OtherGround Forums OG doc. AMA on COVID-19

4/28/20 11:21 PM
2/2/08
Posts: 13797
OG HA Y N - 

And another....

Pfizer: Coronavirus vaccine could be ready by this fall for emergency use

https://www.foxnews.com/health/pfizer-coronavirus-vaccine-could-be-ready-by-this-fall-for-emergency-use


I wonder how much that will cost $ for an average joe like me.
4/29/20 12:27 AM
1/1/01
Posts: 18300
forumnewb -
OG HA Y N - 

And another....

Pfizer: Coronavirus vaccine could be ready by this fall for emergency use

https://www.foxnews.com/health/pfizer-coronavirus-vaccine-could-be-ready-by-this-fall-for-emergency-use


I wonder how much that will cost $ for an average joe like me.

Bout tree fiddy

4/29/20 9:09 AM
12/1/12
Posts: 2438

Randomized remdesivir data just came out positive. Let the markets rip! What a roller coaster.

4/29/20 10:35 AM
1/1/01
Posts: 11817
used2wrestle -

Randomized remdesivir data just came out positive. Let the markets rip! What a roller coaster.

Link or more info, please?

4/29/20 10:38 AM
2/4/09
Posts: 11139
prof -
used2wrestle -

Randomized remdesivir data just came out positive. Let the markets rip! What a roller coaster.

Link or more info, please?

All I have seen so far was headlines saying it met its primary end goal. 

 

It's a phase I trial those primary end goals can simply be safety...etc. 

 

I'm sure more details will come today

Edited: 4/29/20 10:46 AM
7/4/11
Posts: 13776
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

Edited: 4/29/20 10:49 AM
2/4/09
Posts: 11140
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

4/29/20 10:54 AM
7/4/11
Posts: 13777
NoNeed4aScreenName -
prof -
used2wrestle -

Randomized remdesivir data just came out positive. Let the markets rip! What a roller coaster.

Link or more info, please?

All I have seen so far was headlines saying it met its primary end goal. 

 

It's a phase I trial those primary end goals can simply be safety...etc. 

 

I'm sure more details will come today

Maybe I'm mistaken, but I believe remdesivir is already at phase 3 and Gilead is testing different administration schedules in large scale sample sizes now.

 

Statistically, we've a bit better than a 1-in-2 chance of phase 3 success if it's being run with the same stringency we usually see during RCTs

4/29/20 10:56 AM
7/4/11
Posts: 13778
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

4/29/20 10:56 AM
4/26/13
Posts: 4745

For the doctors in here, just curious how seriously the medical community takes the projection models.  In my semi-rural county the models have consistently been WAY off, initially showing thousands of hospitalizations that have just not materialized.  Local officials are stil using these (adjusted) models to make decisions and it just doesnt make sense to me.  They're wrong every time.  At what point are hospitals saying these things are useless?  

4/29/20 11:00 AM
2/4/09
Posts: 11141
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

Not a coincidence that ARBS and ACEi are being explored in all the preexisting conditions that make one susceptible to Covid-19

4/29/20 11:01 AM
4/26/13
Posts: 4746

Another one for the professionals - can someone explain (bro science is best) exactly why testing is so important compared to hospitalizations?  I keep hearing "test, test, test" but why is testing so important when hospitalizations are so low?  Is it just the ability to isolate and track?  

 

I guess I just dont see how testing is going to change much.  Right now it seems like there's enough tests in my region to test anybody who meets the criteria, but they're still saying they need to double testing capacity.  Is the plan to start testing asymptomatic citizens too?  Isnt the protocal going to be the same, quarantine for two weeks if you have symptoms, positive test or not?  

4/29/20 11:03 AM
2/4/09
Posts: 11142
NoNeed4aScreenName -
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

Not a coincidence that ARBS and ACEi are being explored in all the preexisting conditions that make one susceptible to Covid-19

Now the  studies that claim ACE and ARBS have not shown any increase in soluble forms of ACE2. 

 

Well there lies the problem is that they are measuring circulating levels in vivo cell bound ACE2. 

 

The circulation levels could be regulated at a different level I.E. by enzymes that cleave cell bound ACE2 

4/29/20 11:05 AM
4/26/13
Posts: 4747
Tomato Can - ACEP and AAEM released a joint statement condemning those 2 urgent care docs above, calling them reckless and their data biased:

https://www.acep.org/corona/COVID-19/covid-19-articles/acep-aaem-joint-statement-on-physician-misinformation/

So I'm seeing lots of doctors shit on these guys but so far nobody has said their data is incorrect.  What am I missing here? 

Edited: 4/29/20 11:10 AM
2/4/09
Posts: 11143
NoNeed4aScreenName -
NoNeed4aScreenName -
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

Not a coincidence that ARBS and ACEi are being explored in all the preexisting conditions that make one susceptible to Covid-19

Now the  studies that claim ACE and ARBS have not shown any increase in soluble forms of ACE2. 

 

Well there lies the problem is that they are measuring circulating levels in vivo cell bound ACE2. 

 

The circulation levels could be regulated at a different level I.E. by enzymes that cleave cell bound ACE2 

I will admit i havent read all the studies about in vivo measurements so they may have measured more than just soluble ACE2 in some of them. When they use the studies to support the lack of upregulated ACE2 levels while on ARBS ACEi they always mention soluble ACE2. Reasonable since I dont imagine it will be very easy to take biopsies of healthy lung tissue

Edited: 4/29/20 11:13 AM
2/4/09
Posts: 11144
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

we can take this information we are learning from Covid and probably make some important new discoveries in lung treatment. 

 

I feel like we can for one thing revolutionize ARDS treatment 

4/29/20 11:14 AM
1/1/01
Posts: 11818

Thanks to the pros for answers.

BTW, yesterday as I was passing my corner convenience store
I noted two older people buying and staying in the tiny store playing their lottery tickets. One even without a mask!

Talk about an example of how badly human beings can mismanage odds and priorities! Odds of winning lottery vs odds of catching deadly pandemic virus going to store to play lottery....
4/29/20 12:13 PM
1/1/01
Posts: 65684
Easters - 
Tomato Can - ACEP and AAEM released a joint statement condemning those 2 urgent care docs above, calling them reckless and their data biased:

https://www.acep.org/corona/COVID-19/covid-19-articles/acep-aaem-joint-statement-on-physician-misinformation/

So I'm seeing lots of doctors shit on these guys but so far nobody has said their data is incorrect.  What am I missing here? 


It is not that their data is incorrect, it is that they are making claims that are not supported by their data. They are either being intentionally misleading about the implications of their data, or they are morons.
Edited: 4/29/20 12:37 PM
3/9/13
Posts: 4664
used2wrestle -

Randomized remdesivir data just came out positive. Let the markets rip! What a roller coaster.

Looks like they just tested a 5 day treatment vs a 10 day treatment and found the 5 day was just as effective. Good news that IF it works, they would be able to get to more people sooner.

 

I don't think we have data yet regarding its efficacy. Theoretically its possible that the 5 day treatment and 10 day treatment had the same results because the treatment doesn't work. Someone can correct me if I'm wrong.

4/29/20 12:54 PM
9/8/02
Posts: 25989
I saw a hysterical post on social media, citing 135 new CV cases in Texas along with 10 deaths, the worst ever on record for the state.

Of course everyone is blaming the increase on the recent re-opening and suggesting the Governor has blood on his hands (expected).

Question: Isn't the incubation period for this virus 7-10 days. If so, wouldn't that mean anyone getting sick today or dying today contracted the virus well before re-opening. Not to mention nearly 50% of all Texas deaths are in nursing homes, so the people dying are not getting it from Waffle House on their day out of the house.



4/29/20 1:25 PM
2/4/09
Posts: 11145
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

They arent targeting ACE2 for the treatment of diabetes but ACE. 

 

A side effect of the drugs is increased ACE2. Hence the reason why they are more at risk. Not only that but overproduction  of the receptor also makes neighboring cells more at risk of being infected from the primary source. Much like a positive feedback loop. 

 

Once this feedback loop gets strong enough it overwhelms ACE2 through down regulation (by covid-19 itself). That's when ARDS sets in IMO. 

 

This is all speculation of course but based on primary research 

4/29/20 1:31 PM
11/23/10
Posts: 239
NoNeed4aScreenName -
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

we can take this information we are learning from Covid and probably make some important new discoveries in lung treatment. 

 

I feel like we can for one thing revolutionize ARDS treatment 

Don’t know if this is relevant to this discussion, but some of my colleagues ran a regression model on about 700 patients admitted to hospitals here for COVID-19 to look for risk factors of death or ICU-treatment. About 30% of them were on ACE-inhibitors.

They found age, male sex and beta-blocker treatment to be risk factors - but not ACE- or ARB-inhibitors.

IMO, the Beta-blockers are probably showing up due to residual confounding from not being able to properly adjust for cardiovascular comorbidity. Still, it seems like ACE-inhibitors at least do no harm - at least until we have the results from the ongoing RCTs.

4/29/20 1:38 PM
2/4/09
Posts: 11146
Job Security -
NoNeed4aScreenName -
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

we can take this information we are learning from Covid and probably make some important new discoveries in lung treatment. 

 

I feel like we can for one thing revolutionize ARDS treatment 

Don’t know if this is relevant to this discussion, but some of my colleagues ran a regression model on about 700 patients admitted to hospitals here for COVID-19 to look for risk factors of death or ICU-treatment. About 30% of them were on ACE-inhibitors.

They found age, male sex and beta-blocker treatment to be risk factors - but not ACE- or ARB-inhibitors.

IMO, the Beta-blockers are probably showing up due to residual confounding from not being able to properly adjust for cardiovascular comorbidity. Still, it seems like ACE-inhibitors at least do no harm - at least until we have the results from the ongoing RCTs.

Did they show an age of the 30% of the inhibitors?

4/29/20 1:40 PM
2/4/09
Posts: 11147
NoNeed4aScreenName -
Job Security -
NoNeed4aScreenName -
MattyECB -
NoNeed4aScreenName -
MattyECB -
prof - For the medical professionals:

One worry has been that if there is a second wave of COVID-19
it could coincide or overlap with the flu season, hence putting far more pressure on the health care system and hospitals than we are even seeing now.

On the other hand, it seems there may be some factors mitigating that scenario:

1. We will in all likelihood still have in place the type of physical distancing practices we've become accustomed to, and other practices, that have "lowered the curve" infection rate for COVID. It would seem other contagious disease infection rates like The Flu would also be much lower due to this as well. (Of course if COVID rates in a second wave are maintained just below hospital capacity, even reduced flu infection could push hospitalizations above the threshold).

2. Hopefully we will be better prepared in a second wave, having ramped up production of PPE and other necessary equipment, having established better emergency care plans for overflow, etc.

So one thing I haven't seen info on yet:

Are infection rates for any other diseases down at this time, due to physical distancing etc - colds, flu, whatever?
 

When I checked a week or two ago, flu deaths were in line with historical expectations if you adjusted for the lag in reporting that we tend to see.

 

Comparing non-COVID deaths after the fact will definitely help us suss out the accuracy of our diagnoses in absence of real testing and arguably help us understand which pre-existing conditions get fucked by COVID. Everyone jokes about inflated numbers for pre-existing conditions, but you can have a great prognosis and life expectancy with diabetes but get mouth fucked by COVID.

 

The research on obesity, diabetes, and smoking as COVID risk factors is still nascent but already pretty damning.

The diabetes tie in could be the fact that now they have started to explore ARBs and ACEi in diabetes. 

 

In patients with type 2 diabetes, hypertension, and microalbuminuria, ACE inhibitors and ARBs have been shown to delay the progression to macroalbuminuria. (A) In those with type 2 diabetes, hypertension, macroalbuminuria (>300 mg/day), and renal insufficiency, an ARB should be strongly considered.

 

https://www.google.com/search?q=arbs+ace+diabetes&oq=arbs+ace+diabetes&aqs=chrome..69i57j0l2.5042j0j7&client=ms-android-rogers-ca&sourceid=chrome-mobile&ie=UTF-8

 

 

IMO if they want to really tackle this. Target ACE2 and find a workaround for the Mas pathway to alleviate ARDS

That's fascinating. Besides learning it in undergrad a decade ago, I haven't touched diabetes material at all. Didn't know the Ace2 receptor was involved in its pathogenesis, and I've only read statistical studies linking it to COVID.

 

Thanks for giving me something fun to look up!

we can take this information we are learning from Covid and probably make some important new discoveries in lung treatment. 

 

I feel like we can for one thing revolutionize ARDS treatment 

Don’t know if this is relevant to this discussion, but some of my colleagues ran a regression model on about 700 patients admitted to hospitals here for COVID-19 to look for risk factors of death or ICU-treatment. About 30% of them were on ACE-inhibitors.

They found age, male sex and beta-blocker treatment to be risk factors - but not ACE- or ARB-inhibitors.

IMO, the Beta-blockers are probably showing up due to residual confounding from not being able to properly adjust for cardiovascular comorbidity. Still, it seems like ACE-inhibitors at least do no harm - at least until we have the results from the ongoing RCTs.

Did they show an age of the 30% of the inhibitors?

Cause the male sex is also correlated to women having higher levels of soluble ACE2. 

4/29/20 1:42 PM
1/13/10
Posts: 47783

Three nursing homes in my county have outbreaks, a meat packing house as well.