OtherGround Forums OG doc. AMA on COVID-19

3/16/20 7:33 AM
5/13/13
Posts: 2099

^i guess it's been longer than I thought, it was actually 6-8 weeks ago, I was sick through Valentine's. 

3/16/20 9:24 AM
10/23/05
Posts: 2915

Hi all,

Just finished my call so will now respond to every unanswered question.

A big thank you to Job Security for his input! I agree with everything he said.

3/16/20 9:29 AM
10/23/05
Posts: 2916
Job Security - 
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.


Correct. And Lyme also has minimal impact on the immune system (your likelihood to contract or combat other infections)

3/16/20 9:32 AM
10/23/05
Posts: 2917
OxymoronicalAmbiguity - 
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? 


Yes, absolutely. Although you're likely to have been in contact but don't take chances. Remember that incubation period is 4-8 days.

3/16/20 9:34 AM
10/23/05
Posts: 2918
SpunQ - 
If it ain't Dutch, it ain't much -
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

Vape / king

 


You must know that there are plenty of data coming out that vaping puts you at increased risk for pneumonitis and other types of lung damage, that may cause problem with a respiratory virus

3/16/20 9:41 AM
1/1/01
Posts: 17947

Hey, mataleo1, thanks for this and your time!  Teh OG is still great under all the stinky outer layers!

 

My question:

 

My wife is 11 weeks pregnant with twins.  I know the data is sparse and coming in a million miles per hour on covid, but what would your, or your wife’s, thoughts on first trimester issues related to covid?  I know the Chinese report on the nine pregnant women were all third trimester and all had levels of fetal distress.

She is 35 so high risk regardless of twins, and with the main thing being pre term labor with twins, we are concerned.  We had our first OB appointment this past Wed and the doc seemed up to date on info, and her advice was she was more worried about the flu’s affect on the wife, not a SARS virus. 
 

Any input would be greatly appreciated!

3/16/20 9:41 AM
10/23/05
Posts: 2919
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. 


It's a long story.

I do a lot of research, and I have many buddies in NYC. I also always wanted to live there. So I took up a position here on top of my responsibilities in Montreal. I'm board certified in the US and Canada.

I think your other questions were answered? There hasn't been many cases of reinfection.

Let me know when you're in town, drinks on me!

3/16/20 9:46 AM
10/23/05
Posts: 2920
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. 


That is inaccurate. I think this has been answered somewhere. But Italy were relatively proactive and ready to face this (which doesn't mean they didn't make errors)

3/16/20 9:49 AM
10/23/05
Posts: 2921
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.


If you're over 8 inches you're statistically ok.

3/16/20 9:53 AM
10/23/05
Posts: 2922
EFM - 

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.


I was all prepared to make the big move to Europe in April. Had several tournaments lined up... For another time perhaps. I'm training this week and playing on chess.com. Rating is over 2600 so i'm feeling good. But this COVID thing changes all plans. I'm not complaining. Many people are getting fucked in many more ways. I'm also taking the time to finishing the write-up of research papers, it's all good.

3/16/20 9:54 AM
6/13/04
Posts: 11410
Mataleo,

I'm seeing reports of people who take NSAIDS having complications. Young people.

Which is what i was alluding to earlier. That the fever is a GOOD thing, and you don't want to reduce it. The fever/inflammation is how your body fights the disease.
3/16/20 9:59 AM
10/23/05
Posts: 2923
the_shrike - 

Hey, mataleo1, thanks for this and your time!  Teh OG is still great under all the stinky outer layers!

 

My question:

 

My wife is 11 weeks pregnant with twins.  I know the data is sparse and coming in a million miles per hour on covid, but what would your, or your wife’s, thoughts on first trimester issues related to covid?  I know the Chinese report on the nine pregnant women were all third trimester and all had levels of fetal distress.

She is 35 so high risk regardless of twins, and with the main thing being pre term labor with twins, we are concerned.  We had our first OB appointment this past Wed and the doc seemed up to date on info, and her advice was she was more worried about the flu’s affect on the wife, not a SARS virus. 
 

Any input would be greatly appreciated!


Keep in mind that you, her, and your future kids are likely to be just fine.

Very little data on pregnancy but if we take into account what we know from other viruses (influenca, varicella), I'd suggest she limit her travels to a minimum. It's really shitty for her but there's too much uncertainty to take chances.

3/16/20 10:04 AM
10/23/05
Posts: 2924
sanguine cynic - Mataleo,

I'm seeing reports of people who take NSAIDS having complications. Young people.

Which is what i was alluding to earlier. That the fever is a GOOD thing, and you don't want to reduce it. The fever/inflammation is how your body fights the disease.

Good point.

This came out after I suggested to use NSAIDs, so as you see data is changing every minute.

However, the likely reason NSAIDs are bad is not because they reduce fever. It's because a small % of patients develop renal problems and NSAIDs can hurt you if you're dehydrated. But I'm waiting for more data on this.

NSAIDs have never shown to be hurtful when decreasing fever in infections that do not put you at risk of AKI (acute kidney injury). I had influenza a few years ago and I can assure you that NSAIDs were life-saving for me!

3/16/20 10:06 AM
7/10/12
Posts: 6521
Sur2eaL -
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. 

You blokes do know this virus was first identified in Dec 19 right?

 

3/16/20 10:08 AM
1/1/01
Posts: 17954
mataleo1 -
the_shrike - 

Hey, mataleo1, thanks for this and your time!  Teh OG is still great under all the stinky outer layers!

 

My question:

 

My wife is 11 weeks pregnant with twins.  I know the data is sparse and coming in a million miles per hour on covid, but what would your, or your wife’s, thoughts on first trimester issues related to covid?  I know the Chinese report on the nine pregnant women were all third trimester and all had levels of fetal distress.

She is 35 so high risk regardless of twins, and with the main thing being pre term labor with twins, we are concerned.  We had our first OB appointment this past Wed and the doc seemed up to date on info, and her advice was she was more worried about the flu’s affect on the wife, not a SARS virus. 
 

Any input would be greatly appreciated!


Keep in mind that you, her, and your future kids are likely to be just fine.

Very little data on pregnancy but if we take into account what we know from other viruses (influenca, varicella), I'd suggest she limit her travels to a minimum. It's really shitty for her but there's too much uncertainty to take chances.

Thanks, bro.

REALLY shitty for her.  These are IVF twins after three years of trying with medicated cycles and IUIs.  We got lucky and hit on our first IVF cycle.

She was looking forward to going out and living life excited and happy while pregnant.

3/16/20 10:12 AM
10/23/05
Posts: 2925

Update in NYC:
Cases are coming in. Few that are very ill, but we're already seeing it. I have an academic position but I'm only allowed to do clinical work for the foreseeable future. No teaching, no research. Shit seems about to hit the fan.

3/16/20 10:15 AM
10/23/05
Posts: 2926
the_shrike - 
mataleo1 -
the_shrike - 

Hey, mataleo1, thanks for this and your time!  Teh OG is still great under all the stinky outer layers!

 

My question:

 

My wife is 11 weeks pregnant with twins.  I know the data is sparse and coming in a million miles per hour on covid, but what would your, or your wife’s, thoughts on first trimester issues related to covid?  I know the Chinese report on the nine pregnant women were all third trimester and all had levels of fetal distress.

She is 35 so high risk regardless of twins, and with the main thing being pre term labor with twins, we are concerned.  We had our first OB appointment this past Wed and the doc seemed up to date on info, and her advice was she was more worried about the flu’s affect on the wife, not a SARS virus. 
 

Any input would be greatly appreciated!


Keep in mind that you, her, and your future kids are likely to be just fine.

Very little data on pregnancy but if we take into account what we know from other viruses (influenca, varicella), I'd suggest she limit her travels to a minimum. It's really shitty for her but there's too much uncertainty to take chances.

Thanks, bro.

REALLY shitty for her.  These are IVF twins after three years of trying with medicated cycles and IUIs.  We got lucky and hit on our first IVF cycle.

She was looking forward to going out and living life excited and happy while pregnant.


Yeah sorry about that. Just tell her that it's shitty for all. Restaurants are closing, no more vacation days, people losing their jobs. Sitting at home doesn't seem too bad in the circumstances, but yeah it's tough. Good luck to you guys

3/16/20 10:16 AM
3/23/12
Posts: 25157
Rabid Bunyip -
Sur2eaL -
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. 

You blokes do know this virus was first identified in Dec 19 right?

 

Not in the US it wasn’t.

3/16/20 10:18 AM
6/13/04
Posts: 11411
mataleo1 - 
sanguine cynic - Mataleo,

I'm seeing reports of people who take NSAIDS having complications. Young people.

Which is what i was alluding to earlier. That the fever is a GOOD thing, and you don't want to reduce it. The fever/inflammation is how your body fights the disease.

Good point.

This came out after I suggested to use NSAIDs, so as you see data is changing every minute.

However, the likely reason NSAIDs are bad is not because they reduce fever. It's because a small % of patients develop renal problems and NSAIDs can hurt you if you're dehydrated. But I'm waiting for more data on this.

NSAIDs have never shown to be hurtful when decreasing fever in infections that do not put you at risk of AKI (acute kidney injury). I had influenza a few years ago and I can assure you that NSAIDs were life-saving for me!


You're right it may not be the fever itself in COVID19. But due to reduced inflammation, which has negative consequences for ..

"There is now a sizeable literature from case control studies in several countries that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used – both respiratory or septic complications (1-10) and cardiovascular complications (11, 12)"
3/16/20 10:18 AM
11/23/10
Posts: 87
mataleo1 -
sanguine cynic - Mataleo,

I'm seeing reports of people who take NSAIDS having complications. Young people.

Which is what i was alluding to earlier. That the fever is a GOOD thing, and you don't want to reduce it. The fever/inflammation is how your body fights the disease.

Good point.

This came out after I suggested to use NSAIDs, so as you see data is changing every minute.

However, the likely reason NSAIDs are bad is not because they reduce fever. It's because a small % of patients develop renal problems and NSAIDs can hurt you if you're dehydrated. But I'm waiting for more data on this.

NSAIDs have never shown to be hurtful when decreasing fever in infections that do not put you at risk of AKI (acute kidney injury). I had influenza a few years ago and I can assure you that NSAIDs were life-saving for me!

True. With the speed and “rawness” of the data coming in, it might also just be down to confounding by indication - that is, those who decide/are prescribed to take NSAIDs are those with more serious infections or are already on NSAID due to comorbidities/frailty.

With the increasing rumours/reports of cardiomyopathy in covid19-patients, that might also be exacerbated by NSAIDs.

In any case, we can’t know any time sure, and if you don’t feel like you absolutely need them, don’t take NSAIDs for the moment. Especially if you’re in the vulnerable, older groups.

 

Btw., how are events unfolding at your hospital mataleo? I’m home with flu-like symptoms (yeah, RIP me), so don’t have my fingers in the clinical bees nest at the moment. What I’m hearing is that it’s (still slowly) picking up steam here.

3/16/20 10:21 AM
10/16/10
Posts: 29873
mataleo1 - 

Update in NYC:
Cases are coming in. Few that are very ill, but we're already seeing it. I have an academic position but I'm only allowed to do clinical work for the foreseeable future. No teaching, no research. Shit seems about to hit the fan.


Are they all old?


Stay safe homie.
3/16/20 10:25 AM
10/23/05
Posts: 2927

It's coming. We're seeing more cases. Testing is becoming available. You may have heard that 2 ER docs are affected. One in his 40s.

Everybody is waiting for the big hit. It's eerie. Big cities are seeing more cases. This is nothing like Swine flu.

3/16/20 10:26 AM
10/23/05
Posts: 2928
Stache - 
mataleo1 - 

Update in NYC:
Cases are coming in. Few that are very ill, but we're already seeing it. I have an academic position but I'm only allowed to do clinical work for the foreseeable future. No teaching, no research. Shit seems about to hit the fan.


Are they all old?


Stay safe homie.

Yes, mostly old (over 70), but some that are young and sick. But not critically so, fluids and send them home.

3/16/20 10:56 AM
11/5/03
Posts: 22188

I was supposed to fly to NYC three weeks from today to see my family for the first time in several years. Several of them are 80+ years old, so even if there are no travel restrictions at that time, I'd be traveling from one of the busiest international destination hubs in the US to an even busier one. Can't take a chance on exposing any of them to it. Been planning this since last year too. El mucho sucko. 

3/16/20 10:57 AM
12/9/13
Posts: 27361
mataleo1 -

It's coming. We're seeing more cases. Testing is becoming available. You may have heard that 2 ER docs are affected. One in his 40s.

Everybody is waiting for the big hit. It's eerie. Big cities are seeing more cases. This is nothing like Swine flu.

i know, the ones who survive are the ones, who can adjust the most in their life and isolate themselves.