OtherGround Forums OG doc. AMA on COVID-19

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".

3/14/20 4:35 PM
6/30/09
Posts: 1673

My 3year old son has a subglottic stenosis. When he gets a cold it sounds more like croup and he get bad stridor. Sometimes it causes him to cough until he throws up.

 

Do you have any advice on what extra steps I can take in care he were to catch this funk? Steroids, nebulizer, humidifier?  Obviously the hospital is a solution but in case it isn't one down the road, I'd like to be prepared.

 

Thanks for taking the time!

3/14/20 4:36 PM
1/7/09
Posts: 15774

https://www.sciencedirect.com/science/article/pii/S0924857920300820

 

There's a fair bit of info on chloroquine use coming out of China and South Korea, as treatment not prophylaxis. But it seems like the western countries have tunnel vision with remdesivir/kaletra/antivirals in general.

3/14/20 4:36 PM
10/23/05
Posts: 2838
Dryfly - 
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.


I can't believe your doc will be pissed. We've all been sent memos to be very accommodating. I've been denied vacation days for 2 months. It's part of the times.

3/14/20 4:37 PM
2/4/09
Posts: 10418
Caladan -

Have you guys seen a lot of random unexplained viral infections this year affecting the upper respiratory system? More than usual I mean, of people who aren't positive for anything on the normal flu test?

 

I've had this theory for a few days now that this shit has been here for awhile and everyone has or has had it. We've heard for awhile now how this is an extra bad flu year and I've heard so many anecsotes of people who have had a weird viral infection that they "just can't quite shake".

Personally I can tell you that I found a higher amount of medicine patients being put on droplet precautions... 

 

On the other hand many can simply be precautionary measures. I've seen different diagnosis that had nothing to due with pneumonia or the flu and they were put on droplet precautions. 

 

I will say I have seen a larger number of pneunomia though. 

Edited: 3/14/20 4:38 PM
11/17/10
Posts: 52410
trobinson21 -
In Limbo -
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.

ok we get it, trob

 

youre such an alpha who just doesnt give a fuck

 

 

 

 

but yet here you are, caring about what others do and calling actual physicians bullshitters bc you want to maintain this wannabe alpha "youre all panicking and im the chill alpha spiral man" schtick

Don’t get upset, I’m just wondering why a busy doctor pulling “16 hour shifts” at his busy hospital fighting to get this thing under control has 8 straight hours to post on the OG.

7 hours ago this dude was in the Italy thread explaining how our healthcare system is just like theirs when the fact is Italian hospitals are notoriously operating at peak capacity without the coronavirus shit.

My wife is a disaster recovery RN and our neighbor is an internist and they are taking it seriously but they would never repeat “250 deaths in Italy in 24 hours” over and over and over again while mixing in disdain for governments lack of preparation. Why wasn’t this doctor begging for tests in January instead of waiting for Trump to come deliver some to his hospital?

Sorry for interrupting your doom and gloom echo chamber.

your reading comprehension stinks

lol @ "16 hour shift" for an MD

re read what he wrote

and learn what "on call" means

3/14/20 4:39 PM
1/7/09
Posts: 15775
NiteProwleR -
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.

It's worth talking about, but seems like there's no clear answer. I'm not a doctor 

 

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

13 Mar 2020

Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects, hypotheses have been put forward to suggest a potential adverse effects of angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs). It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2. The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs. 

Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

 

Prof. Giovanni de Simone,

Chair, ESC Council on Hypertension

On behalf of the Nucleus Members

Edited: 3/14/20 4:40 PM
2/4/09
Posts: 10419
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...

I think this is si,ply due to the fact that normally ACE2 doesnt act as a receptor and these are downstream targets of the metabolic pathway. 

 

Maybe the response to lung injury is a mechanism to heal. My forte was in oxidative metabolism so maybe someone that is more knowledgeable in this pathway can give a clearer answer at the moment, 

 

wrong pathway. I'll put up the correct one in an edit

3/14/20 4:41 PM
10/23/05
Posts: 2839
Caladan - 

Have you guys seen a lot of random unexplained viral infections this year affecting the upper respiratory system? More than usual I mean, of people who aren't positive for anything on the normal flu test?

 

I've had this theory for a few days now that this shit has been here for awhile and everyone has or has had it. We've heard for awhile now how this is an extra bad flu year and I've heard so many anecsotes of people who have had a weird viral infection that they "just can't quite shake".


Interesting.

I've seen a shitload of RSV infections this winter. It's usually really benign but I've had many patients hospitalized for it.

The only argument against this is the exponential curve of cases (and especially deaths). That means we started from somewhere close to 0. Yes, I know that we haven't been testing, but it's unlikely that the current corona has been here a long time.

3/14/20 4:42 PM
5/5/07
Posts: 11711
Caladan -

Have you guys seen a lot of random unexplained viral infections this year affecting the upper respiratory system? More than usual I mean, of people who aren't positive for anything on the normal flu test?

 

I've had this theory for a few days now that this shit has been here for awhile and everyone has or has had it. We've heard for awhile now how this is an extra bad flu year and I've heard so many anecsotes of people who have had a weird viral infection that they "just can't quite shake".

Nope havent seen anything like this.

Flu season hasnt actually been that bad in canada requiring admissions at least.   It was really bad a few years ago and was very deadly causing lots of multiorgan failures.  It doesn't typically cause pneumonias.

This strain of corona is causing viral pneumonias leading to ards which isnt even common with regular common cold corona.  This is why the medical community is so spooked.  There isnt really any good way to treat this.  Everything tried is basically experimental at this point and they trying lots of heavy guns. 

3/14/20 4:42 PM
1/18/03
Posts: 3412
NoNeed4aScreenName -
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 

 

I sort of understand what you are saying but I'd rather they set these things up prior to a big event instead of waiting until the last minute and half assing it.

 

To Mataleo thanks again for the info.

3/14/20 4:44 PM
10/23/05
Posts: 2840
TwoFatNuts - 

My 3year old son has a subglottic stenosis. When he gets a cold it sounds more like croup and he get bad stridor. Sometimes it causes him to cough until he throws up.

 

Do you have any advice on what extra steps I can take in care he were to catch this funk? Steroids, nebulizer, humidifier?  Obviously the hospital is a solution but in case it isn't one down the road, I'd like to be prepared.

 

Thanks for taking the time!


As of today: no specific things to make it better. Everything remains in testing or awaiting better results.

Corticosteroids are a good example. Preliminary data from China was promising but retrospective data now shows that it might worsen outcomes. So we have to let data add up.

Chloroquine and retrovirals are being studied and debated now. Awaiting results from Italy. But neither are benign treatments. As an aside, the worst overdoses I've had to treat were chloroquine ODs. Terrible outcomes.

3/14/20 4:47 PM
5/5/07
Posts: 11712
JLK -
NoNeed4aScreenName -
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 

 

I sort of understand what you are saying but I'd rather they set these things up prior to a big event instead of waiting until the last minute and half assing it.

 

To Mataleo thanks again for the info.

The whole point now is to flatten the curve they all talk about.

More testing means more will self isolate and not spread to others more vulnerable thus reducing the strain on hospitals.     Its a month too late imo but at least we taking steps now to limit spread as best as possible.

 

Panic gonna set it regardless.  Probably would have been better if we actually took it seriously like the East did instead of only caring once the markets crashed

3/14/20 4:48 PM
10/23/05
Posts: 2841
turducken - 
NiteProwleR -
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.

It's worth talking about, but seems like there's no clear answer. I'm not a doctor 

 

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

13 Mar 2020

Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects, hypotheses have been put forward to suggest a potential adverse effects of angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs). It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2. The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs. 

Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

 

Prof. Giovanni de Simone,

Chair, ESC Council on Hypertension

On behalf of the Nucleus Members


As an aside, this is a position statement. These are not guidelines nor recommendations. Conclusions are reasonable, but there are also about 12 of antihypertensive medications. So there is also some sense in switching if it's safe.

We're still in the dark here.

3/14/20 4:52 PM
5/5/07
Posts: 11713
mataleo1 -
TwoFatNuts - 

My 3year old son has a subglottic stenosis. When he gets a cold it sounds more like croup and he get bad stridor. Sometimes it causes him to cough until he throws up.

 

Do you have any advice on what extra steps I can take in care he were to catch this funk? Steroids, nebulizer, humidifier?  Obviously the hospital is a solution but in case it isn't one down the road, I'd like to be prepared.

 

Thanks for taking the time!


As of today: no specific things to make it better. Everything remains in testing or awaiting better results.

Corticosteroids are a good example. Preliminary data from China was promising but retrospective data now shows that it might worsen outcomes. So we have to let data add up.

Chloroquine and retrovirals are being studied and debated now. Awaiting results from Italy. But neither are benign treatments. As an aside, the worst overdoses I've had to treat were chloroquine ODs. Terrible outcomes.

I was surprised about the steroids part as well.

In theory seems like it would help with severe cases.    There must be more to it like onset of initiation, multiorgan failure, etc.

Hope more info comes out based on success stories.  Seems right now we dont really have anh proven method to fight this.  Seems all experimental at this point.    

Edited: 3/14/20 4:52 PM
2/4/09
Posts: 10420
JLK -
NoNeed4aScreenName -
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 

 

I sort of understand what you are saying but I'd rather they set these things up prior to a big event instead of waiting until the last minute and half assing it.

 

To Mataleo thanks again for the info.

I think it's great what they are doing. I just think the people will only focus on total new cases while not examing the acuity of the cases. Most people only see the headlines like PEI finds first Covid but won't read past to see that the patient came back from a high risk area and is only experiencing mild fever and cough and is self isolating. 


The response from China and social media is partly to blame and not just the media. I can easily take a trip through an ED on a busy day with stretchers spanning the halls and post it but everyone will just think the hospitals are being overwhelmed when really it's just another day at the office. 

3/14/20 4:53 PM
1/7/09
Posts: 15777
mataleo1 -
turducken - 
NiteProwleR -
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.

It's worth talking about, but seems like there's no clear answer. I'm not a doctor 

 

Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers

13 Mar 2020

Based on initial reports from China, and subsequent evidence that arterial hypertension may be associated with increased risk of mortality in hospitalized COVID-19 infected subjects, hypotheses have been put forward to suggest a potential adverse effects of angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs). It has been suggested, especially on social media sites, that these commonly used drugs may increase both the risk of infection and the severity of SARS-CoV2. The concern arises from the observation that, similar to the coronavirus causing SARS, the COVID-19 virus binds to a specific enzyme called ACE2 to infect cells, and ACE2 levels are increased following treatment with ACE-i and ARBs. 

Because of the social media-related amplification, patients taking these drugs for their high blood pressure and their doctors have become increasingly concerned, and, in some cases, have stopped taking their ACE-I or ARB medications.

This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection.

 

Prof. Giovanni de Simone,

Chair, ESC Council on Hypertension

On behalf of the Nucleus Members


As an aside, this is a position statement. These are not guidelines nor recommendations. Conclusions are reasonable, but there are also about 12 of antihypertensive medications. So there is also some sense in switching if it's safe.

We're still in the dark here.

Yea, no one seems to know. Which I guess is expected with something so new and rapidly developing.

 

#1 goal I'm trying to accomplish with my parents is for them to stay isolated and avoid infection in the first place. Then you never even have to get to the issue of whether the med is beneficial or harmful.

3/14/20 4:54 PM
2/4/09
Posts: 10421
NoNeed4aScreenName -
JLK -
NoNeed4aScreenName -
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 

 

I sort of understand what you are saying but I'd rather they set these things up prior to a big event instead of waiting until the last minute and half assing it.

 

To Mataleo thanks again for the info.

I think it's great what they are doing. I just think the people will only focus on total new cases while not examing the acuity of the cases. Most people only see the headlines like PEI finds first Covid but won't read past to see that the patient came back from a high risk area and is only experiencing mild fever and cough and is self isolating. 


The response from China and social media is partly to blame and not just the media. I can easily take a trip through an ED on a busy day with stretchers spanning the halls and post it but everyone will just think the hospitals are being overwhelmed when really it's just another day at the office. 

Also Wuhan seems to have had higher acuity.... for now

3/14/20 4:56 PM
10/23/05
Posts: 2842
Rahjai MD - 
mataleo1 -
TwoFatNuts - 

My 3year old son has a subglottic stenosis. When he gets a cold it sounds more like croup and he get bad stridor. Sometimes it causes him to cough until he throws up.

 

Do you have any advice on what extra steps I can take in care he were to catch this funk? Steroids, nebulizer, humidifier?  Obviously the hospital is a solution but in case it isn't one down the road, I'd like to be prepared.

 

Thanks for taking the time!


As of today: no specific things to make it better. Everything remains in testing or awaiting better results.

Corticosteroids are a good example. Preliminary data from China was promising but retrospective data now shows that it might worsen outcomes. So we have to let data add up.

Chloroquine and retrovirals are being studied and debated now. Awaiting results from Italy. But neither are benign treatments. As an aside, the worst overdoses I've had to treat were chloroquine ODs. Terrible outcomes.

I was surprised about the steroids part as well.

In theory seems like it would help with severe cases.    There must be more to it like onset of initiation, multiorgan failure, etc.

Hope more info comes out based on success stories.  Seems right now we dont really have anh proven method to fight this.  Seems all experimental at this point.    


Yeah. I remember when were giving steroids to all ARDS cases until it was shown to not improve mortality. Then we stopped. Until we started giving them for sepsis.

Medicine is far from being a science sometimes.

3/14/20 4:58 PM
9/4/11
Posts: 1856

Thanks for the thread. I'm in the UK and I'm absolutely discusted how blasé we are being about it. We don't seem to be taking it seriously.

My question is, dispite my gym not closing, would recommend staying away from bjj >

3/14/20 5:05 PM
10/23/05
Posts: 2843
Askren never lost - 

Thanks for the thread. I'm in the UK and I'm absolutely discusted how blasé we are being about it. We don't seem to be taking it seriously.

My question is, dispite my gym not closing, would recommend staying away from bjj >


I can only tell you what I've decided to do:

I'm active, I do BJJ, and go to the gym whenever I can. I cancelled a trip (well, I had to, hospital policy) and I'm trying to limit unnecessary social interactions including BJJ for a few weeks. I'm NOT worried about my safety but both my parents have had chemo and I treat sick dialysis patients. I have a responsibility towards them to limit my risk. This should blow over soon enough, and normal life will resume then.

3/14/20 5:06 PM
5/24/18
Posts: 740

Are you the nephrologist?

3/14/20 5:06 PM
6/30/09
Posts: 1674
mataleo1 -
TwoFatNuts - 

My 3year old son has a subglottic stenosis. When he gets a cold it sounds more like croup and he get bad stridor. Sometimes it causes him to cough until he throws up.

 

Do you have any advice on what extra steps I can take in care he were to catch this funk? Steroids, nebulizer, humidifier?  Obviously the hospital is a solution but in case it isn't one down the road, I'd like to be prepared.

 

Thanks for taking the time!


As of today: no specific things to make it better. Everything remains in testing or awaiting better results.

Corticosteroids are a good example. Preliminary data from China was promising but retrospective data now shows that it might worsen outcomes. So we have to let data add up.

Chloroquine and retrovirals are being studied and debated now. Awaiting results from Italy. But neither are benign treatments. As an aside, the worst overdoses I've had to treat were chloroquine ODs. Terrible outcomes.

Wait so NOTHING is even alleviating the symptoms? Am i reading that right? If thats the case, why even go to the ER?

3/14/20 5:07 PM
10/23/05
Posts: 2844
DemonDeacon - 

Are you the nephrologist?


Yes, ICU and internist too :)

Edited: 3/14/20 5:07 PM
1/27/04
Posts: 14090

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.