INFOGRAPHICS: “COVID-19 COMPARED TO OTHER DISEASES AND CONDITIONS”
Tag Archives: SARS-COV2
PODCAST INTERVIEWS: DIAGNOSIS AND EARLY TREATMENT OF COVID-19
In this audio interview conducted on June 3, 2020, the editors discuss two new studies: one comparing test swabs collected by health care workers with swabs collected by the patients themselves and one assessing hydroxychloroquine treatment in people who had been exposed to Covid-19 but weren’t yet ill.
The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.
Eric Rubin is the Editor-in-Chief of the Journal. Lindsey Baden is a Deputy Editor of the Journal. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.
COVID-19: CASE SEVERITY IS DEPENDENT ON VIRAL LOAD
From the New York Times
….in the case of the new coronavirus, people who have no symptoms seem to have viral loads — that is, the amount of virus in their bodies — just as high as those who are seriously ill, according to some studies.
When experts recommend wearing masks, staying at least six feet away from others, washing your hands frequently and avoiding crowded spaces, what they’re really saying is: Try to minimize the amount of virus you encounter.
A few viral particles cannot make you sick — the immune system would vanquish the intruders before they could. But how much virus is needed for an infection to take root? What is the minimum effective dose?
And coronavirus patients are most infectious two to three days before symptoms begin, less so after the illness really hits.
Some people are generous transmitters of the coronavirus; others are stingy. So-called super-spreaders seem to be particularly gifted in transmitting it, although it’s unclear whether that’s because of their biology or their behavior.
On the receiving end, the shape of a person’s nostrils and the amount of nose hair and mucus present — as well as the distribution of certain cellular receptors in the airway that the virus needs to latch on to — can all influence how much virus it takes to become infected.
COMMENTARY
HEALTH: THE HISTORY OF FACEMASKS AND DISEASE THROUGH THE CENTURIES
Originating during the Black Death of the Middle Ages, face coverings to protect against the transmission of disease are not just medical requirements; they’re now a fashion statement. Mark Phillips talks with medical historian Mark Honigsbaum (“The Pandemic Century”) about the purpose and style of facemasks.
COMMENTARY
Medicine has always operated in the context of theory, which is easier to generate than fact. The medieval physician with the “bird mask” thought he was protecting himself from “miasma”, which was theorized to be the means by which PLAGUE was spread. In fact, the masks’ main function was to hide his identity from his Patient, whom he could not help. The painting makes him appear to be the Grim Reaper himself.
The story of Guaiac, another illustration medieval medicine, is entwined with Syphillis, the stigmatizing STD of post Columbian Europe. Each country blamed Syphillis on its’ rival- the English called it the French disease, for instance-until they were able to blame it on the “new world”. Since it came from the Americas, so must its’ HERBAL REMEDY, according to theory.
GUAIAIC, the resin from the small tree from the Caribbean, became a popular cure. It might have even lessened suffering from Siphillis, since it was used instead of the highly toxic MERCURY.
Guaiac eventually found a use in Criminology, as a test for blood at the crime scene. When Guaiac is mixed with a suspicious spot and peroxide, it changes color rapidly to a bright blue. Medicine later used Guaiac as a test for hidden (occult) Blood In the stool; a positive, brilliant blue test throws suspicion on intestinal cancer as the culprit.
We come full circle to present day mask usage in the Covid epidemic. Some countries outlaw masks because masks interfere with criminal investigation. This interdict had to be relaxed during The Pandemic. How convenient for the rioters and looters in Minnesota!
—Dr. C.
PATIENT EDUCATION: THE “2020 WEEKLY CROSSWORD PUZZLE CHALLENGE” (MAY 30)
CORONAVIRUS: CONFUSING HYDROXYCHLOROQUINE STUDIES (NATURE PODCAST)
President Trump’s preferred coronavirus treatment is the focus of a new study suggesting it could cause more harm than good, but not everybody agrees. We discuss the fallout as trials around the world are paused and countries diverge over policy advice.
12:12 Are we rushing science?
Coronavirus papers are being published extremely quickly, while normally healthy scientific debate is being blown up in the world’s press. Is there a balancing act between timely research and accurate messaging?
18:49 One good thing
Our hosts pick out things that have made them smile in the last week, including hedgerow brews and a trip into the past using AI.
Recipe: Elderflower ‘Champagne’
Video: Denis Shiryaev restores historic footage with AI
22:30 The latest coronavirus research papers
Noah Baker takes a look through some of the key coronavirus papers of the last few weeks.
News: Coronavirus research updates
medRxiv: Full genome viral sequences inform patterns of SARS-CoV-2 spread into and within Israel
Harvard Library: Reductions in commuting mobility predict geographic differences in SARS-CoV-2 prevalence in New York City
Science: DNA vaccine protection against SARS-CoV-2 in rhesus macaques
DR. C’S MEDICINE CABINET: “OVERVIEW OF METABOLISM”
“Life is nothing but an electron looking for a place to rest”.
Albert Szent-Gyorgy
Overview of Metabolism – Seeing an Essence of Nanosystems in the Hum of a Vibrant City; the Skyscraper as Catalyst, and Thought as Electron
What did it take to bring the world to its’ knees? SARS-CoV2? We will never know, because we instituted DISTANCING to control the virus because the projected number of deaths were unacceptable.
The distancing and isolation did hold the number of deaths, still large, below projection. However, it DEVASTATED our Economy.
OUR WORLD is a massive, cooperative, interdependent system, with hubs, factories, supply chains and a myriad of products. It is a COMPLEX SYSTEM.
I would like to use the world as an analogy, and compare it to another Complex System, the HUMAN BODY.
Our bodies are essentially a large pile of chemicals (mostly proteins) in a sack, our skin. These chemicals are constantly interacting with each other. If they grow to larger, more complex chemicals in a process we call anabolism, we take in more chemicals and energy by eating, and get bigger. If our chemicals get less numerous and complex in a process we call catabolism, we lose weight and get smaller.
Some of the proteins in our bodies are ENZYMES, and bring other proteins CLOSER TOGETHER, so that they can LINK TOGETHER become more complex and PRODUCE things. Enzymes are a sine qua non of life. Without enzymes, life would slow so much as to be impossible.
Let’s go back to our Society, Before Covid.
Vast numbers of people are cooperating in close proximity, working together with machines, often supplied by other people far away, making things. This process takes place most efficiently in CITIES, where people are in closest proximity, doing things together.
Enter Covid. This interdependent process stops. What things that are produced are made to fight Covid. It is just like one of our cells infected by Covid: we have been HIJACKED by the virus!
Lets’ GO BACK TO OUR CELLS. Our METABOLISM is like our teeming, cooperative CITIES, with SUPPLY CHAINS, factories and products. Our PROTEINS NEED PROXIMITY to function.
Some Proteins are at a critical HUB, and comprise a RATE-LIMITING step in the production line.
Many Vitamins and nutrients are COENZYMES, and act to ACCELERATE critical supply lines.
If the Hubs are OUT OF BALANCE and OVERACTIVE, many MEDICATIONS act to BLOCK THE ACTION of an enzyme to bring the system closer to balance.
Thus coordination, cooperation and careful monitoring to PREVENT A PROBLEM is superior to letting it break down and correcting the imbalance.
I hope that this Overview will be helpful. I will go through my MEDICINE CABINET to discuss a few of the 20,000 or so Medications approved by the FDA. I will also VIEW THE TEST RESULTS from my LABORATORY TESTS. NORMAL results show a SYSTEM IN BALANCE. Abnormal results show inefficiencies in the metabolism (supply chains, hubs), which need correction to restore balance.
— Dr. C
TELEMEDICINE BENEFITS: PATIENT’S “CONVENIENCE & SAFETY” TOP THE LIST
From a Permanente.org online article (May 11, 2020):
“Our patients are glad we offer telehealth options because they don’t want to come to the medical centers. This allows them to stay home and stay safe,” Dr. Lee says. “Before, telehealth was a choice and convenience, but now it’s one of the ways patients remain healthy with social distancing.”
The majority of telehealth visits are phone appointments, but Dr. Lee says video usage is increasing as more patients become comfortable with the platform.
Telehealth can also include services such as remote patient monitoring, which allows patients to take blood pressure measurements and blood sugar readings at home so that their care teams can monitor ongoing health conditions. In the case of the Kaiser Permanente Mid-Atlantic States region, doctors also use telehealth to do rounds virtually for patients who have suspected or confirmed COVID-19.
Patients at higher risk for complications are given pulse oximeters so their doctor can monitor for signs of severe respiratory infection before other symptoms might indicate a need for additional care, including hospitalization.
COMMENTARY
TELEHEALTH is HERE TO STAY. It came in with the telephone, and has been gaining in recent decades. The distancing and Patient convenience so characteristic of Telehealth made it a natural fit for Covid 19, which has accelerated its’ adoption.
Your CLINICAL HISTORY, led by the Story of your Present Illness, has since time immemorial been the MOST IMPORTANT ELEMENT leading to accurate DIAGNOSIS. During a TELEMEDICINE VISIT, your doctor must make the MOST out of your clinical history. She can’t do a proper Physical Exam, although she can usually see you, and maybe direct a SELF exam. Teledata, such as EKG,B.P., and blood sugar will become increasingly available.
Your Doctor can usually get enough information to order Lab work and Imaging; and prolix ordering can be tempered, since a good HISTORY of the PRESENT ILLNESS, systems review, past and family history can narrow the diagnostic possibilities considerably. The pressure of time and demanding computer Records may lead the overworked Doctor to use Lab Tests to make up for insufficient Medical History.
Integrated medical systems, such as Kaiser, can also easily access your past medical information, one of the advantages of having everything under one roof.
Informed Patients, SELF-EDUCATING themselves from the vast trove of medical information on the internet (and maybe DWWR) can author their own MEDICAL NARRATIVE, or at least make the Doctors job easier.
—Dr. C.
OPINION: “HIGH ANXIETY IN THE TIME OF COVID-19”
“Develop interest in life as you see it; in people, things, literature, music – the world is so rich, simply throbbing with rich treasures, beautiful souls and interesting people. FORGET YOURSELF.“
Henry Miller
Individualism and authenticity are highly valued traits in a free democratic society. My own concepts of American ideals canonize the associated freedom. But there is never a “free lunch” in the realm of human nature.
Roy F. Baumeister’s Book, “Escaping The Self” (which I read a couple of decades ago and either loaned out or lost) started me thinking about the BURDEN OF SELFHOOD. I recently listened to a BBC podcast on the Philosophy of Authenticity (BBC Radio 4 – In Our Time has upwards of 1000 forty-five-minute programs on topics I recommend highly). They discussed the plight of the “Existential Hero”, and rekindled my interest in the over-demanding Self, which idea I will argue can help guide an approach to ANXIETY.
Cooped in by SARS CoV-2, the U.S. has experienced a sharp rise in Anxiety and Depression. The Pandemic has deprived us of the sociability, diversions and travel that had previously lured us outside ourselves, and our jobs (except for the computer-connected) which give us purpose. The connectivity (and self-abnegation preached) in religious services has long been on the wane in secular America, and Covid 19 has temporarily closed the remaining Houses of Worship.
How does the Idea of getting OUTSIDE OURSELVES help the person in the grips of Anxiety? If nothing else, it serves as an organizing principle for the CHANGES IN BEHAVIOR (eg. CBT) necessary for lessening Anxiety. Changes in behavior are necessary; you cannot merely will Anxiety away.
IMAGINE the self as an expensive over-large HOUSE. It’s construction started at the moment of your birth, and progressed through infancy (perhaps with a few defects- we can always blame our parents – i.e. attachment theory). It was damaged by Adolescence, improved by our education and occupation, and remodeling continues our entire lives.
Being restricted to our homes is like Solitary Confinement. Having only our own minds to keep us company is severe punishment for 99% of humanity. What would you do if deprived of the internet and confined to a mountain cabin for just one day? We are used to pervasive and instant connectivity. Our norms of isolation now would have been considered quite expansive just a generation ago. Well, maybe practice living with ourselves is a benefit of Covid – that which does not kill us, etc…
Using the house analogy, we spend a lot of Money and effort decorating the outside of the house to impress our neighbors (‘amor propre’ of Rousseau). Spending time on Facebook rather than improving the inside, via re-framing and behavioral change. The many rooms of the house also suggests the many compartments of the mind, some of which are more accessible than others, some almost unknown.
The analogy is far from perfect. For one thing our house should have legs to let us, the little person inside (the ‘homunculus’ of consciousness metaphor), walk our expensive and beloved (I hope) house through the world. Or better yet, ESCAPE IT BY OUTWARD FOCUS.
The ‘yourself-embracing reality’, out in the world, without the distortions (and protections) of your carefully crafted identity.
Do you dare?
Service (work) gets you outside yourself. To quote Kant:
“I slept and dreamt that life that life was joy. I awoke and saw that life was service. I acted, and behold, service was joy.”
Mindfulness (meditation) gets you outside yourself, to focus on the outside world. The religions of the world prescribe much of our behavior, defining our self-importance, and our expensive houses as “pride”, as something to diminish.
The word Ecstasy (not the recreational drug) is from the Greek (“to step outside oneself”). Ecstasy ( as well as orgasm, i.e. Woody Allen) may be OK occasionally, but for every day, most of us would prefer the Delphic Oracle admonition: “Medan agan (μηδὲν ἄγαν) – “Nothing in Excess”.
Enough hot air already! For those who prefer practical tips or neurobiology to conceptual framework, see the articles below.
-Dr. C.
OPINION: FACE MASKS AND SHIELDS TO PREVENT COVID
My main exercise for the day is a 45 minute fast walk around my community.
Hat – check. Sunglasses – check, FACE SHIELD – check.
Yes, face shield. The shield has the advantage of allowing me to talk, plus being more comfortable to wear. I clean it with a woolen cloth on one side and cotton on the other, hoping for a condenser electrostatic effect (I’m open to suggestion from engineers).
If I cough, any large particles of mucus would impact the shield, leaving only tiny aerosol particles to escape around the edges into the environment to endanger others.
It is Saturday today, and I pass a man and a woman pushing a baby buggy, and give them wide berth. I don’t consider 6-feet far enough distancing. 12-18 feet would be better, since, at 88-years of age, I am at least 2-3 times more susceptible.
A 12-year old zooms by me on a scooter. His age predicts less viral effluent, and the exposure time is less. I then go by a large collection of 20-year olds, Wide berth again, and, holding my breath, continuing to walk fast.
As I walk, I breathe air in through my nose, and out through my mouth. I feel the warmth (and purity) of the exhaled air, which may push aside and dilute any contaminants coming from the outside.
Another group of young adults! Well, maybe the risk is not as bad as the numbers would indicate. Odds are there would be only one spreader in the group, and the healthy ones would act as particle filters for me.
So far, not a single young person had a mask on. They are probably just thoughtless young people, and not necessarily “objectors” believing that mask-wearing is a sign of submission. As Peggy Noonan said in her column in today’s WSJ:
“…IT’S A SIGN OF RESPECT, RESPONSIBILTY AND ECONOMIC ENCOURAGEMENT”.
Going forward, we must all do our part to reduce the likelihood of another Covid surge. WEARING A MASK PROTECTS OTHERS.
I finally spied 2 masks! They were fitted on 2 ceramic lions flanking a front door. It is true that felines can catch Covid. But ceramic ones?
I thought I was walking fast, but was overtaken from the rear by a long-legged young lady. She passed within 4 feet of me, and of course had no mask on. I only hope she didn’t have Covid, and that my shield worked.
On the subject of the effectiveness of wearing a shield, while walking I tune into the odors along the way. I use the odors as surrogate aerosols, especially a recently fertilized curbside flower bed, I compare walking by the flowers, with and without my face shield, and find that the shield reduces but does not eliminate the odor. For more distant odors, like a barbecue, it does not make a difference.
Perhaps the shield, like the prow of a ship, pushes aside STREAMS of particle-laden air. Like coughing or talking nearby. But if the particles (yes, odors are nanometer particles) are well mixed with the air, there is no effect. Air must be breathed, after all.
There are a couple of other things I practice on my walk. I exercise my EYES by looking into the DISTANCE as much as possible. I try to walk as erect as I can. Gravity, my friend in grounding many big Covid-containing mucus particles, tries to bend me over.
The BOTTOM LINE, until more information is available), is: SPREADERS WEAR MASKS, SUSCEPTIBLES WEAR SHIELDS. Of course, hand-washing, social-distancing, coughing into your elbow, and staying at home, especially if sick, are all still important admonitions.,
Doctors Without Waiting Rooms 