Medical Discussion of Coronavirus

[Kamban]

Unfortunately, the same could be said for the obese, those with uncontrolled blood pressure/diabetes, those who have COPD and continue to smoke, those who have CHF but refuse to even attempt to alter their diet, those who are clearly end of life but family can’t accept it, etc. COVID is new but I’m tired of using up our resources for all of the above.

Most of these take years to occur, and some like CHF and BP may be treated but not well controlled for no fault of theirs and don't tie up resources all at once. COVID has a good vaccine that can really change the equation completely. If you don' t take it, your choice. But when an ICU bed opens up it should be the post transplant patient and not this unvaccinated COVID.

[blippi]

Electives canceled now.

Interestingly, I had a Covid positive smoker the other day. It’s doesn’t come up very often. I admit multiple covid patients per shift through multiple waves now, and I cant remember admitting a smoker with serious enough covid to be admitted yet. Perhaps smoking is just more rare these days. But it’s oddly rare in covid patients. Still thinking it’s actually protective. Shhhh….

It can also be cured by standing in the senate chamber for five minutes.

we are not russian bots.

[StarTrekDoc]

You're not heartless, but your thinking is magical. Logical while simultaneously naive.

Our society is all about freedom and liberty and individuality...until that approach doesn't work for the individual.

There is a solution -- insurance coverage -- exclusions --

-Check box if you decline covid vaccination - if so, you waive insurance coverage for covid related illness.
-same for federal assistance. just like how some state governments are trying to enforce nonmandates by withholding state funding; same for fed covid relief funds related assistance to low vaccinated areas. a la charter school vouchers. --- what's good for the goose is good for the gander.

I doubt the Dems have the fortitude to do this scorched earth tactic,

[CordMcNally]

Most of these take years to occur, and some like CHF and BP may be treated but not well controlled for no fault of theirs and don't tie up resources all at once. COVID has a good vaccine that can really change the equation completely. If you don' t take it, your choice. But when an ICU bed opens up it should be the post transplant patient and not this unvaccinated COVID.

Not getting the vaccination should be implied DNR/DNI.

[burritos]

Can someone venture a mechanism of action on how someone a seemingly a fit/healthy like John Eyers passed?

https://news.yahoo.com/42-old-fitness-fanatic-beating-090128572.html

Unvaccinated, ok, but this guys looks like an absolute beast. It states that he ate healthy, whatever that means, but I don't get how viral runaway and subsequent complications could take a fatal hold.

[Lordosis]

Electives canceled now.

Interestingly, I had a Covid positive smoker the other day. It’s doesn’t come up very often. I admit multiple covid patients per shift through multiple waves now, and I cant remember admitting a smoker with serious enough covid to be admitted yet. Perhaps smoking is just more rare these days. But it’s oddly rare in covid patients. Still thinking it’s actually protective. Shhhh….

Maybe it is just that no one wants to be around the smokers?

[CordMcNally]

Can someone venture a mechanism of action on how someone a seemingly a fit/healthy like John Eyers passed?

https://news.yahoo.com/42-old-fitnes...090128572.html

Unvaccinated, ok, but this guys looks like an absolute beast. It states that he ate healthy, whatever that means, but I don't get how viral runaway and subsequent complications could take a fatal hold.

It says he was a bodybuilder. Was he a natural bodybuilder? The unnatural bodybuilders are typically far from healthy. On the flip side, sometimes healthy people die of diseases such as the flu for no great reason other than bad luck.

[G]

Electives canceled now.

Interestingly, I had a Covid positive smoker the other day. It’s doesn’t come up very often. I admit multiple covid patients per shift through multiple waves now, and I cant remember admitting a smoker with serious enough covid to be admitted yet. Perhaps smoking is just more rare these days. But it’s oddly rare in covid patients. Still thinking it’s actually protective. Shhhh….

Ha! I thought everybody smoked down there!

Suffice it to say that we have not noticed that trend. Maybe the wildfire smoke reverses the protection of tobacco smoke?

[Brains428]

We're at a plateau in SW MO after 6 weeks of this. Vaccination rates still abysmal. Several physicians willing to retire early/get fired over the hospital vaccine mandate. FEMA has shown up to help staff the units, but it might be too late (we probably needed them 2 weeks ago, other places probably in higher need).

Fintwit/crypto twitter has a weird thing about not getting the vaccine. Probably because it's dominated by young males.

Didn't they say that long COVID would be eligible for social security disability? Is there not a way to exclude you from that option if you decided to not get vaccinated?

[ObgynMD]

Can someone venture a mechanism of action on how someone a seemingly a fit/healthy like John Eyers passed?

https://news.yahoo.com/42-old-fitness-fanatic-beating-090128572.html

Unvaccinated, ok, but this guys looks like an absolute beast. It states that he ate healthy, whatever that means, but I don't get how viral runaway and subsequent complications could take a fatal hold.

PE?

[burritos]

PE?

I believe that thrombosis is a function of Netosis. Neutrophilic Extracellular Traps.

https://en.wikipedia.org/wiki/Neutrophil_extracellular_traps

I did not learn this in med school or residency. General medicine ideology has us believe that thrombosis is just due to hypercoagulable tendencies.

I believe that if you have viremia, bacteremia, or malignancy in the vasculature, thrombosis is a function of neutrophilic action(netosis) against these foreign entities. In excess these chromatin traps then physically obstruct blood flow. If you have persistent viremia due to a novel virus in which your immune system is slow to recognize, then clots form. PE. But someone who is metabolically healthy should be able to clear virus, and viremia should not persist. That I don't understand in this particular individual.

Wish they had this video when I was in med school, though when I was in med school they were just starting to roll out email:

[HikingDO]

I firmly believe in the freedom of individual choice. I also firmly believe in dealing with the consequences of that individual choice. As a country, we don't do a great job of letting people suffer the consequences. I know the reality is much more difficult than the thought but our government seems to make everything it touches just a bit worse than they found it.

Funny, I could have written this word for word myself. Great minds think alike I guess.

[burritos]

It says he was a bodybuilder. Was he a natural bodybuilder? The unnatural bodybuilders are typically far from healthy. On the flip side, sometimes healthy people die of diseases such as the flu for no great reason other than bad luck.

He also did triathlons, so definitely able to do cardio, though not sure if he powered himself with sugar gels instead of allowing fat metabolism to fuel his endeavors.

Macroscopically it may appear like bad luck. Though I believe that something is happening that is eminently understandable at the cellular and biochemical level. It just hasn't positively been elucidated. Too bad we can't micronize ourselves with our iphones and videotape what is happening and then upload it to the cloud. But if biochemists and cell physiologists decades ago were able to identify and explain things that we take for granted as true like mitosis, dna replication, RNA transcription, protein synthesis, insulin signaling, Krebs cycle, electron transport system, etc... it's just a matter of time that smart people in the lab will be able to accurately describe how things can go sideways at the cellular level.

[PedsCCM]

Immune dysregulation is REALLY complicated. Multiple pieces of this can lead to coagulopathy, endothelial damage, etc. I’m sure low insulin levels and low blood glucose levels are protective - but I would guess they’re probably not absolutely protective. If the dysfunction were really restricted to one cell line, wouldn’t we have figured it out by now?

[Zaphod]

Give a virus to billions, and you're going to get some crazy, one in a billion outcomes.