OtherGround Forums OG doc. AMA on COVID-19

3/15/20 9:06 PM
2/27/11
Posts: 11199
captainplanet -
androb -
mataleo1 -
tbizzle - 

Why is COVID-19 more dangerous than swine flu when 60 million Americans were infected and 300,000 were hospitalized? There was no where near this amount of panic back then. 


We don't have exact data to compare and numbers might be completely off, but, based on what we have, I can break it down quickly:

Mortality: for swine flu (in the US) was about 4k/22 million and preliminary data from Italy and Spain is that it's somewhere between 2-5%

Acute Care necessity: around 0.2% for swine flue and about 10-15% for COVID-19.

Hospitalizations: about 1-2% for swine flu, about 25% for COVID

Again, the numbers might be completely different as we know more, but it seems reasonable to be prepared.

That’s from Italy. (Not sure why Italy is such a hotbed) but there are other countries reporting numbers not nearly so scary. 
 

and a previous post of yours says 90% of people showing symptoms that are tested are coming back negative 

Italy is a hot bed because they didn’t take the virus serious at all. So when the virus spread, they weren’t able to handle the amount of cases they were receiving to the point where if you were considered a high mortality chance, they’d send you home to die. 

absolutely untrue.

3/15/20 9:13 PM
3/4/03
Posts: 9231

Is it better to have cash on hand right now or will that potentially be seen as too much of a contagious vehicle?

3/15/20 9:32 PM
1/1/01
Posts: 13781

My question is 

So after hearing that the virus hates sunlight, high temperatures and humidity. Wouldn’t a good 2 hours in a Sauna and maybe an hour in a tanning bed kill it? Sounds like a joke but Ya never know 

3/15/20 10:05 PM
3/9/13
Posts: 4340
uniquetechnique -

My question is 

So after hearing that the virus hates sunlight, high temperatures and humidity. Wouldn’t a good 2 hours in a Sauna and maybe an hour in a tanning bed kill it? Sounds like a joke but Ya never know 

They addressed this with the disease expert on rogans podcast. Short answer is no. The places in your body where the virus lives don't get to the temperature that it would need to get to in order to kill it. 

3/15/20 10:07 PM
2/4/09
Posts: 10477
NoNeed4aScreenName -
NoNeed4aScreenName -

Whats with worldometers info.... 

 

Suddenly the entire vatican just died. 

never mind. They fixed it. It was a little unreal to show a someone the site and suddenly there was 800K deaths, almost all from the vatican

We apologize for the temporary disservice that you may have experienced. For about 20 minutes, our site showed clearly incorrect data due to a malicious act. We have investigated the issue and we're now implementing protective measures to prevent this from happening again. The other day we got hit with a big DDoS attack. Now this. We'll continue with our daily efforts and we'll not give up.

3/15/20 10:08 PM
2/4/09
Posts: 10478
uniquetechnique -

My question is 

So after hearing that the virus hates sunlight, high temperatures and humidity. Wouldn’t a good 2 hours in a Sauna and maybe an hour in a tanning bed kill it? Sounds like a joke but Ya never know 

The only cure is to lift harder !

3/15/20 10:10 PM
10/11/14
Posts: 266

TTT

3/15/20 10:24 PM
7/23/02
Posts: 595

For the critical care docs:

PulmCrit – Splitting ventilators to provide titrated support to a large group of patients

 

stay safe. 

3/15/20 10:55 PM
12/12/07
Posts: 13871
pidgey -
captainplanet -
androb -
mataleo1 -
tbizzle - 

Why is COVID-19 more dangerous than swine flu when 60 million Americans were infected and 300,000 were hospitalized? There was no where near this amount of panic back then. 


We don't have exact data to compare and numbers might be completely off, but, based on what we have, I can break it down quickly:

Mortality: for swine flu (in the US) was about 4k/22 million and preliminary data from Italy and Spain is that it's somewhere between 2-5%

Acute Care necessity: around 0.2% for swine flue and about 10-15% for COVID-19.

Hospitalizations: about 1-2% for swine flu, about 25% for COVID

Again, the numbers might be completely different as we know more, but it seems reasonable to be prepared.

That’s from Italy. (Not sure why Italy is such a hotbed) but there are other countries reporting numbers not nearly so scary. 
 

and a previous post of yours says 90% of people showing symptoms that are tested are coming back negative 

Italy is a hot bed because they didn’t take the virus serious at all. So when the virus spread, they weren’t able to handle the amount of cases they were receiving to the point where if you were considered a high mortality chance, they’d send you home to die. 

absolutely untrue.

Oh cool. Guess my friends that live in Tuscany are full of shit.

3/15/20 11:10 PM
1/13/11
Posts: 8402
uniquetechnique -

My question is 

So after hearing that the virus hates sunlight, high temperatures and humidity. Wouldn’t a good 2 hours in a Sauna and maybe an hour in a tanning bed kill it? Sounds like a joke but Ya never know 

Well it already gives you a fever so I'm not sure adding heat would help.  

3/15/20 11:34 PM
1/7/09
Posts: 15806
uniquetechnique -

My question is 

So after hearing that the virus hates sunlight, high temperatures and humidity. Wouldn’t a good 2 hours in a Sauna and maybe an hour in a tanning bed kill it? Sounds like a joke but Ya never know 

No.  The ambient air in the sauna may be 200 degrees, but the temperature in your lungs never comes anywhere close to that.  You'd die if it did.  Similarly UV light doesn't penetrate your chest and irradiate your lungs

3/15/20 11:39 PM
4/13/12
Posts: 33389

Wife works in a hospital in physical medicine.  She's in management but still has a patient case load including a covid19 patient.  She gets all gowned up when seeing them but still.  Isn't that disease all over her hospital?

Am I at a higher risk of catching this?  She swears I'm not but I'm willing to do whatever to avoid this disease up to and including divorce.  I'm pretty fit and healthy.  I'm also really good looking and have a huge dick.  I've heard those things can help prevent covid19.

Thanks in advance.

3/15/20 11:45 PM
1/7/09
Posts: 15807

Of course you're at higher risk. That risk is mitigated depending on how well your wife practices her personal protection, but you are in close contact with someone who is going to be repeatedly exposed to infected people. 

3/15/20 11:51 PM
10/14/03
Posts: 30772
EFM - 

Wife works in a hospital in physical medicine.  She's in management but still has a patient case load including a covid19 patient.  She gets all gowned up when seeing them but still.  Isn't that disease all over her hospital?

Am I at a higher risk of catching this?  She swears I'm not but I'm willing to do whatever to avoid this disease up to and including divorce.  I'm pretty fit and healthy.  I'm also really good looking and have a huge dick.  I've heard those things can help prevent covid19.

Thanks in advance.


Maybe you should just goggle it and then reply like you are an expert on the subject.

It's what the OG looks forward to.

3/15/20 11:56 PM
2/4/09
Posts: 10481

Here are some percentages to consider

 

Edited: 3/16/20 12:38 AM
1/1/01
Posts: 19447
mataleo1 -
Rambo John J - ages of your positive tests with symptoms ?

just give a range if you can't be precise

Positives come in all ages (20-85) in equal proportions, but the sicker ones were usually older than 70. We have an intubated patient now who's in his twenties. I only work with adults so don't have experience with pediatric populations.

Family member works at a major American pediatrics hospital in a big U.S. city.

 

No cases yet but all hands on deck. Elective cases cancelled. It is expected they will take care of some adults.

 

 

Edited: 3/16/20 1:27 AM
11/23/10
Posts: 82
turducken -

Have you seen a more detailed breakdown of any of the statistics of hypertensive cases? 

 

We see that hypertension increases the risk of a severe outcome, but what does that mean really?  Are these people who have untreated high blood pressure?  Are they people who had hypertension but are treated and present with normal blood pressure?  If they are treated, what medications are they on?  I saw some statistic that only 13% of people with high blood pressure in China are medicated.

It’s very interesting.

It’s probably due to a combination of factors, comorbidities associated with hypertension being one of them.

The real kicker though, is that coronavirus penetrates cells via angiotensin-converting-enzyme(ACE)-receptors. ACE is physiologically used to regulate blood pressure in the kidneya, but is present in all cells, especially the lungs... And all first-line hypertension treatment drugs block ACE-receptors. So it might not just be the hypertension or the frailty associated with hypertension that modulates risk of mortality - it might also be the treatment or the underlying cellular causes og hypertension (elevated ACE in hypertensive persons)

3/16/20 1:54 AM
11/23/10
Posts: 83
pidgey -
captainplanet -
androb -
mataleo1 -
tbizzle - 

Why is COVID-19 more dangerous than swine flu when 60 million Americans were infected and 300,000 were hospitalized? There was no where near this amount of panic back then. 


We don't have exact data to compare and numbers might be completely off, but, based on what we have, I can break it down quickly:

Mortality: for swine flu (in the US) was about 4k/22 million and preliminary data from Italy and Spain is that it's somewhere between 2-5%

Acute Care necessity: around 0.2% for swine flue and about 10-15% for COVID-19.

Hospitalizations: about 1-2% for swine flu, about 25% for COVID

Again, the numbers might be completely different as we know more, but it seems reasonable to be prepared.

That’s from Italy. (Not sure why Italy is such a hotbed) but there are other countries reporting numbers not nearly so scary. 
 

and a previous post of yours says 90% of people showing symptoms that are tested are coming back negative 

Italy is a hot bed because they didn’t take the virus serious at all. So when the virus spread, they weren’t able to handle the amount of cases they were receiving to the point where if you were considered a high mortality chance, they’d send you home to die. 

absolutely untrue.

Agreed, at least not any more than the rest of the world has underestimated this. All countries except Taiwan and South Korea have completely missed containment of this thing (and you could argue South Korea missed it too, but they did not have a systematic failure to contain cases, just one super spreader as case number 31 that infected thousands).

In the last 2-3 weeks, every western country has gone from “There’s only a very low risk of corona virus coming here”, to “Just a few imported cases - If you’ve travelled to these places or been in contact with a corona-infected, get tested and self-quarantine if positive”, to “This is a national emergency, please stay at home and we hope this doesn’t hit as hard here as it did everywhere else before us”, to “Okay this is serious, send in the army to enforce georestriction and close the borders.”

It’s scary how not a single country has learned enough from Italy’s collapse to be able to take measures that enable them to avoid the most expensive last-ditch measures (lockdown/shutdown of economy).

Italy might have been slower than most western countries to go through those stages, but that is to be expected since they where the first to be hit.

3/16/20 2:05 AM
4/13/12
Posts: 33397
Job Security -
pidgey -
captainplanet -
androb -
mataleo1 -
tbizzle - 

Why is COVID-19 more dangerous than swine flu when 60 million Americans were infected and 300,000 were hospitalized? There was no where near this amount of panic back then. 


We don't have exact data to compare and numbers might be completely off, but, based on what we have, I can break it down quickly:

Mortality: for swine flu (in the US) was about 4k/22 million and preliminary data from Italy and Spain is that it's somewhere between 2-5%

Acute Care necessity: around 0.2% for swine flue and about 10-15% for COVID-19.

Hospitalizations: about 1-2% for swine flu, about 25% for COVID

Again, the numbers might be completely different as we know more, but it seems reasonable to be prepared.

That’s from Italy. (Not sure why Italy is such a hotbed) but there are other countries reporting numbers not nearly so scary. 
 

and a previous post of yours says 90% of people showing symptoms that are tested are coming back negative 

Italy is a hot bed because they didn’t take the virus serious at all. So when the virus spread, they weren’t able to handle the amount of cases they were receiving to the point where if you were considered a high mortality chance, they’d send you home to die. 

absolutely untrue.

Agreed, at least not any more than the rest of the world has underestimated this. All countries except Taiwan and South Korea have completely missed containment of this thing (and you could argue South Korea missed it too, but they did not have a systematic failure to contain cases, just one super spreader as case number 31 that infected thousands).

In the last 2-3 weeks, every western country has gone from “There’s only a very low risk of corona virus coming here”, to “Just a few imported cases - If you’ve travelled to these places or been in contact with a corona-infected, get tested and self-quarantine if positive”, to “This is a national emergency, please stay at home and we hope this doesn’t hit as hard here as it did everywhere else before us”, to “Okay this is serious, send in the army to enforce georestriction and close the borders.”

It’s scary how not a single country has learned enough from Italy’s collapse to be able to take measures that enable them to avoid the most expensive last-ditch measures (lockdown/shutdown of economy).

Italy might have been slower than most western countries to go through those stages, but that is to be expected since they where the first to be hit.

Vietnam has done a remarkable job.

3/16/20 2:53 AM
1/1/01
Posts: 20297
Michael De Santa -
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!

Research Event 201 put on by the Bill and Melinda Gates Foundation on October 18, 2019 in Seattle, WA simulating a corona virus outbreak that killed 65 million people in a span of 18 months. Also why the Wuhan Military games took place that same day in Wuhan China. Why the Netflix documentary, "The Next Outbreak" came out a day before the virus release date. Why Microsoft put out a game called, "A Plagues Tale" which is about rats spreading disease during the year of the rat. Why back in 2010 during a "Ted Talk" Bill Gates talks about using vaccines for population control. How many coincidences before something becomes mathematically impossible? 

Many more than this shit.

3/16/20 3:04 AM
1/7/09
Posts: 15811
Job Security -
turducken -

Have you seen a more detailed breakdown of any of the statistics of hypertensive cases? 

 

We see that hypertension increases the risk of a severe outcome, but what does that mean really?  Are these people who have untreated high blood pressure?  Are they people who had hypertension but are treated and present with normal blood pressure?  If they are treated, what medications are they on?  I saw some statistic that only 13% of people with high blood pressure in China are medicated.

It’s very interesting.

It’s probably due to a combination of factors, comorbidities associated with hypertension being one of them.

The real kicker though, is that coronavirus penetrates cells via angiotensin-converting-enzyme(ACE)-receptors. ACE is physiologically used to regulate blood pressure in the kidneya, but is present in all cells, especially the lungs... And all first-line hypertension treatment drugs block ACE-receptors. So it might not just be the hypertension or the frailty associated with hypertension that modulates risk of mortality - it might also be the treatment or the underlying cellular causes og hypertension (elevated ACE in hypertensive persons)

That's my question and why I want to see more detail about that group of patients. Its contradictory. 

Drugs such as losartan upregulate ACE2 expression.  ACE2 is the means of entry for the virus, however the increased ACE2 has also been shown to be protective against lung injury in ARDS and viral pneumonia.  What's effect in this case, is it leading to a more severe infection or doing the exact opposite and preventing serious illness?

3/16/20 3:53 AM
4/13/12
Posts: 33407

Hey mataleo1,

Many here know you're a serious chess player and looking to move up from Master to International Master, a serious feat in the game of Chess this year.

Just curious if you have any motivators in this time.  I feel like Im glued to 2 things:. My wife and kid and the news.  How are you focusing on your sanity and still focusing on other goals.

3/16/20 5:02 AM
11/23/10
Posts: 84
EFM -
Job Security -
pidgey -
captainplanet -
androb -
mataleo1 -
tbizzle - 

Why is COVID-19 more dangerous than swine flu when 60 million Americans were infected and 300,000 were hospitalized? There was no where near this amount of panic back then. 


We don't have exact data to compare and numbers might be completely off, but, based on what we have, I can break it down quickly:

Mortality: for swine flu (in the US) was about 4k/22 million and preliminary data from Italy and Spain is that it's somewhere between 2-5%

Acute Care necessity: around 0.2% for swine flue and about 10-15% for COVID-19.

Hospitalizations: about 1-2% for swine flu, about 25% for COVID

Again, the numbers might be completely different as we know more, but it seems reasonable to be prepared.

That’s from Italy. (Not sure why Italy is such a hotbed) but there are other countries reporting numbers not nearly so scary. 
 

and a previous post of yours says 90% of people showing symptoms that are tested are coming back negative 

Italy is a hot bed because they didn’t take the virus serious at all. So when the virus spread, they weren’t able to handle the amount of cases they were receiving to the point where if you were considered a high mortality chance, they’d send you home to die. 

absolutely untrue.

Agreed, at least not any more than the rest of the world has underestimated this. All countries except Taiwan and South Korea have completely missed containment of this thing (and you could argue South Korea missed it too, but they did not have a systematic failure to contain cases, just one super spreader as case number 31 that infected thousands).

In the last 2-3 weeks, every western country has gone from “There’s only a very low risk of corona virus coming here”, to “Just a few imported cases - If you’ve travelled to these places or been in contact with a corona-infected, get tested and self-quarantine if positive”, to “This is a national emergency, please stay at home and we hope this doesn’t hit as hard here as it did everywhere else before us”, to “Okay this is serious, send in the army to enforce georestriction and close the borders.”

It’s scary how not a single country has learned enough from Italy’s collapse to be able to take measures that enable them to avoid the most expensive last-ditch measures (lockdown/shutdown of economy).

Italy might have been slower than most western countries to go through those stages, but that is to be expected since they where the first to be hit.

Vietnam has done a remarkable job.

You’re right. Vietnam haven’t had as many cases to contend with, though. Can’t fault them for that of course.

Hong Kong have been able to contain it, and Singapore too, though barely. China is the only place so far where we can begin to gauge the effect and aftermath of mitigation strategy on this thing. And their enforcement of mitigation policies probably can’t be replicated in western societies.

3/16/20 5:20 AM
11/23/10
Posts: 85
turducken -
Job Security -
turducken -

Have you seen a more detailed breakdown of any of the statistics of hypertensive cases? 

 

We see that hypertension increases the risk of a severe outcome, but what does that mean really?  Are these people who have untreated high blood pressure?  Are they people who had hypertension but are treated and present with normal blood pressure?  If they are treated, what medications are they on?  I saw some statistic that only 13% of people with high blood pressure in China are medicated.

It’s very interesting.

It’s probably due to a combination of factors, comorbidities associated with hypertension being one of them.

The real kicker though, is that coronavirus penetrates cells via angiotensin-converting-enzyme(ACE)-receptors. ACE is physiologically used to regulate blood pressure in the kidneya, but is present in all cells, especially the lungs... And all first-line hypertension treatment drugs block ACE-receptors. So it might not just be the hypertension or the frailty associated with hypertension that modulates risk of mortality - it might also be the treatment or the underlying cellular causes og hypertension (elevated ACE in hypertensive persons)

That's my question and why I want to see more detail about that group of patients. Its contradictory. 

Drugs such as losartan upregulate ACE2 expression.  ACE2 is the means of entry for the virus, however the increased ACE2 has also been shown to be protective against lung injury in ARDS and viral pneumonia.  What's effect in this case, is it leading to a more severe infection or doing the exact opposite and preventing serious illness?

That’s the million dollar question!

It’s going to be very hard to answer that question without randomize controlled trials, which are impossible to initiate without 6-12 months of legal groundwork to get permission from ethics and patient safety committees etc.

It’s going to be hard to answer based on the real-world data is, because almost all hypertension patients are treated with ACE-inhibitors or Angiotensin-receptor (AR) blockers. So you lack a large control group of hypertension without treatment affecting the Renin-Angiotensin-Aldosteron pathway. And that group would likely be uncomparable to the treatment group in most cases (more likely to be uninsured for example). You could probably look at AR-blockers compared to ACE-inhibitors and get decent estimates if you adjust for other known risk factors. I expect those studies to come out as enough cases are registered and pooled in databases.

3/16/20 7:31 AM
5/13/13
Posts: 2098
Caladan -

Have you guys seen a lot of random unexplained viral infections this year affecting the upper respiratory system? More than usual I mean, of people who aren't positive for anything on the normal flu test?

 

I've had this theory for a few days now that this shit has been here for awhile and everyone has or has had it. We've heard for awhile now how this is an extra bad flu year and I've heard so many anecsotes of people who have had a weird viral infection that they "just can't quite shake".

I feel the same way, around 2-4 weeks ago, myself and an entire warehouse of about 50-60 workers depending on the night, all got sick, I mean everybody, some worse than others but we all had the same symptoms, dry cough, fever, body aches and difficulty breathing.

I felt I got it pretty bad, I was sick for 3 1/2 weeks, the first 2 weeks was pure hell, constant dry cough, night sweats multiple times, terrible fever. 

One night it snowed really bad and I had to shovel some snow, only took about 20 mins but I was absolutely destroyed, I could barely breathe, felt like I was going to pass out and it started getting very difficult to breathe, I started choking and coughing, my eyes burst with water, it legit scared the hell out of me, luckily my wife had an inhaler, I used that and it helped me breathe. The last week and a half it SLOWLY started going away.

I literally felt like I was going to die, I was so messed up, I can easily see how an elderly person or somebody with existing health conditions can die from this.

I truly believe its been here and has been for a while and we were just getting told it's a severe flu this year and let it run its course. We just haven't been getting tested until recently.