Dr. Stacey Rizza, an Mayo Clinic infectious diseases specialist, discusses the various ways COVID-19 is diagnosed and treated.
COVID-19 can be diagnosed several ways when looking for active infection.
“The most common way that testing is done is with a swab into the nose or into the nasal pharyngeal area,” says Dr. Stacey Rizza, a Mayo Clinic infectious diseases expert.
“This polymerase chain reaction (PCR) test is essentially a test looking for the genetic material of the virus.” If it’s positive, it means that person is infected with SARS-CoV-2, the coronavirus that causes COVID-19.
Dr. Stacey Rizza from Mayo Clinic gave the standard Academic recommendations for Covid Testing and treatment. I will comment on how this differs from the testing recommendations of Dr. Michael Mina from the Chan school at Harvard and the actual treatment given to Donald Trump as we speak.
I agree with the latter recommendations, and route that I would opt for, were I to catch Covid 19. TESTING, if it is to be Epidemiologically effective should offer results that are rapidly available so as to reduce spreading of the virus and treatment delay. One trouble with PCR- based tests is that they are slow. Another trouble, according to Dr. Mina, is that if they run for 40 cycles for maximum sensitivity, they may pick up viral shedding that is too minor to be infective, and may cause unnecessary precautions, such as quarantining. If they run for 35 or even 30 cycles to show only infective, actionable cases, they take several days, and even then labs do not usually report the number of cycles run, but only yes or no, positive or negative.
The RAPID TESTS detect viral protein are available within hours. They are less sensitive, but in Dr. Mina’s view, this can be a virtue, since only definitely infected patients are identified. They are cheaper, and can even be done on site. Frequent testing more than makes up for decreased sensitivity. Most tests currently available use only specimens from nasal swabs, which are uncomfortable.
SALIVA is almost as sensitive, and has one additional virtue, when it comes to testing school children. If school children are organized into learning “pods”, They can all spit into a common collector, and the pod tested preemptively, at least twice weekly. If positive The entire pod is individually tested to find who is positive. Of course if a full 20 kids are in a pod, The sensitivity of the protein test may be insufficient for positive to survive a 20-fold dilution, but this can be empirically worked out. Twice weekly testing vs. every other week is much better for reducing the number of the pod members infected at time of discovery, as the NYT has illustrated.
TREATMENT given to Donald Trump has so far consisted of more than Remdesivir. He is also receiving Corticosteroids, plus an experimental double antibody mixture, derived from both Covid Convalescent serum, and monoclonal antibodies from a “humanized” murine source. The antibodies should theoretically be given early. The corticosteroids are generally not given until a bit later, but with the reported drop in O2 sats, he may be later in the disease than we are led to believe. To my knowledge, he is not receiving his tweeted Hydroxychloroquine- azithromycin combination.
If I were infected, at age 88, I would also like the antibody treatment, but most likely would not be allowed to get it.
A growing number of hospitals are relying on remote ICUs to monitor and evaluate patients virtually, which helps to cope with an unrelenting COVID-19 caseload.
The Journal Science recently reported on nearly 77,000 patients hospitalized with Covid 19. 29% were overweight and 48% were Obese. A total of 77% of admissions for Covid were overweight or worse.
Overweight was defined as BMI of 25-29.9 Kg. per Square Meter, and Obese was defined as BMI of 30 or greater. Another way of stating the data is giving the rate of Hospital admissions per 10,000 People.
- Normal Weight, BMI 18.5-25 kg. Per square Meter—12%
- Overweight, BMI 25-29.9 per square a Meter———-19%
- Obese, BMI 30-34.9 per square Meter——————-23%
- Severe Obesity, more than 35 per square meter——-42%
BMI calculators are everywhere to be found on the internet. Put in your weight and height, and find your BMI displayed.
These are striking figures, the more so because of the LARGE SAMPLE, and the LINEAR Relationship; the greater the overweight, the greater the hospitalization rate.
Every way you look at it, obesity is hazardous. More hip and knee replacements, harder to exercise, find comfortable seats, more difficult to do surgery, more diabetes, heart attacks, stroke, Hypertension, Sleep apnea, worse immunity, and now, confirming previous suspicions, clearly higher risk of being hospitalized (and dying) with Covid.
I realize that nobody chooses to be Obese; in addition to the health problems, overweight people are Subjected to discrimination.
Obesity is notoriously hard to treat; one of the few, seldom mentioned medical truths is that Diets fail long term. Starting and maintaining a diet takes Herculean Will Power, which is in short supply in our overindulgent, overadvertised, and overfed society.
If I were morbidly Obese, I might opt for Bariatric Surgery, and try my best to hold the short term weight loss, since even with surgery the pounds tend to creep back on over time.
The best way to treat Obesity is to treat it as the Plague it is. CHILDHOOD OBESITY should be treated aggressively. Keep the Obese Child from becoming an obese adult, and maybe carry yourself along with the Family.
Better yet, Good SLEEP, DIET, and EXERCISE come as an interactive mutually reinforcing package deal. Prevention always beats treatment.
My article on ABDOMINAL FAT is suggested reading, and there is a link to the Infographic which Displays the above date in graphic form.
Finasteride is a medication that I was given by my urologist, after my operation for an enlarged prostate with restricted urine flow. It was used to prevent the re-growth of the prostate, and subsequent recurrence of urinary obstruction.
It is also recommended to treat male-pattern baldness. That it is used to treat male problems suggests that it has something to do with testosterone, and indeed it does. Finasteride (proscar) is a 5-alpha reductase inhibitor, preventing testosterone from being converted to dihydrotesterone, the active form, in the prostate and the skin.
Finasteride is well studied, and has been found to decrease PSA in the blood, and is suspected of interfering with the use of PSA as a screening device for Prostatic Cancer. It has also been suspected of increasing severe, high grade cancer. These findings have been refuted in later papers.
It has also been found to decrease sexual function, which it has in my case. I have continued it for several reasons.
First, my urine flow remains fine. Second, the bulk of the data indicates that it hinders prostatic cancer formation; and in a previous posting, I stated that Prostatic cancer in 88 year-olds is almost universal. Third, we are continuing in a Covid 19 pandemic.
One of the markers for severe infection is male-pattern baldness, which finasteride prevents. I did find in my reading about finasteride that there is a 1 mg. dose, and I am taking 5 mg..
When the Covid epidemic slows, I will probably opt for the 1 mg. Dose, which produces a significant effect, though of course less than the 5 mg. Less medication is usually better.
For Patients with BPH opting for medical treatment, Finasteride is usually recommended along with an alpha adrenergic agonist to relax the bladder sphincter.
For the men out there, facing an ever-increasing likelihood of BPH, or wanting to slow down baldness, you may eventually be making the decision whether or not to take this effective medication.
COVID 19 is a nasty disease, in case you hadn’t noticed. It is SNEAKY: you can catch it from a person who has no symptoms.
It is UNPREDICTABLE: you may develop no symptoms or Die from it. It can affect any part of your body, including HEART and BRAIN.
And now we hear that it can DRAG ON. The outstanding infographic, “a multi-systems disease, which is intended for PRIMARY CARE PROVIDERS, has a lot to offer patients, who can do a lot to Care for themselves:
- –They can get a THERMOMETER and a PULSE OXIMETER to watch their own temperatures and oxygen saturations
- –They can monitor their own COMORBIDITIES, like Diabetes and HYPERTENSION, which are common with severe Covid. In patients who get very ill .
- –They can watch their GENERAL HEALTH, including SLEEP and DIET (the exercise part is relegated to DOCTORS recommendations).
You should also RESTRICT Alcohol, Caffeine and it goes without saying CIGARETTE SMOKING. Of course PREVENTION, with DISTANCING, MASKING and being Outside, coupled with SLEEP, DIET and EXERCISE is always best.
Science Editor-in-Chief Holden Thorp joins host Sarah Crespi to discuss his editorial on preventing vaccine hesitancy during the coronavirus pandemic. Even before the current crisis, fear of vaccines had become a global problem, with the World Health Organization naming it as one of the top 10 worldwide health threats in 2019. Now, it seems increasingly possible that many people will refuse to get vaccinated. What can public health officials and researchers do to get ahead of this issue?
Also this week, Sarah talks with Science Senior Correspondent Jon Cohen about his story on Chinese scientist Shi Zhengli, the bat researcher at the center of the COVID-19 origins controversy—and why she thinks President Donald Trump owes her an apology.
Finally, Geert Van der Snickt, a professor in the conservation-restoration department at the University of Antwerp, talks with Sarah about his Science Advances paper on a new process for peering into the past of paintings. His team used a combination of techniques to look beneath an overpainting on the Ghent Altarpiece by Hubert and Jan Van Eyck—a pivotal piece that showed the potential of oil paints and even included an early example of painting from an aerial view.