OtherGround Forums OG doc. AMA on COVID-19

3/14/20 4:00 PM
10/23/05
Posts: 2827
turducken - 
mataleo1 -
androushka - 

If you get hospitalized from this thing, what is the treatment? How far would just keeping the fever in check with acetaminophen at home go?

Anything in the way of health practices/diet/widly available meds known to help with immunity/virus in general?

Appreciate the info man, it is very important and helpful


Depending where you live, you might be treated with some antivirals (Remdesivir or Kaletra). Corticosteroids seems to worsen outcomes (preliminary data from China).

I'd go with NSAIDs, lots of fluids.

As improving immunity, nothing specific, but exercise, good diet, stop smoking. Won't go into curcuma and other things (that's a thread on its own)

What are your thoughts on chloroquine as a treatment?  It seems to be used often in China and South Korea


Most of what I've read was on TREATMENT with antivirals and PROPHYLAXIS with chloroquine, but it seems promising. We have not been using it in my hospital.

Keep in mind that chloroquine may be very toxic in susceptible individuals.

3/14/20 4:01 PM
1/18/03
Posts: 3411
mataleo1 -
JLK - 

My mother is above 70 and has some health issues (I believe it's referred to as aut-immune diffeciencies).  On the radio today it was saying they should all self quarentine.  She now rarely leaves the house but I got her to go out to an indoor facility where at most (including us) there were less than 10 people.  Should I  stop doing that?

 

Also we are thinking of bringing my neice over while this is going on, as long as she's not showing any symptoms we should be good with that or should we avoid that?


Lots of people are immunosuppressed. What does your mother have specifically? Some are worse than others. Humoral vs cell-mediated? As long as she's not swamped by crowds and that she washes hands (or uses hand sanitizers) her risk is for the moment minimal, unless you're in an endemic area.

Ok to bring your niece over if she's asymptomatic. Risk is never 0 but it's minimal.

I believe she is cell-mediated (at least from what I've heard and understood).  Thanks for the advice but when I told her what you said she replied that the Premier of Quebec is telling people in her age group to stay at home so that's what she's going to do.  Mothers, what are you going to do?  I'm just worried she's gonna go stir crazy in the house and just puttering around the bag yard.

3/14/20 4:02 PM
10/23/05
Posts: 2828
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. 


I'd be happy to help you out. PM me

3/14/20 4:02 PM
5/5/07
Posts: 11707

Hey man.

Good looking out.  Im internist now practicing in Ontario.   Used to work in murica. 

Over here its just as much of a shit show as it has been in america with the testing parameters and bullshit politics.    Our testing still takes well over a day and gets sent to winnepeg.   They opened a few of them drive thru testing but man is it a little too late.

The numbers up north are also grossly inaccurate just as they are in america.    Probably thousands upon thousands unaccounted for.

Our icus are already at capacity, we really cant handle an influx of corona cases.  Fortunately in my area, havent any admits needing icu yet. 

Stay safe my fellow colleague.   We got docs self quarantining themselves after travelling even to the states because of lack of testing lol.  

3/14/20 4:02 PM
6/30/07
Posts: 60010
mataleo1 -
trobinson21 - 
mataleo1 -
trobinson21 - 

Why aren’t you treating patients and searching for answers instead of playing politics and arguing on here all day?


Fuck off buddy: I've been on call for the last 16 days straight.

I'm still on call now covering the ICU. Fortunately, I have residents and fellow to help out. Happy?

Lol you’re full of shit.


I've been on this forum awhile. I practice as an internist, intensivist, nephrologist and clinical toxicologist.

If you're here to derail the thread, go play somewhere else.

Ignore the moran

3/14/20 4:03 PM
10/23/05
Posts: 2829
sanguine cynic - Do you recommend taking fever reducing medication?

Or since a fever helps your body fight off the infection, you should let the fever do its thing ?(unless dangerously high)

I find NSAIDs work better than tylenol.

Dangerous hyperthermia is not common with COVID so consider it a symptomatic solution (use it if needed)

3/14/20 4:06 PM
10/23/05
Posts: 2830
Dryfly - 
mataleo1 - 
The Closed Guard - 

Ive heard a rumor this is mutating. Any idea if thats true? Can you be infected more than once? (If yes, wouldn't your body have created antibodies already?)


Yes it's mutating, no different from influenza. In fact corona has existed forever, the strain we see now is a mutated form.

I answered the point about re-infection but it's also true that you may not be immune with a mutated form too, good point.


Thank you for taking the time to do this, it is appreciated.

I have a cousin who is a surgeon, I know how busy you all can be during the best of times...and this isn't one of those times.


Thx for the feedback.

I try to give evidence-based data but as you can see there is very little hard evidence as of yet. If I don't know, I say so.

I'm actually not busier than usual, so I have time to OG :) Call ends on monday morning.

3/14/20 4:07 PM
2/4/09
Posts: 10416
Rahjai MD -

Hey man.

Good looking out.  Im internist now practicing in Ontario.   Used to work in murica. 

Over here its just as much of a shit show as it has been in america with the testing parameters and bullshit politics.    Our testing still takes well over a day and gets sent to winnepeg.   They opened a few of them drive thru testing but man is it a little too late.

The numbers up north are also grossly inaccurate just as they are in america.    Probably thousands upon thousands unaccounted for.

Our icus are already at capacity, we really cant handle an influx of corona cases.  Fortunately in my area, havent any admits needing icu yet. 

Stay safe my fellow colleague.   We got docs self quarantining themselves after travelling even to the states because of lack of testing lol.  

All these new testing sites are gonna do is fuel more panic. 

 

People are uninformed and don't know how to properly interpret statistics it seems. 

 

The news is only really drawing attention to total cases and not mentioning that the majority are being sent home in self isolation. 

 

Let's follow Ottawa for a case study. New testing sites are just being opened up now and apparently there's only like 3 confirmed cases. 

 

Now sure if there's panic yet but news stories show the shelves are starting to empty in Canada. 

 

I assume this is what the situation is like in Ottawa as well 

 

3/14/20 4:08 PM
10/23/05
Posts: 2831
Rahjai MD - 

Hey man.

Good looking out.  Im internist now practicing in Ontario.   Used to work in murica. 

Over here its just as much of a shit show as it has been in america with the testing parameters and bullshit politics.    Our testing still takes well over a day and gets sent to winnepeg.   They opened a few of them drive thru testing but man is it a little too late.

The numbers up north are also grossly inaccurate just as they are in america.    Probably thousands upon thousands unaccounted for.

Our icus are already at capacity, we really cant handle an influx of corona cases.  Fortunately in my area, havent any admits needing icu yet. 

Stay safe my fellow colleague.   We got docs self quarantining themselves after travelling even to the states because of lack of testing lol.  


Hey man! Good to have you on board. Please chime in and offer your expertise. Stay safe too.

Edited: 3/14/20 4:10 PM
12/10/09
Posts: 18943
acai -

Based on the information that's out there, i don't think it's necessary nor a good idea to wear a mask.  It also causes you to fidget with it, which brings your hands on your face or close to it...Peter Attia MD mentioned the same thing in one of his recent videos on the subject.  

 

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

 

>>>If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.

 

>>Wear a mask if you are coughing or sneezing.

 

What to do:

 

(1.) Get a thermometer, fever is 100.4 or higher

(2.) Purchase a Pulse Oximeter to measure your oxygen levels at home.  Since COVID-19 causes a slow decrease in Oxygen levels before someone actually feels the effects, that's why you would measure your levels at home.  If you notice it go below 95% contact your doctor right away.

Lol. You’re a retard. Your advice would have just about everyone calling their doctor in a panic after a walk to the restroom. How man people have you cared for using pulse oximetry to qualify to give medical advice?

3/14/20 4:11 PM
10/23/05
Posts: 2832
JLK - 
mataleo1 -
JLK - 

My mother is above 70 and has some health issues (I believe it's referred to as aut-immune diffeciencies).  On the radio today it was saying they should all self quarentine.  She now rarely leaves the house but I got her to go out to an indoor facility where at most (including us) there were less than 10 people.  Should I  stop doing that?

 

Also we are thinking of bringing my neice over while this is going on, as long as she's not showing any symptoms we should be good with that or should we avoid that?


Lots of people are immunosuppressed. What does your mother have specifically? Some are worse than others. Humoral vs cell-mediated? As long as she's not swamped by crowds and that she washes hands (or uses hand sanitizers) her risk is for the moment minimal, unless you're in an endemic area.

Ok to bring your niece over if she's asymptomatic. Risk is never 0 but it's minimal.

I believe she is cell-mediated (at least from what I've heard and understood).  Thanks for the advice but when I told her what you said she replied that the Premier of Quebec is telling people in her age group to stay at home so that's what she's going to do.  Mothers, what are you going to do?  I'm just worried she's gonna go stir crazy in the house and just puttering around the bag yard.


I work in Montreal so I'm painfully aware of what the premier said. He is forcing me to go into a forced 14 day quarantine when I'm back in Montreal. So I won't be working there for 14 days. I understand the rationale and plan to comply but it's pretty shitty for those willing to work.

3/14/20 4:13 PM
1/1/01
Posts: 6193
mataleo1 - 
Dryfly - 
mataleo1 - 
The Closed Guard - 

Ive heard a rumor this is mutating. Any idea if thats true? Can you be infected more than once? (If yes, wouldn't your body have created antibodies already?)


Yes it's mutating, no different from influenza. In fact corona has existed forever, the strain we see now is a mutated form.

I answered the point about re-infection but it's also true that you may not be immune with a mutated form too, good point.


Thank you for taking the time to do this, it is appreciated.

I have a cousin who is a surgeon, I know how busy you all can be during the best of times...and this isn't one of those times.


Thx for the feedback.

I try to give evidence-based data but as you can see there is very little hard evidence as of yet. If I don't know, I say so.

I'm actually not busier than usual, so I have time to OG :) Call ends on monday morning.


I have a quick question if you don't mind.

I am supposed to be having surgery (elective) next week at the biggest hospital around here.

If you were me, would you postpone it just to be safe?

Seriously considering doing just that. Don't want to be stuck in bed for weeks if this gets worse. Surgery is bi-lateral SI Joint fusion, so I would be down for a while.

3/14/20 4:18 PM
4/13/07
Posts: 2870

Also an ICU doc. The one thing I would advise differently for those not sick enough to call 911 is NOT to go directly to the ER if you think you may have it.

 Call them first so that they are prepared to intake a possibly infected patient. Options including testing you in your car if you’re not that sick or in a negative pressure tent that they have set up.  If you are sicker than u thought on initial intake, they will bring you to a special isolation room in the ER.

 

Do NOT directly go to the ER without calling first!  This could potentially infect the first line health care workers.

 

 

3/14/20 4:18 PM
10/23/05
Posts: 2833
Dryfly - 
mataleo1 - 
Dryfly - 
mataleo1 - 
The Closed Guard - 

Ive heard a rumor this is mutating. Any idea if thats true? Can you be infected more than once? (If yes, wouldn't your body have created antibodies already?)


Yes it's mutating, no different from influenza. In fact corona has existed forever, the strain we see now is a mutated form.

I answered the point about re-infection but it's also true that you may not be immune with a mutated form too, good point.


Thank you for taking the time to do this, it is appreciated.

I have a cousin who is a surgeon, I know how busy you all can be during the best of times...and this isn't one of those times.


Thx for the feedback.

I try to give evidence-based data but as you can see there is very little hard evidence as of yet. If I don't know, I say so.

I'm actually not busier than usual, so I have time to OG :) Call ends on monday morning.


I have a quick question if you don't mind.

I am supposed to be having surgery (elective) next week at the biggest hospital around here.

If you were me, would you postpone it just to be safe?

Seriously considering doing just that. Don't want to be stuck in bed for weeks if this gets worse. Surgery is bi-lateral SI Joint fusion, so I would be down for a while.


Yes, I would consider postponing. We already have cancelled most outpatient clinics and some elective surgeries in my hospital. If you're young and healthy the risk of COVID infection for you is extremely low but it's all about minimizing risks to more vulnerable ones.

3/14/20 4:22 PM
10/23/05
Posts: 2834
sage77 - 

Also an ICU doc. The one thing I would advise differently for those not sick enough to call 911 is NOT to go directly to the ER if you think you may have it.

 Call them first so that they are prepared to intake a possibly infected patient. Options including testing you in your car if you’re not that sick or in a negative pressure tent that they have set up.  If you are sicker than u thought on initial intake, they will bring you to a special isolation room in the ER.

 

Do NOT directly go to the ER without calling first!  This could potentially infect the first line health care workers.

 

 


Agreed 100%. Sage and intelligent advice. Most ERs around me have specific triage systems and dedicated clinics. Always call first if you can.

Nice to have you on board brother!

3/14/20 4:27 PM
11/15/04
Posts: 38609

More of a fun science question...

Is it possible to get COVID and the flu at the same time?

3/14/20 4:28 PM
10/23/05
Posts: 2836
LiveWire - 

More of a fun science question...

Is it possible to get COVID and the flu at the same time?


Why not?

My brother had C.diff and mono at the same time.

3/14/20 4:30 PM
1/1/01
Posts: 58644
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

Thank you. My mom takes it. I'll let her doc know.

3/14/20 4:30 PM
1/7/09
Posts: 15773
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...

3/14/20 4:31 PM
2/4/09
Posts: 10417
mataleo1 -
LiveWire - 

More of a fun science question...

Is it possible to get COVID and the flu at the same time?


Why not?

My brother had C.diff and mono at the same time.

MRSA and ESBL.... I know not viruses 

3/14/20 4:32 PM
9/27/15
Posts: 11671
trobinson21 - 
mataleo1 -
trobinson21 - 

Why aren’t you treating patients and searching for answers instead of playing politics and arguing on here all day?


Fuck off buddy: I've been on call for the last 16 days straight.

I'm still on call now covering the ICU. Fortunately, I have residents and fellow to help out. Happy?

Lol you’re full of shit.


Dude get off this thread.. If you want to cry about his whereabouts or what he does in his free time, do it on another thread
3/14/20 4:33 PM
10/23/05
Posts: 2837

Your guess is as good as mine.

This is VERY low-evidence data but the prevailing opinion among ID docs is to switch ARBs to something else. More data hopefully this week.

3/14/20 4:33 PM
1/1/01
Posts: 6195
mataleo1 - 
Dryfly - 
mataleo1 - 
Dryfly - 
mataleo1 - 
The Closed Guard - 

Ive heard a rumor this is mutating. Any idea if thats true? Can you be infected more than once? (If yes, wouldn't your body have created antibodies already?)


Yes it's mutating, no different from influenza. In fact corona has existed forever, the strain we see now is a mutated form.

I answered the point about re-infection but it's also true that you may not be immune with a mutated form too, good point.


Thank you for taking the time to do this, it is appreciated.

I have a cousin who is a surgeon, I know how busy you all can be during the best of times...and this isn't one of those times.


Thx for the feedback.

I try to give evidence-based data but as you can see there is very little hard evidence as of yet. If I don't know, I say so.

I'm actually not busier than usual, so I have time to OG :) Call ends on monday morning.


I have a quick question if you don't mind.

I am supposed to be having surgery (elective) next week at the biggest hospital around here.

If you were me, would you postpone it just to be safe?

Seriously considering doing just that. Don't want to be stuck in bed for weeks if this gets worse. Surgery is bi-lateral SI Joint fusion, so I would be down for a while.


Yes, I would consider postponing. We already have cancelled most outpatient clinics and some elective surgeries in my hospital. If you're young and healthy the risk of COVID infection for you is extremely low but it's all about minimizing risks to more vulnerable ones.


Thanks again. I believe I will postpone it.

He is the only surgeon around here willing to do both sides at once for me, hope It doesn't piss him off that I am bailing for now.

I am far to impatient to do one side at a time. Twice as long to heal v. more pain and shorter healing time...I'll take the pain option every time.

3/14/20 4:33 PM
11/17/10
Posts: 52409
Rahjai MD -

Hey man.

Good looking out.  Im internist now practicing in Ontario.   Used to work in murica. 

Over here its just as much of a shit show as it has been in america with the testing parameters and bullshit politics.    Our testing still takes well over a day and gets sent to winnepeg.   They opened a few of them drive thru testing but man is it a little too late.

The numbers up north are also grossly inaccurate just as they are in america.    Probably thousands upon thousands unaccounted for.

Our icus are already at capacity, we really cant handle an influx of corona cases.  Fortunately in my area, havent any admits needing icu yet. 

Stay safe my fellow colleague.   We got docs self quarantining themselves after travelling even to the states because of lack of testing lol.  

but Dr. Trobinson from teh OG says you doctors are full of shit and this is a doom and gloom echochamber

3/14/20 4:34 PM
3/9/13
Posts: 4327

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".