Medical Discussion of Coronavirus

[White.Beard.Doc]

We have been seeing a vey high prevalence of severe COVID in obese patients, way out of proportion to other younger and middle aged adults. And now what we are seeing has been confirmed with data. A study was just published documenting a >7 fold risk for severe COVID requiring intubation in adult patients under age 60 with a BMI >35. The standard American diet has now become even more lethal.

[snowcanyon]

I'm not so sure about that. I haven't read stories of doctors walking off the job in Italy. In New York, where the death rate is twice Italy's, doctors and nurses are flying in from other less impacted states and coming out of retirement to help. This one's not even getting paid: https://www.barrons.com/articles/com...ty-51586696402

Health care workers are just a different breed. Much more altruistic, but this illuminates more than ever why administrators have their way with us.

Sure they have. Look at Health and Hospitals in NYC: https://www.ny1.com/nyc/all-boroughs...-call-out-sick
And here come the lawsuits. From what I've heard, they are highly justified: https://www.newsweek.com/new-york-st...gainst-1498997

[jfoxcpacfp]

Great question, which I have thought a lot about. I’m 61, though healthy with no other risk factors. I personally know more than 20 people with COVID-19, including 4 patients in my practice. There are a lot of cases in my area. I would like to live to a ripe old age, so my goal is a risk of as close to zero as possible. I am a psychiatrist doing primarily psychotherapy with some psychopharm, and all of my patients, mostly stable long term relationships, are continuing to see me through telemedicine. I get food delivered and have no need to go out. I live in the outer reaches of NY metro but my house borders a large beautiful forest where I hike daily.
If it were up to me, I would opt to stay home under these perfectly acceptable conditions until there is a vaccine or a highly effective therapeutic strategy.

Only one glitch. At some point, and I expect it will be long before there are very low risk options, the schools will reopen. I have a child in 11th grade. Refusing to allow her to return to school does not seem like an option. So I will not be able to remain isolated for the duration. I would if I could though. No question.

One problem with this is that elderly ppl (not you, obviously, you’re middle aged!) who live alone are going stir-crazy and feeling very isolated. Even my 82-yo mom, who I see at least 6 days/wk and who keeps Beau most days, is struggling. I worry about those who don’t have someone checking on them, especially those who are not in a city or suburb and who don’t have the convenience of grocery delivery, for example. Mom’s social life is her church and that’s not an option right now.

[jfoxcpacfp]

The old survive by eating off the table of the young and thrive off the sweat of the young in any society. Does that mean the old don't have a right to live?

Seriously? What century are you living in? The old around here are the great wave of inheritance and saving passing down to their kids and grandkids. Maybe I’m just not in tune to the society you are connected with. Maybe nursing home pts?

[Lithium]

Seriously? What century are you living in? The old around here are the great wave of inheritance and saving passing down to their kids and grandkids. Maybe I’m just not in tune to the society you are connected with. Maybe nursing home pts?

This is exposing the ugly underbelly of intergenerational conflict we also saw with OK Boomer etc.

I don't want to derail this with a political argument but this is a phenomenon largely of the last 50 years and it is only going to get worse. Just look where federal spending is going.

[artemis]

Iowa got smacked hard with Smith workers out -- this is what lack of social distancing at the workplace will cause despite a relatively low prevalence rate.

Same thing happened in Singapore -- largely avoided surge but 2nd wave hitting the migrant worker dorms -- spreading like wildfire. Same on the Teddy - spread fast and furiously quickly.

Distance is needed .

We had the same thing happen here in Nebraska - an outbreak in the workforce in a meat packing plant in the town of Grand Island. Now Grand Island (population 52,000) has more cases than Omaha (population 800,000). It’s by far the biggest hot spot in the state right now. Fortunately the local hospital hasn’t been completely overwhelmed; fingers crossed that remains the case.

So I’m worried that the combination of legitimate economic concerns plus general stir-craziness will lead to opening up some areas too quickly, resulting in a large second wave in those places. Once this virus gets into a crowd, things get ugly in a hurry!

I just bought gift cards for a couple of movie theater chains. It may end up being money wasted, but I love to go out to the movies and feel I need to do my part to try to support a pastime I love. Alas, I don’t know of any drive-in theaters in my area; I suppose I should look!

[artemis]

We have been seeing a vey high prevalence of severe COVID in obese patients, way out of proportion to other younger and middle aged adults. And now what we are seeing has been confirmed with data. A study was just published documenting a >7 fold risk for severe COVID requiring intubation in adult patients under age 60 with a BMI >35. The standard American diet has now become even more lethal.

That’s really frightening, given the prevalence of obesity in our population.

[G]

But NOT new releases -- would love to have that come back and SAFELY reopen movie releases

StarTrekDoc and artemis I realize you are talking about new releases, but there is something really fun about "drive-out" movies. Download a new-to-you movie or old favorite onto your phone/tablet and drive out to the boonies for dinner and a movie.

[Otolith]

There are communities with continued down trending COVID cases, no mass public transit, and plenty of open hospital beds. Start loosening restrictions SLOWLY and Strategically there. (Like start with allowing businesses to open with a max occupancy and 6 foot restriction). Monitor very close and find out what works and what doesn't.

Difficult to have a conversation about this due to the bias.

Bias #1: I have had friends or family die and worked on front lines. Keep everything shut down this is no Joke!
Bias #2: The surge never happened, we have tons of open hospital beds.
Bias#3: My life financially depends on my non essential business which is forced closed, we need a plan to re open.

This is a financial forum of doctors being financially stable enough to weather this storm.....

[Lordosis]

There are communities with continued down trending COVID cases, no mass public transit, and plenty of open hospital beds. Start loosening restrictions SLOWLY and Strategically there. (Like start with allowing businesses to open with a max occupancy and 6 foot restriction). Monitor very close and find out what works and what doesn't.

Difficult to have a conversation about this due to the bias.

Bias #1: I have had friends or family die and worked on front lines. Keep everything shut down this is no Joke!
Bias #2: The surge never happened, we have tons of open hospital beds.
Bias#3: My life financially depends on my non essential business which is forced closed, we need a plan to re open.

This is a financial forum of doctors being financially stable enough to weather this storm.....

We also have been hearing stories from docs on the front lines. I for one really appreciate the work they are doing and sharing their story here.

It is not perfect but I saw this map and it shows how heterogeneous the distribution is.

I agree I am biased. I am close enough to NYC and still have a lot of family in the tri state area. They cannot understand why the rest of the county cannot get with the picture that this is a big deal.

But it started before that. I have family in Northern Italy. When things got bad there is when I took this for real. It started impacting someone I know. Someone I shared a meal with.

Sooner or later it will hit close to home for almost everyone.

[billy]

It shouldnt be all or none. I am in an area hit pretty hard, and would blast any of my friends for wanting to go out now. But in a low density, low hit area, I can see re-opening businesses responsibly. I think we get a lot of " well this state, town, county, etc opened, so why cant we hey lets protest it" as we slowly allow openings, which will lead to disaster in some areas. I believe Tennessee will start reopening soon but Nashville wont- if true, I'll give their leaders credit for following data. But Florida /georgia re-opening while still seeing a rise in cases, i'm not sure that'll work out too great. Sorry georgia, I can't see bowling alleys being essential enough to open at a time like this.

[Anne]

I’m all for a nuanced, graded approach to loosening restrictions based on what is occurring locally. It will be interesting to see how things go in Germany. I will admit this is a gross generalization, but Germans are good at following rules and good at enforcing rules (have you ever ridden a bike in Germany outside of the prescribed bike lane? I don’t advise it) and able to accept nuanced restrictions. Americans on the other hand tend to be more of an all-or-nothing, the-rules-that-don’t-directly-benefit-me-don’t-apply-to-me bunch.

[Tim]

The volatility of the “scientific healthcare models “ have lost tremendous credibility. Quite frankly, no one doubts the healthcare risk to individuals. The “flattening” was sold as the motivation for economic sacrifice. Save the hospital systems was the rally cry. People are standing in their yards scratching their heads saying “ where is it?”
Now the “funding” seems to be targeted to self inflicted economic damage, from the shutdown, not covid-19. The state, city and hospitals need money? Everyone of the politicians and “scientific employees “ is getting paid.
The owners of the shuttered businesses no longer believe the models and systems. Forget the explanations, talking about better data or containment techniques are no longer worth the economic sacrifices suggested.
Opening the bowling alley is essential to the owner and employees. They don’t believe or care about the problems the “might” happen. Bad forecasts and flattening have left most relying on their own eyes. Our hospital is functioning just fine except for the “electives” that would have been just fine. NYC and “visions” have zero impact on the bowling alley. Going to work.
Its not that they don’t trust you, they don’t believe you. That is the sentiment developing across the country.

[Tangler]

We have been seeing a vey high prevalence of severe COVID in obese patients, way out of proportion to other younger and middle aged adults. And now what we are seeing has been confirmed with data. A study was just published documenting a >7 fold risk for severe COVID requiring intubation in adult patients under age 60 with a BMI >35. The standard American diet has now become even more lethal.

Yes, seeing the same. Occasionally there is a young thin person, but many are obese. I wonder if it is obesity related pulmonary disease or right heart strain or if there is a molecular mechanism involving insulin resistance or hyperglycemia or immunodeficiency due to that? I need to miss some meals!

[White.Beard.Doc]

Yes, seeing the same. Occasionally there is a young thin person, but many are obese. I wonder if it is obesity related pulmonary disease or right heart strain or if there is a molecular mechanism involving insulin resistance or hyperglycemia or immunodeficiency due to that? I need to miss some meals!

There is a theory about high expression of angiotensin receptors in adipose tissue creating greater susceptibility to the virus, as the virus enters host cells via ACE2 receptors.