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Stayin' Alive - Covid-19 #10


Fragile Bird

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5 hours ago, Toth said:

Day 23 of the lockdown. I... I'm afraid my body starts to dissolve into a heap of pain. While I am a big couch potato, this amount of sitting at the laptop that I am doing right now is truly ridiculous. Because I have started to fight with constant neck pain and headaches I have started to pick up jogging again yesterday. After a small jog and a shower my pain is like blown away, but over the course of the day and into the night till the next morning it slowly returns. This happened yesterday and this happened today, with me already having my headache back. This... this is super frustrating... I guess I have to look for stuff I can do inside to work on my fitness, but here I have to deal with my usual anxiety attacks that prevent me from doing any exercise for fear of getting seen. Gah...

Change position

Change position

Change position

Motion is lotion

Mobility is key

The best posture is your next posture

 

 

Your body is designed to move, not to hold any static position for a prolonged period of time.

Yes, go for a run, or a walk if you can, but even around the home, you can move to a different room, change chair, or just constantly fidget.

 

If it's really hitting the neck, shoulders, and head, then spend some time in the opposite to your 'normal' position - likely hunched over a screen of keyboard. Push your arms behind you, and down. Take the shoulders back and down with them, nod the head all the forwards (or all the way back if that relieves).

 

Stretch &/ strengthen the muscles of the neck, first by simply taking the head as far as it goes (without aggravating pain) into twisting, side bending and looking up& down. Move your eyes in the same direction for twisting and up&down.

Then by doing the same, but using your hands to not let the head move, so an 80% contraction of the muscles that bend your neck to the side - against full resisitance - repeat for all 6 directions of movement.

 

I've PM.d you, and if you like, I can do a Zoom consultation via the links included, - free of charge

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25 minutes ago, Fragile Bird said:

Lol, you haven't been paying attention! A couple of us reported seeing the story, but we can we find the damn thing now? The problem is you end up following link after link, and you might note the details but not save the link.

No, I have been paying attention, I just thought it would make sense to ask for the link in case you have the specific Chinese study re: cholesterol that you were talking about. I don't like making conclusions, especially  medical ones, without reading the research in question. :dunno:

I guess I'll look for it myself when I have the time.

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For ergonomics, the 20 20 20 rule is also useful (for eyes and movement, for example)

For eyes: Every 20 minutes, look at something 20 feet away for 20 seconds

For motion: Every 20 minutes, walk 20 feet away for 20 seconds (easier to do if you get up to chat with a coworker, lol)

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There's good cholesterol and the not so good cholesterol, so not shocking that their could be some immunity benefits from the more desirable type of cholesterol.

The better cholesterol can be raised through exercise, I believe eating plenty of olives can assist those levels as well.

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52 minutes ago, Fragile Bird said:

There are pages and pages of links to studies about cholesterol levels in patients fighting infections, this is just one of many that saw a relationship between cholesterol levels and the ability to fight infections. The fact they are renal patients is irrelevant, the way cholesterol works in your body doesn't change because you are a renal patient.

I am not making any claims about Covid-19 patients with the link. Chinese researchers reported that after looking at 2,000 blood samples they found people with higher levels of cholesterol dealt with Covid-19 better. 2,000 samples was obviously a big enough sample they thought they should report it. The possible role cholesterol plays in fighting infections has been studied for decades. There was a study from the 1990s that I looked at last week when I first mentioned the Chinese story, of residents in nursing homes showing better outcomes fighting the flu in patients with higher cholesterol levels. No Covid-19 back then, either. That does not mean it's irrelevant.

Cardiovascular disease and kidney disease can be linked, which is why cholesterol levels are studied in both cases. High blood pressure can force the heart to work harder, damaging the heart and damaging kidneys because more blood is being pushed through the kidneys. In many renal patients it's a chicken or egg situation, did the patient have damaged kidneys because they had high blood pressure, or high blood pressure because they had damaged kidneys. (My mom was a dialysis patient for many years).

Not all people with CVD develop kidney problems, and not all kidney patients develop CVD. Research has shown that dialysis patients with higher cholesterol have fewer hospitalizations and live longer than dialysis patients with lower cholesterol. I'm pretty sure not only the Chinese are going to study cholesterol levels in Covid-19 survivors, because cholesterol does appear to play a role in fighting infection. 

 

I can see a biochemical reason for high levels of cholesterol and lipids helping for COVID-19 patients.  COVID-19 ravages the lung tissues, which have a huge surface area, which means very large numbers of cells are damaged or destroyed and need to be repaired or replaced.  The cell membrane is made of lipids, cholesterol, and other materials, so having enough of these materials on hand would be helpful for recovery.

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So people are wondering what the future looks like, and it's like this: if you do not have great contact tracing and great testing, you'll have sporadic lockdowns. And this is from Singapore, one of the better places as far as being scientifically and data-based goes.

The US absolutely needs massive amounts of fast testing and significant ability to monitor population breakouts and containment strategies. Otherwise this will happen again and again.

 

 

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1 hour ago, Toth said:

I actually ended up looking for exercise videos against neck pain and this those exercises for about half an hour and I am absolutely stunned. My pain has diminished greatly. Or at least it wandered down from the head to the shoulders that are now burning like fire.

... an exchange I would take any day.^^

But it left me wonder as a Computer Science teacher. Since I am currently busy furnishing an online learning platform for my students, I wonder whether it is reasonable for me to add a few of those exercises to the dashboard to help them. I am sure students switching back and forth between homeschooling and videogames will be in dire need of that as well.

Absolutely.  It's essential.  And even dancing is good!

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9 minutes ago, Kalbear said:

So people are wondering what the future looks like, and it's like this: if you do not have great contact tracing and great testing, you'll have sporadic lockdowns. And this is from Singapore, one of the better places as far as being scientifically and data-based goes.

The US absolutely needs massive amounts of fast testing and significant ability to monitor population breakouts and containment strategies. Otherwise this will happen again and again.

 

 

I think this is Singapore's first lockdown.  They have been doing a containment strategy and have been gradually implementing mitigation measures before implementing the lockdown.  Looking at the daily cases chart, I don't see a second wave of cases either.  It's been gradually picking up since early March.  If there was an earlier lockdown, when would it have been implemented?  And why wouldn't there have been a clear drop in cases?  I don't see it.  I did a little bit of googling, and I couldn't confirm that there was an earlier lockdown.  There were some recent stories making the same claim, but no story published at the time of the first alleged lockdown.

Shoddy reporting aside, I think the point still holds that if you end the lockdown, cases will begin to go up exponentially again unless you implement an effective containment strategy, which as you say requires aggressive testing, contact tracing, and individual quarantine.  You can also slow the exponential growth by retaining some of the mitigation measures, like wearing a facial covering in public or in crowded places (i.e., at work, on public transportation, etc.).  Unfortunately, the contact tracing is extremely labor intensive, so it won't be possible until we get the numbers of new cases down to maybe around 100 new cases per day, or maybe a little more than that (200?, 300?), before it becomes unfeasible.  Early on, California was tracking thousands of people when we had less than a dozen or so cases.  The long incubation period and asymptomatic or presymptomatic transmission also make this much more difficult.

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Everyone will be Sweden at some point or other, except for those few nations (mostly islands like Taiwan, Singapore, NZ, Japan, or countries with only one or two borders to concern themselves with) which can feasibly slow outside vectors to a trickle until a vaccine exists. This would include quarantine of citizens whenever they return from trip abroads, quarantining visitors, etc.

It’ll kill tourism and harm adjacent sectors, but depending on how much that matters to the country, maybe that’s a fair price to pay. 

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29 minutes ago, Ran said:

Everyone will be Sweden at some point or other, except for those few nations (mostly islands like Taiwan, Singapore, NZ, Japan, or countries with only one or two borders to concern themselves with) which can feasibly slow outside vectors to a trickle until a vaccine exists. This would include quarantine of citizens whenever they return from trip abroads, quarantining visitors, etc.

It’ll kill tourism and harm adjacent sectors, but depending on how much that matters to the country, maybe that’s a fair price to pay. 

What do you mean by this exactly?  I think that I might be able to guess, at least partly of what you mean, but I don't want to assume.

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1 hour ago, Fragile Bird said:

There are pages and pages of links to studies about cholesterol levels in patients fighting infections, this is just one of many that saw a relationship between cholesterol levels and the ability to fight infections. The fact they are renal patients is irrelevant, the way cholesterol works in your body doesn't change because you are a renal patient.

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. 

1 hour ago, Fragile Bird said:

I am not making any claims about Covid-19 patients with the link. Chinese researchers reported that after looking at 2,000 blood samples they found people with higher levels of cholesterol dealt with Covid-19 better. 2,000 samples was obviously a big enough sample they thought they should report it. The possible role cholesterol plays in fighting infections has been studied for decades. There was a study from the 1990s that I looked at last week when I first mentioned the Chinese story, of residents in nursing homes showing better outcomes fighting the flu in patients with higher cholesterol levels. No Covid-19 back then, either. That does not mean it's irrelevant.

#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. 

1 hour ago, Fragile Bird said:

Cardiovascular disease and kidney disease can be linked, which is why cholesterol levels are studied in both cases. High blood pressure can force the heart to work harder, damaging the heart and damaging kidneys because more blood is being pushed through the kidneys. In many renal patients it's a chicken or egg situation, did the patient have damaged kidneys because they had high blood pressure, or high blood pressure because they had damaged kidneys. (My mom was a dialysis patient for many years).

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. 

1 hour ago, Fragile Bird said:

Not all people with CVD develop kidney problems, and not all kidney patients develop CVD. Research has shown that dialysis patients with higher cholesterol have fewer hospitalizations and live longer than dialysis patients with lower cholesterol. I'm pretty sure not only the Chinese are going to study cholesterol levels in Covid-19 survivors, because cholesterol does appear to play a role in fighting infection. 

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.)

43 minutes ago, Mudguard said:

I can see a biochemical reason for high levels of cholesterol and lipids helping for COVID-19 patients.  COVID-19 ravages the lung tissues, which have a huge surface area, which means very large numbers of cells are damaged or destroyed and need to be repaired or replaced.  The cell membrane is made of lipids, cholesterol, and other materials, so having enough of these materials on hand would be helpful for recovery.

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. 

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48 minutes ago, Mudguard said:

What do you mean by this exactly?  I think that I might be able to guess, at least partly of what you mean, but I don't want to assume.

Every country except a relative handful will attempt to control the virus at a level that does not overload the health care system but is otherwise as loose as is possible. Rather than going full lockdown every time things get past test-and-trace, I think most countries will accept that there's a certain amount of spread that will have be tolerated that extends beyond what testing and tracing regimens are simply capable of. That's my view of where this is going.

 

Especially in the US. And not even through Trump's incompetence or malfeasance, but because the United States is a place where you aren't even obligated to provide identification to authorities in most states. The idea that we're going to able to pervasively track and identify carriers within state boundaries, much less across them, in the time it takes this thing to spread a few times is fantastical.

Paul Romer, whom Yglesias mentioned in the embedded tweet, is talking about the US building up the ability to take and process 100 million tests per week to combat a virus that will not be stomped out. It's absurd. The flu season in 2017-2018 may have killed 61,000 Americans, according to the CDC, and it's just something we accept and approach from the perspective of reasonable mitigation.

COVID-19 will also be the subject of reasonable mitigation as we keep seeing these outbreaks, especially if the vaccines people talk about are a pipe dream. I thought vaccination was time consuming but relatively easy, but reading more about it, we have basically never created a coronavirus vaccine before. Not even for SARS. It'd make more sense to try variolation techniques than to hold out hope for a vaccine that may never come and, in any case, may be all rather moot ~12 - 18 months out if most of the world has gone through infection anyways.

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7 minutes ago, Ran said:

Paul Romer, whom Yglesias mentioned in the embedde tweet, is talking about the US building up the ability to take and process 100 million tests per week to combat a virus that will not be stomped out. It's absurd. 

Why is it absurd? When you look at the cost of an extended lockdown, or look at the cost of hundreds of thousands of deaths, why not consider the cost of an extraordinarily expansive testing regime instead? It might very well be the cheapest option, and by orders of magnitude.

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6 minutes ago, Fez said:

Why is it absurd? When you look at the cost of an extended lockdown, or look at the cost of hundreds of thousands of deaths, why not consider the cost of an extraordinarily expansive testing regime instead? It might very well be the cheapest option, and by orders of magnitude.

Is it physically possible to do that many tests? Presumably you'd need enough qualified people and specialised equipment to actually process the tests. I'd guess there probably isn't enough of either to do anything like 100 million tests and there's probably a good chance even throwing vast amounts of money at the problem wouldn't change that in anything like the time frame needed for it to be useful.

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Depends a lot on the kind of testing we're doing. 100 million tests a week is probably close to the total test capacity of the US for ALL kinds of bloodwork, so that's unreasonable. 5 million a week, if the test was made a bit better and didn't require both specialized labs and specialized lab workers? Probably far closer to reasonable. 

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23 minutes ago, Ran said:

Every country except a relative handful will attempt to control the virus at a level that does not overload the health care system but is otherwise as loose as is possible. Rather than going full lockdown every time things get past test-and-trace, I think most countries will accept that there's a certain amount of spread that will have be tolerated that extends beyond what testing and tracing regimens are simply capable of. That's my view of where this is going.

Especially in the US. And not even through Trump's incompetence or malfeasance, but because the United States is a place where you aren't even obligated to provide identification to authorities in most states. The idea that we're going to able to pervasively track and identify carriers within state boundaries, much less across them, in the time it takes this thing to spread a few times is fantastical.

Paul Romer, whom Yglesias mentioned in the embedded tweet, is talking about the US building up the ability to take and process 100 million tests per week to combat a virus that will not be stomped out. It's absurd. The flu season in 2017-2018 may have killed 61,000 Americans, according to the CDC, and it's just something we accept and approach from the perspective of reasonable mitigation.

COVID-19 will also be the subject of reasonable mitigation as we keep seeing these outbreaks, especially if the vaccines people talk about are a pipe dream. I thought vaccination was time consuming but relatively easy, but reading more about it, we have basically never created a coronavirus vaccine before. Not even for SARS. It'd make more sense to try variolation techniques than to hold out hope for a vaccine that may never come and, in any case, may be all rather moot ~12 - 18 months out if most of the world has gone through infection anyways.

It's certainly possible that lockdowns are going to be ended, and what remains is a set of less stringent mitigation measures.  We can't keep this up for another 12 months.  China is an interesting test case, since they've recently eased the lockdown of Wuhan, so it will be interesting to see how well they can keep the virus in check.  Unfortunately, we didn't or can't replicate the severity of China's lockdown, so I'm skeptical that we can get case numbers down low enough for containment measures to be even feasible.

I don't think lockdowns are going away.  In a densely populated area, an outbreak can quickly overwhelm the local health care system, making a lockdown necessary.  For a less densely populated area where the R0 is naturally lower, as in Sweden, it's possible that lockdowns are not needed, but that remains to be seen.  

Hitting the sweet spot where your health care system can indefinitely keep up with new cases is extremely difficult because no one really has a good idea how effective the various mitigation measures are, and you have to wait around a month after implementation to see an effect.  In addition, all our models have a huge degree of error built into them.  We are talking about numbers of deaths that can vary by one or more orders of magnitude.  A wrong assumption on the degree of effectiveness of the current mitigation measures, even if small, could mean many more cases than expected, due to the nature of exponential growth.

As bad as things are now, consider how bad things would be if we have to rely on reaching herd immunity, which is roughly 50% of the population immune after recovering from infection.  The population of the earth is around 7.5 billion.  Currently, there are about 1.5 million confirmed cases, so if you assume that we only detect 20% of the cases, that would mean there's currently about 7.5 million cases.  That's just 0.1% of the population infected.  To reach herd immunity worldwide, we would need 500 times more people to get infected.  Current deaths stands at roughly 90,000, with the caveat that of the current 1.5 million confirmed cases, 1.1 million cases are active, which means the 90,000 number is just a rough baseline.  90,000 times 500 is 45 million dead, at a minimum, which also excludes the under-reporting of COVID-19 deaths that we are seeing worldwide.  

Anything we can do to avoid this scenario should be attempted.  It's possible that we fail, and herd immunity is the path that we all end up on, but I don't think it's a given yet.

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4 hours ago, Jen'ari said:

TB seems to be something that doesn’t get thought of as still being around much, well in the U.K. anyway, I know it is much more prevalent in the developing world still.

I’m not too knowledgeable on the treatments, is it similar to Syphilis in that it’s a very long antibiotic treatment that spans several months I’m guessing?.

TB gets imported to the UK from places where the healthcare infrastructure isn't quite as good. It's still around. 

Treatment is five different drugs for six months. Compliance for that is a massive issue, as you can imagine. 

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