OtherGround Forums OG doc. AMA on COVID-19

Edited: 3/14/20 5:49 PM
7/6/14
Posts: 4015
mataleo1 -
lazermonkey - 
mataleo1 -
lazermonkey - 

Is it true there are patients suffering scar tissue in their lungs? I don’t think it’s a real common after effect? But, I’m pretty sure I read an article stating that that is in the more severe cases.

Thanks for being here and answering our questions and as always. Stay safe.


Not enough data and not enough longitudinal data.

Some with severe ARDS from influenza or pneumonia may have scarring tissue and a decrease in lung parameters such as FEV1.

My personal bias is that this isn't true but we'll have to see.

Thanks for taking the time to answer our questions. 
 

In your opinion, based on the numbers we’ve seen and those yet to be tested, how many people in the United States and Canada will test positive?


Putting me on the spot here and I'm sure I'll be off by a factor-10 here at least. But if I had to bet: 500k. Smarter and more knowledgeable MDs think that it'll be vastly superior to that number

From you, the other experts on YouTube and some other very experienced doctors that I know personally I keep getting between 400k and 600k. All depends on our next steps the next few weeks. Could be way worse, we need to get the test rolling out to EVERYONE, not just first responders, nurses, ect. 

3/14/20 5:50 PM
10/23/05
Posts: 2856
BJ Penn Forever - 
trobinson21 -
mataleo1 -
Believe in the Power of One - 

Been hearing kids under 9 aren't getting it, is that true?

What SHOULD we be doing other than avoiding people? 


Bear in mind this is based on incomplete data.

There are many cases of infants and children having it, but no lethalities so far.

What to do:
-Avoid crowds
-Avoid unnecessary travel
-If you're sick, stay home, many toll free numbers out there to help you figure out if you have symptoms.
-If you're very sick, go to the ER, try protecting your mouth on your way there (or wear a mask if you have one)

And remember guys, water is wet and the Earth is round. 
 

Stay safe gang! Lol

Your 20 vote downs should give you a clue that you are being a giant fucking dick while mataleo1 is trying to be cool.


Not trying to be cool brotha. I'm a giant nerd. Nerds are never cool.

But I'm trying to be helpful while I'm waiting around.

3/14/20 5:51 PM
11/1/03
Posts: 21347

Just want to say thanks to op for providing good info for the forum. Obviously the stats being posted are subject to change drastically and could be inaccurate. My feelings are with everybody being super cautious we may luck out and total infections may be lower than expected.

3/14/20 5:57 PM
1/24/20
Posts: 276

The number of jackoffs being a prick to OP for no reason whatsoever is sad but not shocking. The cleansing of them from the gene pool is one of the few positives this pandemic might bring.

3/14/20 6:06 PM
1/1/01
Posts: 47763

tt

3/14/20 6:08 PM
5/23/07
Posts: 20684

Trobinson the douchebag got banned?

3/14/20 6:08 PM
2/4/09
Posts: 10424
turducken -
mataleo1 -
turducken - 

What are your thoughts on anti-hypertensive medications such as Losartan as far as how they could influence the severity of an infection? 

 

Along the same lines, when we are told that high blood pressure is a risk factor, does that mean treated or untreated?  

 

I have seen thoughts on both sides, some suggesting that because the virus binds to ACE2 as its means of entry into the body, that drugs which increase expression of that enzyme such as Losartan would lead to worse outcomes(which seems to be supported by the stats on hypertension as a comorbidity), but there are others saying that the increase in ACE2 has actually been shown to be protective and has been shown to prevent lung damage in other instances of viral pneumonia and ARDS, with some theorizing it could even be used as a treatment for covid19.  But I'm not a doctor so I dont know what to think of it all since the info is so contradictory.

 

If your parents were on Losartan, would you have them continue taking it or try to switch to a calcium channel blocker or something else? 


This is a great question.

Losartan is a angiotensin receptor blocker. It is somehow related to ACE inhibitors (which blocks conversion of angiotensin). Losartan may increase expression of the receptor (upgregulation) and upstream increase production of angiotensin 1 but as of now, there is insufficient data to say much about its effect on COVID expression or infection. HOWEVER, if you have high BP, it would make sense to switch to something like a CCB (norvasc or adalat)

Here's a paper published in the lancet: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

Thanks. That's the paper I was referring to.

 

But what about these contradictory points?

 

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmf

 

https://www.ncbi.nlm.nih.gov/m/pubmed/32129518/

 

https://www.bmj.com/content/368/bmj.m325/rr

 

Confusing/scary time...

Upon reading this it appears that using ACE-i inhibitors they focused on a cardiac treatment. 

 

These are generally taken orally. I wonder if there's some type of inhalant that would direct it to the lungs. This alone presents new risks. 

 

There's also the soluble form of ACE2 that can be used to bind to the virus 

 

4.

Delivering excessive soluble form of ACE2.

Kuba et al. [10] demonstrated in mice that SARS-CoV downregulates ACE2 protein (but not ACE) by binding its spike protein, contributing to severe lung injury. This suggests that excessive ACE2 may competitively bind with SARS-CoV-2 not only to neutralize the virus but also rescue cellular ACE2 activity which negatively regulates the renin-angiotensin system (RAS) to protect the lung from injury [1230]. Indeed, enhanced ACE activity and decreased ACE2 availability contribute to lung injury during acid- and ventilator-induced lung injury [123132]. Thus, treatment with a soluble form of ACE2 itself may exert dual functions: (1) slow viral entry into cells and hence viral spread [79] and (2) protect the lung from injury [10123132].

 

https://link.springer.com/article/10.1007/s00134-020-05985-9

3/14/20 6:11 PM
2/27/03
Posts: 1291

Thank you for doing this!

3/14/20 6:12 PM
10/23/05
Posts: 2857
NoNeed4aScreenName - 
turducken -
mataleo1 -
turducken - 

What are your thoughts on anti-hypertensive medications such as Losartan as far as how they could influence the severity of an infection? 

 

Along the same lines, when we are told that high blood pressure is a risk factor, does that mean treated or untreated?  

 

I have seen thoughts on both sides, some suggesting that because the virus binds to ACE2 as its means of entry into the body, that drugs which increase expression of that enzyme such as Losartan would lead to worse outcomes(which seems to be supported by the stats on hypertension as a comorbidity), but there are others saying that the increase in ACE2 has actually been shown to be protective and has been shown to prevent lung damage in other instances of viral pneumonia and ARDS, with some theorizing it could even be used as a treatment for covid19.  But I'm not a doctor so I dont know what to think of it all since the info is so contradictory.

 

If your parents were on Losartan, would you have them continue taking it or try to switch to a calcium channel blocker or something else? 


This is a great question.

Losartan is a angiotensin receptor blocker. It is somehow related to ACE inhibitors (which blocks conversion of angiotensin). Losartan may increase expression of the receptor (upgregulation) and upstream increase production of angiotensin 1 but as of now, there is insufficient data to say much about its effect on COVID expression or infection. HOWEVER, if you have high BP, it would make sense to switch to something like a CCB (norvasc or adalat)

Here's a paper published in the lancet: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

Thanks. That's the paper I was referring to.

 

But what about these contradictory points?

 

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmf

 

https://www.ncbi.nlm.nih.gov/m/pubmed/32129518/

 

https://www.bmj.com/content/368/bmj.m325/rr

 

Confusing/scary time...

Upon reading this it appears that using ACE-i inhibitors they focused on a cardiac treatment. 

 

These are generally taken orally. I wonder if there's some type of inhalant that would direct it to the lungs. This alone presents new risks. 

 

There's also the soluble form of ACE2 that can be used to bind to the virus 

 

4.

Delivering excessive soluble form of ACE2.

Kuba et al. [10] demonstrated in mice that SARS-CoV downregulates ACE2 protein (but not ACE) by binding its spike protein, contributing to severe lung injury. This suggests that excessive ACE2 may competitively bind with SARS-CoV-2 not only to neutralize the virus but also rescue cellular ACE2 activity which negatively regulates the renin-angiotensin system (RAS) to protect the lung from injury [1230]. Indeed, enhanced ACE activity and decreased ACE2 availability contribute to lung injury during acid- and ventilator-induced lung injury [123132]. Thus, treatment with a soluble form of ACE2 itself may exert dual functions: (1) slow viral entry into cells and hence viral spread [79] and (2) protect the lung from injury [10123132].

 

https://link.springer.com/article/10.1007/s00134-020-05985-9


Awesome, thx.

But I have NO CLUE what this means for ARBs and ACEIs!

3/14/20 6:13 PM
3/20/12
Posts: 35223

It has been loose since late october/early november...China has confirmed cases in november

Doc is probably really close with the 500K or plus estimate...possibly on the low side
global travel spreads stuff like wildfire

3/14/20 6:13 PM
1/1/01
Posts: 10685
Mutant -
mataleo1 -
Mutant - 

I've been sick for 5 weeks coughing, wheezing, can't wait breathe get exhausted and out of breath just walking around.

 

Been on 3 roundabout antibiotics, multiple rounds of predsidone last night round started 60 mg for 4 days before the taper, on a nebulizer, benzonatate, promethazine with codeine, breo inhaler, pro air inhaler. 

 

Dr says I don't have Coronavirus but have upper respiratory infection but it's not going away. I haven't been tested and no idea how to get tested. 

 

I'm going to die am I?

 

Edit 

I also live in the same neighborhood the first reported case in AZ was confirmed. 


Have you been tested for RSV? Influenza? Where do you live?

Corona doesn't usually last 6 weeks, I'm guessing you have something else. Eosinophillic pneumonia? Hyperreactive bronchis (like asthma)? BOOP? Sorry I can't be of much help

Thanks I live in Phoenix x-rays for pneumonia negative, valley fever negative, I do have asthma but I've never had anything to like this before and last this long. 

Not a doctor, but someone who has asthma and bad allergies.

 

Any changes to your diet in the last few weeks? Any changes in your life>

 

Are you using any different items be it detergent, deodorant, etc?

 

I went to the hospital last year because I had difficulty breathing. They did the same tests that they did on you and couldnt figure it out.

 

I started backtracking what changes I made in my life and I realized I started using gold Bond powder on privates a few weeks earlier. Apparently, my body did not react well to it. I stopped using it and within a few days I was back to normal.

 

Praying for your bro!

3/14/20 6:13 PM
1/1/01
Posts: 36851
mataleo1 -
BJ Penn Forever - 
trobinson21 -
mataleo1 -
Believe in the Power of One - 

Been hearing kids under 9 aren't getting it, is that true?

What SHOULD we be doing other than avoiding people? 


Bear in mind this is based on incomplete data.

There are many cases of infants and children having it, but no lethalities so far.

What to do:
-Avoid crowds
-Avoid unnecessary travel
-If you're sick, stay home, many toll free numbers out there to help you figure out if you have symptoms.
-If you're very sick, go to the ER, try protecting your mouth on your way there (or wear a mask if you have one)

And remember guys, water is wet and the Earth is round. 
 

Stay safe gang! Lol

Your 20 vote downs should give you a clue that you are being a giant fucking dick while mataleo1 is trying to be cool.


Not trying to be cool brotha. I'm a giant nerd. Nerds are never cool.

But I'm trying to be helpful while I'm waiting around.

Well sometimes being helpful is cool, as in this instance.

The older you get, the more being helpful is cool, at least that is what I have found.

I'm sure things will get crazier for you out there before they settle down, hope you and the wife take care of yourselves when you can.

Thanks for posting.

3/14/20 6:15 PM
6/22/09
Posts: 1880

Thanks for the thread

3/14/20 6:20 PM
1/1/01
Posts: 1943
mataleo1 -
lazermonkey -
mataleo1 -
lazermonkey - 
mataleo1 -
lazermonkey - 

Is it true there are patients suffering scar tissue in their lungs? I don’t think it’s a real common after effect? But, I’m pretty sure I read an article stating that that is in the more severe cases.

Thanks for being here and answering our questions and as always. Stay safe.


Not enough data and not enough longitudinal data.

Some with severe ARDS from influenza or pneumonia may have scarring tissue and a decrease in lung parameters such as FEV1.

My personal bias is that this isn't true but we'll have to see.

Thanks for taking the time to answer our questions. 
 

In your opinion, based on the numbers we’ve seen and those yet to be tested, how many people in the United States and Canada will test positive?


Putting me on the spot here and I'm sure I'll be off by a factor-10 here at least. But if I had to bet: 500k. Smarter and more knowledgeable MDs think that it'll be vastly superior to that number

Again thanks for answering all of our questions. 
 

I read an article where a Professor from Johns Hopkins threw out a number just like yours. So, you may be spot on with your estimate. 
 

 

Thx but honestly I don't care to be completely off the mark here.

I don't even care that i'll get a lot of shit on here if it turns out to be completely benign. Politicians and health care professionals are taking this seriously. There's enough reasons to be worried and I'll be the first one to cheer if we get out of this with minimal damage.

It’s going to take weeks to get 500k tests to those that needs it so I doubt we will get 500k confirmed cases anytime soon even though we are likely to have over 500k people infected. A good friend that is a physician and has been sick with fever and severe respiratory issues for 8 days and she couldn’t get tested here in Los Angeles. Her husband is exhibiting the same symptoms and he can’t get tested, in spite of teaching at USC and working at Children’s Hospital. Hospitals don’t have the tests. We just got 10,000 test delivered to the state of California. 10,000 tests for 40 million people. Our government has let us down. 
 

 

3/14/20 6:21 PM
2/4/09
Posts: 10425
mataleo1 -
NoNeed4aScreenName - 
turducken -
mataleo1 -
turducken - 

What are your thoughts on anti-hypertensive medications such as Losartan as far as how they could influence the severity of an infection? 

 

Along the same lines, when we are told that high blood pressure is a risk factor, does that mean treated or untreated?  

 

I have seen thoughts on both sides, some suggesting that because the virus binds to ACE2 as its means of entry into the body, that drugs which increase expression of that enzyme such as Losartan would lead to worse outcomes(which seems to be supported by the stats on hypertension as a comorbidity), but there are others saying that the increase in ACE2 has actually been shown to be protective and has been shown to prevent lung damage in other instances of viral pneumonia and ARDS, with some theorizing it could even be used as a treatment for covid19.  But I'm not a doctor so I dont know what to think of it all since the info is so contradictory.

 

If your parents were on Losartan, would you have them continue taking it or try to switch to a calcium channel blocker or something else? 


This is a great question.

Losartan is a angiotensin receptor blocker. It is somehow related to ACE inhibitors (which blocks conversion of angiotensin). Losartan may increase expression of the receptor (upgregulation) and upstream increase production of angiotensin 1 but as of now, there is insufficient data to say much about its effect on COVID expression or infection. HOWEVER, if you have high BP, it would make sense to switch to something like a CCB (norvasc or adalat)

Here's a paper published in the lancet: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

Thanks. That's the paper I was referring to.

 

But what about these contradictory points?

 

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang?utm_source=share&utm_medium=ios_app&utm_name=iossmf

 

https://www.ncbi.nlm.nih.gov/m/pubmed/32129518/

 

https://www.bmj.com/content/368/bmj.m325/rr

 

Confusing/scary time...

Upon reading this it appears that using ACE-i inhibitors they focused on a cardiac treatment. 

 

These are generally taken orally. I wonder if there's some type of inhalant that would direct it to the lungs. This alone presents new risks. 

 

There's also the soluble form of ACE2 that can be used to bind to the virus 

 

4.

Delivering excessive soluble form of ACE2.

Kuba et al. [10] demonstrated in mice that SARS-CoV downregulates ACE2 protein (but not ACE) by binding its spike protein, contributing to severe lung injury. This suggests that excessive ACE2 may competitively bind with SARS-CoV-2 not only to neutralize the virus but also rescue cellular ACE2 activity which negatively regulates the renin-angiotensin system (RAS) to protect the lung from injury [1230]. Indeed, enhanced ACE activity and decreased ACE2 availability contribute to lung injury during acid- and ventilator-induced lung injury [123132]. Thus, treatment with a soluble form of ACE2 itself may exert dual functions: (1) slow viral entry into cells and hence viral spread [79] and (2) protect the lung from injury [10123132].

 

https://link.springer.com/article/10.1007/s00134-020-05985-9


Awesome, thx.

But I have NO CLUE what this means for ARBs and ACEIs!

I was just thinking in terms of the paradoxial upregulation of the receptors in the presence of the inhibitors.... 

 

It could be that the soluble form could be the best treatment. 

 

MBN and Slowshot posted a video from a conference on another thread that discussed the soluble form as a possible treatment. 

 

It's interesting that Women produce more of the soluble form and this could be the reason for the increased incidents observed in Men. 

3/14/20 6:25 PM
2/2/15
Posts: 8942
mataleo1 -
Bilge Water - 

As a Canadian I have to laugh at all the Canadians getting triggered by Trump's response to this and criticizing while our government has done sweet fuck all.


You're being harsh. Measures are being done federally and provincially. Quebec (surprisingly) has taken very serious and strict measures to contain this. Yeah, I wish they'd close the border but otherwise they've done a decent job.

Federally what measures were taken before now? All I saw were flyers being handed out at airports and being told to wash your hands. Zero travel restrictions, self isolate if you feel like it etc. Now I'm not going to say I know more than you, but as an outsider I didn't see much being done. To me, travel restrictions should have been #1 priority, and they did nothing of the sort, imo, that's a MAJOR dropping of the ball. 

We even had the former health minister (or some shit like that) on CBC about a month ago telling everyone quarantines don't work. What kind of medical expert could claim with a straight face that restricting potentially infected people from entering the country is pointless. Unreal.

3/14/20 6:26 PM
9/9/02
Posts: 13311
Should all BJJ gyms shutdown?

Hot topic in the BJJ community
Edited: 3/14/20 6:28 PM
11/17/15
Posts: 166

Why is this strain viewed as being so dangerous?  I get that it's very contagious, but the symptoms themselves seem fairly mild when compared to your typical flu bout that leads to dehydration from diarrhea/vomiting, and the recovery rate is very high.  What is causing the deaths?  Collapsed lungs from coughing, pneumonia developing?  I'm just tired of people acting like this thing is a death sentence...

Edited: 3/14/20 7:21 PM
2/27/11
Posts: 11192

Some Italian hospitals are having success treating covid-19 patients with Tocilizumab, Roche is saying they're going to deliver the drug for free, have you heard anything about it?

 

3/14/20 6:32 PM
2/4/09
Posts: 10426

^youre link just brings us back to this page. 

3/14/20 6:34 PM
4/2/10
Posts: 6777

Thanks for doing this.  I learned a lot reading through it

3/14/20 6:38 PM
10/23/05
Posts: 2858
Bilge Water - 
mataleo1 -
Bilge Water - 

As a Canadian I have to laugh at all the Canadians getting triggered by Trump's response to this and criticizing while our government has done sweet fuck all.


You're being harsh. Measures are being done federally and provincially. Quebec (surprisingly) has taken very serious and strict measures to contain this. Yeah, I wish they'd close the border but otherwise they've done a decent job.

Federally what measures were taken before now? All I saw were flyers being handed out at airports and being told to wash your hands. Zero travel restrictions, self isolate if you feel like it etc. Now I'm not going to say I know more than you, but as an outsider I didn't see much being done. To me, travel restrictions should have been #1 priority, and they did nothing of the sort, imo, that's a MAJOR dropping of the ball. 

We even had the former health minister (or some shit like that) on CBC about a month ago telling everyone quarantines don't work. What kind of medical expert could claim with a straight face that restricting potentially infected people from entering the country is pointless. Unreal.


You're likely right. We've had federal funding to open up a hospital that was shut down. We've had decent access to test kits. Funding for several call centers and dedicated clinics for people wanting some screening. We've had major funding to call back retired nurses.

I know that at the border there's been better screening. I agree with you that we need travel restrictions and that's been a big letdown.

3/14/20 6:39 PM
1/1/01
Posts: 23450
"Mataleo1: 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."

So is simply inhaling air that an infected person exhaled OK?

But breathing in their coughed-out air (droplet-rich) is the risk?

Thanks.
3/14/20 6:41 PM
1/7/09
Posts: 15778

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.

3/14/20 6:43 PM
10/23/05
Posts: 2859
Meals Hitman - 

Why is this strain viewed as being so dangerous?  I get that it's very contagious, but the symptoms themselves seem fairly mild when compared to your typical flu bout that leads to dehydration from diarrhea/vomiting, and the recovery rate is very high.  What is causing the deaths?  Collapsed lungs from coughing, pneumonia developing?  I'm just tired of people acting like this thing is a death sentence...


Good question. Most cases are totally benign. There are several factors:

-It's a long infection. Most cases of the flu are done after 5 days, whereas patients with COVID are sick for longer.
-Because it's so long, your likely to develop secondary pneumonia especially if you're on a ventilator
-Young patients, much like the flu, may develop an exaggerated immune reaction to the infection, called ARDS, which is quite like having your lungs full of water.