COVID-19

[BicepsTriceps]

Can we start a COVID-19 discussion?

There is one case at my hospital so far.

He got sick initially with a prodrome of cough, malaise... presented two weeks later to ED with severe respiratory symptoms. Got admitted, bilateral infiltrates more in the peripheries. WBC normal with lymphopenia. Flu, RSV and general viral panel negative. Tested two days after admission for COVID-19 which came back positive. Community infection with no travel or sick contact. His hypoxia escalated quickly, failed high flow oxygen after two days and got intubated. Still intubated with a very bad ARDS, almost a week now but he did improve slightly, off paralytics and better oxygenation. Getting Remdesivir was a huge challenge and it was started 2-3 days after intubation despite it being requested the moment of diagnosis. Did it help? who knows.
The patient has a pre-existing lung disease and couple other co-morbidites as well but over all was very functional and healthy in the community.

I'm sorry for omitting many details cause this is still a grey HIPAA area since not many cases yet and patients can be identified if given too many details.

Other experiences?

Let's make this a learning opportunity since we probably will see dozens of cases in the near future!

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[leviathan]

Funny that I logged in to see if there was any discussion and you posted this literally 3 minutes ago. No cases at all (community spread or otherwise) where I work but I just saw a patient today with diffuse bilateral groundglass opacities, upper lobe predominant, who has been feeling sick for 2 weeks, Flu/RSV negative, WBC of only 12, and is now on high flow nasal O2 despite 5 days of appropriate antimicrobial coverage for community acquired pneumonia. CRP has gone from 60 up to 200. Her nurse asked if it could be coronavirus and I said no. I'm thinking more likely BOOP/AIP or maybe vasculitis (renal function has been also dropping) or something else, but I guess you never know.

 

[jdh71]

Great thread. I hope we don’t see cases like Italy has had to see cases - drinking from a firehose. There aren’t enough hospital, let alone ICU beds. Good luck to us all. I do hope the curve flattens. We won’t know until we look back. I think our experience by the end of this will be hundreds of cases.

I am disappointed we can’t get more details on the specifics of cases, especially in the US. I think it’s important for us to know.

I will post my experience when it occurs.

 

[leviathan]

I heard second-hand that the deaths in Florida were in relatively healthy 60-ish patients, husband and wife.

 

[BicepsTriceps]

Funny that I logged in to see if there was any discussion and you posted this literally 3 minutes ago. No cases at all (community spread or otherwise) where I work but I just saw a patient today with diffuse bilateral groundglass opacities, upper lobe predominant, who has been feeling sick for 2 weeks, Flu/RSV negative, WBC of only 12, and is now on high flow nasal O2 despite 5 days of appropriate antimicrobial coverage for community acquired pneumonia. CRP has gone from 60 up to 200. Her nurse asked if it could be coronavirus and I said no. I'm thinking more likely BOOP/AIP or maybe vasculitis (renal function has been also dropping) or something else, but I guess you never know.

I'd definitely test this patient to be on the safe side.

 

[jdh71]

Funny that I logged in to see if there was any discussion and you posted this literally 3 minutes ago. No cases at all (community spread or otherwise) where I work but I just saw a patient today with diffuse bilateral groundglass opacities, upper lobe predominant, who has been feeling sick for 2 weeks, Flu/RSV negative, WBC of only 12, and is now on high flow nasal O2 despite 5 days of appropriate antimicrobial coverage for community acquired pneumonia. CRP has gone from 60 up to 200. Her nurse asked if it could be coronavirus and I said no. I'm thinking more likely BOOP/AIP or maybe vasculitis (renal function has been also dropping) or something else, but I guess you never know.

agree get them tested - too many “random” infections these days

 

[DrMetal]

Getting Remdesivir was a huge challenge

In what sense? Not on your formulary, or pharmacy didn't want to release it?

 

[BicepsTriceps]

In what sense? Not on your formulary, or pharmacy didn't want to release it?

The amount of paper work that had to be done and legal hoops you had to jump through to get it sent to your hospital.
Push back from Gilead for no obvious or clear reason even after all of that.
Our ID physician spent hours everyday doing this in addition to tons of phone calls to get it delivered.

 

[jdh71]

In what sense? Not on your formulary, or pharmacy didn't want to release it?

It's only for compassionate use. I remember doing the paper work for "IV Tamiflu" back in residency during H1N1. Takes some hoops and a few days. Might not be soon enough, ya know? Maybe . . . just maybe . . . IF sooner? That's what you wonder in those situations. The kid lived anyway. So who knows.

 

[DrMetal]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

 

[jdh71]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

the data from China notes that steroids do not help and they haven’t been recommended UNLESS you think you are ALSO treating an asthma/COPD exacerbation

the experience in Italy notes lots of presser use and acute renal failure

 

[leviathan]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

I think it's similar to influenza where there's some weak evidence it may cause harm.
Interestingly has anyone read the DEXA-ARDS trial that showed a mortality benefit in ARDS?

 

[BicepsTriceps]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

We're treating an ARDS so fluid limited as much as possible and the patient kept dry.

No steroids used.

 

[chessknt]

We stand at 4 confirmed cases, 2 critically ill ards (moderate and haven't needed proning yet) . This is probably because our testing capacity is so strangled and slow that we can't diagnose anyone.

Our hospital, despite being well resourced, seems to have no plans in place for multiple contingencies that are being discovered on a daily basis (eg transfer of ahrf pt with comorbidities, no workup done to rule out viral conditions and could be covid by ct and we have no icu negative pressure isolation beds).

A lot of fear and hoarding in our community and very poor messaging from leadership regarding changing our isolation procedures as the potential cases exceed our capacity for negative pressure rooms and expanding data indicates droplets are probably fine.

Everyone in charge is reacting at a glacial beurocratic pace and we have single individuals assigned duties like approving covid testing in all outpt/inpt operations or coordinating isolation beds who just ceased functioning after being inundated with requests toward the end of the week foxing us to find work-around to get basic clinical work done.

The end of next week will be quite different from today I imagine...

 

[deleted547339]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

Im too lazy to look it up right now, but the Maryland CC project said that steroids increase mortality significantly.

 

[Hernandez]

A lot of fear and hoarding in our community and very poor messaging from leadership regarding changing our isolation procedures as the potential cases exceed our capacity for negative pressure rooms and expanding data indicates droplets are probably fine.
...

 

[chessknt]

View attachment 298499

Yep we tried to point to these guidelines but policy from the overlords remains all cases get airborne precautions even if ambulatory not on oxygen.

 

[lymphocyte]

Do steroids help at all? Any of the 'surviving sepsis' techniques, IV steroids ? I guess too early to tell.

the data from China notes that steroids do not help and they haven’t been recommended UNLESS you think you are ALSO treating an asthma/COPD exacerbation

the experience in Italy notes lots of presser use and acute renal failure

Consensus view is not to give steroids for COVID. There's likely increased viral shedding from past experience with MERS, and there's some signals of harm based on the Chinese data.

Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020 Feb 6; S0140-6736(20)30305-6.

 

[jdh71]

Consensus view is not to give steroids for COVID. There's likely increased viral shedding from past experience with MERS, and there's some signals of harm based on the Chinese data.

Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020 Feb 6; S0140-6736(20)30305-6.

correct. use in usual care during this illness, but if you are ALSO dealing with significant bronchospastic physiology from an asthmatic or COPD patient with this illness, you will need to the steroids - nothing is perfect in medicine - if you can't ventilate *first* especially with the low tidal volumes you will be using AND the patient isn't an ECMO candidate . . . I guess you can just transition to comfort care, or perhaps try some steroids - bedside risk vs benefit analysis is always going to be hard, but it is what we are tasked with doing

 

[DrMetal]

I had a patient in clinic actually ask me an intelligent question, stated "I've had my full schedule of immunization, in accordance with everything the CDC has ever recommended (all childhood shots, HPV, MCV, etc etc), and I've had the flu shot yearly for the last 20 years (in the military, you have to). Does any of that protect against new viral infections such as COVID?"

I told him No, not necessarily. That you have a lot of IgG floating around from your immunizations may help, maybe there's some cross reactivity, but how much it help (if at all) is unclear.

Am I right there? Thoughts? I guess its too early to tell if compliance with other immunizations has an impact on covid.

 

[lymphocyte]

We stand at 4 confirmed cases, 2 critically ill ards (moderate and haven't needed proning yet) . This is probably because our testing capacity is so strangled and slow that we can't diagnose anyone.

Our hospital, despite being well resourced, seems to have no plans in place for multiple contingencies that are being discovered on a daily basis (eg transfer of ahrf pt with comorbidities, no workup done to rule out viral conditions and could be covid by ct and we have no icu negative pressure isolation beds).

A lot of fear and hoarding in our community and very poor messaging from leadership regarding changing our isolation procedures as the potential cases exceed our capacity for negative pressure rooms and expanding data indicates droplets are probably fine.

Everyone in charge is reacting at a glacial beurocratic pace and we have single individuals assigned duties like approving covid testing in all outpt/inpt operations or coordinating isolation beds who just ceased functioning after being inundated with requests toward the end of the week foxing us to find work-around to get basic clinical work done.

The end of next week will be quite different from today I imagine...

Thank you for positing this and sharing your experience.

There's some excited talk in our part of the world about chloroquine, which may also be making its way into the Chinese COVID Treatment Protocol. There are 16 registered trials underway with no interim data yet. Just curious if you're trialling any unique or novel strategies at this stage.

Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020). https://doi.org/10.1038/s41422-020-0282-0

 

[chessknt]

Thank you for positing this and sharing your experience.

There's some excited talk in our part of the world about chloroquine, which may also be making its way into the Chinese COVID Treatment Protocol. There are 16 registered trials underway with no interim data yet. Just curious if you're trialling any unique or novel strategies at this stage.

Wang, M., Cao, R., Zhang, L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 30, 269–271 (2020). https://doi.org/10.1038/s41422-020-0282-0

Plaquenil has been floated but so far just remdesevir for now (compassionate use)

 

[DrMetal]

Plaquenil has been floated but so far just remdesevir for now (compassionate use)

At least Plaquenil is something most pharmacies have, could argue for its use off-label, or as an immunosuppressive?

 

[MoMoGesiologist]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

 

[deleted547339]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

It sounds nuts, but so did a lot of things we do routinely now.

 

[jdh71]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

I had not thought about that. Most people won't tolerate being on their bellies for long though. Might be better to simply have them sitting in a chair.

At some point these worries about aerosolization will be tossed out the window I think. I mean they are real. It just won't matter. We'll have close wards where everyone in there has COVID19 and might as well use the NIV and HF.

 

[lifeisamystery]

Can we start a COVID-19 discussion?

There is one case at my hospital so far.

He got sick initially with a prodrome of cough, malaise... presented two weeks later to ED with severe respiratory symptoms. Got admitted, bilateral infiltrates more in the peripheries. WBC normal with lymphopenia. Flu, RSV and general viral panel negative. Tested two days after admission for COVID-19 which came back positive. Community infection with no travel or sick contact. His hypoxia escalated quickly, failed high flow oxygen after two days and got intubated. Still intubated with a very bad ARDS, almost a week now but he did improve slightly, off paralytics and better oxygenation. Getting Remdesivir was a huge challenge and it was started 2-3 days after intubation despite it being requested the moment of diagnosis. Did it help? who knows.
The patient has a pre-existing lung disease and couple other co-morbidites as well but over all was very functional and healthy in the community.

I'm sorry for omitting many details cause this is still a grey HIPAA area since not many cases yet and patients can be identified if given too many details.

Other experiences?

Let's make this a learning opportunity since we probably will see dozens of cases in the near future!

Please everyone begin by providing age, sex, weight, and so on, before providing detailed patient history. Gives us a better idea of what to expect.

 

[jdh71]

Please everyone begin by providing age, sex, weight, and so on, before providing detailed patient history. Gives us a better idea of what to expect.

this was dropped in the anesthesia forum

Care for Critically Ill Patients With COVID-19

This JAMA Insights article reviews care for the most severely ill patients with coronavirus disease 2019 (COVID-19), including standards of management of ARDS, preventing SARS-CoV-2 spread in health care settings, and surge preparation.

jamanetwork.com

 

[jdh71]

Hm. @Lee

Sorry to tag you but maybe an entire forum dedicated to this COVID19 would be a good thing - and something much more easily searchable on "google" (or similar) that allows physicians to trade experience and advice with this?

Tagging a few mods from critical care and anesthesia as well @Arch Guillotti @group_theory

 

[deleted171991]

the data from China notes that steroids do not help and they haven’t been recommended UNLESS you think you are ALSO treating an asthma/COPD exacerbation

the experience in Italy notes lots of presser use and acute renal failure

I distinctly remember that steroids are a killer in Covid. Even the usual inhaled steroids COPD patients are chronically on.

 

[SurfingDoctor]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

We do it in pediatrics not infrequently, but the patients are generally easier to rotate...

 

[deleted171991]

In what sense? Not on your formulary, or pharmacy didn't want to release it?

As far as I know, it's not FDA-approved. It's still just a trial.

 

[deleted171991]

I had a patient in clinic actually ask me an intelligent question, stated "I've had my full schedule of immunization, in accordance with everything the CDC has ever recommended (all childhood shots, HPV, MCV, etc etc), and I've had the flu shot yearly for the last 20 years (in the military, you have to). Does any of that protect against new viral infections such as COVID?"

I told him No, not necessarily. That you have a lot of IgG floating around from your immunizations may help, maybe there's some cross reactivity, but how much it help (if at all) is unclear.

Am I right there? Thoughts? I guess its too early to tell if compliance with other immunizations has an impact on covid.

The answer is a clear No. We don't vaccinate against anything even remotely-related to Covid.

 

[SurfingDoctor]

‎Pediatrica intensiva: Italian COVID19 experience on Apple Podcasts

Experience of two ICU physicians out of Italy. Sorry there is a slight pediatric slant, but considering they turned the whole hospital into an isolation unit...

I mean, they have infectious disease physicians managing non-invasive ventilation due to staffing.

 

[deleted171991]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

They are correct. No NIPPV for these patients. HFNC is debatable. On the other hand, these patients aerosolize by definition when they cough, and we don't have enough ventilators, so why rush to intubate?

I would definitely allow minimally-sedated (think fentanyl) intubated patients to sit in the bed (make it into a chair), or whatever position they find easier, no-brainer with NC. (One of my memories from fellowship is being called to approve intubation for this 300 lb guy, that 3 nurses were keeping down, while all he wanted and needed was to sit up on the side of the bed.)

 

[deleted171991]

For those of us relatively new to Covid:

Management of COVID-19 patients admitted to stepdown or ICU

CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib...

emcrit.org

 

[lifeisamystery]

this was dropped in the anesthesia forum

Care for Critically Ill Patients With COVID-19

This JAMA Insights article reviews care for the most severely ill patients with coronavirus disease 2019 (COVID-19), including standards of management of ARDS, preventing SARS-CoV-2 spread in health care settings, and surge preparation.

jamanetwork.com

Thank you

 

[jdh71]

I distinctly remember that steroids are a killer in Covid. Even the usual inhaled steroids COPD patients are chronically on.

again it seems to be unhelpful to potentially detrimental in all comers but those who will have significant associated bronchoconstriction that isn’t responding to just bronchodilators will need some steroids - you will need to ventilate and you can only push permissive hypercapnia so far in ARDS vent settings especially if you throw in something that will make the hypercapnia worse. I suppose if you have an ECMO candidate for that route but otherwise I’d try steroids or just transition to comfort. I’m not suggesting boat loads either. My usual daily exacerbation dose is 40mg and that is what I will use in that instance if I think it’s called for.

 

[deleted171991]

again it seems to be unhelpful to potentially detrimental in all comers but those who will have significant associated bronchoconstriction that isn’t responding to just bronchodilators will need some steroids - you will need to ventilate and you can only push permissive hypercapnia so far in ARDS vent settings especially if you throw in something that will make the hypercapnia worse. I suppose if you have an ECMO candidate for that route but otherwise I’d try steroids or just transition to comfort. I’m not suggesting boat loads either. My usual daily exacerbation dose is 40mg and that is what I will use in that instance if I think it’s called for.

I'll tell you when I cross that bridge. But for me, right now, it's a last resort medication (as much as I know how effective it is in COPD exacerbations). This is an aggressive viral pneumonia/ARDS.

 

[jdh71]

I'll tell you when I cross that bridge. But for me, right now, it's a last resort medication (as much as I know how effective it is in COPD exacerbations). This is an aggressive viral pneumonia/ARDS.

and pneumonia (of all varieties), especially the viral variety, tends to exacerbate both underlying copd and especially asthma. To try it last ditch wouldn’t make a lot of sense. Either don’t use at all or start early in the course if you think you have significant bronchoconstriction not responding to dilators and probably magnesium and ketamine. You can’t exactly use your normal bad asthma vent settings in ARDS. It’s definitely rock and hard place physiology and clinic decisions. I’ve not seen any data though that this specifically exacerbates asthma horribly. Though we may see more of that with our obese population.

 

[grt398]

For the awake proning question...obviously not standard, but Farkas did a post on it a few years back which is linked in the COVID-19 above. See here:

PulmCrit Wee- Proning the non-intubated patient

From the pulmonary standpoint, supine positioning may be the worst possible position. Supine positioning may promote aspiration, as gravity tends to pull oral secretions towards the larynx. Supine positioning promotes atelectasis of the posterior lung segments (which are larger and more...

emcrit.org

Kind of interesting, but only 1 retrospective case series of 15 pts.

Edit: Also, for those interested, medRXiv is a great place to look for things coming out. It's the medical equivalent of the science rxiv. So to be clear, everything that is posted is not yet peer reviewed, but an initial draft. But it lets you get a sense of where things are going and what people are doing. And you can download the pdf's free. For example, three that were posted recently and might be of interest:

Clinical characteristics of 101 non-surviving hospitalized patients with COVID-19: A single center, retrospective study

Clinical characteristics of 101 non-surviving hospitalized patients with COVID-19—A single center, retrospective study

Rationale COVID-19 have deprived many lives in Wuhan, China and caused global concerns. Few studies focused on clinical characteristics non-survivors hospitalized with COVID-19. Objectives We aimed to clarify the clinical characteristics of died patients with COVID-19 and tracked the causes of...

www.medrxiv.org

Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis

Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis

Backgrounds Since December 2019, a novel coronavirus epidemic has emerged in Wuhan city, China and then rapidly spread to other areas. As of 20 Feb 2020, a total of 2,055 medical staff confirmed with coronavirus disease 2019 (COVID-19) caused by SARS-Cov-2 in China had been reported. We sought...

www.medrxiv.org

Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1

Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1

A novel human coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as HCoV-19 here) that emerged in Wuhan, China in late 2019 is now causing a pandemic[1][1]. Here, we analyze the aerosol and surface stability of HCoV-19 and compare it with SARS-CoV-1...

www.medrxiv.org

If you use the "Advanced Search", you can search by date too.

 

[deleted171991]

and pneumonia (of all varieties), especially the viral variety, tends to exacerbate both underlying copd and especially asthma. To try it last ditch wouldn’t make a lot of sense. Either don’t use at all or start early in the course if you think you have significant bronchoconstriction not responding to dilators and probably magnesium and ketamine. You can’t exactly use your normal bad asthma vent settings in ARDS. It’s definitely rock and hard place physiology and clinic decisions. I’ve not seen any data though that this specifically exacerbates asthma horribly. Though we may see more of that with our obese population.

Yes, sir!

Let's just say that I am more comfortable with ketamine, magnesium or epi drips than some medical intensivists. That's what I meant by last resort.

Plus I am a huge believer in first do no harm (especially in the ICU), and in iterative therapeutic trials. I distinctly remember the warning about steroids from the Chinese.

Again, this is all theoretical. These patients will probably test our knowledge of ARDS and respiratory (patho)physiology to the limit.

 

[jdh71]

Yes, sir!

Let's just say that I am more comfortable with ketamine, magnesium or epi drips than some medical intensivists. That's what I meant by last resort.

Plus I am a huge believer in first do no harm (especially in the ICU), and in iterative therapeutic trials. I distinctly remember the warning about steroids from the Chinese.

Again, this is all theoretical. These patients will probably test our knowledge of ARDS and respiratory (patho)physiology to the limit.

I hope and online database of clinical data is started that we all can view

 

[deleted171991]

COVID-19 Clinical Discussions with Dr. Marco Garrone & Dr. Peng Zhiyong. #FOAMed

COVID19 has made for a rough start to 2020 for humans. Now ramping up in Canada, we can only hope that lessons learnt in China and Italy by governments and medical teams can be applied in a timely …

thinkingcriticalcare.com

 

[deleted171991]

 

[chocomorsel]

It sounds nuts, but so did a lot of things we do routinely now.

Doesn’t sound nuts to me. Sounds much easier than proning intubated patients. At least they can shift themselves and not get pressure sores if awake.
How many people in the general public sleep on their abdomens?
Why does it sounds nuts?

 

[deleted171991]

Anybody proning awake, non intubated pts? Our hospital is requesting we not put these pts on NIV or HHF to reduce aerosolization. I’m thinking proning while on NC may improve oxygenation and may prevent or at least delay intubation. What do y’all think?

Apparently it's OK to use NIPPV, even BiPAP, in negative pressure rooms (per the Chinese intensivist in the interview above). Makes perfect sense, as long as medical personnel uses the proper PPE. With the proper PPE, medical personnel infection is the same, even without negative pressure (1%).

tl;dr: If you run out of ventilators, or you think you can avoid intubation and save a vent, consider BiPAP.

 

[chocomorsel]

I had not thought about that. Most people won't tolerate being on their bellies for long though. Might be better to simply have them sitting in a chair.

At some point these worries about aerosolization will be tossed out the window I think. I mean they are real. It just won't matter. We'll have close wards where everyone in there has COVID19 and might as well use the NIV and HF.

Hmm, most people won’t tolerate being on their bellies?
Oh, I forgot we are a nation full of rotund people. How could I forget.

 

[deleted171991]

Covid-19 Podcast from Italy with Roberto Cosentini. St Emlyn's

Dr Roberto Cosentini is an old friend of St Emlyn’s who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid-19 outbreak. He kindly […]

www.stemlynsblog.org

 

[Perrotfish]

I had a patient in clinic actually ask me an intelligent question, stated "I've had my full schedule of immunization, in accordance with everything the CDC has ever recommended (all childhood shots, HPV, MCV, etc etc), and I've had the flu shot yearly for the last 20 years (in the military, you have to). Does any of that protect against new viral infections such as COVID?"

I told him No, not necessarily. That you have a lot of IgG floating around from your immunizations may help, maybe there's some cross reactivity, but how much it help (if at all) is unclear.

Am I right there? Thoughts? I guess its too early to tell if compliance with other immunizations has an impact on covid.

Immunodepletion from recent flu infection is associated with a higher rate of subsequent infection with a dozen bacterial infections and with cardiac pathology, so the idea that immunedepletion from flu might leave someone more vulnerable to COVID isn't a bizarre idea. Its definitely not proven, though.