Covid II: Medical Info and Implications

[pogi]

8 hours ago, provoman said:

These are types of frustrations that need to addressed, to get more people on board

I address them all the time.   The problem is that people don’t have questions, they have answers and I am just wrong.  I have personally provided multiple studies (including by the CDC) and have addressed all of these issues with you personally already.  Did it make a difference?  The cement has already hardened for most people.   It is 99% from people who have specific media preferences. 

[provoman]

51 minutes ago, pogi said:

I address them all the time.   The problem is that people don’t have questions, they have answers and I am just wrong.  I have personally provided multiple studies (including by the CDC) and have addressed all of these issues with you personally already.  Did it make a difference?  The cement has already hardened for most people.   It is 99% from people who have specific media preferences. 

That explains, in part, why I don't think you have tried to understand  peoples frustration.

Edited December 19, 2020 by provoman

[Rain]

10 hours ago, bsjkki said:

WHO updated guidance PCR testing and CT. 
 

https://www.who.int/news/item/14-12-2020-who-information-notice-for-ivd-users

“As with any diagnostic procedure, the positive and negative predictive values for the product in a given testing population are important to note. As the positivity rate for SARS-CoV-2 decreases, the positive predictive value also decreases. This means that the probability that a person who has a positive result (SARS-CoV-2 detected) is truly infected with SARS-CoV-2 decreases as positivity rate decreases, irrespective of the assay specificity. Therefore, healthcare providers are encouraged to take into consideration testing results along with clinical signs and symptoms, confirmed status of any contacts, etc.

Your chances for having it decrease when fewer people are testing positive?

10 hours ago, bsjkki said:

Users of RT-PCR reagents should read the IFU carefully to determine if manual adjustment of the PCR positivity threshold is necessary to account for any background noise which may lead to a specimen with a high cycle threshold (Ct) value result being interpreted as a positive result.  The design principle of RT-PCR means that for patients with high levels of circulating virus (viral load), relatively few cycles will be needed to detect virus and so the Ct value will be low. Conversely, when specimens return a high Ct value, it means that many cycles were required to detect virus. In some circumstances, the distinction between background noise and actual presence of the target virus is difficult to ascertain. Thus, the IFU will state how to interpret specimens at or near the limit for PCR positivity. In some cases, the IFU will state that the cut-off should be manually adjusted to ensure that specimens with high Ct values are not incorrectly assigned SARS-CoV-2 detected due to background noise.”

If a negative is found they run the test again and again to make sure it isn't a false negative?  And the more you run it the chances will increase for a false positive?

10 hours ago, bsjkki said:

...” 3. Consider any positive result (SARS-CoV-2 detected) or negative results (SARS-CoV-2 not detected) in combination with specimen type, clinical observations, patient history, and epidemiological information.

Medical staff should not rely on test result only...for what?  Treatment? Or just considering whether it is positive or negative?  

10 hours ago, bsjkki said:

4. Provide the Ct value in the report to the requesting healthcare provider.”

 

[bsjkki]

3 hours ago, Rain said:

If a negative is found they run the test again and again to make sure it isn't a false negative?  And the more you run it the chances will increase for a false positive?

A PCR test is run in cycles. The more cycles you run, the chances increase you will have a false positive. Labs run these test at different CT thresholds. The higher the cycle count, the higher the chance of picking up the virus in a dead form...so slight to mean nothing at all. Florida is now making all labs list the CT because anything over a 35 is basically meaningless. This is why there were so many false positives with athletes that were found after follow up testing.

[bsjkki]

"A simple binary approach to the interpretation of PCR results will result in the possible segregation of large numbers of people who are not infectious and, hence, not a threat to public health. It will probably also result in regular disinfection of surfaces, leading to a reduction in the diversity of the microbiome and an increase in the diversity of resistance genes."

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30883-5/fulltext

 

[Chum]

8 hours ago, provoman said:

I don't think you have tried to understand  peoples frustration.

Let's say that understanding their frustration led to the best possible outcome. What would that outcome be?

[pogi]

12 hours ago, provoman said:

That explains, in part, why I don't think you have tried to understand  peoples frustration.

Provoman, this has been my life for the past 9 months or so.  It's all I do.  I talk about Covid and preventive measures directly with patients on the phone from my office, all day everyday for work.  I hear it all.   I am a good listener and am always respectful, even if they are being abhorrent, loathsome, jerks who want me dead.  I think I understand people's frustrations well.  I literally hear them everyday and probably understand the general publics frustrations better than most.   Unless you personally are hiding something from me, I am pretty sure I understand what your frustrations are too.  We have talked about them in detail.  If all you want is empathy, I am sorry but I am too damn burnt out for that.  I have spent all my empathetic listening on my job.   I am going to tell you how I see it.  And I need a place to vent.  I am genuinely sorry that many of you have been on the other end of that and have had to endure my venting.  

What about my frustrations and the frustrations of public health workers who are being harassed, humiliated, and threatened, across the country (yes, I have personally been the recipient of it for doing my job of trying to protect the public)?  What about the frustrations of the front line workers who are working 80 hour weeks in the ICU PLEADING for the public to LISTEN!!!  What do they get in response to their desperate pleas?  "Ya, but at first masks were not recommended and now they are, so...".  Talk about frustrating!

Edited December 20, 2020 by pogi

[Rain]

9 hours ago, bsjkki said:

A PCR test is run in cycles. The more cycles you run, the chances increase you will have a false positive. Labs run these test at different CT thresholds. The higher the cycle count, the higher the chance of picking up the virus in a dead form...so slight to mean nothing at all. Florida is now making all labs list the CT because anything over a 35 is basically meaningless. This is why there were so many false positives with athletes that were found after follow up testing.

Thank you.

[Rain]

25 minutes ago, pogi said:

Provoman, this has been my life for the past 9 months or so.  It's all I do.  I talk about Covid and preventive measures directly with patients on the phone from my office, all day everyday for work.  I hear it all.   I am a good listener and am always respectful, even if they are being abhorrent, loathsome, jerks who want me dead.  I think I understand people's frustrations well.  I literally hear them everyday and probably understand the general publics frustrations better than most.   Unless you personally are hiding something from me, I am pretty sure I understand what your frustrations are too.  We have talked about them in detail.  If all you want is empathy, I am sorry but I am too damn burnt out for that.  I have spent all my empathetic listening on my job.   I am going to tell you how I see it.  And I need a place to vent.  I am genuinely sorry that many of you have been on the other end of that and have had to endure my venting.  

What about my frustrations and the frustrations of public health workers who are being harassed, humiliated, and threatened, across the country?  What about the frustrations of the front line workers who are working 80 hour weeks in the ICU PLEADING for the public to LISTEN!!!  What do they get in response to their desperate pleas?  "Ya, but at first masks were not recommended and now they are and so I need empathy for my frustrations". 

Hugs.  Thank you for all you do.

[bsjkki]

What do you of think of this? https://www.wsj.com/articles/hospitals-retreat-from-early-covid-treatment-and-return-to-basics-11608491436?redirect=amp#click=https://t.co/QNnBSygB1j
 

 

 

[juliann]

9 hours ago, bsjkki said:

What do you of think of this? https://www.wsj.com/articles/hospitals-retreat-from-early-covid-treatment-and-return-to-basics-11608491436?redirect=amp#click=https://t.co/QNnBSygB1j
 

 

 

I understand the problem but it still seems unethical. That is such an invasive procedure.

I will add that my husband was terrified to be left alone in the hospital and after a couple of instances, I was afraid to leave him. My greatest fear is not having Covid, it is being isolated in a hospital with no advocate. That is why stuff like this can happen. 

Edited December 22, 2020 by juliann

[pogi]

9 hours ago, bsjkki said:

What do you of think of this? https://www.wsj.com/articles/hospitals-retreat-from-early-covid-treatment-and-return-to-basics-11608491436?redirect=amp#click=https://t.co/QNnBSygB1j
 

 

 

 

23 minutes ago, juliann said:

I understand the problem but it still seems unethical. That is such an invasive procedure.

I will add that my husband was terrified to be left alone in the hospital and after a couple of instances, I was afraid to leave him. My greatest fear is not having Covid, it is being isolated in a hospital with no advocate. That is why stuff like this can happen. 

I agree Juliann.   The doctors (and nurses especially) are supposed to be the advocates for the patient.  If this truly happened as described, that is a violation of that trust and a violation of a core medical ethic, and likely illegal. 

It is hard for me to comment without understanding the context and background of this.  I agree that this looks unethical from the small clip we see here (can't read the whole article).  It would completely violate the medical ethic and practice of informed consent to push a highly invasive and dangerous procedure on a patient without informing them that it is not medically indicated for them personally, and will not medically benefit and may potentially harm them.  Something seems out of place here.  If each patient was not coerced, but was made aware of the risks and that is was being done to protect others in the hospital more than for their own benefit, and the patient consents to it, then I have no problem with it.  Otherwise, this was wrong. 

Edited December 22, 2020 by pogi

[Peacefully]

On 12/19/2020 at 10:15 PM, pogi said:

Provoman, this has been my life for the past 9 months or so.  It's all I do.  I talk about Covid and preventive measures directly with patients on the phone from my office, all day everyday for work.  I hear it all.   I am a good listener and am always respectful, even if they are being abhorrent, loathsome, jerks who want me dead.  I think I understand people's frustrations well.  I literally hear them everyday and probably understand the general publics frustrations better than most.   Unless you personally are hiding something from me, I am pretty sure I understand what your frustrations are too.  We have talked about them in detail.  If all you want is empathy, I am sorry but I am too damn burnt out for that.  I have spent all my empathetic listening on my job.   I am going to tell you how I see it.  And I need a place to vent.  I am genuinely sorry that many of you have been on the other end of that and have had to endure my venting.  

What about my frustrations and the frustrations of public health workers who are being harassed, humiliated, and threatened, across the country (yes, I have personally been the recipient of it for doing my job of trying to protect the public)?  What about the frustrations of the front line workers who are working 80 hour weeks in the ICU PLEADING for the public to LISTEN!!!  What do they get in response to their desperate pleas?  "Ya, but at first masks were not recommended and now they are, so...".  Talk about frustrating!

I would like to thank you for the work you do, and for the information you impart on this site. I find it very helpful.

My daughter had a question the other day about babies and children, and I would love to get your expert opinion. Since there is no vaccine approved for them, yet, how will vaccinating adults protect the babies and children, if it turns out that the vaccine doesn’t prevent the disease, but only makes symptoms milder? I hope this question makes sense. 

 

[rongo]

1 hour ago, Peacefully said:

I would like to thank you for the work you do, and for the information you impart on this site. I find it very helpful.

My daughter had a question the other day about babies and children, and I would love to get your expert opinion. Since there is no vaccine approved for them, yet, how will vaccinating adults protect the babies and children, if it turns out that the vaccine doesn’t prevent the disease, but only makes symptoms milder? I hope this question makes sense. 

Babies and children have very strong immune systems that dispatch things fairly easily (in general) compared to adults. That's why childhood diseases are childhood diseases, but are potentially dangerous in adults if they have no immunity (e.g., chicken pox, measles, mumps, etc.). I don't think vaccination of babies and small children is a priority or even planned with Covid-19.

I've read discussion and speculation about how and why Covid-19 seems to be so mild and asymptomatic in children. One theory is that children are exposed to an average of six coronaviruses (colds, etc.), while adults average 1-2, so the thought is that their immune systems are calibrated and have more antibodies and other defenses for a variety of different ones, but adults generally aren't exposed to what kids are. I know that my first couple of years teaching, I was very sick and had what seemed like seasonal pneumonia. Now, in my 19th year, I can't remember the last time I've been sick. It's been years. 

[pogi]

13 hours ago, Peacefully said:

I would like to thank you for the work you do, and for the information you impart on this site. I find it very helpful.

My daughter had a question the other day about babies and children, and I would love to get your expert opinion. Since there is no vaccine approved for them, yet, how will vaccinating adults protect the babies and children, if it turns out that the vaccine doesn’t prevent the disease, but only makes symptoms milder? I hope this question makes sense. 

 

Hi Peacefully,

Thank you for the kind words!  That's a good question.  Unfortunately, as of yet, there isn't really any protection for children beyond masking and distancing.  They have started testing Covid vaccines in younger children, but I am not sure how much further out those results are expected. Based on how children react to the wild virus, I don't anticipate the vaccine being a problem for younger children and should be available to them in the not too distant future.  Fortunately, as Rongo points out, extremely rarely is the virus fatal in children and typically expresses mild symptoms.  The flu is much more dangerous in young children than Covid and we should definitely be more concerned about that and get our kids vaccinated.  While it is not yet indicated for children, it will protect the most vulnerable among us, and hopefully it actually prevents infection - then kids could have some indirect benefit as well. 

12 hours ago, rongo said:

Babies and children have very strong immune systems that dispatch things fairly easily (in general) compared to adults. That's why childhood diseases are childhood diseases, but are potentially dangerous in adults if they have no immunity (e.g., chicken pox, measles, mumps, etc.). I don't think vaccination of babies and small children is a priority or even planned with Covid-19.

I've read discussion and speculation about how and why Covid-19 seems to be so mild and asymptomatic in children. One theory is that children are exposed to an average of six coronaviruses (colds, etc.), while adults average 1-2, so the thought is that their immune systems are calibrated and have more antibodies and other defenses for a variety of different ones, but adults generally aren't exposed to what kids are. I know that my first couple of years teaching, I was very sick and had what seemed like seasonal pneumonia. Now, in my 19th year, I can't remember the last time I've been sick. It's been years. 

When Covid first started, I remember having a hard time convincing people that the symptoms are more mild in children.  A lot of people here were not believing the information coming out of China and argued that it will be more severe in children because their immune systems are not as developed.  I had to remind them that sometimes diseases actually can be more mild in children and the evidence seems to suggest that is what is happening with Covid.   

Well, you are both partly correct.  Yes, the symptoms are more mild in children with Covid (+1 for Rongo).  And yes children have weaker and less developed immune systems (+1 for the others).    Young children and older adults are typically the two most vulnerable groups when it comes to infectious disease.  You named one of the rare instances where a disease is more mild in children than adults - chicken pox.  Hepatitis A is another rare example, and now we can add Covid to the list too.   Measles is actually WAY more deadly in young children than in adults, along with most other infections.  Most measles deaths are from children under 5.  Newborns have basically zero immune system and rely almost entirely on the mothers breast milk for antibodies (which is partly why breast feeding is so much more preferred) which helps some, bust isn't as robust as a full immune response with fully developed phagocytes (the bug eating cells), which doesn't happen until around 6+ years old. 

I have heard the theory about more exposure to other coronaviruses in children leading to higher immunity for Covid, but I don't buy it.  The virus is extremely mild in completely immunonaïve newborns who don't even breastfeed too, so that can't explain it.  At this point it is anybody's guess.   I don't think we fully understand why chickenpox and Hep A are more mild in children either, but there are some different theories floating around.  Adults are more prone to secondary infections like pneumonia with chickenpox, which is why it is more dangerous in adults.  For whatever blessed reason, children are spared - as if 2020 wasn't a big enough nightmare with over 300,000 dead already, could you imagine if that number was doubled with young children counting for half of the total mortality?  We have been spared in many ways. 

Edited December 22, 2020 by pogi

[rongo]

8 minutes ago, pogi said:

When Covid first started, I remember having a hard time convincing people that the symptoms are more mild in children.  A lot of people here were not believing the information coming out of China and argued that it will be more severe in children because their immune systems are not as developed.  Well, you are both partly correct.  Yes, the symptoms are more mild in children with Covid (+1 for Rongo).  And yes children have weaker and less developed immune systems (+1 for the others).    Young children and older adults are typically the two most vulnerable groups when it comes to infectious disease.  You named one of the rare instances where a disease is more mild in children than adults - chicken pox.  Hepatitis A is another rare example, and now we can add Covid to the list too.   Measles is actually WAY more deadly in young children than in adults, along with most other infections.  Most measles deaths are from children under 5.  Newborns have basically zero immune system and rely almost entirely on the mothers breast milk for antibodies (which is partly why breast feeding is so much more preferred) which helps some, bust isn't as robust as a full immune response with fully developed phagocytes (the bug eating cells), which doesn't happen until around 6+ years old. 

I have heard the theory about more exposure to other coronaviruses in children leading to higher immunity for Covid, but I don't buy it.  The virus is extremely mild in immunonaive newborns too, so that can't explain it.  At this point it is anybody's guess.   I don't think we fully understand why chickenpox and Hep A are more mild in children either, but there are some different theories floating around.  Adults are more prone to secondary infections like pneumonia with chickenpox, which is why it is more dangerous in adults.  For whatever blessed reason, children are spared - as if 2020 wasn't a big enough nightmare with over 300,000 dead already, could you imagine if that number was doubled with young children counting for half of the total mortality?  We have been spared in many ways. 

Personally, I think that the big factor vis a vis children vs. adults is that children don't yet have underlying chronic inflammation from the comorbidities that mark those who will really struggle or die from Covid. So, the body's inflammatory response is generally unremarkable in children, while it can be deadly for adults when the body unleashes the "cytokine storm" in response to Covid. 

It's more and more evident that good overall health is crucial in this and coming years. Gum disease (chronic, low-grade inflammation), seemingly not that big a deal, erodes heart muscle and heart valves. Obesity affects everything else. Smoking/vaping? Disastrous. Diabetes affects so much else (nothing Type I people can do but follow their treatment regimen, but they will have circulatory, vision, and extremity issues no matter what). Basically, anything that can be done to not be in a chronic state of inflammation will help one avoid bad symptoms with Covid and everything else. And children's bodies are still "under warranty," so to say. 

[rongo]

Here's a question that directly impacts my family:

My wife has been hospitalized with lengthy stays for complications from a rare autoimmune disease (CAPS: catastrophic antiphospholipid syndrome) since 2008. She clots all over the place in her internal organs, and in 2008, they couldn't figure out why she was blacking out and finally opened her up for exploratory surgery in desperation (her liver showed signs of cirrhosis, but she had never had alcohol or hepatitis). She had necrotic (dead) portions of her GI tract from clots, and they removed part of her ileum and colon. She is on high doses of warfarin for life to keep the clotting at bay, but suffers from vitamin B12 deficiency because of "shortgut" (she is missing key portions of her digestive system). Things sometimes go south and she has to have transfusions, but you can't just go in and get them when we know she's in a bad way --- she has to be admitted via the ER and have a week's worth of fruitless tests before doctors do what we already know she needs: transfusions (five, last time) and B12 shots. Last time, she wasn't breathing when I got her to the ER, and we obviously don't want to cut it that close again.

She is in a bad way again, and we are doing everything we can (including her doctor). If we have to take her to the ER, I don't think I can be with her, can I? Arizona is "code red," with reportedly 92% ICU capacity. She would almost rather take her chances at home than risk being admitted and not see any of us indefinitely.

Is that generally correct, that people are basically on their own right now when admitted into a hospital (no visitors or advocates)? This is a big concern for us. 

[pogi]

1 hour ago, rongo said:

Personally, I think that the big factor vis a vis children vs. adults is that children don't yet have underlying chronic inflammation from the comorbidities that mark those who will really struggle or die from Covid. So, the body's inflammatory response is generally unremarkable in children, while it can be deadly for adults when the body unleashes the "cytokine storm" in response to Covid. 

It's more and more evident that good overall health is crucial in this and coming years. Gum disease (chronic, low-grade inflammation), seemingly not that big a deal, erodes heart muscle and heart valves. Obesity affects everything else. Smoking/vaping? Disastrous. Diabetes affects so much else (nothing Type I people can do but follow their treatment regimen, but they will have circulatory, vision, and extremity issues no matter what). Basically, anything that can be done to not be in a chronic state of inflammation will help one avoid bad symptoms with Covid and everything else. And children's bodies are still "under warranty," so to say. 

That is probably the best theory as to why Covid doesn't effect children as bad.  This is a highly inflammatory disease and most of the harm from Covid comes from inflammation or secondary infections.  It is a cruel irony that our greatest defense cells against disease can also be responsible for the most harm at times.  The reason children's inflammatory response is weak is because they have weaker immune systems.  Rarely, that can actually be a good thing, but usually children are more vulnerable because of it. 

[Calm]

Do we know if the current vaccines will help with the new strain in England?

[Calm]

Looks like it would take a lot less time now the basic work has been done even if the vaccine doesn’t work to adapt it for the new strain. 
 

https://www.thedailybeast.com/biontech-says-new-vaccine-for-mutant-coronavirus-strain-would-only-take-weeks

[pogi]

1 hour ago, rongo said:

Here's a question that directly impacts my family:

My wife has been hospitalized with lengthy stays for complications from a rare autoimmune disease (CAPS: catastrophic antiphospholipid syndrome) since 2008. She clots all over the place in her internal organs, and in 2008, they couldn't figure out why she was blacking out and finally opened her up for exploratory surgery in desperation (her liver showed signs of cirrhosis, but she had never had alcohol or hepatitis). She had necrotic (dead) portions of her GI tract from clots, and they removed part of her ileum and colon. She is on high doses of warfarin for life to keep the clotting at bay, but suffers from vitamin B12 deficiency because of "shortgut" (she is missing key portions of her digestive system). Things sometimes go south and she has to have transfusions, but you can't just go in and get them when we know she's in a bad way --- she has to be admitted via the ER and have a week's worth of fruitless tests before doctors do what we already know she needs: transfusions (five, last time) and B12 shots. Last time, she wasn't breathing when I got her to the ER, and we obviously don't want to cut it that close again.

She is in a bad way again, and we are doing everything we can (including her doctor). If we have to take her to the ER, I don't think I can be with her, can I? Arizona is "code red," with reportedly 92% ICU capacity. She would almost rather take her chances at home than risk being admitted and not see any of us indefinitely.

Is that generally correct, that people are basically on their own right now when admitted into a hospital (no visitors or advocates)? This is a big concern for us. 

My heart goes out to you.  I am sorry to hear about your wife.  It is a terribly unfortunate time to be admitted to the ICU pretty much for anywhere right now.  To be honest, I am not sure about visitors in non-Covid units.   I know that they won't be allowed in Covid units for obvious reasons, but I could also understand why visitors might be restricted from non-Covid units as well.  The last thing you want to catch in an ICU in that serious of condition is Covid.  That could be devastating.  I understand the fears and concerns of not being with family in the hospital, but if transfusion or something else major is needed, please don't take your chances at home.  I also don't know about visitors in the ER.  They very well may be allowed if it is just an ER visit.  You can still advocate for her over the phone.  With technology today, you can almost be in the room with her for advocacy purposes.  She can discuss all recommended procedures with you in advance.   Most hospitals actually have professional patient advocates (sometimes called patient navigators) who are nurses, social workers, or chaplains, etc. that you can utilize as well. 

[The Nehor]

Hey guys, I was just thinking about what I was up to last year in the Fall and remembered this story. I was walking around and I found something odd, a weirdly preserved monkey’s paw. I started thinking about how things in the world could be better.

“Ninjas are neat. I want to wear a ninja mask in public but that would weird people out. I wish that could be normal.”

”Work has been exhausting and my commute horrible. I wish I could work from home more and have more spare time.”

“This Universal Basic Income thing sounds weird. I wish we could have a brief trial run on it before we consider it seriously.”

“Church leadership meetings can be such a pain having to dress up and go to the building. I wish we could hold them all virtually so I don’t have to get out of bed for them.”

”I got the flu vaccine but so many do not take it seriously. I wish we could have a national awakening about the threat of infectious diseases.”

Anyways I looked down and saw that all the fingers on the paw had curled inwards and thought that was odd. I decided it was weird to carry it around so I threw it away. Not sure why I felt the need to share this story.

Edited December 22, 2020 by The Nehor

[Calm]

I have always hated that story. Creeped me out as a kid. Still does. 

[pogi]

9 minutes ago, Calm said:

I have always hated that story. Creeped me out as a kid. Still does. 

That's why I like it  

[Calm]

3 minutes ago, pogi said:

That's why I like it  

I have never understood being creeped out for entertainment.