confusion here. It doesn't seem to be airborne but can still travel because of droplets. The main risk is contact with an infected host and then touching your face. So hand washing remains paramount.

2) I don't know about that, I'll ask my wife. At my hospital, they've put EVERY health care worker that comes back from outside the country in forced quarantine.

3) It really depends on how successful we are at enforcing the quarantine. They seem to have had success in China and South Korea with this.

Can you verify this 

250 000 test were given in SK (to those with symptoms) and only 2% of the tests came back positive 

are you seeing those types of numbers as well. That most people with symptoms that are getting tested are coming back negative?


I don't know what's going on in Saskatchawan but I can find out.

More patients have been tested in Montreal than NYC as of today. More than 90% have been negative so far.

Lots of RSV and influenza infections though (which can mimic COVID)

SK=South Korea. 
they seem to have the best handle on it. 
 

lol I don’t know if 250k people total live in Saskatchewan (jokes)


Ha!

Have you read their car drive-in system for detection? That was a brilliant idea. We should do this here. SK has done an amazing job of isolating people at risk, quick detection, and quick treatments. Hope we were as good here!

actually, why aren't we doing that in canada? what canadian agencies would be responsible for implementing it? ministry of health? individual hospitals? min of transport?

 

also, you are in nyc because of your wife? i thought you were in montreal (is there a connection with your hospitals?)

general curiousity, please don't divulge anything too personal of course, i just didn't know that canadian hospitals had direct contact with us hospitals outside of research collaborations. 

 

real question: what's your view on the idea that there's an S strain and an L strain? it seems quite plausible to me as there have been varying death rates. 

 

also, why would people who recovered catch again 45 days later? My assumption would be that they caught another strain (l and s maybe)? or that the COV19 could hide in the nervous system? is there another explanation as your body should have developed antibodies and a more reactive immune system?

 

cheers mate, if this virus is done, i hope to drop by montreal. 

Hes most likely dual credentialed.  A lot of docs that work close to border have this.

Im credentialed in canada but also have license to practice in ny and PA

In terms of testing positive again.   My suspicion is that is had moreso to do with the PCR testing they using and creating false positives.    Similar thing we see if patients treated for c. Diff with them still testing positive long after recovering from acute illness.

They are testing specifically for covid19 and not other coronavirus.  The normal viral swab is different test than the one for covid19.

Canada is just now getting better testing.   Some labs able get results back quickly but for confirmation still being sent to winnipeg.   This is what er doc told me today.  Again things keep changing day by day and faster methods will come now that we actually taking this seriously. 

 

3/15/20 5:45 PM
10/14/03
Posts: 30764

Great idea for a thread, but I just wish these were real doctors answering. I mean come on 15 pages and none of them have even mentioned toilet paper!!

JUST KIDDING, thanks for the info guys, Stay safe out there.