Coronavirus Tidbits #13 3/19/20

My new post @Forbes:

An Unexpected Loss Of Smell And Taste In Coronavirus Patients

https://www.forbes.com/sites/judystone/2020/03/20/theres-an-unexpected-loss-of-smell-and-taste-in-coronavirus-patients/#4a59103f5101

Epidemiology:

From Stanford ER: Of the 562 patients, 127 (22.6%) were positive for other viruses. (24.5% if we use 181+336 = 517 as denominator).

Of the 49 positive SARS-COV-2 results, 11 (22.4%) also had a co-infection. Of the 127 positive for other viruses, 11 (8.66%) had a SARS-COV-2 co-infection. These co-infection rate are much higher than previously reported rates.

Good explainer on incubation and infectious periods by Ian Mackay, Australian virologist

https://virologydownunder.com/politically-infectious-period/

Coronavirus is running so rampant in Colorado’s mountains residents, visitors should “minimize all contact with other people”

https://coloradosun.com/2020/03/15/coronavirus-colorado-mountains/

Our health department reports no cases…but refuses to say how many have been tested. https://www.times-news.com/coronavirus/health-department-no-confirmed-covid–cases-in-allegany-county/article_8da0f816-69e0-11ea-8403-ef41c28159a6.html

 

Health care workers:

In Italy 9% of all infections are among medical personnel. In Lombardy alone, 20% of providers were infected.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/fulltext

For medical staff:

As a MICU pharmacist taking care of COVID patients, one strategy I’ve implemented to minimize the number of times a nurse needs to enter the room (thus saving PPE) is to consolidate and bundle all medication due times. For example… 1/5

Most patients often receive medications no more than QID or every 6 hours (now this isn’t everyone but a lot of patients). So I’ve scheduled all medications to be given on one or more of the following: 0000, 0600, 1200, or 1800… 2/5

This will limit the need to enter the room for off time medications or to give that miralax dose that is due at 0900 etc. This will not apply to all patients but can be a starter. If the most frequently administered drug is given every 8 hours….. 3/5

Then cluster around those due times. If a patient is getting a medication every 4 hours. First ask if it is necessary or if it can be adjusted to less frequent administrations. If not then cluster around those time

Masks:

https://www.bloomberg.com/news/articles/2020-03-18/hospital-makes-face-masks-covid-19-shields-from-office-supplies

see also https://twitter.com/TahaMD_EM/status/1240498663409045504 paper towel masks

Some of the docs are taking their N-95s home and cleaning them w clorox…others making their own.

If you see any great innovations, please let me know.

~ ~ ~

Simple Respiratory Mask – Volume 12, Number 6—June 2006 – Emerging Infectious Diseases journal – CDC
https://wwwnc.cdc.gov/eid/article/12/6/05-1468_article

CDC is pathetic: HCP use of homemade masks:
In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

Drugs:

Chloroquine and Plaquenil (hydroxychloroquine)

The only sound way to do this is through clinical trials.  With the administration’s push for deregulation of everything (goodbye clean air and water!) the FDA “has also said it is temporarily halting inspections of drug plants in the U.S. and abroad.”

https://www.bloomberg.com/news/articles/2020-03-19/trump-touts-malaria-drug-as-potential-coronavirus-treatment

You can read about why we have an FDA in my section on Evolution of Drug Law and why clinical trials are important in my book, Conducting Clinical Research. I have made it free here http://conductingclinicalresearch.com/full_text.php

(or you could buy it if you want the whole deal about drug development; I did trials for 25 years)

See Politics, below, for Trump’s ill-informed press conference. Where’s Fauci?

Lopinavir-Ritonavir trial failure—no surprise, since in severely ill patients. More study needed. This was not a “fair” trial.

https://www.nytimes.com/2020/03/18/health/coronavirus-antiviral-drugs-fail.html?action=click&module=Top%20Stories&pgtype=Homepage

Ibuprofen
“There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19,” according to a statement posted on the agency’s website. “EMA is monitoring the situation closely and will review any new information that becomes available on this issue in the context of the pandemic.”

https://www.medpagetoday.com/infectiousdisease/covid19/85485

ACE and ARB blood pressure meds

Similarly, do not stop your blood pressure meds  because of one or another rumors. NO data

Drug Shortages:

A number of us have been writing for years about the outsourcing of drugs being a national security issue. We rely on the active ingredients for many drugs from China. Even w/o Coronavirus concerns, why would you want to have trade wars w someone who controls our access to vital medicines?

Scott Gottlieb has a good read today; particularly interesting is his section on Regeneron and antibody-based prophylactic

https://nationalinterest.org/feature/next-coronavirus-nightmare-theres-drug-shortage-horizon-134147?utm_source=The%20Bulwark%20Newsletter&utm_campaign=e575744de2-EMAIL_CAMPAIGN_2020_03_19_01_23&utm_medium=email&utm_term=0_f4bd64ac2e-e575744de2-70241113&page=0%2C1

Senate bill now: Section 4111: US National Academies asked to produce a report, within 60 days of passage, “on the security of the US medical product supply chain.” ’bout time.

News:

Helen Branswell: 9 days since @CDCgov had a #Covid19 briefing. That is an extraordinary length of time in a public health crisis like this. I cannot believe this is by choice. –

Perspective:

What it’s like to have a baby during the coronavirus pandemic – by Julia Belluz, a terrific journalist

https://www.vox.com/2020/3/18/21172874/coronavirus-pandemic-having-a-baby-pregnancy-hospitals

Practice careful infection control NOW before things get more out of hand.

This would be a good time to have Glo-Germ samples for everyone to practice. We (almost) all make mistakes. Here’s one I did last night, for you to have a laugh.

Dear Daughter is currently relatively isolated from us, having come from the Big City. While we have been keeping our distance, I’ve kept close company with my granddogs, who I need for psychological support now. I’ve been pretty good about handwashing (not as much about keeping hands from face) but slipped last night, when I instinctively bent down to give them a bedtime kiss. Oops.

Fomite 1 & Fomite 2

We now call the dogs Fomite 1 and Fomite 2 to remind me that I need to be more careful about handwashing and also to remind YOU that

Pets can carry infection, just like anything else. If someone in your family has Covid19, the pet should not be playing or snuggling with other family members. After playing w any animal, wash your hands!

 

Politics and Lies:

Emma Kinery @EmmaKinery

11:47: *TRUMP SAYS FDA HAS APPROVED CHLOROQUINE FOR USE IN COVID-19 11:48: *TRUMP SAYS STILL COLLECTING EVIDENCE OF CHLOROQUINE EFFICACY 11:48: *TRUMP SAYS CHLOROQUINE RISKS LOW AND ARE WELL-KNOWN 12:12: *FDA SAYS IT HAS NOT APPROVED CHLOROQUINE FOR COVID-19 USE

Trump said chloroquine had been approved and could be given to patients with a prescription. Minutes later, FDA Commissioner Hahn, said use of the drug would be in a clinical trial to find out whether it works, and if so what dose would safe and effective

@drmt: 11:49 PHONES RING OFF THE HOOK IN MEDICAL OFFICES

Good coverage of this Chloroquine press conference and FDA

Incl that Trump wanted Jim O’Neill, a staunch libertarian, who championed the idea of letting the FDA approve drugs without proving they were effective, to lead the FDA. The FDA’s mandate since 1960s was to include efficacy as well as drug safety (1938)

https://www.statnews.com/2020/03/19/with-the-coronavirus-surging-trump-wants-drug-development-to-move-far-faster-it-cant/

 

Selfcare:

Accessing Inner Resilience: Tools and Actions to Work with Challenging Times – free webinar March 26, 2020 (5:00 – 6:30 pm PDT/San Francisco)

https://zencaregiving.org/events/event/accessing-inner-resilience/

Also an archived webinar presented to the Family Caregiver Alliance

https://zencaregiving.org/2020/03/webinar-on-building-resilience/

 

Thoughtful read:


And the people stayed home.

And read books, and listened,

and rested, and exercised,

and made art, and played games,

and learned new ways of being,

and were still.

And listened more deeply.

Some meditated,

some prayed,

some danced.

Some met their shadows.

And the people began to think

differently.

And the people healed.

 

And, in the absence of people living

in ignorant,

dangerous,

mindless, and heartless ways,

the earth began to heal.

And when the danger passed,

and the people joined together again,

they grieved their losses,

and made new choices,

and dreamed new images, and created new ways to live

and heal the earth fully,

as they had been healed.

 

Kathleen O’Meara

 

Comic Relief:

 

 

 

 

 

 

 

Bits of beauty

“A bit of beauty from Hell” from my friend in Lombardy,

 

along with “a hospital room with a view”

 

 

 

 

 

 

A funny face in the woods

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