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Showing posts from April, 2020

The Nine Symptoms that Go with Covid-19

The Centers for Disease Control and Prevention (CDC) have added to the list of symptoms that reliably go along with Corona Covid-19 infections.  The nine symptoms are:
ChillsShortness of breathFeverCoughRigors (shaking chills often followed by sweating)HeadacheMuscle painSore throatNew loss of taste or smell One or more of these symptoms are reliably present in documented Covid infections and can be a guide for patients to watch out and isolate early if any of them occur.  A patient doesn't have to have all of the symptoms, but as the infection progresses more may occur.  Fatigue is also often what patients report and we are also seeing blood clots, chest pain and and pressure. 
I've answered a number of questions from patients who have GI symptoms like diarrhea, abdominal cramping and nausea and wonder if it is Covid-19.  Those symptoms alone are not likely to be Corona Covid-19.  The Corona virus is specific for the respiratory tract and symptoms always involve the lungs. 
I …

Loss of Taste and Smell common with Covid-19

Over the past month doctors and researchers are gaining more information as we make our way through the novel Corona Covid-19 virus.  We now know that a high number of patients diagnosed with Covid-19 have a sudden loss of smell (anosmia) and/or taste as a presenting symptom.  Some of these patients have no other symptoms and remain otherwise well, yet testing shows they do, in fact, have the virus.

The American Academy of Otolaryngology-Head and Neck Surgery CEO, Dr. James C. Denneny, believes the symptoms could be an early warning signal and patients with acute onset loss of smell or taste should have a high index of suspicion for Covid-19 (also known as SARS-CoV-2) infection.

Since Covid-19 is extremely contagious, any early hints that someone could be carrying the virus would be a clue to get tested and go into quarantine.

The CDC puts out a weekly report called Morbidity and Mortality Weekly and in a study of 5000 healthcare workers who reported symptoms, 750 (16%)s wrote loss o…

Leaving WHO is a Huge Mistake

Donald Trump's declaration that the United States would stop funding the World Health Organization in the middle of a global pandemic sent shock-waves through the medical world.

Less than twelve hours later, the American College of Physicians (the largest medical specialty organization in the United States with members in 145 countries worldwide) declared grave concern that this decision will undermine the effort to make progress on the Covid-19 pandemic. The ACP stated, "We urge the President to immediately restore U.S. funding to WHO, and for Congress to take appropriate action to ensure the continued funding."

In case you wondered, the United States pays about 1/5 of the budget ($400-500 million according to Trump), which sounds like a terrific deal to me. 

What does the WHO do?  Why does it matter if we participate?

The World Health Organization consists of more than 7000 people from 150 countries that work together promote health, keep the world safe and serve the …

Most Covid-19 Hospital Admissions Have Underlying Conditions

Corona Covid-19 Virus is scary.  We remain concerned that the hospital admissions and death rate in the United States continues to rise, even though we are seeing some "flattening of the curve" in some areas that put in early stay-at-home measures.
But the great majority of people will not be hospitalized and will recover from this infection.  Let me emphasize that.  
The great majority of people will not require hospitalization and will recover from this infection.
We have information from the Centers for Disease Control and Prevention (CDC) that helps us understand what is happening.  The hospitalization rate is 4.6 per 100,000 population and almost 90% of those hospitalized have some type of underlying condition; hypertension, obesity, chronic lung disease, diabetes or cardiovascular disease.
As reported before, patients age 65 and over are most likely to have one or more underlying condition (94.4%) but even younger individuals between ages 18-44 had co-morbidities (85.4…

Antibody Testing Is Our Path Back to Work

The world has been sheltering in place for over a month now and everyone wants it to end.  There is much speculation about when cities in the US could start functioning again.  I've had a number of patients and friends ask about antibody tests to see if one has actually had Covid.  Most everyone can remember a "cold" or "sore throat" that they had since December and now wonder "Did I really have Covid-19?"

The answer to that will be provided with a serologic (blood) antibody test.  By taking a few drops of blood (not nasal swabs) we will be able to see if a person has built up antibodies to the virus.  That would mean they were at one time infected. We still don't know what level of antibody provides protection against catching it again, but if Covid-19 follows other viruses, it should be one-and-done, at least for a couple of years, which gives us time to develop a vaccine.

A number of studies are ongoing in humans to answer the question of who …

Covid Virus Challenges of Sub Clinical Infections

The New England Journal of Medicine (NEJM) reported a letter to the editor today (April 6, 2020) from scientists in South Korea describing the challenges of dealing with early infection in patients who do not show symptoms.

Remember that South Korea started testing patients very early and tracking patients they tested. The first confirmed case of Corona Covid-19 was on January 20, 2020.  They started testing people who had traveled and by Feb 10 there were 28 cases of laboratory confirmed Covid Virus ranging in age from 21 to 73.  Only twenty of the patients developed early symptoms and only 8 of the 20 started with a fever.  Some patients reported severe sore throat and some had only a mild cough.

They were able to track all of these patients who had recently traveled and see how they transmitted the virus.  Patient 3, who had no symptoms, transmitted the virus infection to Patient 6, who in turn transmitted it to patients, 10,11 and 21. Patient 12 contracted the virus during a stay…

Will Telemedicine Be The New Normal

The technology for telemedicine (video visits with your doctor) has been around for decades. Sutter Health was the first hospital system in the West to install the electronic ICU (eICU) where critical care physicians and nurses could do remote video monitoring of all patients in ICU beds and jump on problems before they became serious (drop in blood pressure, restless patients, changes on oxygen, or other critical markers).  We have wearable technology for patients to transmit their blood glucose levels, EKGs and even sonograms but despite the technology and hype, none of this has been adopted on a wide scale.

So why has it taken so long for patients and doctors to adopt this technology and use it every day instead of relying on last century visits to the doctors office?  Why does a patient in a rural community need to drive for hours and wait months to see a specialist in a big city?

The Corona Covid-19 Virus will revolutionize telemedicine and I don't see us ever going back.


Ventilators and Corona Covid-19

We are hearing about the need for ventilators during this Corona Covid-19 surge time so thought I’d explain how ventilators work in this crisis and why there is such a demand. It’s important to remember that the Covid-19 virus has no treatment. When a patient is admitted to the hospital we provide supportive care. That means we help the patient stay alive long enough for their own immune system to mount a defense and eradicate the virus.

Supportive care is provided by intense nursing with IV fluids, oxygen, anti-fever drugs, blood pressure support, anti-blood clot drugs and close monitoring for decompensation. Covid patients decompensate (get worse) very quickly and can develop a condition called ARDS (acute respiratory distress syndrome). This is a life-threatening pneumonia where fluid leaks into the lungs and does not allow the alveoli (pulmonary cells) to exchange air.

When patients go downhill and their blood oxygen saturation (O2 sat) falls, they will need mechanical ventilatio…

PPE Is A Massive Problem

I was shocked to receive an email from a friend today with a story that sent chills down my spine.
Everyone knows there has been a shortage of PPE (personal protective equipment) that puts health providers at risk of contracting the contagious Corona Covid-19 virus.  Yesterday (April 2) at the White House briefing it was reported that 200,000 N-95 masks were sent to New York and millions of masks and other PPE will be sent across the nation.   When I received this email, I realized that response is totally inadequate.  The doctor referred to in this email is being kept completely anonymous because he fears his position as a resident would be impacted if the hospital or identifying information were known.

Considering the recent firing of U.S Navy Captain Crozier after he asked for help for his stricken men, this doctor is not being paranoid to want anonymity.

Read this plea and then ask yourself if we are doing enough.

"Dear Toni,
My brother is on the front line in _____________…

Covid Test Negative? Not So Fast

Now that we are expanding testing for Corona Covid-19 Virus, many patients are confused when they feel sick but get a negative test result.  They have all the signs of Covid infection with fever, cough and malaise but the test came back negative.  The Washington Post reported on a woman who was hospitalized with presumed Covid pneumonia but her test was repeatedly negative.  What is going on?
Every clinical test we use in science and medicine has a sensitivity and a specificity.  This tells us how good the test is in diagnosing who has the disease (true positive) and how many people with the disease we missed (false negative).  Doctors know that tests with high sensitivity are pretty good at giving us accurate results for Covid-19 to show us the patients who have the virus. 
With the Covid Virus we have many many tests that are being used and each of them, depending upon how they are testing and how they were developed in the Petri dish, have different values.  None of these tests we…