How Coronavirus Kills Some People But Not Others - I'm a Lung Doctor (ME...

If you want to learn much more about how Covid-19 makes people so ill and how they die. Its complicated and has similar methods as other lethal diseases. Besides causing pulmonary insufficiency it causes increased coagulation in other organs such as the heart, lungs, kidneys, and brain. 









Dr. Mike Hanson is an outstanding clinician and an outstanding communicator. I highly recommend this video as a credible source.



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Telehealth and the Future

2020 witnessed amazing explosive growth in telehealth.  Although an infrastructure for telehealth developed in the prior five years by visionary entrepreneurs there was slow to non-existent adoption by providers, hospitals, and allied health providers.  Much of the reticence was due to poor reimbursement by health plans.  

During January 2020 to current times telehealth became an established and at times preferred method for outpatient visits.  This was due to an existing crisis fueled by a viral epidemic (pandemic) by a novel coronavirus (COVID-19). Social and physical distancing was mandated by public health officials globally.  This served to radically alter the health care setting. Physician office visits plummeted, even for the normal population. Elective surgical procedures were canceled and postponed. 

How COVID-19 is affecting internet performance

According to Fastly, to understand how the internet is performing with the changes in internet use brought on by the COVID-19 pandemic, we investigated two key metrics during February and March in some of the countries and states that were hit hardest by the virus: changes in the traffic volume served to those regions as a reflection of changes in internet use, and changes in download speed measured at our servers as a reflection of internet quality. In almost all regions, the largest increases in traffic volume occurred immediately after public policy announcements, such as school closures or stay-at-home orders. Similarly, the most dramatic decreases in download speed followed the official starts of those policies — presumably when populations made the shift to staying home.

Table 1 reveals the sharp uptick in internet traffic by country and state and the effect on broadband speed.  The findings reveal metropolitan areas suffered the least, most likely due to penetration and redundancy of the internet in cities.  Italy suffered the most increase in usage and the decrease in broadband speed. In the U.S.A. rural states such as Michigan saw a marked decrease in internet speed. Michigan is a rural state and the penetration and less redundancy in infrastructure caused network speeds to decrease by almost 40%.

Definition of High-speed internet

Perhaps the best modern measurement of whether an Internet connection is “high speed” is in what services are supported at that speed. Virtually any broadband, or non-dialup, connection can support a home user’s standard browsing habits. Streaming of standard-definition video, with a pixel width of 480, requires a minimum 1Mbps connection. Low-end high-definition video, with a pixel width of 720, requires at least 2.5Mbps. Streaming high-definition 1080p video needs at least a 9Mbps pipeline to avoid buffering delays. And these numbers only take into account a single device — if five users in your office network simultaneously stream separate 1080p videos, your 10Mbps will not seem “high speed.”   

If one lives in a rural area there may be severe limitations on live streaming used by telehealth.

The. Brookings Institute published a breakdown of what type of internet customers can access.  There are some surprising results

The lack of internet broadband access in the mid-south has created a need for cellular coverage.  While 4G/LTE is widely available there are some areas that only provide 3G. 4G/LTE may be adequate for video streaming when signal strength is strong. As 5G cell coverage becomes ubiquitous it becomes mainstream.   A recent test on T-mobile cell coverage in Southern California revealed a 60-75 MPs download and 40 MPs upload speed. That is adequate for live streaming as indicated by calls on Zoom and other video conferencing apps such as GoToMeeting, Google Meet, Webex, or Cisco.

Webinar: What is the future for telehealth?  REGISTER

There are some indications that some payor and Medicare are planning to re-institute restrictions on telehealth reimbursement once the acute pandemic ends.  However, that is a big contingency since the ongoing pandemic is still evolving.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

There have been conflicting comments and opinions on the efficacy of Hydroxychloroquine for the treatment of Covid-19 patients. Many have opined on the failure of HCQ to reduce morbidity and death in patients with Covid-19.

The patients studied at HFH Systems were treated early in their disease. 

In a large-scale retrospective analysis of 2,541 patients hospitalized between March 10 and May 2, 2020 across the system’s six hospitals, the study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine. None of the patients had documented serious heart abnormalities; however, patients were monitored for a heart condition routinely pointed to as a reason to avoid the drug as a treatment for COVID-19.

                                      


Patients treated with hydroxychloroquine at Henry Ford met specific protocol criteria as outlined by the hospital system’s Division of Infectious Diseases. The vast majority received the drug soon after admission; 82% within 24 hours and 91% within 48 hours of admission. All patients in the study were 18 or over with a median age of 64 years; 51% were men and 56% African American.

“The findings have been highly analyzed and peer-reviewed,” said Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, who co-authored the study with Henry Ford epidemiologist Samia Arshad. “We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring. Our dosing also differed from other studies not showing the benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”

Dr. Zervos also pointed out, as does the paper, that the study results should be interpreted with some caution, should not be applied to patients treated outside of hospital settings and require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety and efficacy of hydroxychloroquine therapy for COVID-19.

“Currently, the drug is "off label" and should be used only in hospitalized patients with appropriate monitoring, and as part of study protocols, in accordance with all relevant federal regulations,” Dr. Zervos said.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

FDA MedWatch - Hand Sanitizers with Methanol

In a rush to manufacture and distribute hand sanitizers some companies took shortcuts and had defective alcohol production methods resulting in the production of methanol.  This was also a problem during the era of prohibition in the 1920s.  Methanol is toxic to the optic nerve and will cause blindness.   A MedWatch Safety Alert was added to the FDA Drug Safety and Availability webpage.  TOPIC: Hand Sanitizers with Methanol: FDA Updates  AUDIENCE: Consumer, Health Professional  ISSUE: FDA is warning consumers and health care providers that the agency has seen a sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination. The agency is aware of adults and children ingesting hand sanitizer products contaminated with methanol that has led to recent adverse events including blindness, hospitalizations, and death. Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects. FDA’s investigation of methanol in certain hand sanitizers is ongoing. The agency will provide additional information as it becomes available. Recent recalls include:  All Clean Hand Sanitizer, Moisturizer and Disinfectant by ITECH 361 Mystic Shield Protection Topical Solution by Transliquid Technologies BACKGROUND: Substantial methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death. Although all persons using these products on their hands are at risk, young children who accidently ingest these products and adolescents and adults who drink these products as an alcohol (ethanol) substitute, are most at risk for methanol poisoning.

RECOMMENDATION: FDA reminds consumers to wash their hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. If soap and water are not readily available, the Centers for Disease Control and Prevention (CDC) recommend consumers use an alcohol-based hand sanitizer that contains at least 60 percent ethanol. This chart outlines the information on hand sanitizer labels for consumers to use to identify a product that has been tested by FDA and found to contain methanol, that is being recalled by the manufacturer or distributor, or that is purportedly made at the same facility as products that have been tested by FDA and found to contain methanol. FDA advises consumers not to use hand sanitizers from these companies, or products with these names or NDC numbers. Consumers and health professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: Complete and submit the report online. Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178.

FDA MedWatch - Hand Sanitizers with Methanol

How can the Coronavirus pandemic end?

As we struggle to re-open our economic and social fabric in the United States we wonder how will the pandemic end?

There are two ways it can end.

1. Herd Immunity (also called herd effect, community immunity, population immunity, or social immunity)



In our present setting, the coronavirus only affects a very small percentage of the world population.  Even so, it is causing major disruption to the economy and to social functions.

A mathematical model for the unrestricted spread of infectious diseases, such as smallpox,  pertussis, measles, or coronavirus has been developed.  The model has been tested and proven by previous pandemics.  The variables in the equation are R (the number of infections transmitted by a single host) and S ( the proportion of the population who are susceptible to infection and setting this product to be equal to 1.

Viral entity                                R0                                   HIT       

Measles Airborne                    12–18                              92–95%

Pertussis Airborne droplet 12–17[51]                      92–94%

Diphtheria Saliva                       6–7                              83–86%

Rubella Airborne droplet          6                                       83–86%

Smallpox                                       5–7                                       80–86%

Polio Fecal-oral route

Mumps Airborne droplet           4–7                                 75–86%

COVID-19

(COVID-19 pandemic)              2–6                                50–83%

SARS

(2002–2004 SARS outbreak)               2–5                    50–80%

Ebola

(Ebola virus epidemic Bodily fluids      1.5–2.5               33–60%

Influenza

(influenza pandemics) Airborne      1.5–1.8                    33-40%

These are the facts, numbers do not lie.  

Prevention at the moment (summer 2020) may reduce the numbers, or flatten the curve but has the disadvantage of population variables, such as political motivation, willingness to comply with distance, wearing PPE, following CDC and WHO guidelines.  As we have experienced as soon as PPE, social distancing are removed the infectious rate quickly returns to a high level since the vast majority of the population is naive to coronavirus.


2  An effective vaccine.

Belgian virologist Guido Vanham, the former head of virology at the Institute for Tropical Medicine in Antwerp, Belgium, and asked him: how will this pandemic end? And on which factors might that depend?

Guido Vanham (GV): It will probably never end, in the sense that this virus is clearly here to stay unless we eradicate it. And the only way to eradicate such a virus would be with a very effective vaccine that is delivered to every human being. We have done that with smallpox, but that's the only example - and that has taken many years.

So it will most probably stay. It belongs to a family of viruses that we know - the coronaviruses - and one of the questions now is whether it will behave like those other viruses.

It may reappear seasonally - more in the winter, spring and autumn and less in the early summer. So we will see whether that will have an impact.

But at some point in this epidemic - and certainly in the countries that are most affected, like Italy and Spain - there will be saturation, because according to predictions, up to 40% percent of the Spanish and 26% of the Italian population are or have been infected already. And, of course, when you go over 50% or so, even without doing anything else, the virus just has fewer people to infect - and so the epidemic will come down naturally. And that's what happened in all the previous epidemics when we didn't have any [treatments]. The rate of infection and the number of those susceptible will determine when that happens.

This natural course, prior to vaccines places a demand on health services, significant morbidity, and mortality.  The cost of a natural process would exceed the cost of quickly developing an effective vaccine. Despite media exaggerating the mortality rate coronavirus kills few that it effects, mainly older and the chronically ill. Examining the R0 and HIT covid-19 is far less infectious than Pertussis and Measles.

Measles have been a chronic illness of children and when a vaccine developed it was eliminated very quickly.

The charts above display the rapid diminution of viral epidemics once vaccination begins. Normally the development of a safe and effective vaccine may take several years using previous technology.  Vaccines are now manufactured using RNA technology rather than growing batches of viral particles to be injected.  If the proper RNA is developed it can be injected directly into humans and the normal biochemistry of cells will develop the protein segment of the virus to be used as a vaccine. This means an entire viral particle is not necessary to produce immunity.

Several other factors could take place.  Covid-19 has exhibited some mutations in serotype already which are minor thus far.  A mutation could evolve spontaneously that would alter it immunologically and also it's pathophysiology.

Today pharmacology allows a pipeline to be developed to manufacture like products without having to reinvent the entire process.

Antibody Research Q&A | Baseline COVID-19 Research Project

If you or a friend have had documented Covid-19 this important information will help others who are ill.  You may be able to donate your blood (plasma) for their treatment.  Studies have revealed it reduces mortality from Covid-19

Coronavirus vaccine will not be available until 2021.  However  Coronavirus serum antibodies are available now. The vaccine will induce immunity and is preventive, while the results of antibodies are immediate.

3 Wishes Project – Helping to make meaningful memories at end-of-life

End of life conundrum for families with parents in ICUs

As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance but also by the cruelty of the coronavirus.  Even at times when family members cannot attend the end of life activities for a loved one, there are means of addressing this challenge. As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance but also by the cruelty of the coronavirus.  Unlike many families of dying COVID patients, Breed and her family were able to find some comfort in her mother’s final hours because of the 3 Wishes Project, a UCLA Health end-of-life program repurposed to meet the demands of the coronavirus crisis. In the U.S., where more than 120,000 people have died of COVID, it’s part of a wider push for palliative care during the pandemic.

At 5 p.m. on May 10, Mother’s Day, before Breed-Rabitoy’s life support was removed, more than a dozen family members from multiple cities and states gathered on a Zoom call to say goodbye. John Denver’s “Rocky Mountain High,” one of her soft-rock ’70s favorites, played on speakers. Online, a chaplain prayed. 

  

The project was developed in Canada but co-launched at UCLA Health in 2017 by Dr. Thanh Neville, an intensive care physician who serves as 3 Wishes’ medical director. It aims to make the end of life more dignified and personalized by fulfilling small requests for dying patients and their families in the ICU.

“I would still say the majority of COVID patients die without families at their bedside,” Neville said. “There are a lot of reasons why they can’t come in. Some are sick or old or they have small kids. A lot of people don’t want to take that risk and bring it home.”

                                                      Overall Goal

To improve the quality of the dying experience for patients and their families

Start Up Guide

The 3 Wishes Project Start-Up Guide was developed as a tool to help clinicians to try to improve the quality of the dying experience in ICU and to assist those who are interested in starting the project or adapting it to their own site.

A study published by Neville and colleagues last year found that 3 Wishes is a “transferrable, affordable, sustainable program” that benefits patients, families, clinicians and their institutions. They calculated that the mean cost of a single wish, funded by grants and donations, was $5.19.

Email milo@mcmaster.ca for a free copy of the 3Wishes Project Start-Up Guide.

3 Wishes Project – Helping to make meaningful memories at end-of-life