Intensivists are gobsmacked on how to tackle this disease ...this is not behaving like typical ARDS! There is widespread pulmonary microthrombus disadvantaging any lungs recruitment. Higher PEEP is counter productive. Some liberal fluids is OK. Prostacyclin , Nitric Oxide is back so is systemic anticoagulation! Don;t push patient on CPAP , early intubation is must! Those intubated needing proning within 24 hours.
Once on ventilator mortality is 50% + !
Wuhan Coronavirus Resource Thread
Re: Wuhan Coronavirus Resource Thread
Virus is highly potent and even fit & well in 40s, who exercise daily are barely making out of it! In second week Covid19 has tendency to worsen (Boris Jhonson), will repeat again, there is real good chance of going down slippery slope in 2nd week !
Re: Wuhan Coronavirus Resource Thread
"Once on ventilator mortality is 50% + !"
That's also what I heard from some people who have gone thru it and survived.
This brings into question the usage protocol of CHQ + Azm. Assuming it is effective, the current ICMR guideline is to give it to patients in an advanced/critical stage. But by then, the survival chances are dimming and if the patient dies, we get a +1 to the statistic "died despite being on CHQ protocol". And might lead us to conclude the drug is not effective.
Wouldn't treating with CHQ + Azm as needed ***as soon as infection is confirmed***, increase the chances of patient survival and improve the efficacy stats for the drug in a fair manner?
That's also what I heard from some people who have gone thru it and survived.
This brings into question the usage protocol of CHQ + Azm. Assuming it is effective, the current ICMR guideline is to give it to patients in an advanced/critical stage. But by then, the survival chances are dimming and if the patient dies, we get a +1 to the statistic "died despite being on CHQ protocol". And might lead us to conclude the drug is not effective.
Wouldn't treating with CHQ + Azm as needed ***as soon as infection is confirmed***, increase the chances of patient survival and improve the efficacy stats for the drug in a fair manner?
Re: Wuhan Coronavirus Resource Thread
Coronavirus warning for people from black and minority backgrounds as NHS data suggests they are at more risk of life-threatening complications
https://www.dailymail.co.uk/news/articl ... virus.html
Coronavirus patients from black and ethnic minority backgrounds may be at higher risk of suffering deadly complications of the disease, an NHS report suggests.
Despite making up just 13 per cent of the UK population, a third of patients who fall critically ill with COVID-19 are from black, Asian or minority ethnic (BME) groups.
The report, by the Intensive Care National Audit and Research Centre, found 14 per cent were Asian, 14 per cent black and 7 per cent described themselves as other.
The study of 2,249 patients has raised fears non-white communities could suffer a disproportionate amount of deaths during the pandemic.
Those living in poverty smoke and drink alcohol more and are more likely to be obese - all of which increase the likelihood of chronic health conditions.
Patients with pre-existing health troubles struggle to fight off COVID-19 before it causes deadly complications such as pneumonia.
Poor people are also more likely to use public transport more often and live in crowded houses - driving up their chance of catching and spreading the virus.
Anecdotal evidence has also suggested that ethnic minorities are more likely to fall seriously ill with the coronavirus.
Professors Kamlesh Khunti and Wasim Hanif, from the charity South Asian Health Foundation (SAHF), say doctors have been reporting a disproportionate number of South Asian patients in ICU.
Khunti, a professor in primary care diabetes and vascular medicine at the University of Leicester, said: 'We have been concerned about this issue based on anecdotal reports and now this data is showing a signal regarding what we have been saying.
'This is a signal but at this stage, that's all it is. We now need more data, so we are therefore embarking on a mission to learn more through research.'
Fears there will be a disproportionate number of ethnic minorities suffering deadly symptoms of coronavirus are also being echoed in the US.
Dr Ashwin Vasan, a public health expert and assistant professor at Columbia University in New York City, said the virus was going to be felt most 'by the poor, the vulnerable, the marginalized, and obviously that falls down in this country on communities of color.'
Dr Vasan told USA Today it wasn't that minorities are more vulnerable to getting the virus, but they are more susceptible to suffering severe consequences which can kill them.
He said in blacks, Latinos and Native American suffer from the very diseases that COVID-19 presents a problem for and have less access to healthcare.
People of color could also be more at risk because of their professions, according to Shaomeng Jia, an economics professor at Alabama State University’s College of Business Administration.
Those working in retail and construction - who cannot work from home - are still mingling and risking infection even as the outbreak peaks, she said.
Meanwhile, health care jobs, including personal care aides and practitioners, are among the top 10 jobs with a high concentration of African Americans, she told USA Today.
The ICNARC report came from data reported into the Case Mix Programme. This programme represents all NHS adult, general intensive care and combined intensive care, high dependency units in England, Wales and Northern Ireland, as well as some specialist and non-NHS critical care units.
At the time of the last census in 2011, 13 per cent of the UK population, equivalent to around 8.1 million people, identified themselves as black, Asian or minority ethnic.
Meanwhile official NHS data suggests two-thirds of coronavirus patients in the UK who need to be hooked up to a ventilator will die from the illness.
A separate report by the Intensive Care National Audit and Research Center (ICNARC) found ventilated patients succumb to the virus 66.3 per cent of the time.
That is double the mortality rate of non-virus patients who were put on breathing support between 2017 and 2019, before the outbreak.
The NHS is still 22,000 ventilators short of the estimated 30,000 it will need during the peak of this crisis, which has infected almost 34,000 Britons.
The high death rate has led some doctors to question whether some critically ill COVID-19 patients are being put on ventilation 'for the sake of it', when the machine could be spared for a healthy person with a higher chance of survival.
https://www.dailymail.co.uk/news/articl ... virus.html
Coronavirus patients from black and ethnic minority backgrounds may be at higher risk of suffering deadly complications of the disease, an NHS report suggests.
Despite making up just 13 per cent of the UK population, a third of patients who fall critically ill with COVID-19 are from black, Asian or minority ethnic (BME) groups.
The report, by the Intensive Care National Audit and Research Centre, found 14 per cent were Asian, 14 per cent black and 7 per cent described themselves as other.
The study of 2,249 patients has raised fears non-white communities could suffer a disproportionate amount of deaths during the pandemic.
Those living in poverty smoke and drink alcohol more and are more likely to be obese - all of which increase the likelihood of chronic health conditions.
Patients with pre-existing health troubles struggle to fight off COVID-19 before it causes deadly complications such as pneumonia.
Poor people are also more likely to use public transport more often and live in crowded houses - driving up their chance of catching and spreading the virus.
Anecdotal evidence has also suggested that ethnic minorities are more likely to fall seriously ill with the coronavirus.
Professors Kamlesh Khunti and Wasim Hanif, from the charity South Asian Health Foundation (SAHF), say doctors have been reporting a disproportionate number of South Asian patients in ICU.
Khunti, a professor in primary care diabetes and vascular medicine at the University of Leicester, said: 'We have been concerned about this issue based on anecdotal reports and now this data is showing a signal regarding what we have been saying.
'This is a signal but at this stage, that's all it is. We now need more data, so we are therefore embarking on a mission to learn more through research.'
Fears there will be a disproportionate number of ethnic minorities suffering deadly symptoms of coronavirus are also being echoed in the US.
Dr Ashwin Vasan, a public health expert and assistant professor at Columbia University in New York City, said the virus was going to be felt most 'by the poor, the vulnerable, the marginalized, and obviously that falls down in this country on communities of color.'
Dr Vasan told USA Today it wasn't that minorities are more vulnerable to getting the virus, but they are more susceptible to suffering severe consequences which can kill them.
He said in blacks, Latinos and Native American suffer from the very diseases that COVID-19 presents a problem for and have less access to healthcare.
People of color could also be more at risk because of their professions, according to Shaomeng Jia, an economics professor at Alabama State University’s College of Business Administration.
Those working in retail and construction - who cannot work from home - are still mingling and risking infection even as the outbreak peaks, she said.
Meanwhile, health care jobs, including personal care aides and practitioners, are among the top 10 jobs with a high concentration of African Americans, she told USA Today.
The ICNARC report came from data reported into the Case Mix Programme. This programme represents all NHS adult, general intensive care and combined intensive care, high dependency units in England, Wales and Northern Ireland, as well as some specialist and non-NHS critical care units.
At the time of the last census in 2011, 13 per cent of the UK population, equivalent to around 8.1 million people, identified themselves as black, Asian or minority ethnic.
Meanwhile official NHS data suggests two-thirds of coronavirus patients in the UK who need to be hooked up to a ventilator will die from the illness.
A separate report by the Intensive Care National Audit and Research Center (ICNARC) found ventilated patients succumb to the virus 66.3 per cent of the time.
That is double the mortality rate of non-virus patients who were put on breathing support between 2017 and 2019, before the outbreak.
The NHS is still 22,000 ventilators short of the estimated 30,000 it will need during the peak of this crisis, which has infected almost 34,000 Britons.
The high death rate has led some doctors to question whether some critically ill COVID-19 patients are being put on ventilation 'for the sake of it', when the machine could be spared for a healthy person with a higher chance of survival.
Re: Wuhan Coronavirus Resource Thread
HCQ is only being given to those who are part of trial (WHO has floated SOLIDARITY trial involving 4 different group of drugs)amar_p wrote:"Once on ventilator mortality is 50% + !"
That's also what I heard from some people who have gone thru it and survived.
This brings into question the usage protocol of CHQ + Azm. Assuming it is effective, the current ICMR guideline is to give it to patients in an advanced/critical stage. But by then, the survival chances are dimming and if the patient dies, we get a +1 to the statistic "died despite being on CHQ protocol". And might lead us to conclude the drug is not effective.
Wouldn't treating with CHQ + Azm as needed ***as soon as infection is confirmed***, increase the chances of patient survival and improve the efficacy stats for the drug in a fair manner?
Unlike US & India who have approved it.
HCQ so far has inconsistent effect. When it works it cures quickly, but in many it doesn't work.
Certainly it should be started early, started late has minimal effect.
Re: Wuhan Coronavirus Resource Thread
Increase in temperature can only possibly impact the viability of the virus on surfaces and in the environment, not in infected hosts. So it might mean that the increased temperatures and UV radiation in the summer makes the virus on a contaminated surface viable for less time, but is not going to stop direct person to person transmission, especially with the kind of filthy unhygienic habits practiced by for example the Tableeghis.Pratyush wrote:Guys,
Early on people speculated that increase in temperature may reduce the potency of the virus.
Has this been validated by research till now??
As have not seen any thing on it.
Re: Wuhan Coronavirus Resource Thread
Indeed.IndraD wrote:Virus is highly potent and even fit & well in 40s, who exercise daily are barely making out of it! In second week Covid19 has tendency to worsen (Boris Jhonson), will repeat again, there is real good chance of going down slippery slope in 2nd week !
Yesterday, a marathi News channel(forgot the name) reported one such case from Ahmed Nagar in Maharashtra. They said, the patient had come back from the US and was in quarantine at home despite being asymptomatic. AIso, he had tested negative for COVID- 19. Still, looking perfectly normal on the 15th day he suddenly collapsed and died. Later, he was found to be positive for the same.
This makes it a really scary prospect.
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DrRatnadip
- BRFite
- Posts: 604
- Joined: 31 Dec 2016 00:40
Re: Wuhan Coronavirus Resource Thread
In India HCQ is given in all positive patients.. Prognosis is very bad in pts needing ventilator.. But Number of patients actually needing ventilator support seems less in India.. Even pts showing moderate symptoms are less.. This info I got from informal talk with someone actualy managing COVID hospital.. I dont have any proofs to back his claims..What role HCQ is playing in this needs to be determined.. But early treatment by HCQ is beneficial than starting it late in course of disease.. I think anti inflammatory and immunomodulatory properties of chloroquine also play a big part in its efficacy..IndraD wrote:HCQ is only being given to those who are part of trial (WHO has floated SOLIDARITY trial involving 4 different group of drugs)amar_p wrote:"Once on ventilator mortality is 50% + !"
That's also what I heard from some people who have gone thru it and survived.
This brings into question the usage protocol of CHQ + Azm. Assuming it is effective, the current ICMR guideline is to give it to patients in an advanced/critical stage. But by then, the survival chances are dimming and if the patient dies, we get a +1 to the statistic "died despite being on CHQ protocol". And might lead us to conclude the drug is not effective.
Wouldn't treating with CHQ + Azm as needed ***as soon as infection is confirmed***, increase the chances of patient survival and improve the efficacy stats for the drug in a fair manner?
Unlike US & India who have approved it.
HCQ so far has inconsistent effect. When it works it cures quickly, but in many it doesn't work.
Certainly it should be started early, started late has minimal effect.
Re: Wuhan Coronavirus Resource Thread
A huge thanks to you DrR, Primus and other doctors & medical service people on this forum, and doctors/medical staff in general to keep us safe, healthy and informed. Your one post is worth more than an entire page of posts and stats from the rest of us, even if your post is only anecdotal - because it comes from the trenches and comes without an agenda. Let's hope that between our hot climate, BCG vaccinations, spice consumption, HCQ/Azithromycin, age profile, lockdowns and God's will, we are spared the worst of this disease (yes I know most of these connections are unproven), and we learn to improve our personal hygiene & respect personal space after this over.DrRatnadip wrote:In India HCQ is given in all positive patients.. Prognosis is very bad in pts needing ventilator.. But Number of patients actually needing ventilator support seems less in India.. Even pts showing moderate symptoms are less.. This info I got from informal talk with someone actualy managing COVID hospital.. I dont have any proofs to back his claims..What role HCQ is playing in this needs to be determined.. But early treatment by HCQ is beneficial than starting it late in course of disease.. I think anti inflammatory and immunomodulatory properties of chloroquine also play a big part in its efficacy..
Re: Wuhan Coronavirus Resource Thread
The figures in the Article are incorrect and confusing. I think presently we have capacity to produce 5-10 metric tons per month API for Hydroxychloroquine & similar amount for Chloroquine, which is around 25+25=50 million tablets per month. Enough for 1 million patients.
It can be ramped up by 10x times in next few months. I.e. around 50 MT per month of each drug = 500 million tablets per month enough for 10 million patients.
Luckily we are not in Malaria season and there was lot of idle capacity. Indian curtent stocks can be upto 30-50 metric tons, at various levels enough for 1 million patients in India.
It can be ramped up by 10x times in next few months. I.e. around 50 MT per month of each drug = 500 million tablets per month enough for 10 million patients.
Luckily we are not in Malaria season and there was lot of idle capacity. Indian curtent stocks can be upto 30-50 metric tons, at various levels enough for 1 million patients in India.
Re: Wuhan Coronavirus Resource Thread
https://www.walesonline.co.uk/news/wale ... s-18048123
more than half Covid19 patients at certain ITU units are less than 30 years old
more than half Covid19 patients at certain ITU units are less than 30 years old
Re: Wuhan Coronavirus Resource Thread
I'm a follower of this YT channel from its very early days. This guy makes good videos & in fact he himself is a biomedical engineer & in past worked for "Medtronic" . This current video covers most of the points discussed here in BRF
A must watch video
A Guide To Designing Low-Cost Ventilators for COVID-19
https://www.youtube.com/watch?v=7vLPefHYWpY
A must watch video
A Guide To Designing Low-Cost Ventilators for COVID-19
https://www.youtube.com/watch?v=7vLPefHYWpY
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DrRatnadip
- BRFite
- Posts: 604
- Joined: 31 Dec 2016 00:40
Re: Wuhan Coronavirus Resource Thread
Thank you for kind words sir..yensoy wrote:A huge thanks to you DrR, Primus and other doctors & medical service people on this forum, and doctors/medical staff in general to keep us safe, healthy and informed. Your one post is worth more than an entire page of posts and stats from the rest of us, even if your post is only anecdotal - because it comes from the trenches and comes without an agenda. Let's hope that between our hot climate, BCG vaccinations, spice consumption, HCQ/Azithromycin, age profile, lockdowns and God's will, we are spared the worst of this disease (yes I know most of these connections are unproven), and we learn to improve our personal hygiene & respect personal space after this over.DrRatnadip wrote:In India HCQ is given in all positive patients.. Prognosis is very bad in pts needing ventilator.. But Number of patients actually needing ventilator support seems less in India.. Even pts showing moderate symptoms are less.. This info I got from informal talk with someone actualy managing COVID hospital.. I dont have any proofs to back his claims..What role HCQ is playing in this needs to be determined.. But early treatment by HCQ is beneficial than starting it late in course of disease.. I think anti inflammatory and immunomodulatory properties of chloroquine also play a big part in its efficacy..
Re: Wuhan Coronavirus Resource Thread
Cheen better not be hit with a second wave if we need to ramp up pharma. This is the same for a lot of critical medical supplies needed to fight this infection right now.schinnas wrote:Imports of 150 Million tonnes of APIs that India had ordered from China earlier have either reached India or expected to reach in next few days. So India pharma industry is back on its feet. Don't worry about exports. We will have ample to export to friends and those with deep pockets.
And it will be the same when the economy comes back online. We are hearing that a lot of firms who never used China before are now inquiring because their own suppliers are devastated.
Hate to say it but having Cheen up and running is absolutely critical in fighting this disease and then leading the global economy back. We can't even wish bad karma on the SOBs for causing this chit without affecting ourselves.
Re: Wuhan Coronavirus Resource Thread
https://twitter.com/sidhant/status/1247388612615798787
https://twitter.com/ParulChandraP/statu ... 5752318976
Export while not banned will need export license henceforth .. effectively GOI permission for all exports. This AFTER the current contracted obligations are discharged .. US and Brazil orders put in just prior to the ban.Sidhant Sibal @sidhant
Just in: India says Hydroxychloroquine (HCQ) will be kept in a licensed category & the stock position "could allow our companies to meet the export commitments that they had contracted."
Different source .. Same gist.Just in: India says it will allow hydrochorocquine in "appropriate quantities" to all its neighbouring countries & will also be supplying these "essential drugs to some nations" who have been particularly badly affected by the #covid pandemic.
https://twitter.com/ParulChandraP/statu ... 5752318976
Parul Chandra @ParulChandraP
#Breaking: India says hydroxychloroquine (HCQ), and paracetamol will be kept in a licensed category and their demand position would be continuously monitored. However, also says the stock position could allow our companies to meet the export commitments that they had contracted.
Parul Chandra @ParulChandraP
@MEAIndia: “Like any responsible government, our first obligation is to ensure that there are adequate stocks of medicines for the requirement of our own people. In order to ensure this, some temporary steps were taken to restrict exports of a number of pharmaceutical products.”
So US to get its supply of hydrochloriquine with @MEAIndia indicating, “We will also be supplying these essential drugs to some nations who have been particularly badly affected by the pandemic.”
I guess we have already started supplying our neighbours that depend on Indian capacity for these essential items.India’s neighbourhood too to benefit. @MEAIndia
: “In view of the humanitarian aspects of the pandemic, it has been decided that India would licence paracetamol and HCQ in appropriate quantities to all our neighbouring countries who are dependent on our capabilities.”
Re: Wuhan Coronavirus Resource Thread
Mollick.R wrote:Quick pointsCentre partially lifts ban on export of hydroxychloroquine and paracetamol
1. Hope we are not messing things up, still very difficult and early to say in which way desh is leading (& thus domestic requirement too). [b]If in future things hit the roof and there is just one news from xyz block hospital about shortage of HCL, media, BIF will eat GOI alive. Wish and hope some babu at North block is not setting out or falling on some trap...........
[/b]
2. Just one silver bullet in the hour of need and this gives us so much strategic hard and soft power. Hope India reminds all the countries (minus Israel courtesy Kargil) that we are "HELPING" them now & they do owe us something.India is the world’s largest producer and exporter of hydroxychloroquine.......
On Monday, the latest to call was from Scott Morrison, Australian PM, who also urged Modi to open up pharma exports. In the past few days, Modi has fielded calls from Brazil, Israel, Bahrain, Spain, France, Germany and UK among others, all urging him to open up pharma, particularly hydroxychloroquine, exports.
The highlighted part (mocking by chamchas & BIF gang) has already started. Currently on Twitter #Retaliation is trending in top
Re: Wuhan Coronavirus Resource Thread
^^
While it is painful to hear people mocking their own country (in the name of mocking Modi), one must remember that Modi has trumped over thousands of mocking sessions before.
The correct thread for such India specific political discussion in the other active thread ...
While it is painful to hear people mocking their own country (in the name of mocking Modi), one must remember that Modi has trumped over thousands of mocking sessions before.
The correct thread for such India specific political discussion in the other active thread ...
Re: Wuhan Coronavirus Resource Thread
https://abc7.com/coronavirus-drug-covid ... e/6079864/
HCQ working well only when given with Zinc: LA doctor
HCQ working well only when given with Zinc: LA doctor
Re: Wuhan Coronavirus Resource Thread
Mumbai cases now reached 642. that's huge.Sachin Kalbag
@SachinKalbag
BREAKING: Maharashtra crosses 1000 positive Covid-19 cases. 150 new cases reported today, taking the total to 1018. Mumbai reports 116 new cases, taking city's total to 642.
Re: Wuhan Coronavirus Resource Thread
My colleagues in NY are increasingly thinking that this is some sort of pulmonary vascular issues, maybe some sort of pulmonary vasculitis. The protocol at the hospital I used to work there, which is the flagship hospital of a major healthcare system in NYC, is now checking a D-Dimer on every COVID patient and anticoagulating accordingly.IndraD wrote:Intensivists are gobsmacked on how to tackle this disease ...this is not behaving like typical ARDS! There is widespread pulmonary microthrombus disadvantaging any lungs recruitment. Higher PEEP is counter productive. Some liberal fluids is OK. Prostacyclin , Nitric Oxide is back so is systemic anticoagulation! Don;t push patient on CPAP , early intubation is must! Those intubated needing proning within 24 hours.
Once on ventilator mortality is 50% + !
As for HCQ, it's actually used typically earlier on in the disease course and not as a last-resort medication in both NYC and the Bay Area. Physicians are also very well aware of the difficulty in getting useful data from high mortality patient population, so even if it's used as a last resort medication the results will be interpreted correctly IMO.
Re: Wuhan Coronavirus Resource Thread
Primus/Davidd/Indrad - there seems to be some positive traction on plasma from cured patients and seems like a few US hospitals are trying it, any additional inputs on this ?
Re: Wuhan Coronavirus Resource Thread
Covid-19 had us all fooled, but now we might have finally found its secret.
In the last 3–5 days, a mountain of anecdotal evidence has come out of NYC, Italy, Spain, etc. about COVID-19 and characteristics of patients who get seriously ill. It’s not only piling up but now leading to a general field-level consensus backed up by a few previously little-known studies that we’ve had it all wrong the whole time. Well, a few had some things eerily correct (cough Trump cough), especially with Hydroxychloroquine with Azithromicin, but we’ll get to that in a minute.
There is no ‘pneumonia’ nor ARDS. At least not the ARDS with established treatment protocols and procedures we’re familiar with. Ventilators are not only the wrong solution, but high pressure intubation can actually wind up causing more damage than without, not to mention complications from tracheal scarring and ulcers given the duration of intubation often required… They may still have a use in the immediate future for patients too far to bring back with this newfound knowledge, but moving forward a new treatment protocol needs to be established so we stop treating patients for the wrong disease.
The past 48 hours or so have seen a huge revelation: COVID-19 causes prolonged and progressive hypoxia (starving your body of oxygen) by binding to the heme groups in hemoglobin in your red blood cells. People are simply desaturating (losing o2 in their blood), and that’s what eventually leads to organ failures that kill them, not any form of ARDS or pneumonia. All the damage to the lungs you see in CT scans are from the release of oxidative iron from the hemes, this overwhelms the natural defenses against pulmonary oxidative stress and causes that nice, always-bilateral ground glass opacity in the lungs. Patients returning for re-hospitalization days or weeks after recovery suffering from apparent delayed post-hypoxic leukoencephalopathy strengthen the notion COVID-19 patients are suffering from hypoxia despite no signs of respiratory ‘tire out’ or fatigue.
Here’s the breakdown of the whole process, including some ELI5-level cliff notes. Much has been simplified just to keep it digestible and layman-friendly.
Your red blood cells carry oxygen from your lungs to all your organs and the rest of your body. Red blood cells can do this thanks to hemoglobin, which is a protein consisting of four “hemes”. Hemes have a special kind of iron ion, which is normally quite toxic in its free form, locked away in its center with a porphyrin acting as it’s ‘container’. In this way, the iron ion can be ‘caged’ and carried around safely by the hemoglobin, but used to bind to oxygen when it gets to your lungs.
When the red blood cell gets to the alveoli, or the little sacs in your lungs where all the gas exchange happens, that special little iron ion can flip between FE2+ and FE3+ states with electron exchange and bond to some oxygen, then it goes off on its little merry way to deliver o2 elsewhere.
Here’s where COVID-19 comes in. Its glycoproteins bond to the heme, and in doing so that special and toxic oxidative iron ion is “disassociated” (released). It’s basically let out of the cage and now freely roaming around on its own. This is bad for two reasons:
1) Without the iron ion, hemoglobin can no longer bind to oxygen. Once all the hemoglobin is impaired, the red blood cell is essentially turned into a Freightliner truck cab with no trailer and no ability to store its cargo.. it is useless and just running around with COVID-19 virus attached to its porphyrin. All these useless trucks running around not delivering oxygen is what starts to lead to desaturation, or watching the patient’s spo2 levels drop. It is INCORRECT to assume traditional ARDS and in doing so, you’re treating the WRONG DISEASE. Think of it a lot like carbon monoxide poisoning, in which CO is bound to the hemoglobin, making it unable to carry oxygen. In those cases, ventilators aren’t treating the root cause; the patient’s lungs aren’t ‘tiring out’, they’re pumping just fine. The red blood cells just can’t carry o2, end of story. Only in this case, unlike CO poisoning in which eventually the CO can break off, the affected hemoglobin is permanently stripped of its ability to carry o2 because it has lost its iron ion. The body compensates for this lack of o2 carrying capacity and deliveries by having your kidneys release hormones like erythropoietin, which tell your bone marrow factories to ramp up production on new red blood cells with freshly made and fully functioning hemoglobin. This is the reason you find elevated hemoglobin and decreased blood oxygen saturation as one of the 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.
2) That little iron ion, along with millions of its friends released from other hemes, are now floating through your blood freely. As I mentioned before, this type of iron ion is highly reactive and causes oxidative damage. It turns out that this happens to a limited extent naturally in our bodies and we have cleanup & defense mechanisms to keep the balance. The lungs, in particular, have 3 primary defenses to maintain “iron homeostasis”, 2 of which are in the alveoli, those little sacs in your lungs we talked about earlier. The first of the two are little macrophages that roam around and scavenge up any free radicals like this oxidative iron. The second is a lining on the walls (called the epithelial surface) which has a thin layer of fluid packed with high levels of antioxidant molecules.. things like abscorbic acid (AKA Vitamin C) among others. Well, this is usually good enough for naturally occurring rogue iron ions but with COVID-19 running rampant your body is now basically like a progressive state letting out all the prisoners out of the prisons… it’s just too much iron and it begins to overwhelm your lungs’ countermeasures, and thus begins the process of pulmonary oxidative stress. This leads to damage and inflammation, which leads to all that nasty stuff and damage you see in CT scans of COVID-19 patient lungs. Ever noticed how it’s always bilateral? (both lungs at the same time) Pneumonia rarely ever does that, but COVID-19 does… EVERY. SINGLE. TIME.
— — — — — — — — — — — — -
Once your body is now running out of control, with all your oxygen trucks running around without any freight, and tons of this toxic form of iron floating around in your bloodstream, other defenses kick in. While your lungs are busy with all this oxidative stress they can’t handle, and your organs are being starved of o2 without their constant stream of deliveries from red blood cell’s hemoglobin, and your liver is attempting to do its best to remove the iron and store it in its ‘iron vault’. Only its getting overwhelmed too. It’s starved for oxygen and fighting a losing battle from all your hemoglobin letting its iron free, and starts crying out “help, I’m taking damage!” by releasing an enzyme called alanine aminotransferase (ALT). BOOM, there is your second of 3 primary indicators of whether the shit is about to hit the fan for a particular patient or not.
Eventually, if the patient’s immune system doesn’t fight off the virus in time before their blood oxygen saturation drops too low, ventilator or no ventilator, organs start shutting down. No fuel, no work. The only way to even try to keep them going is max oxygen, even a hyperbaric chamber if one is available on 100% oxygen at multiple atmospheres of pressure, just to give what’s left of their functioning hemoglobin a chance to carry enough o2 to the organs and keep them alive. Yeah we don’t have nearly enough of those chambers, so some fresh red blood cells with normal hemoglobin in the form of a transfusion will have to do.
The core point being, treating patients with the iron ions stripped from their hemoglobin (rendering it abnormally nonfunctional) with ventilator intubation is futile, unless you’re just hoping the patient’s immune system will work its magic in time. The root of the illness needs to be addressed.
Best case scenario? Treatment regimen early, before symptoms progress too far. Hydroxychloroquine (more on that in a minute, I promise) with Azithromicin has shown fantastic, albeit critics keep mentioning ‘anecdotal’ to describe the mountain, promise and I’ll explain why it does so well next. But forget straight-up plasma with antibodies, that might work early but if the patient is too far gone they’ll need more. They’ll need all the blood: antibodies and red blood cells. No help in sending over a detachment of ammunition to a soldier already unconscious and bleeding out on the battlefield, you need to send that ammo along with some hemoglobin-stimulant-magic so that he can wake up and fire those shots at the enemy.
The story with Hydroxychloroquine
All that hilariously misguided and counterproductive criticism the media piled on chloroquine (purely for political reasons) as a viable treatment will now go down as the biggest Fake News blunder to rule them all. The media actively engaged their activism to fight ‘bad orange man’ at the cost of thousands of lives. Shame on them.
How does chloroquine work? Same way as it does for malaria. You see, malaria is this little parasite that enters the red blood cells and starts eating hemoglobin as its food source. The reason chloroquine works for malaria is the same reason it works for COVID-19 — while not fully understood, it is suspected to bind to DNA and interfere with the ability to work magic on hemoglobin. The same mechanism that stops malaria from getting its hands on hemoglobin and gobbling it up seems to do the same to COVID-19 (essentially little snippets of DNA in an envelope) from binding to it. On top of that, Hydroxychloroquine (an advanced descendant of regular old chloroquine) lowers the pH which can interfere with the replication of the virus. Again, while the full details are not known, the entire premise of this potentially ‘game changing’ treatment is to prevent hemoglobin from being interfered with, whether due to malaria or COVID-19.
No longer can the media and armchair pseudo-physicians sit in their little ivory towers, proclaiming “DUR so stoopid, malaria is bacteria, COVID-19 is virus, anti-bacteria drug no work on virus!”. They never got the memo that a drug doesn’t need to directly act on the pathogen to be effective. Sometimes it’s enough just to stop it from doing what it does to hemoglobin, regardless of the means it uses to do so.
Anyway, enough of the rant. What’s the end result here? First, the ventilator emergency needs to be re-examined. If you’re putting a patient on a ventilator because they’re going into a coma and need mechanical breathing to stay alive, okay we get it. Give ’em time for their immune systems to pull through. But if they’re conscious, alert, compliant — keep them on O2. Max it if you have to. If you HAVE to inevitably ventilate, do it at low pressure but max O2. Don’t tear up their lungs with max PEEP, you’re doing more harm to the patient because you’re treating the wrong disease.
Ideally, some form of treatment needs to happen to:[*]Inhibit viral growth and replication. Here plays CHQ+ZPAK+ZINC or other retroviral therapies being studies. Less virus, less hemoglobin losing its iron, less severity and damage.[*]Therapies used for anyone with abnormal hemoglobin or malfunctioning red blood cells. Blood transfusions. Whatever, I don’t know the full breadth and scope because I’m not a physician. But think along those lines, and treat the real disease. If you’re thinking about giving them plasma with antibodies, maybe if they’re already in bad shape think again and give them BLOOD with antibodies, or at least blood followed by plasma with antibodies.[*]Now that we know more about how this virus works and affects our bodies, a whole range of options should open up.[*]Don’t trust China. China is ASSHOE. (disclaimer: not talking about the people, just talking about the regime). They covered this up and have caused all kinds of death and carnage, both literal and economic. The ripples of this pandemic will be felt for decades.
Fini.
Re: Wuhan Coronavirus Resource Thread
I find it unbelievable that countries and hospitals cannot run a mass HC or (any other drug which has shown promise) trails across the world and gather data.
There are now more than million positive cases and thousands in hospital. But what drug to use has become a political football.
Lives of people are been held at a doctor's belief system, rather than solid guidance. Some doctors believe it works for them and they keep giving them. If they find it useful, please let the world know the dosage and at what stage to administer the drug.
For those who think, it didn't work for them, please let the world know what was the dosage and the routine.
We need data. Not beliefs.
There are now more than million positive cases and thousands in hospital. But what drug to use has become a political football.
Lives of people are been held at a doctor's belief system, rather than solid guidance. Some doctors believe it works for them and they keep giving them. If they find it useful, please let the world know the dosage and at what stage to administer the drug.
For those who think, it didn't work for them, please let the world know what was the dosage and the routine.
We need data. Not beliefs.
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DrRatnadip
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Re: Wuhan Coronavirus Resource Thread
People came with very interesting theories regarding COVID 19 in last few days..
What they want to say is
1) Its not ARDS
2) It is some sort of pulmonary vasculitis leading to unusual microthrombi in pulmonary vasculature
3) problem is not with gas exchange at respiratory membrane i.e alveoli, but problem is with oxygen carrying capacity of hemoglobin
4) Disease is somewhat similar to high altitude sickness or carbon monoxide poisoning
5) ventilators are causing harm to pts as we are not treating root cause of disease..
But I want to make certain points..
1) Does COVID 19 related respiratory illness fullfills criteria for ARDS?
It does..
The AECC defined ARDS as an acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema.
2) Do patients have clinical features of ARDS?
Yes .. They do.. Patients present with tachypnea, tachycardia, cynosis.. High FiO2 is needed to mantain oxygen saturation..
Many patients show cardiovascular collapse and shock.. These are features of ARDS due to other causes too..
3) Does ARDS due to COVID 19 has unusually high mortality?
ARDS due to any cause is associated with very high mortality.. Mortality increases with age.. Most studies show mortality of more than 60 % in elderly population irrespective of cause of ARDS.. It is well known by now that COVID associated ARDS develops mostly in elderly population so high mortality in ARDS is nothing unexpected..
4) Covid is causing thrombosis in microvasculature of lungs.. Is it unusual?
Thrombosis is vessels is usualy due to combination of factor known as virchow's triad.. It includes stasis of flow, endothelial injury and hypercoagubility.. all three factors are common in all ARDS.. Histologic studies from the 1970s and '80s revealed diffuse pulmonary endothelial injury in early ARDS associated with macro- and microthrombi consisting of fibrin and red and white cell clots that were thought to be either embolic or formed in situ or both.. IT IS NOTHING UNIQUE to COVID19.
5) Covid viral proteins are binding to hemoglobin not allowing oxygen to be transported..Is it possible?
Maybe.. But why it is hampering oxygen carrying capacity in selected population (elderly, smoker, with asthema COPD etc) only..
Any disease affecting at such basic phenomenon of life will kill with much more impunity..
6) Are ventilators causing more harm than good..?
Complications due to ventilators are well known.. But Ventilators are usually last resort to save patients who are detoriating fast.. There is no other way to save such patients.. current guidelines have strict indications of using ventilators and there is no doubt ventilators are saving lives..
Novel thoughts and hypothesis are always welcome but they need to be backed by sufficient clinical/experimental evidence..
What they want to say is
1) Its not ARDS
2) It is some sort of pulmonary vasculitis leading to unusual microthrombi in pulmonary vasculature
3) problem is not with gas exchange at respiratory membrane i.e alveoli, but problem is with oxygen carrying capacity of hemoglobin
4) Disease is somewhat similar to high altitude sickness or carbon monoxide poisoning
5) ventilators are causing harm to pts as we are not treating root cause of disease..
But I want to make certain points..
1) Does COVID 19 related respiratory illness fullfills criteria for ARDS?
It does..
The AECC defined ARDS as an acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema.
2) Do patients have clinical features of ARDS?
Yes .. They do.. Patients present with tachypnea, tachycardia, cynosis.. High FiO2 is needed to mantain oxygen saturation..
Many patients show cardiovascular collapse and shock.. These are features of ARDS due to other causes too..
3) Does ARDS due to COVID 19 has unusually high mortality?
ARDS due to any cause is associated with very high mortality.. Mortality increases with age.. Most studies show mortality of more than 60 % in elderly population irrespective of cause of ARDS.. It is well known by now that COVID associated ARDS develops mostly in elderly population so high mortality in ARDS is nothing unexpected..
4) Covid is causing thrombosis in microvasculature of lungs.. Is it unusual?
Thrombosis is vessels is usualy due to combination of factor known as virchow's triad.. It includes stasis of flow, endothelial injury and hypercoagubility.. all three factors are common in all ARDS.. Histologic studies from the 1970s and '80s revealed diffuse pulmonary endothelial injury in early ARDS associated with macro- and microthrombi consisting of fibrin and red and white cell clots that were thought to be either embolic or formed in situ or both.. IT IS NOTHING UNIQUE to COVID19.
5) Covid viral proteins are binding to hemoglobin not allowing oxygen to be transported..Is it possible?
Maybe.. But why it is hampering oxygen carrying capacity in selected population (elderly, smoker, with asthema COPD etc) only..
Any disease affecting at such basic phenomenon of life will kill with much more impunity..
6) Are ventilators causing more harm than good..?
Complications due to ventilators are well known.. But Ventilators are usually last resort to save patients who are detoriating fast.. There is no other way to save such patients.. current guidelines have strict indications of using ventilators and there is no doubt ventilators are saving lives..
Novel thoughts and hypothesis are always welcome but they need to be backed by sufficient clinical/experimental evidence..
Re: Wuhan Coronavirus Resource Thread
Reading the article above on Covid's impact on haemoglobin, and resulting low O2 saturation, it seems blood transfusions may help replenish O2 carrying capacity and buy time until other treatments work.
Havent heard of blood transfusions being tried anywhere so far.
Havent heard of blood transfusions being tried anywhere so far.
Re: Wuhan Coronavirus Resource Thread
If it's related to haemoglobin and iron, then why are men more susceptible? I thought women were more likely to be iron deficient. Or is it because men are more likely to have those toxic free radical iron ions?
Also, I wish these guys wouldn't present their thoughts in such a glib and gleeful tone. Puts up the backs of the doctors, who are then more likely to pick on their lack of credentials (especially with the guy's disclaimer that "I am not an MD"). A more sober presentation would be better received.
Doc Ratnadip, what's the difference between intubation and ventilating?
EDIT: Thanks for the response.
Also, I wish these guys wouldn't present their thoughts in such a glib and gleeful tone. Puts up the backs of the doctors, who are then more likely to pick on their lack of credentials (especially with the guy's disclaimer that "I am not an MD"). A more sober presentation would be better received.
Doc Ratnadip, what's the difference between intubation and ventilating?
EDIT: Thanks for the response.
Last edited by sudarshan on 08 Apr 2020 01:55, edited 1 time in total.
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DrRatnadip
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Re: Wuhan Coronavirus Resource Thread
intubation is putting a tube in patients airway through nose or mouth so that air can be pumped in his lungs..sudarshan wrote:If it's related to haemoglobin and iron, then why are men more susceptible? I thought women were more likely to be iron deficient. Or is it because men are more likely to have those toxic free radical iron ions?
Also, I wish these guys wouldn't present their thoughts in such a glib and gleeful tone. Puts up the backs of the doctors, who are then more likely to pick on their lack of credentials (especially with the guy's disclaimer that "I am not an MD"). A more sober presentation would be better received.
Doc Ratnadip, what's the difference between intubation and ventilating?
ventilation is actually pushing air in lungs.. It can be either invasive in intubated patients or non invasive ( using a special mask which tightly fits around nose and mouth)..
Re: Wuhan Coronavirus Resource Thread
First hand information about the same from Cardiff, which is major city in Wales.IndraD wrote:https://www.walesonline.co.uk/news/wale ... s-18048123
more than half Covid19 patients at certain ITU units are less than 30 years old
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sanjaykumar
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Re: Wuhan Coronavirus Resource Thread
https://web.archive.org/web/20200405061 ... 182386efcb
Sigh. Most hospital labs can assay hematocrit, haptoglobin, urinary bilinogen and do a peripheral blood smear. Are the numbers even consistent with hemolysis?
Sigh. Most hospital labs can assay hematocrit, haptoglobin, urinary bilinogen and do a peripheral blood smear. Are the numbers even consistent with hemolysis?
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sanjaykumar
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Re: Wuhan Coronavirus Resource Thread
https://www.theguardian.com/environment ... tudy-finds
Some support for my post on possible air pollution risks for Chinese virus infection/outcomes.
Some support for my post on possible air pollution risks for Chinese virus infection/outcomes.
Re: Wuhan Coronavirus Resource Thread
Well put, Doc. As I said in a previous post on deaths from COVID vs automobile accidents/seasonal flu etc, it does not matter how one dies, a death is a death, and there sure are a whole lot of people dying from this disease and a whole lot of others who are very sick. In our hospital alone many doctors are struggling with it at home, a few are hospitalized, our Chief of ID is sick, the wards are full etc etc.DrRatnadip wrote:People came with very interesting theories regarding COVID 19 in last few days..
What they want to say is
1) Its not ARDS
2) It is some sort of pulmonary vasculitis leading to unusual microthrombi in pulmonary vasculature
3) problem is not with gas exchange at respiratory membrane i.e alveoli, but problem is with oxygen carrying capacity of hemoglobin
4) Disease is somewhat similar to high altitude sickness or carbon monoxide poisoning
5) ventilators are causing harm to pts as we are not treating root cause of disease..
But I want to make certain points..
1) Does COVID 19 related respiratory illness fullfills criteria for ARDS?
It does..
The AECC defined ARDS as an acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia in the absence of evidence for cardiogenic pulmonary edema.
2) Do patients have clinical features of ARDS?
Yes .. They do.. Patients present with tachypnea, tachycardia, cynosis.. High FiO2 is needed to mantain oxygen saturation..
Many patients show cardiovascular collapse and shock.. These are features of ARDS due to other causes too..
3) Does ARDS due to COVID 19 has unusually high mortality?
ARDS due to any cause is associated with very high mortality.. Mortality increases with age.. Most studies show mortality of more than 60 % in elderly population irrespective of cause of ARDS.. It is well known by now that COVID associated ARDS develops mostly in elderly population so high mortality in ARDS is nothing unexpected..
4) Covid is causing thrombosis in microvasculature of lungs.. Is it unusual?
Thrombosis is vessels is usualy due to combination of factor known as virchow's triad.. It includes stasis of flow, endothelial injury and hypercoagubility.. all three factors are common in all ARDS.. Histologic studies from the 1970s and '80s revealed diffuse pulmonary endothelial injury in early ARDS associated with macro- and microthrombi consisting of fibrin and red and white cell clots that were thought to be either embolic or formed in situ or both.. IT IS NOTHING UNIQUE to COVID19.
5) Covid viral proteins are binding to hemoglobin not allowing oxygen to be transported..Is it possible?
Maybe.. But why it is hampering oxygen carrying capacity in selected population (elderly, smoker, with asthema COPD etc) only..
Any disease affecting at such basic phenomenon of life will kill with much more impunity..
6) Are ventilators causing more harm than good..?
Complications due to ventilators are well known.. But Ventilators are usually last resort to save patients who are detoriating fast.. There is no other way to save such patients.. current guidelines have strict indications of using ventilators and there is no doubt ventilators are saving lives..
Novel thoughts and hypothesis are always welcome but they need to be backed by sufficient clinical/experimental evidence..
Talking to our Intensivists (disclaimer, I am not one), they insist the clinical picture is that of ARDS. It is a bit like SIRS is not always caused by an infection although that may be a common cause. You treat it on general principles and etiological factors if known. I spoke with them about this new theory of microthrombi, hemoglobin poisoning etc, they said it is unlikely.
Currently the standard of care has become hydroxychloriquine plus azithro plus zinc, all the docs who have sx are taking it, giving it to their families too. One doc I spoke with says this combo definitely helped him. Anti-retrovirals are not working. He also said the problem (he is now almost two weeks into the illness and still has some fevers) of anorexia and malaise has been helped by good old Chyawanprash (mentioned here earlier too). Says his entire family is taking it and it is good for them. Obviously nobody knows if this is placebo or not but it does not hurt to try it.
There is also a strange smell associated with the illness, like an earthy, moldy and unpleasant odor, which is causing nausea and anorexia. One ID guy thinks it is unique to this virus - I don't know what Dr. Ratnadip's opinion is. My friend claims it is so. I have no experience of course.
Doc IndraD, this is a bad illness for sure and it is sad to see young lives being affected in the manner they are. I hope there is a lesson for all of us here.
Re: Wuhan Coronavirus Resource Thread
At the current rate US will overtake Spain for the 2nd highest fatalities in the next 48 hrs and Italy by end of this week. France it looks like refuses to peak and is increasingly at an alarming rate.
Re: Wuhan Coronavirus Resource Thread
Yeah US, France and the UK will take over from Italy and Spain as the dominant hotspots (though regions are better than nations) towards the end of this week and into next week. What we don't know is where the hotspots are going to be beyond that as towards the end of the month, things should be declining in these countries.
Re: Wuhan Coronavirus Resource Thread
English, please, for us non-docs?sanjaykumar wrote:https://web.archive.org/web/20200405061 ... 182386efcb
Sigh. Most hospital labs can assay hematocrit, haptoglobin, urinary bilinogen and do a peripheral blood smear. Are the numbers even consistent with hemolysis?
Re: Wuhan Coronavirus Resource Thread
Can someone who posts a theory with a name like “libertymavenstock” be taken seriously? One of those Trump fanatics pushing unproven as a miracle.
A lot of people who actually need the drug for their existing conditions like Malaria and Lupus are losing out because these pusedo-scientific logic are creating medicine shortages.
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sanjaykumar
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Re: Wuhan Coronavirus Resource Thread
^^i would not spend too much time on that confabulation. In short these putative viral glycoproteins that strip heme from the globin chains and Fe from heme should result in RBC disruption-this is readily determined by a microscopic exam of blood.
The Fe should result in changes to TIBC saturation indices. The heme moiety will result in urine heme degradation product called urobilinogen. Serum haptoglobin levels change as this protein binds free soluble hemoglobin. Of course with a hemolytic process one should observe anemia, more severe in sicker patients if this scenario is to be internally consistent, but again many mechanisms can cause anemia.
It seems to be a half baked undergraduate speculation. Readily available lab tests were not referenced. This is not a clinician writing. I would be embarrassed to call him a biochemist.
The Fe should result in changes to TIBC saturation indices. The heme moiety will result in urine heme degradation product called urobilinogen. Serum haptoglobin levels change as this protein binds free soluble hemoglobin. Of course with a hemolytic process one should observe anemia, more severe in sicker patients if this scenario is to be internally consistent, but again many mechanisms can cause anemia.
It seems to be a half baked undergraduate speculation. Readily available lab tests were not referenced. This is not a clinician writing. I would be embarrassed to call him a biochemist.
Re: Wuhan Coronavirus Resource Thread
Germany seems to be doing good compared to its neighbours. What's the trick there? Are they using homeopathy or something?
our current situation reminds me of older days where villagers put wet napkin on forehead and wait it out.
our current situation reminds me of older days where villagers put wet napkin on forehead and wait it out.