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Aemon Stark

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Everything posted by Aemon Stark

  1. Well, I know where I live so... Pays to be on an island sometimes. We're up to 236 cases now. Some speculation that there will be a big bump after Easter Weekend. Well, I rather enjoy the idea that we could be confused with the Dutch. Kinda like confusing Iceland with Italy.
  2. There's a bit over 200 cases in NL now, mostly not hospitalized, and our area has so far been largely spared. For now. I think the lipid thing is interesting, because there is retrospective data in the dialysis population regarding outcomes and lipid levels. But it's very hard to know what that means; they tend to be high risk at baseline for infectious and vascular complications, among other things. There's still much we don't know about this virus.
  3. I don't like just jumping in, but... chronic kidney disease can have a substantial effect on lipid metabolism and production, not least because proteinuric CKD tends to be complicated by increase production. I have never encountered any substantive literature that higher cholesterol has some sort of protective effect on infectious risk or host-response generally. That doesn't mean I can't be wrong about that, but CKD (and end-stage renal disease in particular) certainly matters, particularly with comorbid conditions like diabetes and atherosclerosis. The study you quoted also suggested that all-cause mortality was if anything decreased by dyslipidemia. I very much doubt that is the case. #confounders These are retrospective case series only. Baseline nutritional status, on the other hand, mitigates against frailty and provides greater physiologic reserve in the face of infection and other disease. Chronic kidney disease tracks fairly well with atherosclerotic risk. Dialysis patients in particular are prone to this and often has some of the worst outcomes. I don't know what this research is, but I can imagine this has at least a bit to do with the fact that people with higher CV risk also have lower LDL targets. Unsurprisingly, people with established coronary artery disease who we try to suppress LDL < 1.8 are overall going to have higher morbidity and mortality. I don't think this statements squares with the literature at all. More important lab findings predicting poorer outcome in COVID-19 include signs of excessive inflammatory response with high serum Ferritin, IL-6, and d-Dimer levels (we've put some of these on our admission order sets). We also know that people with significant comorbid disease fare worse (not all that surprising). (Consider: PMID: 22910937 "Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis." Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GF Ann Intern Med. 2012;157(4):263.) Lipid levels tell you something about lipid metabolism, not nutritional status generally. The key to supporting COVID-19 patients - and critically ill people generally - is aggressive supportive care including enteral nutrition. For people whose GI tract isn't working properly, we do add lipid preparations alongside TPN.
  4. I mean... can we still have that show? It's always kinda remarkable that people that succeed best in TV industry often are the worst writers, with the most poorly-thought-out ideas. I liked Picard a lot in the end. It didn't all work, of course, but I dug the actors and characters and bringing dimension to the Romulans who previously typified the "planet of hats" model of alien cultures. Always a game of chess with them, however. Kurtzman doesn't seem all that different from Berman insofar as "disrespecting the audience" goes. We could have had a post-Dominion War show that didn't feature a single DS9 character, yet drew upon that setting for stories and characters nonetheless. It's not as though Picard didn't require a prequel Short Trek and fairly extensive (if mostly well placed) exposition for the completely novel circumstances we got.
  5. Unfortunately for me, beards and being unshaven generally interfere with N95 mask fit.
  6. We need that kind of war mobilization now. Yesterday. We need the PPE especially.
  7. What's more is that high levels of oxygen introduce a lot of free radicals and, sometimes, cell damage. So for people with poor oxygenation, we try to optimize lung function and gas exchange rather than just cranking up the fraction of O2. Being on 100% oxygen is bad. Also in the last thread Ran said something about people being recommended paracetamol over acetaminophen. Of course, these are the same thing, and I expect he meant ibuprofen. #europeans
  8. I hope you're doing okay, but it's important to point out that there have been no completed randomized controlled trials (or even prospective cohort studies) supporting any of this. There may indeed be a role for chloroquine (and other anti-malarials?) but extra high doses of Vit D might only lead to toxicity. Also, any physician recommending against a vaccine because of "immune-booster" supplements is committing borderline malpractice. Can the supplements, get the flu vaccine. If there were a COVID-19 vaccine (and there will be... in 12-18 months), would this reasoning apply? The respiratory syndrome associated with severe COVID-19 is "ARDS" or "Acute Respiratory Distress Syndrome". It can cause short-term fibrotic changes, but generally lung function returns to baseline within a few months to a year. Assuming you get there. That sounds quite anti-Dentite. My hospital is preparing - and well enough I'd say. Visitors are restricted except to palliative care, pediatric patients, and obstetrics/babies. And even then, only one at a home with screening at the door. In the meantime, we've almost cleared out an entire ward for isolation use. We haven't quite settled on our approach for allocation of ICU beds, but the recovery room will likely take the non-COVID-19 patients at a certain point to maintain some degree of separation. It may all be unnecessary and I really hope it turns out that way. We have one case so far, something like another 150-200 tested without any positive results. Schools are closed along with most other things. Stores are stocked well enough for now. And we are on an island so that doesn't hurt. But I think we'll be as ready as we can be. We're going to some simulation exercises within a few days to really get things ready. I'm also part of a few social media groups for physicians about the virus. Mostly there are a lot of memes and comments about "flattening the curve", but also a lot of anxiety and concern - and some is about the financial side with most "elective" things being cancelled. (I was going to be away this week and next so didn't have much of anything booked anyway.) This does mean a big hit for some, but the complaining seems awfully selfish and tone deaf. No one is getting through this unscathed. I felt a LOT of anxiety about the virus and the consequences of social distancing late last week and over the weekend. At some point, I decided that this is, essentially, a war, and we must mobilize our resources and accept necessary sacrifices to get through it.
  9. Only 600?? We supposedly have 98 in NL, though I suspect that overcalls some beds that aren't truly fully capable ICU beds. Either way, that's for half a million people. A lot of issues in sepsis amount to this kind of immune "overreaction" - which is why people going on about how "strong" their immune system betray a complete lack of knowledge of how this works. We're not very good at finding effective immune-modulators in sepsis or ARDS or viral pneumonias generally. But antivirals might help - except which ones? Chloroquine, which is an old anti-malarial, might be good. We won't really know for a while. Anti-inflammatory diets are more faddish than anything else for this sort of thing.
  10. They're kinda like the people welcoming the arrival of the aliens in Independence Day.
  11. Nothing is as bad as Outbreak, but even Contagion with the dramatic meningitis and seizures is fairly crazy over the top (even if chillingly prescient in other ways). The major difference between SARS-CoV2 and Influenza is the current lack of a vaccine or treatment with a good evidence base. There probably will be a vaccine - maybe within the year, maybe longer - but at this early stage we're mainly looking at "best supportive care". It's certainly possible it could end up being a seasonal event, with regular annual influenza-like epidemics. Or it could go the way of SARS-CoV1 and disappear. There's not enough known about how this virus might evolve over the medium to longer term to know for sure.
  12. We've got our first case: COVID-19 reaches N.L. as 1st presumptive case announced
  13. I bought yesterday. Just as well that I don't actually have much exposure. I only buy once or twice a month so it will be the next pay period until I do again. #dollarcostaveraging
  14. TSX was a bloodbath today. Gonna see how things go tomorrow, but it's a good time to buy anyway...
  15. Just a comment, but influenza susceptibility - and even the potential for a serious infection - has little do with whether you have a "working" immune system. People who are immunocompromised (whether from HIV or chemotherapy or whatever) get all kinds of weirder, and often worse, infections, but just about anyone can get influenza. And while seasonal influenza *generally* hits the elderly and frail hardest, it's hard to predict who might have an exaggerated immune reaction leading to serious illness.
  16. I watched it pretty faithfully throughout its run. But it could have been so much more. I don't know if the Maquis stuff always worked so well in the first season, but at least it added an interesting dynamic. Then it just disappeared - would have been a lot better if a character like Seska had not turned out to be a Cardassian agent - having that conflict around on the ship would have been much better and more interesting. The first two seasons also suffered at the time (and especially now) with the worst alien villains of all - the Kazon.
  17. If you're going to discuss a novel coronavirus, it's best to stick to appropriate technical terms. Otherwise I have no idea what you're doing here apart from trolling. If you have something new to contribute to this discussion, by all means do so. Otherwise I'd request this line of argument end here and now (cue mods).
  18. No no no. You cannot just make up your own meanings for technical terms. Influenza is not spread through "airborne droplets" but through close contact with infected individuals, fomites, and respiratory secretions. I'm not sure why you're referring to influenza as "ordinary" flu - it kills hundreds of thousands of people worldwide every year. This is disingenuous nonsense. There is no "ordinary English" meaning for "airborne transmission". You're simply shifting the goal posts of your unsupportable argument. And, for reference, certain viruses like SARS can become aerosolized in certain circumstances. Generally SARS only spread via droplets and close contacts, but there is a risk of aerosolization during airway management or invasive suctioning. Which is why I sometimes will wear an N95 when intubating patients with uncertain respiratory illnesses (recently that was with a guy who ended up having RSV which it isn't necessary for).
  19. There are so many episodes of Voyager that I've seen - many more than once - and scarcely remember. I'm thinking of some of the dark stretches of the first three seasons especially, stuff like Ex Post Facto or Rise.
  20. Influenza is spread via droplets, which are "airborne" only insofar as they are launched into the air by coughing or sneezing on someone in the immediate vicinity. It is NOT spread via airborne transmission, which is why we NEVER isolated people with influenza in negative pressure rooms, unlike TB, measles, varicella, etc.
  21. I don’t think you are able to distinguish between theories and (conspiratorial) speculation.
  22. Please stop using the term “airborne” in relation to COVID-19. That is a very specific type of infection transmission limited to things like active pulmonary TB, measles, and chicken pox.
  23. You mean facilities with complicated air-handling systems, staff working with extensive PPE, and small samples of viruses and other infectious agents stored and handled with numerous precautions, mainly to test things like growth media and other testing? But I could be wrong - COVID-19 could be a conspiracy involving the RAND Corporation, in conjunction with the saucer people, under the supervision of the reverse vampires to divert attention from fiendish "biolabs" to live animal markets. We're through the looking glass here, people.
  24. Like an old man trying to send back soup in a deli. (I don't really think that but the opening for the Seinfeld quote was irresistible.)
  25. He's not Emo Legolas... for he is the Kwisatz Haderach!
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