Author Topic: Covid-19: sickness, symptoms & relief  (Read 666 times)

Offline chocolateshake

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Re: Covid-19: sickness, symptoms & relief
« Reply #15 on: March 18, 2020, 05:31:16 PM »
There's a new study.  There's good news and there's bad news.  The good news is that 86% of people will have little or no symptoms from a covid infection.  The bad news is that 86% are the ones responsible for infecting 79% of the people that have symptoms.

Just because someone doesn't feel sick, doesn't mean they can't make someone else deadly sick.  This is why testing is critical.  Until then, people should act like they are infected and a spreader.

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Offline Jim Watari

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Re: Covid-19: sickness, symptoms & relief
« Reply #16 on: March 19, 2020, 01:43:56 PM »
Well the new death in LA county was only 34 and his underlining condition was having Bronchitis before, which is not very encouraging for me.
:(
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Re: Covid-19: sickness, symptoms & relief
« Reply #17 on: Today at 02:42:47 PM »

Offline perc2100

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Re: Covid-19: sickness, symptoms & relief
« Reply #17 on: March 19, 2020, 02:09:46 PM »
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There's a new study.  There's good news and there's bad news.  The good news is that 86% of people will have little or no symptoms from a covid infection.  The bad news is that 86% are the ones responsible for infecting 79% of the people that have symptoms.

Just because someone doesn't feel sick, doesn't mean they can't make someone else deadly sick.  This is why testing is critical.  Until then, people should act like they are infected and a spreader.

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Also a great example of why social distancing is crucial

Offline alyssa

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Re: Covid-19: sickness, symptoms & relief
« Reply #18 on: March 19, 2020, 02:23:55 PM »
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Well the new death in LA county was only 34 and his underlining condition was having Bronchitis before, which is not very encouraging for me.
:(
i had a little scare yesterday with a asthma/dry cough & throat tickle. Both of which are completely normal for me since i have asthma & a mild form of copd. ;)
It turned out to be a dehydration issues but it goes to psychosomatic mind games and the need to take care of oneself.

eta: if i get sick, You are not allowed to view links. Register or Login should be able to run everything. We have two people in each position exactly for this type of reason.
« Last Edit: March 19, 2020, 03:26:19 PM by alyssa »
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Offline chocolateshake

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Re: Covid-19: sickness, symptoms & relief
« Reply #19 on: March 19, 2020, 02:44:16 PM »
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Well the new death in LA county was only 34 and his underlining condition was having Bronchitis before, which is not very encouraging for me.
:(

Young people have been lulled into a false sense of security from the China data.  The Chinese experience is mild compared to what's happening in the rest of the world.  Italy for example has a mortality rate 3 times higher than China.  Right around 8%.  Iran is higher.  The same was seen during the Spanish Flu.  Some countries had high mortality, others low.  In this outbreak, I think Korea has been luckiest.  Their MR is only 0.6%.

Back to the lulling of the young.  While the Chinese data said it mostly effected the old, the European and American data is not bearing that out.  I think in the US 69% of people with serious illness are under 65.  20% are between 20-44.  Importantly, just because someone survives doesn't mean they recover unscathed.  The reporting is that due to scaring there can be loss of lung function.  Time will tell if that is permanent.

To the young, you can get covid.  Even if you recover, there can be lasting effects.  You don't want it.  Don't be cavalier about this outbreak.

Online Michael M

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Re: Covid-19: sickness, symptoms & relief
« Reply #20 on: March 19, 2020, 03:33:21 PM »
I was just listening to the radio (sports for me) and they had this clip of this idiot, down in Florida, on Spring Break, and how he's young, and invincible, and it'll blow over, and nothing's going to run his partying and drinking w/friends...what a total...well...!#$%^@
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Offline accelerate

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Re: Covid-19: sickness, symptoms & relief
« Reply #21 on: March 19, 2020, 07:00:28 PM »
Speaking of sports radio, they're really struggling to find topics to talk about now, outside of COVID-19 related stuff. There's only so much Tom Brady segments they can do.

Offline alyssa

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Re: Covid-19: sickness, symptoms & relief
« Reply #22 on: March 19, 2020, 09:28:12 PM »
i just read through the cdc site for what to do if you get sick. I live alone so I need to be prepared.

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Offline omraged9

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Re: Covid-19: sickness, symptoms & relief
« Reply #23 on: March 19, 2020, 11:18:08 PM »
I prepped myself by preemptively asking my PCP for a RX for hydroxychloroquine (Plaquenil) and also buying zinc supplements. There's some preliminary studies or older studies that show zinc can help lessen viral replication in common cold viruses,, and there might be a connection with HCQ and zinc. Right now, it's unclear why an anti-malarial/autoimmune drug like HCQ can treat a viral disease like this but this drug apparently is being used heavily in Italy and other European countries plus China and I think American hospitals are slowly starting to use it too. I'm glad American doctors are slowly trying this drug as treatment but my concern is that they might be prescribing it too late. It seems like once patients reach severe pneumonia/cytokine storm stage, these drugs might not be effective anymore.

I would also take Tylenol for the fevers but not any NSAIDs (Ibuprofen or aspirin) just in case.

Offline Jim Watari

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Re: Covid-19: sickness, symptoms & relief
« Reply #24 on: March 20, 2020, 12:44:07 PM »
More talk about fever and what ranges are dangerous

The more things change, the more they stay the same

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Offline omraged9

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Re: Covid-19: sickness, symptoms & relief
« Reply #25 on: March 20, 2020, 04:33:26 PM »
I've been following this doctor in Spain, Dr. Yale Tung Chen, on twitter. This is what he recommends as far as when to go to the hospital:

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Quote
#COVID19 + patients isolated at home. Screening symptoms during home isolation: fever >39ºC lasting >2 hours, chest tightness, shortness of breath, respiratory frequency ≥30 times/min, dyspnea or aggravated diarrhea/vomiting. Stop home quarantine & call Emergency.

He actually developed COVID-19 himself about 12 days ago and has been keeping a daily diary on his symptoms and scans of his lungs on his twitter account. He's been on paracetamol (Tylenol) for the first couple of days for the fever and then started hydroxychloroquine when the pneumonia started. Then very recently he added azithromycin (Z-pak), I think because a recent study has shown it might help too. It's technically an antibiotic but it's normally given to patients with pneumonia because it has some antiviral properties.

Offline ALF

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Re: Covid-19: sickness, symptoms & relief
« Reply #26 on: March 21, 2020, 08:04:17 AM »
Like a on flight announcement.. is there a doctor or any medical staff On this forum?

It would be nice to have someone in the medical field advising on this forum?  :P

Offline alyssa

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Re: Covid-19: sickness, symptoms & relief
« Reply #27 on: March 21, 2020, 09:06:17 AM »
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Like a on flight announcement.. is there a doctor or any medical staff On this forum?

It would be nice to have someone in the medical field advising on this forum?  :P

way to put the pressure on LOL

« Last Edit: March 21, 2020, 09:08:41 AM by alyssa »
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Re: Covid-19: sickness, symptoms & relief
« Reply #28 on: March 21, 2020, 02:25:10 PM »
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Like a on flight announcement.. is there a doctor or any medical staff On this forum?

It would be nice to have someone in the medical field advising on this forum?  :P


Offline alyssa

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Re: Covid-19: sickness, symptoms & relief
« Reply #29 on: March 26, 2020, 11:52:43 PM »
my sense is here in SD we've managed to slow the virus down....but dreading the living through a New Orleans/NYC



Sobering repost from another group. Forwarded from a friend who is a nurse here in San Diego.

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."
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