Coronavirus Tidbits #37 4/22/20

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Tidbits will likely be a bit shorter and a little less frequent for the next little bit. I have been immersed in it and I need to spend a little more time on self-care, which for me means seeing the spring flowers emerge and digging in the dirt. Pesach is always a bit rough anyway, so I will turn to more nature.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

News 

Patients may have severe pneumonia with minimal symptoms

Picking up hypoxemia (low blood oxygen with a finger oximeter moniter) early and positioning patients to lie on their stomach or sides could avoid intubation (need for mechanical ventilation)

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html?

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Ventilators may be overused in COVID-19. Changing recommendations

This is because patients with COVID tolerate remarkably low blood oxygen levels and their problems are different that typical pneumonias, and ventilators might cause more lung damage.

Interesting: Rather than a ventilator, “We use CPAP a lot, and it works well, especially in combination with having patients lie prone.”

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While we're focusing on COVID, guinea worm, Ebola, and polio are quietly increasing

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Obscene, racist move.

1.2 Million U.S. citizens won’t get coronavirus stimulus checks — because their spouses are immigrants who don't have social security numbers.

https://www.latimes.com/world-nation/story/2020-04-20/u-s-citizens-coronavirus-stimulus-checks-spouses-immigrants

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Immigrants are on the frontlines fighting coronavirus

according to the Migration Policy Institute, immigrants make up

           29% of all physicians in US--higher in many rural areas

38% of home health aides

22% of workers in the US food industry

35% of agricultural/crop production workers

          69% of California's agricultural workers are immigrants

37% of meat processing industry workers

16% of grocery workers

34% of metro, bus and taxi drivers

We have more Coronavirus than other countries...so why, besides white nationalism, does Trump want to end immigration? Who will grow and pick our crops?
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Retaliation or not?

Dr. Rick Bright, who had led BARDA, the Biomedical Advanced Research and Development Authority, since 2016 until Tuesday, was reassigned to a narrower position. He was in charge of vaccine procurement.

He says is is retaliation for disagreeing with Trump over chloroquine and is filing a whistleblower suit.

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So stupid and unethical, Las Vegas Mayor offers city as "control group"...

"we offer to be a control group" to see how many people die without social distancing, since she wants to open up the casinos and hotels. - CNN

 

Diagnostics:

still an incredible, negligent lack of testing.

High-power university labs that are approved to test for #COVID19 are getting turned away by hospitals.

At a time when the US desperately needs to test, administrative & logistical bottlenecks are deadly. --incl lack of integration w EMR.  by Amy Maxman nature.com/articles/d4158

What will antibody tests mean? 

We still don't know how protective they are, or how long protection will last.

Everything we know about coronavirus immunity and antibodies — and plenty we still don’t

Good explainer: https://www.statnews.com/2020/04/20/everything-we-know-about-coronavirus-immunity-and-antibodies-and-plenty-we-still-dont/

Drugs:

NIH Panel Recommends Against Drug Combination Promoted By Trump For COVID-19

As doctors have noted, the combination of hydroxychloroquine and azithromycin increases the risk of cardiac arrhythmias and death and has no proven benefit.

Devices:

Texas nurse Tommye Austin creates face masks that protect against COVID-19 better than N-95 model

using AC material from Home Depot.

https://thegrio.com/2020/04/21/black-nurse-creates-new-face-mask-better-than-n95/

Epidemiology/Infection control:

Impressive...

but you weren't allowed to test people then...or now.

Too bad. Think how many fewer deaths there might have been if Trump had accepted the WHO tests like other countries did. American exceptionalism and hubris bites us in the ass again.

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CDC To Fund 650 Health Experts To Help States Trace, Stop COVID-19

Director Robert Redfield actually has some reasonable comments:

"I am very concerned about the magnitude of functional public health capacity we're going to need next November, December, January and February. We can't let the public health system get overwhelmed. I think the different states will open up again in a measured, stepwise fashion. It's not like we turn a light switch and everybody's back to full non-mitigation.

A lot of the stuff that we're doing now — social distancing, limited human gatherings — a number of these things are going to continue. But the centerpiece of our response needs to be the tried-and-true, proven-to-work public health response of early case recognition, diagnosis, isolation and contact tracing."

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More evidence of asymptomatic/presymptomatic spread => reinforces the importance of social distancing, including the avoidance of congregate settings: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

 

If ill, don't lay flat on your back: lay prone (on stomach) or sides to help oxygenation. 

See https://drive.google.com/file/d/1t6K_K_ryc0Sn3FyLRSOjFtwh7FvDXJ87/view

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Consider getting an oximeter (measures blood oxygen) if you can afford it. See the NYTimes story at the top.

https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html?

Breathing exercises:

Are increasingly being recommended. This article is a reasonable summary and is worth a read.

https://www.dailykos.com/stories/2020/4/8/1935532/-Doctors-and-nurses-demonstrate-breathing-techniques-proven-to-help-with-coronavirus-symptoms?detail=emaildksp

While binge-watching Netflix or whatever, it may be worth practicing these to become comfortable with them. Some are similar to those given to patients with COPD or pneumonia pts, given an incentive spirometer.

Focusing on the breath is an anchor in meditation and some forms of yoga. You might find these helpful in reducing your anxiety as well.

Politics:

Groups opposing stay-at-home order protest outside the Ohio Statehouse in Columbus with a man holding an antisemitic sign.

https://www.columbusjewishnews.com/news/local_news/ohio-leaders-groups-react-to-protester-s-anti-semitic-sign/article_dccecc64-8304-11ea-8b0a-77138336420b.html

Nauseating...especially right before Yom HaShoah.

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Is anyone surprised? Maryland Gov. Larry Hogan tells @TheView that Pres. Trump's support for protesters went against his own policy recommendations from a day earlier.

Trump, in turn, disses Hogan for ordering testing kits from S. Korea since he couldn't get kits from the Feds.

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The Education Department will ban colleges from giving DACA students emergency aid

What would a day without cruelty from this regime be?

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You can't make this stuff up...

A @Reuters special report: HHS chief Alex Azar tapped ex-professional Labradoodle breeder to coordinate the coronavirus response reut.rs/2VTLqwU

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I love this thread about docs/residents being exploited: Colleen Farrell, MD

"I know that silence erodes my soul and betrays my commitment to love and justice in medicine. I’ve been silent on this issue for longer than I am comfortable with."

Feel good du jour:

Obviously heartbreaking circumstances, but beautiful thread by Colleen Farrell and the support amongst them.

https://twitter.com/colleenmfarrell/status/1251342900744650752?s=20

Comic relief:

Perspective/Poem

"The measure of a human life is not how useful they were to capitalism."  Rabbi Danya Ruttenberg

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Calling Me a Hero Only Makes You Feel Better

Cashiers and shelf-stockers and delivery-truck drivers aren’t heroes. They’re victims. To call them heroes is to justify their exploitation. By praising the blue-collar worker’s public service, the progressive consumer is assuaged of her cognitive dissonance. When the world isn’t falling apart, we know the view of us is usually as faceless, throwaway citizens. The wealthy CEO telling his thousands of employees that they are vital, brave, and noble is a manipulative strategy to keep them churning out profits.

I have immense gratitude for my job. I love my co-workers like family. I respect the company that has employed me and given me excellent health-insurance benefits for more than 16 years. The anger I have is not toward my boss, or my boss’s boss, or even that guy’s boss. It’s toward an unfair system that will never change if we workers don’t question the motivations behind such mythmaking.

Bits of beauty:

 

These apple blossoms (Macintosh, I think) have the most heavenly scent... and delicate blush. I look forward to them every spring.

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