A thread for medical professionals

I haven't left my house on 2 weeks

Of course I'm dosing inside

Scary times, no doubt. 

 

if people are too fucking stupid than let the plague thin the heard. If they require a person who hasn’t practiced medicine outside of someone’s observation to tell them to enact their agency then the human race is getting what they deserve. Further more, fuck a bat and you get what you deserve. 

No, they have been fear mongering and spreading propaganda from their political echo chamber while castigating anyone who says otherwise.  Same with a few others on here.  I’ve been all for taking it seriously, but at the same time it not the Black Plague.

I'll preface this by stating that if any physician or other medical professional has information they feel is more accurate, please share. I'm going with what I'm reading as most up to date.

As with any viral illness, treatment is mainly supportive. Rest and fluids are mainstays, like you mentioned.

Fever: there were some reports about NSAIDs (ibuprofen, naproxen, etc.) potentially worsening symptoms. These have been anecdotal. There have not been any specific data to support this, and the current recommendations are still to use NSAIDs if needed. As a personal choice I typically go to acetaminophen first, but that was my practice pattern before this virus hit.

Steroids (prednisone, dexamethasone, et al.): this is interesting. The current recommendation is that steroids actually NOT be used, unless there is another indication. The other indications mainly being asthma and COPD/chronic bronchitis/emphysema flare ups. The reasoning for this is that it has been associated with a delay in clearance of the virus in MERS, another coronavirus. It has also been associated with an increased mortality rate in patient's with influenza.

Oxygen: typically not needed unless oxygen saturation levels are dropping to unsafe levels, in which case you should go to the hospital.

Albuterol/ipratropium breathing treatments: another interesting topic. In the hospital setting we are being very careful with nebulized solutions. While there are benefits to nebulized treatments, the problem is that the droplets that spread the virus can be aerosolized by the nebulizer, making it easier to spread. An inhaler can lessen this risk. As with steroids above, I would say that nebulizers should be mainly reserved for those who already use them, like in asthma and COPD.

In patients who are admitted with pneumonia, or in patients who have invasive surgery, we will give them an incentive spirometer. While rest is important, it is also critical to keep your lungs functioning so that they do not decondition. Having an incentive spirometer, doing breathing exercises, or getting up to move around is crucial to prevent a potentially bad problem from becoming worse.

Mental health: take care of your body, but don't forget to take care of your mind! While social distancing is important, don't forget to reach out and talk with people you care about. As with any medical condition, having a support structure around you is vital. Don't fight the battle alone.

I hope this helps! If recommendations change I will try to update you.

Keep your heads up, everyone! This is going to be a tough fight, but we will get through it.

There’s no good treatment for the flu.tamiflu as you know is only legit if You take it hours following infection. So how can you suggest that 2020 is being shut down until a therapeutic option or vaccine is available 

What year did you graduate in micro? We might’ve been classmates! I was in 03, then MPH in hospital and molecular epidemiology before med school, (now peds onc).

Thanks for the ED work that you’re sure to be doing currently.  I know in my system, they’re looking for volunteers before instituting a draft to chip in at the ER or ICU (though oncologists aren’t included given our patient pop).  

The only thing I’d modify, as a data scientist, is that there is no medical reason to test everybody if it isn’t going to change treatment. However, from a public policy perspective, having increased, randomized testing, better transparency around daily COVID hospital and ICU admissions, etc. would make it easier for us to:

• Predict the curve and set public policy around isolation/shelter-in-place
• Optimize allocation of existing PPE to the geographies that need it most
• Plan and produce additional PPE based on actual needs

The reality is the testing data is incredibly flawed right now (not enough, biased towards the most sick) which makes this thing tough to model.  We need to prioritize those who it will effect treatment in the short term, but hoping as tests and PPE ramps up we can expand things a little bit.

As someone with a background in data science and forecasting methods, I can offer a few possible explanations. From media reports, and what I've read from reputable sources (I consider the MGoDocs on this board to be among them - it's pretty easy to see who knows what they're talking about and who doesn't), there is a high likelihood that the virus circulated for a number of weeks before the first, symptomatic patients began to present at area hospitals and other HC providers in early March.

Using that as an assumption, I looked at the U-Dub Virology dashboard and compared peaks in performed tests against the peaks in Health Weather data for King County, WA (Seattle and surrounding communities). Given the rate of assumed Influenza-Like Illness (ILI) in the County, it's easy to estimate the number of people who might be sick, and how many new cases are added daily. The unknown is the % of people with Covid-19 versus all causes. 

Even with that caveat though, the only practical difference lies in the number of infections. There are multiple, top-down and bottom-up estimations one can do (I have done them for Oakland County) to try to determine why the number of positive patients is what it is, and the implications for the % of population who have the disease and either : a) aren't being tested, b) have it and don't know it, or c) both.

The only way the math works is if there are orders of magnitude more infections in the general population than what are currently being confirmed (even given the lack of testing, for which I have tried to build in factors in my models). Either that, or this bug is way less transmissible than believed. If it's the former, and the rate of hospitalization was even close to what is estimated, (30%-ish), the number of dead in Oakland County alone would already be well north of 1,000. 

That realization comes as a double-edged sword. Due to the lockdown, the number of cases per day in most of Michigan should peak in the 10-14 day time frame (the UW test data lags peaks and valleys in Health Weather estimates by that number of days). Oakland County hit peak ILI on Mar 16. This conclusion is also supported by the understanding that infected people do not become symptomatic for up to 14 days. 

My main concern with the Health Weather data is that their smart thermometer are $40, and so poor cities like Detroit are vastly underrepresented. I fear that the human toll in lives lost will be more than any of us will be able to bear.