OG doc. AMA on COVID-19

uber tony -

Will this affect people with Lyme disease any worse than regular folks?

Not at increased risk or will affect you any worse than general population 

1 Like

uber tony -

Will this affect people with Lyme disease any worse than regular folks?

There’s no data available to answer this, but I would not expect Lyme’s disease in itself to be a cause of higher morbidity/mortality here. Even though it’s a chronic disease, it’s not a cardiovascular/pulmonary disease, which are the most important risk factors in this.

1 Like

Rambo John J -

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

Good move? or Bad Move?

me too, never can be too safe

mataleo1 -
emu67 - 

How about viral dose versus severity of symptoms? Is there any information in this - the thinking is that if you’re exposed to a large number of corona virus at the same time, you’ll be sicker than if you were exposed to a smidgen but just enough to infect you. Any truth to that?


Answered this earlier but yes:
large exposure = higher virus load = overwhelming of defense mechanisms = more severe symptoms and shorter incubation

If you and a loved one both came down with symptoms would you avoid sleeping in the same bed and close contact for the above mentioned reasons? 

Dragunov -
Job Security -
Dragunov -
Job Security -

Great thread!


Im a MD in Europe doing a PhD in epidemiology and was considering going out of my lurking ways to do an AMA - now I’ll just join this thread, if that’s okay.


If anybody wants input from a European point of view - AMA.

What is your take on ‘herd immunity’ and how does that approach affect those in the vulnerable category? It seems this is essentially cutting them adrift but in all honesty I don’t understand enough about it.

Good question.


Aiming for herd immunity with this virus is an uncertain (and likely a very deadly) path to take for a couple of reasons:


Traditionally, herd immunity is defined to be achieved/effective when at least 95% of a population is immune to a certain infectious disease. When only 5 % of a population can be infected, every case/cluster of disease will quickly be self-limiting (it can only spread to one in 20 people at any given contact, and that person - if infected - can only spread the disease to one in 20 of his/her circle of contact).


The problems in a Covid-19-context are:


1. It won’t be effective:


No western country has 95% of it’s population in the non-vulnerable category (age under 80, no comorbidities etc.). So until the virus has infected the majority of the vulnerable group, herd immunity will not be achieved, and transmission from cluster to cluster will continue to happen.


2. It’s dangerous:


Normally, when talking about herd immunity, it’s related to vaccine uptake rates. Vaccinated people don’t die in the process of achieving herd immunity, which would be the case with Covid-19, even in the non-vulnerable groups (mortality is substantial even in the 50+ age group).

Thank you. Both of my parents are in that category. I’m planning to keep them isolated for as long as possible. They’re both retired so shouldn’t be too difficult!

Good decision. Nobody should live in fear of covid-19 forever, but at least stay safe the next 2-3 weeks until we know if this will be a repeat of Wuhan and Italy in the rest of Europe and USA.


If you plan on visiting them or doing their shopping, look out for symptoms of your own, you don’t want to be the transmission link.

1 Like

mataleo1 -
androb - 
mataleo1 -
androb - 
mataleo1 -
Jacks Wasted Life - 

Thank you for this AMA.


 


1) Is it true that because it is aerosol based, we are all likely to get it?  Or will preventative measures like washing hands before eating or preparing food and not touching our nose, mouth, or eyes reduce our chances of getting infected?


2) I’ve heard rumors that some states are strongly considering 2-4 week quarantines for all residents.  Have you heard anything on this?


3) If a 2-4 week quarantine were implemented, how beneficial do you think it would it be in combating the virus?  Would it potentially prevent many cases or just delay them, essentially to give health care facilities more lead time to prepare for the inevitable?


1) There remains confusion here. It doesn't seem to be airborne but can still travel because of droplets. The main risk is contact with an infected host and then touching your face. So hand washing remains paramount.

2) I don't know about that, I'll ask my wife. At my hospital, they've put EVERY health care worker that comes back from outside the country in forced quarantine.

3) It really depends on how successful we are at enforcing the quarantine. They seem to have had success in China and South Korea with this.

Can you verify this 


250 000 test were given in SK (to those with symptoms) and only 2% of the tests came back positive 


are you seeing those types of numbers as well. That most people with symptoms that are getting tested are coming back negative?


I don't know what's going on in Saskatchawan but I can find out.

More patients have been tested in Montreal than NYC as of today. More than 90% have been negative so far.

Lots of RSV and influenza infections though (which can mimic COVID)

SK=South Korea. 
they seem to have the best handle on it. 
 


lol I don’t know if 250k people total live in Saskatchewan (jokes)


Ha!

Have you read their car drive-in system for detection? That was a brilliant idea. We should do this here. SK has done an amazing job of isolating people at risk, quick detection, and quick treatments. Hope we were as good here!

actually, why aren't we doing that in canada? what canadian agencies would be responsible for implementing it? ministry of health? individual hospitals? min of transport?


 


also, you are in nyc because of your wife? i thought you were in montreal (is there a connection with your hospitals?)


general curiousity, please don't divulge anything too personal of course, i just didn't know that canadian hospitals had direct contact with us hospitals outside of research collaborations. 


 


real question: what's your view on the idea that there's an S strain and an L strain? it seems quite plausible to me as there have been varying death rates. 


 


also, why would people who recovered catch again 45 days later? My assumption would be that they caught another strain (l and s maybe)? or that the COV19 could hide in the nervous system? is there another explanation as your body should have developed antibodies and a more reactive immune system?


 


cheers mate, if this virus is done, i hope to drop by montreal. 

Someone told me that there already existed about 5 CV strains in the USA prior to this and that the CV test that USA is using doesn’t differentiate this novel “deadly” strain from the pre-existing strains, so anyone who pops for this strain could just have one of the older ones. Any truth to this?

 

Jump Kick -

Someone told me that there already existed about 5 CV strains in the USA prior to this and that the CV test that USA is using doesn’t differentiate this novel “deadly” strain from the pre-existing strains, so anyone who pops for this strain could just have one of the older ones. Any truth to this?


 

False.


They testing specifically for covid 19.   They have isolated it


Coronovirus is just the genre of viruses that typically cause the common cold.     Been around forever.   Usually gives u the common symptoms.


This is mutated strain similar to sars and seems to be aggressive in causing pneumonias, ards and finally cardiomyopathies which seems to be tue big killer in vulnerable populations.   Coronovirus typically doesnt do this which is why the medical community working so hard to contain this.


 


 

yusul -
mataleo1 -
androb - 
mataleo1 -
androb - 
mataleo1 -
Jacks Wasted Life - 

Thank you for this AMA.


 


1) Is it true that because it is aerosol based, we are all likely to get it?  Or will preventative measures like washing hands before eating or preparing food and not touching our nose, mouth, or eyes reduce our chances of getting infected?


2) I’ve heard rumors that some states are strongly considering 2-4 week quarantines for all residents.  Have you heard anything on this?


3) If a 2-4 week quarantine were implemented, how beneficial do you think it would it be in combating the virus?  Would it potentially prevent many cases or just delay them, essentially to give health care facilities more lead time to prepare for the inevitable?


1) There remains confusion here. It doesn't seem to be airborne but can still travel because of droplets. The main risk is contact with an infected host and then touching your face. So hand washing remains paramount.

2) I don't know about that, I'll ask my wife. At my hospital, they've put EVERY health care worker that comes back from outside the country in forced quarantine.

3) It really depends on how successful we are at enforcing the quarantine. They seem to have had success in China and South Korea with this.

Can you verify this 


250 000 test were given in SK (to those with symptoms) and only 2% of the tests came back positive 


are you seeing those types of numbers as well. That most people with symptoms that are getting tested are coming back negative?


I don't know what's going on in Saskatchawan but I can find out.

More patients have been tested in Montreal than NYC as of today. More than 90% have been negative so far.

Lots of RSV and influenza infections though (which can mimic COVID)

SK=South Korea. 
they seem to have the best handle on it. 
 


lol I don’t know if 250k people total live in Saskatchewan (jokes)


Ha!

Have you read their car drive-in system for detection? That was a brilliant idea. We should do this here. SK has done an amazing job of isolating people at risk, quick detection, and quick treatments. Hope we were as good here!

actually, why aren't we doing that in canada? what canadian agencies would be responsible for implementing it? ministry of health? individual hospitals? min of transport?


 


also, you are in nyc because of your wife? i thought you were in montreal (is there a connection with your hospitals?)


general curiousity, please don't divulge anything too personal of course, i just didn't know that canadian hospitals had direct contact with us hospitals outside of research collaborations. 


 


real question: what's your view on the idea that there's an S strain and an L strain? it seems quite plausible to me as there have been varying death rates. 


 


also, why would people who recovered catch again 45 days later? My assumption would be that they caught another strain (l and s maybe)? or that the COV19 could hide in the nervous system? is there another explanation as your body should have developed antibodies and a more reactive immune system?


 


cheers mate, if this virus is done, i hope to drop by montreal. 

Hes most likely dual credentialed.  A lot of docs that work close to border have this.


Im credentialed in canada but also have license to practice in ny and PA


In terms of testing positive again.   My suspicion is that is had moreso to do with the PCR testing they using and creating false positives.    Similar thing we see if patients treated for c. Diff with them still testing positive long after recovering from acute illness.


They are testing specifically for covid19 and not other coronavirus.  The normal viral swab is different test than the one for covid19.


Canada is just now getting better testing.   Some labs able get results back quickly but for confirmation still being sent to winnipeg.   This is what er doc told me today.  Again things keep changing day by day and faster methods will come now that we actually taking this seriously. 


 

1 Like

Great idea for a thread, but I just wish these were real doctors answering. I mean come on 15 pages and none of them have even mentioned toilet paper!!

JUST KIDDING, thanks for the info guys, Stay safe out there.

GenErick -

Great idea for a thread, but I just wish these were real doctors answering. I mean come on 15 pages and none of them have even mentioned toilet paper!!

JUST KIDDING, thanks for the info guys, Stay safe out there.

Jokes on those suckers. The real treat is in baby wipes!

Dragunov -
mataleo1 -

I'm going to take a break from the thread for a little while. But I'll answer questions tomorrow AM.

A lot of backlash (and now backtrack) on the Herd immunity approach of the UK.

Get some rest man. I’m in the UK. Not at all happy with the approach so far. It’s almost as if we’re waiting for it to really hit the fan before putting any significant measures in place.

I heard something about quarantining all the over 70 in UK, is it true? That would be a brilliant idea.


99% of the dead in Italy are > 70yo, in fact the average is 80.3, large majority with more than one preexisting condition (most common: hypertension, cardiopathies, diabetes), also most of them are in critical conditions in recovery units that are running out of space, which is the biggest problem at this time.


Plus in Italy you cant get the oldies to stay the fuck home, even in the evening you see a lot of bar full of granpas playing cards (this before the bars were closed down for the epidemic of course).


But even to this day, i see them out doing shopping in grocery stores or whatever, going out every fucking day.


 


 


 


 


 

Rahjai MD -
yusul -
mataleo1 -
androb - 
mataleo1 -
androb - 
mataleo1 -
Jacks Wasted Life - 

Thank you for this AMA.


 


1) Is it true that because it is aerosol based, we are all likely to get it?  Or will preventative measures like washing hands before eating or preparing food and not touching our nose, mouth, or eyes reduce our chances of getting infected?


2) I’ve heard rumors that some states are strongly considering 2-4 week quarantines for all residents.  Have you heard anything on this?


3) If a 2-4 week quarantine were implemented, how beneficial do you think it would it be in combating the virus?  Would it potentially prevent many cases or just delay them, essentially to give health care facilities more lead time to prepare for the inevitable?


1) There remains confusion here. It doesn't seem to be airborne but can still travel because of droplets. The main risk is contact with an infected host and then touching your face. So hand washing remains paramount.

2) I don't know about that, I'll ask my wife. At my hospital, they've put EVERY health care worker that comes back from outside the country in forced quarantine.

3) It really depends on how successful we are at enforcing the quarantine. They seem to have had success in China and South Korea with this.

Can you verify this 


250 000 test were given in SK (to those with symptoms) and only 2% of the tests came back positive 


are you seeing those types of numbers as well. That most people with symptoms that are getting tested are coming back negative?


I don't know what's going on in Saskatchawan but I can find out.

More patients have been tested in Montreal than NYC as of today. More than 90% have been negative so far.

Lots of RSV and influenza infections though (which can mimic COVID)

SK=South Korea. 
they seem to have the best handle on it. 
 


lol I don’t know if 250k people total live in Saskatchewan (jokes)


Ha!

Have you read their car drive-in system for detection? That was a brilliant idea. We should do this here. SK has done an amazing job of isolating people at risk, quick detection, and quick treatments. Hope we were as good here!

actually, why aren't we doing that in canada? what canadian agencies would be responsible for implementing it? ministry of health? individual hospitals? min of transport?


 


also, you are in nyc because of your wife? i thought you were in montreal (is there a connection with your hospitals?)


general curiousity, please don't divulge anything too personal of course, i just didn't know that canadian hospitals had direct contact with us hospitals outside of research collaborations. 


 


real question: what's your view on the idea that there's an S strain and an L strain? it seems quite plausible to me as there have been varying death rates. 


 


also, why would people who recovered catch again 45 days later? My assumption would be that they caught another strain (l and s maybe)? or that the COV19 could hide in the nervous system? is there another explanation as your body should have developed antibodies and a more reactive immune system?


 


cheers mate, if this virus is done, i hope to drop by montreal. 

Hes most likely dual credentialed.  A lot of docs that work close to border have this.


Im credentialed in canada but also have license to practice in ny and PA


In terms of testing positive again.   My suspicion is that is had moreso to do with the PCR testing they using and creating false positives.    Similar thing we see if patients treated for c. Diff with them still testing positive long after recovering from acute illness.


They are testing specifically for covid19 and not other coronavirus.  The normal viral swab is different test than the one for covid19.


Canada is just now getting better testing.   Some labs able get results back quickly but for confirmation still being sent to winnipeg.   This is what er doc told me today.  Again things keep changing day by day and faster methods will come now that we actually taking this seriously. 


 

Thanks!

NoNeed4aScreenName -
GenErick -

Great idea for a thread, but I just wish these were real doctors answering. I mean come on 15 pages and none of them have even mentioned toilet paper!!

JUST KIDDING, thanks for the info guys, Stay safe out there.

Jokes on those suckers. The real treat is in baby wipes!

The secret to surviving this is hoarding coffee filters, bro!

Job Security -
NoNeed4aScreenName -
GenErick - Great idea for a thread, but I just wish these were real doctors answering. I mean come on 15 pages and none of them have even mentioned toilet paper!!

JUST KIDDING, thanks for the info guys, Stay safe out there.

Jokes on those suckers. The real treat is in baby wipes!


The secret to surviving this is hoarding coffee filters, bro!



Putting in an Amazon order right now for 17K boxes, make a couple bucks while surviving. What's the worst that could happen?


 


 

Friends of mine say that the lockdown that is happening in some places (you don't leave your home) only hurts the economy and is pointless because it may work for a few days or a week and then people will go out anyway and meet people because that's just what we do. What are your opinions on that?

per -

Friends of mine say that the lockdown that is happening in some places (you don't leave your home) only hurts the economy and is pointless because it may work for a few days or a week and then people will go out anyway and meet people because that's just what we do. What are your opinions on that?

It probably helps the overall effort of increasing social distancing, even though people will sometimes not comply. We already have reports of individuals who were under quarantine for possible exposure breaking the quarantine, in one case to bring a teen to a dance. Some people just refuse to take steps that are restrictive for them but may benefit the greater population. Remember the woman who decided to walk out of quarantine during the Ebola scare? 

Have you seen a more detailed breakdown of any of the statistics of hypertensive cases? 

 

We see that hypertension increases the risk of a severe outcome, but what does that mean really?  Are these people who have untreated high blood pressure?  Are they people who had hypertension but are treated and present with normal blood pressure?  If they are treated, what medications are they on?  I saw some statistic that only 13% of people with high blood pressure in China are medicated.

per -

Friends of mine say that the lockdown that is happening in some places (you don't leave your home) only hurts the economy and is pointless because it may work for a few days or a week and then people will go out anyway and meet people because that's just what we do. What are your opinions on that?

The more people comply, the more effective it is. It's not all or nothing. The goal is to flatten the curve, meaning reduce the overall number of infected and spread out the time frame over which they get infected(so that we dont exceed the capacity of our healthcare systems like what is happening in Italy).


 


Flattening the curve is the best we can do in part because of selfish assholes such as those people you mention(and also because 100% population isolation isn't really practical).  If we were all 100% compliant for X number of weeks we would literally wipe out the virus completely as it would have nowhere to spread with everyone infected either recovering or dying.

Is it better to have cash on hand right now or will that potentially be seen as too much of a contagious vehicle?