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.
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.
Sorry I misread. So it is in fact only one of the 2 that puts patients more at risk.