Coronavirus

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Here is some food for thought,this Doctors father was my doc since I was a teenager,good people..COVID-19 Update – Hospital Treatment Protocol for Critically Ill Patients,his name is Andrew Chernaik...

My urgent focus this week has been developing a treatment protocol for hospitalized COVID-19 patients that can be adopted nationwide. I’ve collaborated with colleagues around the world including Spain and Iran. After countless conversations with pulmonologists and hematologists, here are my conclusions:

1. This is primarily a hematologic disease. People are dying from excessive clotting, not pneumonia or ARDS like we initially thought. This has important implications because treatment needs to be directed towards thinning the blood with the help of our hematologists. Hematologists should be on the front lines and are essential in combating this disease.

2. What is causing the excessive clotting is an exaggerated immune response to the virus. As one colleague put it, it’s a wimpy virus, with a devastating, hyper-exaggerated immune response. It’s the immune response that’s killing us by causing the excessive clotting mentioned above, not the virus. It’s the clotting in the blood vessels going to the lungs that is causing breathing difficulties, not pneumonia/ARDS as previously believed. This is important because I believe we can stop this disproportionate immune response in critically ill patients with the use of steroids.

3. As mentioned in my previous post, much of the ARDS we are seeing is likely being caused by positive pressure ventilation. This is important because we can stop this by changing our threshold to intubate. We need to tolerate patients having low oxygen levels as long as they are not in respiratory distress and show no signs of organ damage as a result of low oxygen levels. In other words, only intubate patients if they are showing signs of respiratory distress or organ damage. Amazingly, for reasons that remain somewhat unclear to me, patients seem to tolerate low levels of oxygen with this specific disease.

4. As discussed above, the majority of critically ill COVID-19 patients do not have classic ARDS, and standard ARDS protocols should not be used in these patients whose lungs are not behaving like ARDS. In my opinion, this will reduce the amount of ARDS caused by ventilators.

If the above measures are adopted broadly, I believe that the course of this disease will change dramatically, and we will see a huge reduction in the death rate.

I don’t claim to be an expert, but I’ve spent a great deal of time these past two weeks learning from people way smarter than me, and this what I’ve compiled. The above protocols are being used in a piecemeal approach, and I’m sure some institutions are doing all of the above, but it is not accepted standard of care yet. Many people in the healthcare field would like to wait for randomized control trials. In the meantime, people are dying at an alarming rate. It’s not the time to wait for trials; we need to act immediately on our solid understanding of physiology, our observations, and our intuition, and continue to adjust protocols as we continue to learn more.

I do want to make one thing abundantly clear. Most people with COVID-19 do not need to be hospitalized. If you have relatively mild disease and are well enough to not be hospitalized, steroids and blood thinners are not indicated. These drugs are not benign and can have serious side effects. Steroids should not be used prophylactically or in the first phase of the disease (note that most patients do not progress to a second phase of the disease). It is up to hospital specialists to decide when the benefits of these drugs outweigh the risks, and how much of each can be safely administered. At this point, it is estimated that roughly 20% of people with COVID-19 require hospitalization, and it's my strong advice to stay home and manage the symptoms unless you have signs of respiratory distress, or an oxygen saturation of less than 90, or other severe symptoms that cannot be managed at home.

Please pass along this information to get the word out about this latest course of treatment.
 
Macks said:
Here is some food for thought,this Doctors father was my doc since I was a teenager,good people..COVID-19 Update – Hospital Treatment Protocol for Critically Ill Patients,his name is Andrew Chernaik...

My urgent focus this week has been developing a treatment protocol for hospitalized COVID-19 patients that can be adopted nationwide. I’ve collaborated with colleagues around the world including Spain and Iran. After countless conversations with pulmonologists and hematologists, here are my conclusions:

1. This is primarily a hematologic disease. People are dying from excessive clotting, not pneumonia or ARDS like we initially thought. This has important implications because treatment needs to be directed towards thinning the blood with the help of our hematologists. Hematologists should be on the front lines and are essential in combating this disease.

2. What is causing the excessive clotting is an exaggerated immune response to the virus. As one colleague put it, it’s a wimpy virus, with a devastating, hyper-exaggerated immune response. It’s the immune response that’s killing us by causing the excessive clotting mentioned above, not the virus. It’s the clotting in the blood vessels going to the lungs that is causing breathing difficulties, not pneumonia/ARDS as previously believed. This is important because I believe we can stop this disproportionate immune response in critically ill patients with the use of steroids.

3. As mentioned in my previous post, much of the ARDS we are seeing is likely being caused by positive pressure ventilation. This is important because we can stop this by changing our threshold to intubate. We need to tolerate patients having low oxygen levels as long as they are not in respiratory distress and show no signs of organ damage as a result of low oxygen levels. In other words, only intubate patients if they are showing signs of respiratory distress or organ damage. Amazingly, for reasons that remain somewhat unclear to me, patients seem to tolerate low levels of oxygen with this specific disease.

4. As discussed above, the majority of critically ill COVID-19 patients do not have classic ARDS, and standard ARDS protocols should not be used in these patients whose lungs are not behaving like ARDS. In my opinion, this will reduce the amount of ARDS caused by ventilators.

If the above measures are adopted broadly, I believe that the course of this disease will change dramatically, and we will see a huge reduction in the death rate.

I don’t claim to be an expert, but I’ve spent a great deal of time these past two weeks learning from people way smarter than me, and this what I’ve compiled. The above protocols are being used in a piecemeal approach, and I’m sure some institutions are doing all of the above, but it is not accepted standard of care yet. Many people in the healthcare field would like to wait for randomized control trials. In the meantime, people are dying at an alarming rate. It’s not the time to wait for trials; we need to act immediately on our solid understanding of physiology, our observations, and our intuition, and continue to adjust protocols as we continue to learn more.

I do want to make one thing abundantly clear. Most people with COVID-19 do not need to be hospitalized. If you have relatively mild disease and are well enough to not be hospitalized, steroids and blood thinners are not indicated. These drugs are not benign and can have serious side effects. Steroids should not be used prophylactically or in the first phase of the disease (note that most patients do not progress to a second phase of the disease). It is up to hospital specialists to decide when the benefits of these drugs outweigh the risks, and how much of each can be safely administered. At this point, it is estimated that roughly 20% of people with COVID-19 require hospitalization, and it's my strong advice to stay home and manage the symptoms unless you have signs of respiratory distress, or an oxygen saturation of less than 90, or other severe symptoms that cannot be managed at home.

Please pass along this information to get the word out about this latest course of treatment.
Click to expand...

that;s sorta similar to what I posted on the previous page & asked for Dx & R7 input
 
I'm not "that kind of doctor" so this is my opinion. The new blurb and opinion cited by Macks & Wader are very definitive in their statements. This Cytokine Storm is something that physicians should consider, along with other possibilities. I just read a paper on COVID-19 Cytokine Storms from Lancet published in late March There are very few absolutes in medicine, so it's important to consider all the options, which is exactly what they say,

All patients with severe COVID-19 should be screened for hyperinflammation using laboratory trends (eg, increasing ferritin, decreasing platelet counts, or erythrocyte sedimentation rate) and the HScore to identify the subgroup of patients for whom immunosuppression could improve mortality. Therapeutic options include steroids, intravenous immunoglobulin, selective cytokine blockade (eg, anakinra or tocilizumab) and JAK inhibition.

Mehta et al. 2020, Lancet, 395:1033-1034
 
Sort of frightening...like we need more news like this. I thought I had read something that they were debating whether or not it could be aerosolized...can't remember with the information overload happening.

 
jpd said:
Sort of frightening...like we need more news like this. I thought I had read something that they were debating whether or not it could be aerosolized...can't remember with the information overload happening.

Click to expand...


I don't recall there was ever any debate about whether or not it was aerosol transmitted. The "debate" was more "To Mask or not To Mask" which IMO was more to downplay it by folks out and about to lessen the effect on available masks.

I ignored all the different BS and started using my N95 inventory as soon as this crap got real and cases were reported in Maine. We had a bunch because over the years The Admiral insisted that I use a mask when applying granular insecticides and herbicides. Since the basic face masks would cause my glasses to fog and my lawn looked like crap after using weed and feed with green stripes, I happened upon N95s which didn't cause any glass fogging. So I started Fall 2019 with a healthy inventory which we've shared with family and the local hospital.
 
CELLFISH said:
should I tell ya how furious I am bout this government turning a lot of the United States intelligence over to China, the universities allowing foreign spies to study here and the World Health Organization to be so screwed up... cellie...
Click to expand...

Its nuts.... The Chief busted one right in his own press conference the other day. The Women sat there smirking after asking an abrasive stupid question.

He did not stand for it and did not take shit from her.
 
Looking at this in totality, a part of me thinks that the "response is worse than the virus itself". Meaning 17 million unemployed as of today; 1100 people unemployed for every 1 person in the US who has past away from Covid-19; complete lock downs for business and people going nuts trying to figure out how to survive.

I'm not suggesting this pandemic isn't bad, but perhaps the response is harming many more people much worse? Than again, perhaps it is because of the lock-downs and social distancing restrictions that the infection rate and death results are not worse then they might be. lt's all F'd up.
 
CELLFISH said:
should I tell ya how furious I am bout this government turning a lot of the United States intelligence over to China, the universities allowing foreign spies to study here and the World Health Organization to be so screwed up... cellie...
Click to expand...
I was just talking about the hot broad farting like a truck driver that ate nothing but cabbage for a month straight.
 
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