Patterico's Pontifications

4/22/2020

COVID Patients and Blood Clotting

Filed under: General — Dana @ 2:48 pm

[guest post by Dana]

Yet another awful find about COVID-19 and sick patients:

As the novel coronavirus spread through New York City in late March, doctors at Mount Sinai Hospital noticed something strange happening to patients’ blood.

Signs of blood thickening and clotting were being detected in different organs by doctors from different specialties. This would turn out to be one of the alarming ways the virus ravages the body, as doctors there and elsewhere were starting to realize.

At Mount Sinai, nephrologists noticed kidney dialysis catheters getting plugged with clots. Pulmonologists monitoring COVID-19 patients on mechanical ventilators could see portions of lungs were oddly bloodless. Neurosurgeons confronted a surge in their usual caseload of strokes due to blood clots, the age of victims skewing younger, with at least half testing positive for the virus.

“It’s very striking how much this disease causes clots to form,” Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think COVID-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient’s first symptom of COVID-19.

Doctors were compelled to develop new treatment protocols:

As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.

“Maybe, just maybe, if you prevent the clotting, you can make the disease less severe,” said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.

The numbers:

In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.

Five were unusually young, under age 49, with no obvious risk factors for strokes, “which is crazy,” he said. “Very, very atypical.” The youngest was only 31.

At least half of the 32 patients would test positive for COVID-19, Mocco said.

Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.

The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.

Poor ran into a kidney doctor that night, who remarked that dialysis catheters were often getting blocked with clots.

“And I said, ‘It’s funny that you mentioned that because I feel like all these patients have blood clots in their lungs,’” Poor recalled.

Doctors throughout the country started noticing the emergence of blood clots in their COVID patients as well. And although blood clots present a common danger for patients immobile for long periods of time, the onset of blood clots in COVID patients appears more rapidly:

Clotting can develop in anyone who gets very sick and spends long periods of time immobile on a ventilator, but doctors say the problem seemed to show up sooner in COVID-19 patients as a more direct consequence of the virus.

Under the new protocols, patients at Mt. Sinai are being given higher doses of the blood thinner, heparin even before clots have been detected.

Just days ago, Broadway actor Nick Cordero, who had been battling coronavirus for three weeks, had to have his leg amputated due to blood clotting:

Cordero, who has been in the hospital since March 31, was being treated with blood thinners to help relieve clotting in his leg, but doctors had to stop the medication because it was causing internal bleeding… On Saturday, the decision was made to amputate, Kloots said, according to the AP.

Losing his leg is just the latest serious complication Cordero has faced after being hospitalized with what was initially thought to be pneumonia, but later turned out to be covid-19, the respiratory illness caused by the novel coronavirus, according to his wife.

On April 12, for example, Cordero “lost consciousness, he lost his pulse and they had to resuscitate him” after a lung infection set off a chain reaction that affected his blood pressure and heart, Kloots said in a now-deleted Instagram story, Variety reported.

The hard reality is this:

Blood clotting has emerged as a phenomenon in covid-19 patients suffering from particularly serious infections, with physicians unsure of what type of treatment is most effective, according to STAT News. While blood clots aren’t unusual in those who are immobile for long periods of time, like people on ventilators, “they seem to be smaller and cause far more severe damage” in patients diagnosed with covid-19, STAT News reported.

As Science Magazine reports, the prevalence of clots may be yet another indication that the novel virus can wreak havoc on the human body far beyond the lungs, which are considered “ground zero.”

The disease “can attack almost anything in the body with devastating consequences,” cardiologist Harlan Krumholz of Yale University and Yale New Haven Hospital told the magazine. “Its ferocity is breathtaking and humbling.”

–Dana

Comments (63)

63 Responses to “COVID Patients and Blood Clotting”

Yet more…
Dana (0feb77) — 4/22/2020 @ 2:49 pm
We really really need to spend a ton of money on antiviral research. We’ve spent 3 or 4 trillion on this one so far, so a proactive approach would seem to be wise.

I’d advocate subsidizing education in the field the way we once did STEM after Sputnik.
Kevin M (ab1c11) — 4/22/2020 @ 3:10 pm
That can explain the link to heart attacks – which have gone way up in New York City,

https://www.nydailynews.com/coronavirus/ny-coronavirus-cardiac-calls-jump-in-the-city-20200407-tzlxcqaqs5a2flpnlmhsffnyjm-story.html

Daily cardiac calls have more than tripled in recent weeks, from 94 on March 20 to 322 on Sunday, FDNY statistics show. Compared to a year ago, the number of calls has more than quadrupled, from a maximum 73 calls per day, the data shows.

Cardiac-related deaths counted by the FDNY have also increased, from 45 on March 20 to an unprecedented 241 on Sunday. [April 5] A year ago, the Fire Department counted about 25 cardiac deaths each day.

In the meantime the number of heart attack patients in hospitals places outside the city has gone down – maybe because people are avoiding hospitals.

But why the clotting?

Anything like that is a clue to what’s going on in general.

It is associated with low air pressure.
Sammy Finkelman (83cfe1) — 4/22/2020 @ 3:12 pm
The first symptom of the disease may be having a stroke? Oh my…

This hits home to me, because my otherwise healthy son had a stroke about five years ago. He was only 19 at the time, and they never did figure out what caused it. He’s fully recovered now, but I’d hate to imagine any parent having to go through that.
Glenn (009dae) — 4/22/2020 @ 3:14 pm
I read a blurb about a youngish Tony Award-winning actor who’d had to have his leg amputated last week. I figured it was a fluke, but now it appears to be much more…and worse.
Ragspierre (d9bec9) — 4/22/2020 @ 3:17 pm
RipMurdock linked too and quoted aWashington Post article about this at #84 in the following thread:

https://patterico.com/2020/04/22/southern-governors-start-to-reopen-but-what-is-the-plan/#comment-2345383

What was the link where you could search and get to view a Washngton Post article?

he article qoted some doctor as saying they know about the clotting but they don;t know why.

Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”

“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”

“That’s when we knew we had a huge problem,” said Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”
Sammy Finkelman (83cfe1) — 4/22/2020 @ 3:22 pm
I don;t think the CDC et al has yet alerted anyone to this.

Maybe they don’t have enough evidence.
Sammy Finkelman (83cfe1) — 4/22/2020 @ 3:24 pm
NY Dr Griffin at Microbe.TV (thanks, Simon Jester!) has discussed COVID clotting and blood thinners for at least 3 weeks. Start at 33 minutes at the podcast link for this week’s discussion. He attributes it to the cytokine storm triggered/caused/? by the virus. It has also been discussed in the immune podcasts.
DRJ (15874d) — 4/22/2020 @ 3:26 pm
Activation of inflammation proteins impact the coagulation system. This can lead to pathological clots. Something as simple as gingivitis is a risk factor for heart attacks. Obviously these observations should alert physicians to be alert for thrombosis.
Fred (542921) — 4/22/2020 @ 3:53 pm
NBC News did a package piece on Nick. Such a sad level of complexities associated w/this virus. Nephew told me his company was contracted to create test kits by the government but it ends up being at a loss and management ain’t too thrilled but his lab tech colleagues are working at this 24/7. He’s pretty tired– his relaxation is walking the dog for 20 minutes at dusk.

Saw stories of some sort of possible coronavirus skin lesions appearing as symptoms as well.

Helluva bug.
DCSCA (797bc0) — 4/22/2020 @ 3:54 pm
Hypoxia has been mentioned quite a bit in the analysis of Covid. Here is a paper on hypoxia:

Summary:
Researchers have found how hypoxia (a low concentration of oxygen) decreases Protein S, a natural anticoagulant, resulting in an increased risk for the development of potentially life-threatening blood clots (thrombosis). Although hypoxia has been associated with an increased risk for thrombosis, this research showed for the first time a molecular cause.

https://www.sciencedaily.com/releases/2018/08/180802115657.htm
BuDuh (24e9db) — 4/22/2020 @ 4:34 pm
Hey, this administration is awesome, in January the HHS named Brian Harrison to head up the virus response. Of course, he has a long history medical research as a scientist…no? Uh, no. So, he’s a medical doctor, right? Uh, no.

Brian Harrison has no medical background, no scientific background, but he was a famouse Labradoodle breeder for the last 8 years. Not as a hobby, that was his business.

Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. In 2006, he joined HHS in a one-year stint as a “Confidential Assistant” to Azar, who was then deputy secretary. He also had posts working for Vice President Dick Cheney, the Department of Defense and a Washington public relations company.

Before joining the Trump Administration in January 2018, Harrison’s official HHS biography says, he ‘ran a small business in Texas.’

The biography does not disclose the name or nature of that business, but his personal financial disclosure forms show that from 2012 until 2018 he ran a company called Dallas Labradoodles.

The company sells Australian Labradoodles, a breed that is a cross between a Labrador Retriever and a Poodle. He sold it in April 2018, his financial disclosure form said. HHS emailed Reuters that the sales price was $225,000

.
Colonel Klink (Ret) (305827) — 4/22/2020 @ 4:56 pm
Heck of a job, Brian!
Kevin M (ab1c11) — 4/22/2020 @ 5:34 pm
Trump downplays risk of coronavirus rebound
~~President~~ Dr. Donald Trump on Wednesday confidently downplayed the risks of a second wave of the coronavirus outbreak in the fall that his own health officials say is almost certain to hit.

“If it comes back though, it won’t be coming back in the form that it was, it will be coming back in smaller doses that we can contain,” Trump said during a White House press briefing, adding that “it’s also possible it doesn’t come back at all.”

Top administration health officials at the same briefing warned of a return of the virus in the fall, though expressed confidence that the country would be more prepared to contain a second wave.

Trump’s comments come one day after CDC Director Robert Redfield warned in a Washington Post interview that a second wave of the coronavirus in the fall could be “even more difficult” than the current outbreak if it coincides with flu season. The CDC director’s comments drew ire from the president, who asked Redfield to clarify his statement during the press briefing.

Redfield repeated his warnings that if the two viruses are circulating at the same time it could make it harder for the health care system to respond, though he downplayed the potential severity of the situation.

“It doesn’t mean it’s going to be more, as some people have said, or worse, it’s just going to be more difficult because we have to distinguish between the two,” Redfield said, adding that what he wanted to articulate was that more Americans should get the flu vaccine.

The nation’s top infectious disease doctor, Anthony Fauci, took the podium a few minutes after Trump and poured cold water on the idea that the coronavirus won’t be back. “We will have coronavirus in the fall. I am convinced of that because of the degree of transmissibility that it has, the global nature,” he said.
>>>>>>>>
RipMurdock (d2a2a8) — 4/22/2020 @ 5:36 pm
Mitch McConnell to States: Drop Dead!
RipMurdock (d2a2a8) — 4/22/2020 @ 5:38 pm
“…it’s also possible it doesn’t come back at all.”

And it was possible the Soviets would have NOT overrun Europe if we didn’t have the bomb.

WAAAAAYYY less than probable. But possible…
Ragspierre (d9bec9) — 4/22/2020 @ 6:07 pm
(Hey, I’m actually on Microbe TV / 603, DRJ!)

It’s frightening how many varied responses a body can have to. Doctors are seeing reactions including toes turning black, skin rashes, and neurological manifestations. Patients go to the hospital and tell their doctors that they fell down, loss of balance, or having to hold onto things, encephalopathy (glassy-eyed stare, confused, combative, hallucinating like Chris Cuomo), loss of strength or malaise/weakness in young people, arterial occlusions, chest pains that resemble acute heart attacks but end up being part of the virus. And on and on it goes.
Dana (0feb77) — 4/22/2020 @ 6:07 pm
“If it comes back though, it won’t be coming back in the form that it was, it will be coming back in smaller doses that we can contain,” Trump said during a White House press briefing, adding that “it’s also possible it doesn’t come back at all.”

Dana was right. By letting Trump slide for this BS in January, Trump learned he did the right thing lying to us. Of course Trump’s intel is not compatible with his statements, but he knows his supporters will interpret this as ‘playing the game’ or something.
Dustin (c56600) — 4/22/2020 @ 6:08 pm
I posted this on the Paging Dr. Trump post. He refuses to listen to his own experts:

Even as states move ahead with plans to reopen their economies, the director of the Centers for Disease Control and Prevention warned Tuesday that a second wave of the novel coronavirus will be far more dire because it is likely to coincide with the start of flu season.

“There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through,” CDC Director Robert Redfield said in an interview with The Washington Post. “And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean.”

“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,” he said.

Having two simultaneous respiratory outbreaks would put unimaginable strain on the health-care system, he said. The first wave of covid-19, the disease caused by the coronavirus, has already killed more than 42,000 people across the country. It has overwhelmed hospitals and revealed gaping shortages in test kits, ventilators and protective equipment for health-care workers.
Dana (0feb77) — 4/22/2020 @ 6:14 pm
I know this is going to be news to everyone, but Donald Trump is a bumbling nincompoop.
Colonel Klink (Ret) (305827) — 4/22/2020 @ 6:16 pm
It is utterly irresponsible and dishonest for Trump to claim that “it won’t be coming back in the form that it was, it will be coming back in smaller doses that we can contain.” He has absolutely no idea what the hell he is talking about. And that is dangerous given his platform. Unfortunately, there is no accountability for what he says, and anyone who is troubled by it, just ends up fired, relocated, publicly humiliated, or targeted in some way. They become victims in his own version of a Witch Hunt.

Try and defend this, Trump loyalists.

P.S. I think Fauci is still there because he doesn’t directly confront Trump when he’s wrong, but he is able to tactfully clean up his mess without directly shaming him in doing so. It’s subtle. Even when he directly contradicts him, it’s in a non-alpha dog way that doesn’t threaten Trump.
Dana (0feb77) — 4/22/2020 @ 6:20 pm
P.S. I think Fauci is still there because he doesn’t directly confront Trump when he’s wrong, but he is able to tactfully clean up his mess without directly shaming him in doing so. It’s subtle. Even when he directly contradicts him, it’s in a non-alpha dog way that doesn’t threaten Trump.

It’s kind of like when you watch a kid’s movie, there’s the layer that is geared to the adults, that kids are blind to.

Sometimes Trump just doesn’t understand that he’s being actively corrected, because he’s really a child…a really dumb child.
Colonel Klink (Ret) (305827) — 4/22/2020 @ 6:31 pm
Having two simultaneous respiratory outbreaks would put unimaginable strain on the health-care system

Yes, it probably will. And there is nothing we can to about it except prepare. In particular, get the FDA approving the drugs and tests that are coming out and they will then be able to test the “If only Trump had warned us in January” theory.
Kevin M (ab1c11) — 4/22/2020 @ 6:39 pm
@21. Try and defend this, Trump loyalists.

Are you kidding?

Switch on Fox.
DCSCA (797bc0) — 4/22/2020 @ 6:41 pm
15

I agree with Mitch. [One of the few times, possibly the only time, I agree with him.] What might be a good idea is bundling a bailout of the states with a drastic restructuring of pensions (and high speed rail projects). If the states choose to divert tax revenue to pensions, that’s their choice.
Kishnevi (22ac03) — 4/22/2020 @ 6:42 pm
This stuff is now part of our world — and I say that as a person Covid-19 is aimed at. If the best and the brightest in all those fancy biotech startups can’t produce what we need, this year or next, then F*ck what good are they?

But we can’t shut down the country for 6 months every year, so we need a better plan.
Kevin M (ab1c11) — 4/22/2020 @ 6:44 pm
Oh remember that thing about an order stopping immigration?

https://www.nbcnews.com/politics/white-house/trump-s-immigration-ban-raises-more-questions-answers-here-s-n1188946
Kishnevi (22ac03) — 4/22/2020 @ 6:45 pm
The pensions that were granted, at least above the low end, are unsustainable and were based on the stock market behaving like 1999 every year.

My plan for fixing the pension mess: a graduated windfall tax on state pensions over a certain amount. Up to, oh $75K a year, no tax. 10% up to 100K, 25% up to 150K, 50% to 200K and 75% over that. Assessed on the payment, not on where the recipient lives. Money to go back into the pension fund.

If you think that people are objecting to paying some of these pensions our of spite or small-mindedness, take a look at some of the ANNUAL pensions being paid to California public employees:

https://transparentcalifornia.com/pensions/all/

For example, Michael Moor, former LA Police Deputy Chief recently retired on a the paltry annual sum of $1,483,028.77. Plus medical.

Those mean old Republicans wanting to drive the poor man into poverty!
Kevin M (ab1c11) — 4/22/2020 @ 7:02 pm
*Moore
Kevin M (ab1c11) — 4/22/2020 @ 7:02 pm
Sometimes Trump just doesn’t understand that he’s being actively corrected, because he’s really a child…a really dumb child.

Even less than smart children are capable of learning and growing after repeated examples and positive reinforcement. Baby Trump is in a class all his own.
Dana (0feb77) — 4/22/2020 @ 7:11 pm
The cheers he gets from his base, the “please hit me again, master” he gets from the GOP establishment, and the criticism from the MSM is, from his view, positive re-inforcement. He’s getting what he wants. Everyone is focused on him.
Kishnevi (22ac03) — 4/22/2020 @ 7:20 pm
At the core of it, is his insatiable need for attention – negative or positive, doesn’t matter.
Dana (0feb77) — 4/22/2020 @ 7:24 pm
To a pathological narcissist there is only attention. Negative attention ceased to be an element in his universe long ago.
Ragspierre (d9bec9) — 4/22/2020 @ 7:26 pm
C’mon, it’s just the flu.
Dave (1bb933) — 4/23/2020 @ 6:30 am
Endeavor to remdesivir.
nk (1d9030) — 4/23/2020 @ 6:39 am
Dana (0feb77) — 4/22/2020 @ 6:20 pm

It is utterly irresponsible and dishonest for Trump to claim that “it won’t be coming back in the form that it was, it will be coming back in smaller doses that we can contain.” He has absolutely no idea what the hell he is talking about.

I don’t think so. He has some idea; just not a full understanding.

This is probably only a slight distortion of what he has been told.

It is almost inevitable that the second wave would be lower. Those who say it will be worse must be operating under the assumption, which I’ve read expressed as an idea, that the population couldn’t or wouldn’t go back to the social distancing, or other non-pharmaceutical interventions, to use the term the Bush Administration used in 2007 when this first became part of a contingency plan at the CDC.

Otherwise, you’d have to assume that we’d react quicker and sooner than we did in early March and so the second wave wouldn’t be quite as bad.

Now how likely it is to be just embers (like Trump offered as the most likely possibility) is another thing.

This epidemic is not obeying William Farr’s Law of epidemics, which holds that the rise and fall of a epidemic is roughly symmetrical.

https://www.cebm.net/covid-19/covid-19-william-farrs-way-out-of-the-pandemic

Trump was probably told about that idea, by someone, without technical terms, like “Bell shaped curve.” But, as I said, Covid-19 is not following Farr’s Law of epidemics. It’s dropped a little bit from the peak, but the number of new cases isn’t dramat/ically shrinking.

Quite logically because the chain of transmission is being artificially depressed. We’re getting a rather steady amount of leakage of virus from a large number of people, and not seeing a genuine decline in R0. The math is different.

And the people who said it would go away were thinking too abstractly.
Sammy Finkelman (83cfe1) — 4/23/2020 @ 6:46 am
Good news, Comrade nk:

Your newest COVID-19 miracle drug: nicotine

French researchers are planning to trial whether nicotine patches will help prevent – or lessen the effects of – the deadly coronavirus.

Evidence is beginning to show the proportion of smokers infected with coronavirus is much lower than the rates in the general population.

Scientists are now questioning whether nicotine could stop the virus from infecting cells, or if it may prevent the immune system overreacting to the infection.

Doctors at a major hospital in Paris – who also found low rates of smoking among the infected – are now planning to give nicotine patches to COVID-19 patients.

They will also give them to frontline workers to see if the stimulant has any effect on preventing the spread of the virus, according to reports.

It comes after world-famous artist David Hockney last week said he believes smoking could protect people against the deadly coronavirus.

MailOnline looked at the science and found he may have been onto something, with one researcher saying there was ‘bizarrely strong’ evidence it could be true.

One study in China, where the pandemic began, showed only 6.5 per cent of COVID-19 patients were smokers, compared to 26.6 per cent of the population.

Another study, by the Centers for Disease Control in the US, found just 1.3 per cent of hospitalised patients were smokers – compared to 14 per cent of America.
Dave (1bb933) — 4/23/2020 @ 6:47 am
I’m going out in the lovely Texas morning and treating myself to…and with…a good cigar!
Ragspierre (d9bec9) — 4/23/2020 @ 7:04 am
It does sort of make sense that if your lungs are already filled with toxic sludge, the virus will find no purchase…
Dave (1bb933) — 4/23/2020 @ 7:17 am
It is indeed a gorgeous morning.
Dustin (c56600) — 4/23/2020 @ 7:32 am
Evidence is beginning to show the proportion of smokers infected with coronavirus is much lower than the rates in the general population.
….
It does sort of make sense that if your lungs are already filled with toxic sludge, the virus will find no purchase…

I have been saying that for a while. Here. Right on this site. I was not making it up. There were papers published in 2004-05 and a friend who is a pulmonologist in Greece’s premier hospital in Athens told me the same thing: The virus attaches to lung epithelium, not the bronchi, and the epithelium is greatly atrophied in smokers. But you don’t have time to atrophy yours, so don’t start smoking now if you already don’t.

They have also found that “smokers don’t get Parkinson’s Disease” — an almost absolute conclusion. Why? They don’t know for sure. One guess is that the kind of brain that gets a kick from nicotine is not the kind of brain that gets Parkinson’s.

So nicotine is a wonderful thing in its own right, but not necessarily “the curative” for either disease.
nk (1d9030) — 4/23/2020 @ 7:39 am
BTW, Greece had the lowest death rate (113) in the EU as of five days ago.
nk (1d9030) — 4/23/2020 @ 7:42 am
Smoking/nicotine worsens Crohn’s Disease but protects against ulcerative colitis. The mechanism is unknown but it thickens intestinal mucous which enhances the protection of the intestinal lining. In addition, it has been “suggested that nicotine influences the cellular and the humoral immune system and interferes with the inflammatory response.” Both of these theories could apply to the lungs in Covid.
DRJ (15874d) — 4/23/2020 @ 8:03 am
Just a FYI for anyone who does not know, but cigar smokers DO NOT inhale (the cigars I smoke would kill me outright). I’m sure there are some who do, but there are some who binge-drink, too.
Ragspierre (d9bec9) — 4/23/2020 @ 8:08 am
https://www.washingtonexaminer.com/policy/defense-national-security/tom-cotton-us-intelligence-investigating-whether-coronavirus-pandemic-originated-in-wuhan-lab

They suddenly changed procedures.
NJRob (4d595c) — 4/23/2020 @ 8:16 am
BTW, Greece had the lowest death rate (113) in the EU as of five days ago.

Even a lowly virus has standards…
Dave (1bb933) — 4/23/2020 @ 8:59 am
Uh-uh! Greeks don’t eat Swanson salisbury steak frozen TV dinners with bat sauce.
nk (1d9030) — 4/23/2020 @ 9:50 am
Speaking of frozen aisle dominance, the former Bow-Tie wonder should unite the fiefdoms:

http://news.yahoo.com/hot-pockets-heiress-wants-serve-030614412.html
urbanleftbehind (c6bd9d) — 4/23/2020 @ 9:57 am
Uh-uh! Greeks don’t eat Swanson salisbury steak frozen TV dinners with bat sauce.

Only because they can’t afford them.
Colonel Haiku (2601c0) — 4/23/2020 @ 10:05 am
Breaking:

https://www.nydailynews.com/coronavirus/ny-coronavirus-cuomo-20200423-alxgtumui5hk3odbusu2yr6kxq-story.html

Cuomo says 21% of NYC infected with coronavirus in random test

Cuomo said a shocking 21% of people from the five boroughs who were tested outside supermarkets had the disease, including a slightly larger number of men than women.

The governor said the stunning assessment — which means up to two million New Yorkers in the city have gotten the virus — will shape the state and city’s plans to reopen at some point from the devastating. pandemic.

“What you do in a place with 21% is very different,” he said. “The facts dictate the action.”

Statewide, 13.9% of New Yorkers tested positive for the antibodies that are produced when people fight off the virus.

Long Island had a 16.7% rate. Westchester and Rockland clocked in at 11.7%.

They were saying it would be at most 10% in New York City and that would be the highest.

Upstate, just 3.9% tested positive in the study, which covered 19 counties and 40 municipalities.
Cuomo announced the figures as the daily death toll dipped a bit to 438 Thursday.

I am not sure hpw random it was, but from what I saw on TV it was biased toward not infected people.

They were approaching people about to enter a supermarket.

It seems like a lot of us have already been “vaccinated” by people we encontered but I don’t know how that would stand up against a big exposuire to the virus

Of course te antibody test tself needs to be duble checked.
Sammy Finkelman (329d95) — 4/23/2020 @ 10:26 am
https://www.cbsnews.com/news/coronavirus-pulse-oximeter-device-oxygen-levels

Dr. Richard Levitan: People were sick for days, and then they only came in with shortness of breath, like, the day they presented. … And they would arrive with oxygen levels that basically were incredible to us. I mean, almost unimaginable how people could be awake and alert and have oxygen levels that are half normal. … Normally we are 94% to 100% on these devices, these pulse oximeters that measure how much oxygen we have in our blood. And people were showing up with oxygen levels of 50%. Now, this matches the level of oxygen that we’ve measured on the summit of Mt. Everest.

Pulse oximeters are reporting impossible results. You can’t say they adjust. Pulse oximeters work by measuring light absorption so most likely there are other changes in the blood that result in it reporting lower than actual results. Not something wrong with the pulse oximeter.

That doctor doctor also thought it might be a good idea for every home to have a pulse oximeter, just like a thermometer. either he or any of the doctor at Bellvue evidently thouht of the idea that the pulse oximeter was reprting false results (althogh oxygen levels were genuinly down)

Covid-19 wasn’t doing something to the body to enable people to talk without oxygen.

He also says they don’t need tat many ventilators, something that the Dr. Fauci i think hasn;t caght up with yet but most of the doctors treating this disease know.
Sammy Finkelman (329d95) — 4/23/2020 @ 10:39 am
Just lightly squeeze your fingertip. If it turns deep pink to red, you have enough oxygen.
nk (1d9030) — 4/23/2020 @ 11:08 am
If it’s white with a bluish tinge you have hypoxia and possibly a bleeding ulcer. If it’s a beautiful sky blue, you have ancestors from Troublesome Creek, Kentucky, but you’d probably already know that. (No, I’m not joking).
nk (1d9030) — 4/23/2020 @ 11:12 am
It is utterly irresponsible and dishonest for Trump to claim that “it won’t be coming back in the form that it was, it will be coming back in smaller doses that we can contain.” He has absolutely no idea what the hell he is talking about.

Except Trump never claimed that. If you think Trump is so stupid, why do you and the Demcorats and the MSM, always have twist his words or lie about him? Supposedly, if he was so terrible and dumb you could attack him AND quote him accurately

Trump said its POSSIBLE that there won’t be a rebound. Dr. Fuaci talked about how there might be a BIG rebound or an AVERAGE one, and trump wanted to give everyone hope so he jumped in and pointed out that there might be a SMALL one. He didn’t CLAIM or FORECAST there would be an insignicant rebound.

If someone can’t understand the difference between “there might be” and “there will be” you should stop typing on the internet. For now, I’ll just chalk this up as MSM/NeverTrumper/Democrat Lie about Trump no. 1,435.
rcocean (1a839e) — 4/23/2020 @ 11:22 am
RCocean,

Trump said it would be better or not come back at all. See bold below. His equivocation is that it won’t come back at all, not that it could be very bad.

If you have some proof to back up your assertion that he’s been misquoted I’d love to see it.

Quote from Trump:

“If we have embers of corona coupled with the flu, that’s not going to be pleasant, but it’s not going to be what we’ve gone through in any way, shape, or form,” Trump said at Wednesday’s coronavirus press briefing, according to The New York Times, where he also said, “It’s also possible it doesn’t come back at all.”

Shortly afterward, responding to a different question, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said unequivocally that the coronavirus would still be around in the fall.

“We will have coronavirus in the fall,” he said. “I am convinced of that.”

Trump’s early focus in the press briefing was to dispute a Washington Post report that said the director of the Centers for Disease Control and Prevention, Robert Redfield, had suggested a “second wave” of the coronavirus could be “even more devastating” because it would coincide with flu season.

2nd question. Any idea why he’s simultaneously saying we need to “liberate” states in quarantine and criticizing the governor of GA for moving to end theirs? I think it’s a desire to be able to say he was right no matter what, but it’s so blatant I feel like I must be missing something.
Time123 (a7a01b) — 4/23/2020 @ 11:35 am
For now, I’ll just chalk this up as Orange Raccoon cultist Lie about Trump no. 1,435.
Ragspierre (d9bec9) — 4/23/2020 @ 2:53 pm
55

Trump’s early focus in the press briefing was to dispute a Washington Post report that said the director of the Centers for Disease Control and Prevention, Robert Redfield, had suggested a “second wave” of the coronavirus could be “even more devastating” because it would coincide with flu season.

Robert Redfield is wrong, and obviously wrong. He says he was trying to make an argument that people should get a flu vaccine, and pushing this kled him astray.

Why is the fall 2020 flu season different from all othe flu seasons?

The answer is:

The same things that interfere with the chain of infection of coronavirus interfere with the chain of infection of the flu. The number of people projected to get serious disease will affect decisions to shut things down. It doesn’t matter whether there is one pathogen or two, or what proportion of it is coronavirus and what proportion of it is flu.

It is hard to believe that when they see it coming fr the second time, they won’t act sooner – one week sooner (unless the thinking will have entirely changed by then)

And that’s why the second wave can’t be worse, even with the possible additional factor of the flu.

Now maybe things could be a little bit more complicated for the doctors – but I think they’d rather have a person sick with the flu than with coronavirus #7.
Sammy Finkelman (329d95) — 4/23/2020 @ 4:25 pm
55. Time123 (a7a01b) — 4/23/2020 @ 11:35 am

Any idea why he’s simultaneously saying we need to “liberate” states in quarantine and criticizing the governor of GA for moving to end theirs? …I must be missing something.

They weren’t simultaneous.

That we need to “liberate” states came before the criticizing the governor of GA (which was a surprise to reporters writing about it.)

Now the factor you mentioned:

I think it’s a desire to be able to say he was right no matter what,

explains why he didn;t retract.

Just about the only way Trump retracts anything is by not repeating it any longer or saying something in contradiction to what he said before. Even when he retracts, like he did with the claim that Barack Obama might not have been born in Hawaii, he doesn’t like anyone to say he retracted, and he denies that he did if he is put on the spot..
Sammy Finkelman (329d95) — 4/23/2020 @ 4:33 pm
Sammy, Simultaneous was the wrong word. But the assertions were made very close to each other.
Time123 (daab2f) — 4/23/2020 @ 5:32 pm
Just got back from a big meeting this morning over Treatment Guidance on covid19…

No one has seen official guidance regarding covid19’s impact on blood clotting outside of patient’s already diagnosed with coagulation issues.

A couple of points I’d like to emphasize with the readers here:
1) The mainstay treatement for covid19 remains to be SUPPORTIVE CARE. The current body of evidence does not meet the rigorous standards to support routine uses of any specific treatment regimen.

2) Whether or not to initiate therapy is at the prescriber’s discretion based on evaluation of risks and benefits with consultation with patients.

Standard supportive care consist of:
a. management of respiratory failure, ARDS, sepsis, septic shock
b. management of consistent fevers
c. antibiotic should ONLY be used for confirmed or strong suspicion of bacterial infection or sepsis

Recommended guidance for covid19 treatment (in clinical trial or ‘moderate’ level evidence suggesting benefit):
i. Covalescent Plasma (via expanded access protocol) seems to be the going preference
ii. Remdesivir via clin trial or expanded access protocol. They’re in stage 3 phase that show’s promise.

The following are NOT recommended, outside clin trials, (still can be prescribed however) due to low quality or variable evidence. (ie, there’s not enough literature to confirm viability of these treatment, and thus agencies take conservative stance when recommending treatment guidance):
Hydroxychloroquine
Azithromycin
Tocilizumab (Actemra)
Corticosteroids
Inhaled Prostanoids

The following were investigated as some point, but now fall into the DO NOT USE guidance:
•Lopinavir/ritonavir (Kaletra)
•Oral Ribavirin
•Neuraminidase Inhibitors (oseltamivir, zanamavir, peramivir) Baloxavir
•Casofungin
•Colistin
•Nelfinavir
•Barcitinib

I’m sure the possible links to this novel virus to patient’s coagulation factor is being investigated, but for right now there doesn’t seem to be even enough anecdotal evidence that there’s any linkage.

What’s interesting is how quickly these guidances are adjusted these last few weeks. The hospital entities, CDC, state agencies and the Clin Trial companies are all working together here… it’s really been an amazing experience.
whembly (c30c83) — 4/24/2020 @ 7:08 am
I’ve just been informed that a second person from my NGO’s board has passed due to this. Out of 11 people, this is pretty hard. He had come off a ventilator, but there were other issues it seems. The first one, a long-time friend, lived in Chicago. This guy, who I did not know nearly as well, lived in Atlanta. But from what I’ve been told (not much), it wasn’t the pneumonia that killed him.
Kevin M (ab1c11) — 4/24/2020 @ 8:04 am
New suggestion from Dr. Trump: Drink bleach!
Kevin M (ab1c11) — 4/24/2020 @ 8:32 am
Impeach him again, this time for the sustainable charges of gross incompetence and failure to perform in a crisis.
Kevin M (ab1c11) — 4/24/2020 @ 8:34 am

4/22/2020

COVID Patients and Blood Clotting

63 Responses to “COVID Patients and Blood Clotting”

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