OtherGround Forums OG doc. AMA on COVID-19

3/14/20 5:09 PM
10/23/05
Posts: 2845
TwoFatNuts - 
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?


One word: Surveillance.

If you get sick, IV fluids and a ventilator will save your life. Some also develop secondary bacterial pneumonia which would require antibiotics. That's why we tell those that are not gravely sick to stay home.

3/14/20 5:12 PM
11/17/10
Posts: 52411
mataleo1 -
DemonDeacon - 

Are you the nephrologist?


Yes, ICU and internist too :)

nice

my friend teaches Internal Med board prep (non practicing MD)...you being in the NYC area, good chance you used his course (IF you did not do self study)

3/14/20 5:12 PM
10/23/05
Posts: 2846
lazermonkey - 

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

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


Not enough data and not enough longitudinal data.

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

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

3/14/20 5:12 PM
2/4/09
Posts: 10423

I will say one thing. Today our ICU numbers are low and the emergy dept is actually probably under the daily average. 

 

I think Covid-19 risk might be scaring some of the lesser cases from coming to the ED. 

3/14/20 5:12 PM
4/6/12
Posts: 11631

In

3/14/20 5:13 PM
10/23/05
Posts: 2847
In Limbo - 
mataleo1 -
DemonDeacon - 

Are you the nephrologist?


Yes, ICU and internist too :)

nice

my friend teaches Internal Med board prep (non practicing MD)...you being in the NYC area, good chance you used his course (IF you did not do self study)


Very cool. But I'm not so young anymore :)

3/14/20 5:16 PM
12/10/09
Posts: 18951
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.

This reminds me. Cocaine blocks the virus, right?

3/14/20 5:16 PM
1/27/04
Posts: 14091
mataleo1 -
lazermonkey - 

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

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


Not enough data and not enough longitudinal data.

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

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

Thanks for taking the time to answer our questions. 
 

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

3/14/20 5:21 PM
10/23/05
Posts: 2848
lazermonkey - 
mataleo1 -
lazermonkey - 

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

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


Not enough data and not enough longitudinal data.

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

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

Thanks for taking the time to answer our questions. 
 

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


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

3/14/20 5:22 PM
3/20/12
Posts: 35220

I switched from smoking cannabis to only ingesting edibles for the time being...

Good move? or Bad Move?

3/14/20 5:23 PM
10/23/05
Posts: 2849
Rambo John J - 

I switched from smoking cannabis to only ingesting edibles for the time being...

Good move? or Bad Move?


Ban this troll :)

3/14/20 5:27 PM
1/1/01
Posts: 36315

What's your opinion of Canada's response.  We haven't shut down any flights outright.

3/14/20 5:30 PM
6/13/03
Posts: 27101

Have you seen any positive feedback from over the counter medications like antitussives and expectorants?

3/14/20 5:30 PM
1/27/04
Posts: 14092
mataleo1 -
lazermonkey - 
mataleo1 -
lazermonkey - 

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

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


Not enough data and not enough longitudinal data.

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

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

Thanks for taking the time to answer our questions. 
 

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


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

Again thanks for answering all of our questions. 
 

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

 

3/14/20 5:32 PM
10/23/05
Posts: 2850
Mit -

What's your opinion of Canada's response.  We haven't shut down any flights outright.

We should. Including the UK. Until we know what we're dealing with (true incidence, severity, endemic areas). I'm quarantined 14 days if I come back from the US and they let all other travellers roam free? Doesn't make any sense. If we're going to do this right, let's close the border until we know more.

3/14/20 5:33 PM
10/23/05
Posts: 2851
Sogsteel -

Have you seen any positive feedback from over the counter medications like antitussives and expectorants?

They're always and only used for symptomatic treatment. They'll make you feel better, but that's it. 

3/14/20 5:35 PM
10/23/05
Posts: 2852
lazermonkey -
mataleo1 -
lazermonkey - 
mataleo1 -
lazermonkey - 

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

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


Not enough data and not enough longitudinal data.

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

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

Thanks for taking the time to answer our questions. 
 

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


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

Again thanks for answering all of our questions. 
 

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

 

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

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

3/14/20 5:37 PM
2/2/15
Posts: 8941

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

3/14/20 5:39 PM
6/13/03
Posts: 27102

One last question.

How many rolls of toilet paper should one have on hand to survive the Covidpocolypse?

3/14/20 5:40 PM
10/23/05
Posts: 2853
Bilge Water - 

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


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

3/14/20 5:42 PM
10/23/05
Posts: 2854
Sogsteel - 

One last question.

How many rolls of toilet paper should one have on hand to survive the Covidpocolypse?


Believe it or not, I haven't stocked anything myself. Too lazy!

Edited: 3/14/20 5:56 PM
2/9/07
Posts: 1151
bjtrashman -
ltlurker -

What are the risks to pregnant women and newborn child?

 

 If your wife was due to have a baby in the next two weeks what would you do?

I’m literally in this situation 

Good luck brother.  

 

Im not personally that concerned for myself, but My wife and unborn kid have me running every scenario inmy head.

 

Worried about hospitals being full.  Worried about supply chains breaking. Worried about the lack oinfo concerning this group of people.  

 

All while making sure she’s notworried 

3/14/20 5:46 PM
3/20/12
Posts: 35221
mataleo1 - 
Rambo John J - 

I switched from smoking cannabis to only ingesting edibles for the time being...

Good move? or Bad Move?


Ban this troll :)


oh not trolling
was serious
just feel like the lungs need to be full strength if possible

thanks for the AMA...very cool and some good stuff to learn

3/14/20 5:48 PM
10/23/05
Posts: 2855
Rambo John J - 
mataleo1 - 
Rambo John J - 

I switched from smoking cannabis to only ingesting edibles for the time being...

Good move? or Bad Move?


Ban this troll :)


oh not trolling
was serious
just feel like the lungs need to be full strength if possible

thanks for the AMA...very cool and some good stuff to learn


oh, sorry about that.

Keep off smoking, of any kind :)

Although I admit in partaking every once in a while. It really depends on the frequency. It's a dose-response curve.

3/14/20 5:48 PM
1/1/01
Posts: 36850
trobinson21 -
mataleo1 -
Believe in the Power of One - 

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

What SHOULD we be doing other than avoiding people? 


Bear in mind this is based on incomplete data.

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

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

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

Stay safe gang! Lol

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