I do wish we had at least one person on this board who was a nurse/doctor.

A FB friend who I grew up with is a nurse, and is posting helpful information about what nurses are learning with treatment methods.

I just can’t understand MANY of the abbreviations.

A co-worker of mine said that wheezing is a classic sign of walking pneumonia. He told me that when I had my cough, but I never had any wheezing. The cure is a steroid shot, apparently.

I was going to go to the doctor, but my primary care physician was a week to get in and said don’t come if you have Corona. I never went and have largely recovered.

No doctor has said this.

Weird, I see Dolphin looking in my asshole

No doctor has said this.

I have read that their are two mutations right now, one called "S" and one called "L". As far as one being more lethal than the other, that's something I have not heard.

I believe the "L" strain is lethal, and the "S" strain is just sort of lethal.

Karma says I definitely get it.

From the Trenches…(3/23/2020) - …I am a Pulmonary(Lungs)/Critical Care Physician (Intensivist) Physician – Yes, still calm and staying calm folks! This is not the Rapture or Armageddon. Ragnarök is not upon us…But this is serious...Lots to go over since my last update on 3/19… I am humbled and grateful to know so many have found these updates helpful and shared. Quite a few people have contacted me and I reply as I am able. I work with some of the best fellow Docs, midlevels, nurses, respiratory therapists and clinical pharmacists in the country and the support we have had for each other and from our hospital leadership has been exceptional. We are living in historic times without precedent certainly…

CHANGE will be the name of this game for the coming weeks. Our knowledge and how we respond and adapt is changing and fast! As we learn more we are applying it with dizzying speed. Once thing that has not changed is my advice on avoiding mainstream media, news outlets, and Facebook medicine. Still not getting it right. Still sensationalistic and putting spins politically and otherwise on this that are not helpful or productive. I have avoided all of them and focused on how I can help my family, friends, and patients.

TESTING & Rates of infection/statistics – As noted, we are TESTING a lot more, so the rate and cases of infection will appear to skyrocket. This is expected. The cases were there, but we weren’t able to test as quickly or at all until just about 2-3 weeks ago. We are now hearing we will have some areas getting the nasal swab PCR test (it is a test where a swab like a Q-tip is put in the back of the nose and pics up viral particles and then we test for the viral RNA with it) is getting resulted in 24-48hr. Some centers will have results in 2-12 hours within 2-3 weeks. This may not seem like much, but never in the history of medicine have we made a test so refined and rapid. This is truly the work of many great minds and built on our prior experiences (H1N1, Sars-CoV, MERs, Ebola). We learn and grow each time we have an outbreak and this is no different. I still maintain that not everyone needs to be tested. If you are home and feel well, do not come out to get tested. Use telephone and virtual visits with your care team whenever you can. Most offices will be closed or selective in who they will see for a few weeks. Equally, most hospitals should have stopped elective surgeries at this point (we need the bed capacity in hospital for COVID patients if there is a surge). I think conscientious hospitals and health systems are launching pathways for their patients to interact with this Docs and care team already, or at least should be well in the planning for this.

Don’t watch the news tickers who show you selected cases (of which you don’t know the real background) or the overall numbers going up like a telethon donation board. It is going to happen. What not to do is manipulate the number to downplay the spread rate. Some have quoted the population of a state or the US and the cases and show it as a relatively low number. Misleading for reasons above. Additionally, this virus spreads much more rapidly than other strains of say, influenza (H1N1) that we have seen in the past. We also may have partial immunity to them, where we do not to COVID 19, which is why it spreads quickly.

PLEASE adhere to SOCIAL DISTANCING and STAY IN PLACE orders from your state and local governments. What states like NY, NJ, CT, and others have done in recent days is the hard thing, but the right thing. What we need is to be sure the virus spread is slow enough so that we have capacity to treat patients who need the hospital. 80-85% who get this will have mild symptoms like a cold….the other 15-20% will have more serious symptoms and have pneumonia. Pneumonia is when the lungs become inflamed and infected from the virus. This causes the patient to be short of breath and have need sometimes for oxygen and to be in the hospital. A smaller percentage of the patients who need the hospital will need to be in the ICU because they need higher levels of support with machines to breathe or medicines to support blood pressure due to shock. As we only have a limited number of ICU beds and resources like ventilators, we need to ensure we don’t get overwhelmed with patients in a short span of time (this is what happened in Italy in areas). Some cities are at risk for this due to density of population (NYC, for example). I have communicated with critical care Docs in NYC, Philly, Washington state, NJ. What all have said is that we are rapidly using up ICU beds and supplies for COVID patients who are very ill. This is not a media thing or a political thing. It is real and already here in some of those cities. If we don’t lay low, it will happen all over. We need to slow this down.

More cases do not mean the virus is more deadly, as most people who have it will get better (please emphasize this…the news reports don’t seem to). However the math is still the same. If we have 50,000,000 cases (reasonable estimate given our population of over 300 million – and remember there are cases going on that we have not detected because they had it and got better and not tested) and 10% need to come to the hospital, that is 5,000,000 hospital admissions. This is on top of other disease that bring people to the hospital that will not hit the pause button. People still have heart attacks, strokes, other kinds of lung problems, appendicitis, etc. Even IF the mortality rate from COVID 19 is 0.5%, that is still 250,000 dead from this. PLEASE listen and take it on as a personal responsibility to stay put at home. Most hospitals have now eliminated or cut back severely on visitors. I know this can be distressing if you have a loved one admitted to a hospital. We want to protect them and the people taking care of them. Each hospital sets its own policy on this. Call the hospital if you aren’t sure.

AVOID – There has been some controversy on the data from France about avoiding NSAIDs which I commented on in my last post. I still think there is enough of a concern there to AVOID NSAIDs. I am not going to take them and neither is my family. I think we don’t have enough evidence to say convincingly they are safe in COVID 19…yet…that may change in the coming weeks. For now I am sticking with acetaminophen (Tylenol). If you look at European news reports they use the term paracetamol which is the cousin of acetaminophen that they use there.

Steroids (oral pill and inhaled) should be minimized if possible for now. Here as well we have some conflicting data on how this type of immune suppressing medication can affect the severity of disease. We just don’t have enough info yet to say it is safe or not definitively. But we are seeing more areas of study into this and I am sure better data will come forward in a few weeks.

What about ACE-INHIBITORS and ARBs (two classes of drugs used for high blood pressure and heart/kidney disease). As of now, if you are well and do not have COVID-19, the major societies say stay on them (stopping abruptly could put you into heart failure or cause heart attack or stroke). We don’t want to prevent one thing and cause another problem. If you are positive for COVID-19, talk to your Primary Doc or Cardiologist/Nephrologist and decide the risk vs benefits of staying on them.

AVOID going to routine office visits – if your clinician/dentist/therapist is even still open. I have heard of some offices still being open, including chiropractors and some primary care offices. This is unwise and would be a prime way to spread infection (close contact in close spaces – you can spread virus even if you have no symptoms). Use the phone or their virtual/tele services instead.

TREATMENT – In the last week we have some evidence published that shows two old antimalarial drugs, chloroquine and hydroxychloroquine (AKA Plaquenil) have antiviral effects against COVID 19. Both have been shown to affect viral entry and replication in the cells. More info is being collected, but we have begun to use these at sites in sicker patients. They come with potential side effects which include changes in your heart’s electrical conduction which can be severe in some people. Another antibiotic, azithromycin, was tried with these in a very small group of patients in France and the response was good, but we need a bigger sample size to see if this is a real effect or just chance. That is underway. Additionally, this drug also changes the electrical conduction in the heart potentially and along with either of the antimalarial drugs, that could be severe or life threatening. So, it is not perfect and not for everyone. Other centers are looking into using the antibodies from people who have beat the virus and want to see if those will help someone who is sicker get well. This is a concept used in other disease states and it may bear fruit… CHANGE to this will undoubtedly occur in the coming weeks as we learn more from scientists and physicians all over the world.

VACCINE – All over the world, companies are working on vaccines. Some have already started trials on healthy human volunteers. This will take a little time, but compared with prior vaccine developments which take years, this is going to be more likely months. Part of it is the way they are being developed is different than the flu vaccine method. Part of it is because we have more sophisticated technology now to isolate, genotype, detect antibodies to, and classify these viruses.

AMERICAN WILLPOWER – Despite all of the changes in the last week there are some great, uplifting stories. 3M is retooling their factories to mass produce the protective masks that we need on the front line. Small businesses (despite the enormous financial losses they are under) have been donating supplies to local hospitals and finding new ways to interact with customers. Distilleries have converted their process to making alcohol for hand sanitizer. These stories will continue to grow and are examples of what the American spirit is all about….we are from many backgrounds coming together for a goal to support our fellow men and women, and overcome this unprecedented outbreak…and we will! Support your local businesses any way you can. Equally, support your local health care teams, whether thru prayer, donated items, or just doing what most should be…staying safe and at home the next few weeks!

Let's pray/hope none of use have the flu when we do get it.

AMERICAN WILLPOWER – Despite all of the changes in the last week there are some great, uplifting stories. 3M is retooling their factories to mass produce the protective masks that we need on the front line. Small businesses (despite the enormous financial losses they are under) have been donating supplies to local hospitals and finding new ways to interact with customers. Distilleries have converted their process to making alcohol for hand sanitizer. These stories will continue to grow and are examples of what the American spirit is all about….we are from many backgrounds coming together for a goal to support our fellow men and women, and overcome this unprecedented outbreak…and we will! Support your local businesses any way you can. Equally, support your local health care teams, whether thru prayer, donated items, or just doing what most should be…staying safe and at home the next few weeks!

More cases do not mean the virus is more deadly, as most people who have it will get better (please emphasize this…the news reports don’t seem to).

It's more fun to be a victim

There will never be an effective vaccine. I'll never get one anyway.

I'm not 100% sure of this because I was only half-ass paying attention, but I think someone asked Dr. Fauci about that at one of the townhalls and he said that it was very unlikely you could have both at once.

After getting over the flu, I imagine that your lungs aren't in great shape.

Weird, I see Dolphin looking in my asshole

Thats good stuff, Jet. Seems to paint an accurately serious picture, yet not an end of the world picture.

A million percent yes. You almost NEVER see the number of recoveries on the news or on the ticker at the bottom of the screen. You also don't see a breakdown of critical/serious cases vs 'people who have a cold and can recover at home'.

Think of the disdain you will have for people with a bad cough in June.

Weird, I see Dolphin looking in my asshole

YES!!!!!!

I am not a legal expert, how many times do I have to say it?

This is a big problem and something that people like Lori Lightfoot aren't thinking about at all. We're going to need to work together to climb out of this mess. And it will be awfully difficult to do that if everyone is primarily concerned with whether other people are going to give them the virus.

Our hotel smelled like dead hooker vagina (before you ask I had gotten a detailed description from beardown)

The victims are the American People and the Republic itself.

Weird, I see Dolphin looking in my asshole

I had something pretty bad a few weeks back. I recall Jorr and CH (I think) saying they felt sick too.

The future holds the possibility to be great or terrible, and since it has not yet occurred it remains simultaneously both.

How is it even possible that we can take the test and possibly have to wait up to a week for the results, whereas in intelligent nations they test in greater numbers and have accurate information in 24-48 hours?

And now they're saying that trump was warned about this before Christmas.

How is it even possible that we can take the test and possibly have to wait up to a week for the results, whereas in intelligent nations they test in greater numbers and have accurate information in 24-48 hours?

And now they're saying that trump was warned about this before Christmas.