Coronavirus

[TEG]

So a little update on my wife's situation...
One thing they are watching is breathing rate vs oxygen sat vs oxygen flow rate.
She hasn't actually received the dexamethasone yet but has a standing order to receive it if:
Oxygen flow rate of 4 liters is needed to maintain 92+ saturation and breathing rate is above 30.
( Hopefully I got those details right. )
Currently she is needing 2 liters of oxygen to maintain 92-96 sat with breathing rate 20 which is somewhat encouraging.

Normally I wouldn't consider minutiae like this and leave it to the medical professionals, but I figured some of the armchair QBs here and visiting medical professionals would find this of some interest.
Trying to take advantage of my front row seat to being in the middle of this experience to distract myself from worrying so much.

 

[bkp_duke]

So a little update on my wife's situation...
One thing they are watching is breathing rate vs oxygen sat vs oxygen flow rate.
She hasn't actually received the dexamethasone yet but has a standing order to receive it if:
Oxygen flow rate of 4 liters is needed to maintain 92+ saturation and breathing rate is above 30.
( Hopefully I got those details right. )
Currently she is needing 2 liters of oxygen to maintain 92-96 sat with breathing rate 20 which is somewhat encouraging.

Normally I wouldn't consider minutiae like this and leave it to the medical professionals, but I figured some of the armchair QBs here and visiting medical professionals would find this of some interest.
Trying to take advantage of my front row seat to being in the middle of this experience to distract myself from worrying so much.

I'm not inclined to nit-pick those numbers, but I will give you a "theoretical" perspective. There are pros and cons to anti-inflammatory steroids (i.e. dex in this case). Pros - reduces inflammation so that the body doesn't "over-react" to the virus and cause excessive damage. Cons - suppresses the immune system, which is critical to clear out the virus.

So, it is walking a tight-rope. A RR of 20 is basically a normal respiratory rate, so right now I would say the only abnormal value is the hypoxia (i.e. requiring O2 to keep just below normal saturations).

 

[madodel]

Yes, it's such a silly story, that even the Biden administration didn't actually say this! Apparently CNN just ran with it. Strange. (Note that the source was not necessarily the Biden administration - just someone with direct knowledge of the work.)

I'm pretty confident that the Biden administration is aware the program needs improvement, but they obviously didn't say it didn't exist. To be clear, the story didn't exactly say this either. It relayed someone's impressions about the strategy of the vaccine distribution program, as near as I can tell. And that strategy was alleged to not exist - not the program itself. That seems like a bit of an overstatement too - obviously there was a strategy, it just didn't work as well as the Trump administration stated:

View attachment 629539

I guess now that there is a bit more methodical administration in charge, the media has gone back to creating stories out of hearsay. I'm sure it'll settle out in the next couple weeks.

Fauci said that they aren't starting from scratch but there is a lot to be done. Also Biden is calling for the federal government to set up 100 large scale vaccination sites throughout the country.

 

[madodel]

So a little update on my wife's situation...
One thing they are watching is breathing rate vs oxygen sat vs oxygen flow rate.
She hasn't actually received the dexamethasone yet but has a standing order to receive it if:
Oxygen flow rate of 4 liters is needed to maintain 92+ saturation and breathing rate is above 30.
( Hopefully I got those details right. )
Currently she is needing 2 liters of oxygen to maintain 92-96 sat with breathing rate 20 which is somewhat encouraging.

Normally I wouldn't consider minutiae like this and leave it to the medical professionals, but I figured some of the armchair QBs here and visiting medical professionals would find this of some interest.
Trying to take advantage of my front row seat to being in the middle of this experience to distract myself from worrying so much.

I asked my wife what COVID Standard Of Care is now. Right now it is just high flow O2, dexamethasone and antibiotics. If respirations are difficult/O2 Sat below normal, the patient is proned - placed face down on their stomach which has been found to make breathing easier. They really try not to intubate anyone unless they have to. There is also ECMO Extracorporeal membrane oxygenation, but she said that is being reserved for COVID patients with heart or lung damage who's hearts can't pump blood well enough.

 

[TEG]

Thanks for the responses, folks. I take it that my wife's case is so far somewhat mild for someone admitted to the COVID ward and starting on Remdesivir.
Going to the ER with COVID and breathing difficulty is not automatic admission I gather. They had observed her for some hours before deciding she needed to be properly admitted and started on more drugs.
Pre-existing conditions were probably a factor in that decision.
Another thing I can tell you is that when people's oxygen sats drop below 90 they can start getting rather grumpy and desperate.
She was begging/demanding to be put back on the oxygen when they took it away to observe how she responded.

She is on a lot of medications, but some of the more notable ones right now are Remdesivir, CefTRIAXone, Doxycycline, Enoxaparin, & Rosuvastatin. I am not sure if all of those are part of her COVID treatments or other things going on.

 

[madodel]

Thanks for the responses, folks. I take it that my wife's case is so far somewhat mild for someone admitted to the COVID ward and starting on Remdesivir.
Going to the ER with COVID and breathing difficulty is not automatic admission I gather. They had observed her for some hours before deciding she needed to be properly admitted and started on more drugs.
Pre-existing conditions were probably a factor in that decision.
Another thing I can tell you is that when people's oxygen sats drop below 90 they can start getting rather grumpy and desperate.
She was begging/demanding to be put back on the oxygen when they took it away to observe how she responded.

She is on a lot of medications, but some of the more notable ones right now are Remdesivir, CefTRIAXone, Doxycycline, Enoxaparin, & Rosuvastatin. I am not sure if all of those are part of her COVID treatments or other things going on.

CefTRIAXone, Doxycycline are antibiotics. Enoxaparin is an anticoagulant to prevent clotting which is a problem with COVID. Rosuvastatin is a statin to help with lipid control. So it sounds like this is all standard of care for COVID now except for the statin but you don't say if she has any heart problems. My wife has said in the past that if she had COVID she would definitely start on an anti-thrombic. That is to prevent organ damage and strokes.

 

[TEG]

I imagine that "standard of care" could vary from place to place. I am intentionally leaving off the details of which particular hospital is treating her in case something turns out to be controversial.
Also, without going into details, she has a complex medical history, so she might get some adjustments to treatments.

 

[madodel]

I imagine that "standard of care" could vary from place to place. I am intentionally leaving off the details of which particular hospital is treating her in case something turns out to be controversial.
Also, without going into details, she has a complex medical history, so she might get some adjustments to treatments.

In normal times SOC is usually pretty universal, at least within the US. But now a lot depends on resources available and demand for services.

 

[TEG]

...but you don't say if she has any heart problems...

Yeah, there is a history of serious heart conditions mixed with a lot of other things.

 

[Mr X]

Taken a few days ago

Just now

https://twitter.com/nbcbayarea/status/1352495575036547073

 

[MXWing]

Taken a few days ago

Just now

https://twitter.com/nbcbayarea/status/1352495575036547073

The two on the right have COVID antibodies.

 

[alloverx]

Interesting update for bamlanivimab

Previously looks like does not help patients to recover

But perhaps it can help prevent infection?

"Lilly's neutralizing antibody bamlanivimab (LY-CoV555) prevented COVID-19 at nursing homes in the BLAZE-2 trial, reducing risk by up to 80 percent for residents"

 

[Ocelot]

So a little update on my wife's situation...
One thing they are watching is breathing rate vs oxygen sat vs oxygen flow rate.
She hasn't actually received the dexamethasone yet but has a standing order to receive it if:
Oxygen flow rate of 4 liters is needed to maintain 92+ saturation and breathing rate is above 30.
( Hopefully I got those details right. )
Currently she is needing 2 liters of oxygen to maintain 92-96 sat with breathing rate 20 which is somewhat encouraging.

Normally I wouldn't consider minutiae like this and leave it to the medical professionals, but I figured some of the armchair QBs here and visiting medical professionals would find this of some interest.
Trying to take advantage of my front row seat to being in the middle of this experience to distract myself from worrying so much.

in general,any oxygen saturation less than 92 per cent requires oxygen, as above 92 per cent you are still in a safe zone. Once you get below 88 per cent or so the curve starts toddle steeply . It is a sigmoid, Ron’s shaped curve...like Tesla ramps.

oxygen dissociation curve explained - Google Search

Wishing your family well.

 

[TEG]

For what it is worth, I did a little test with my pulse oxymeter. My "normal" reading is like 96-97. I tried intentionally hyperventilating (breathing abnormally fast) and after about 30 seconds of this my reading rose to 99%. I then held my breath for about 90 seconds or so. During this time, the readings stayed at 99% for a little while, then slowly started dropping. When they got to 88% I felt dizzy and desperate for breath and finally did my inhale. It then took a while for it to rise back up to normal again.

So my lesson from this:
#1: Yes, I can control my own O2 sats with intentional fast breaths or breath holding. (Well, duh, no surprise there.)
#2: There is a noticeable delay from doing something to when I see the effect on the meter. ( Yeah, probably not surprising that the different oxygen levels take some time to travel from my lungs->heart->finger before the new reading shows up. )
#3: Yeah, O2 sats < 90 become unpleasant.

 

[heltok]

For what it is worth, I did a little test with my pulse oxymeter. My "normal" reading is like 96-97. I tried intentionally hyperventilating (breathing abnormally fast) and after about 30 seconds of this my reading rose to 99%. I then held my breath for about 90 seconds or so. During this time, the readings stayed at 99% for a little while, then slowly started dropping. When they got to 88% I felt dizzy and desperate for breath and finally did my inhale. It then took a while for it to rise back up to normal again.

So my lesson from this:
#1: Yes, I can control my own O2 sats with intentional fast breaths or breath holding. (Well, duh, no surprise there.)
#2: There is a noticeable delay from doing something to when I see the effect on the meter. ( Yeah, probably not surprising that the different oxygen levels take some time to travel from my lungs->heart->finger before the new reading shows up. )
#3: Yeah, O2 sats < 90 become unpleasant.

I have done some freediving. What they teach is that below 80% you black out. Most I got to was 87% when I held my breath for 3min30s on the ground. That was a bit uncomfortable, lost a lot of oxygen the last few seconds as most of my body was spasming as I tried to push for the last seconds.

Hyperventilating helps to remove a lot of CO2 from your body, making you feel the urge to breathe less, which can be very dangerous if it allows you closer to dangerous territories without feeling it.

 

[bkp_duke]

Anyone wanting a semi-professional opinion on "which vaccine to get", I'm going to come out and recommend the Moderna one (I don't own Moderna stock, or any fund that has Moderna stock).

I'm basing this on the fact that in Phase 3 clinical trials, the Moderna vaccine was shown to be 80+% effective at preventing COVID-19 after the first dose (95+% after the second). This is in comparison to the Pfizer vaccine, that was only 52% effective at preventing COVID-19 after the first dose (95% after the second).

Avoid the Russian and Chinese vaccines if you have other options, as their efficacy is far lower. If you don't have other options, they are better than nothing.

Based upon a nice layman's review here:
How effective is a single vaccine dose against Covid-19?

 

[JRP3]

The two on the right have COVID antibodies.

The one on the far right might still be infected and shedding.

 

[TEG]

Some general COVID advice (probably covered other places buried in more info):

#1: At first sign of possible symptoms (headache, fever, cough) note the date on your calendar as "Day 1"
#2: If symptoms persist for ~5 days, and particularly if fever goes up, be prepared for ~day 6 to possibly get much worse possibly needing to try to get to a hospital. This is when oxygen sats can start dropping and unassisted breathing isn't work too well.

So, have a plan... Do you try to call an ambulance even though you are having trouble breathing? Do you know where you want them to take you?
Do you have anyone who can drive you to a COVID ready ER? Hopefully you know someone vaccinated that could do that for you.
I think many people do this with a friend/relative driving with masks on but that is still risky for them and it may be hard to find anyone willing.
I would recommend against trying to drive yourself to the hospital if you are having breathing trouble and low oxygen saturation.
If you do end up going to the hospital make sure to bring some essentials like a toothbrush and a phone charger.

Note, I have no medical background, so you should discuss any of this with your doctor if you have symptoms.

Hopefully you never have to consider any of this.

 

[TEG]

Now my wife is getting "INV - VIR-7831 Or Placebo" which I think may mean "random chance of maybe getting monoclonal antibodies or maybe just placebo." (randomized trial of something like Regeneron.)
She is holding steady there breathing on her own...

VIR-7831 for the Early Treatment of COVID-19 in Outpatients - Full Text View - ClinicalTrials.gov

 

[AlanSubie4Life]

I'm basing this on the fact that in Phase 3 clinical trials, the Moderna vaccine was shown to be 80+% effective at preventing COVID-19 after the first dose (95+% after the second). This is in comparison to the Pfizer vaccine, that was only 52% effective at preventing COVID-19 after the first dose (95% after the second).

Not really true. The answer is we don't know the efficacy after one dose in either case. And it's really best to wait on any exposure until 10+ days after the second dose, since the immune response and preparation will be at least 10x stronger after that second dose (from what I've read - you would know that much better than me, since you are an immunologist, of course).

The high uncertainty numbers, after eliminating the initial 10/12/14-day period from the observation interval, are about 92% efficacy for both vaccines.

The Moderna results over the entire interval between first and second dose are ALWAYS going to be skewed to look better, because there is a longer delay between first and second dose, so there is a longer period after immune response kicks in relative to the entire period (time for more cases in the placebo group). Also the N is very small in both cases, so the uncertainty is high (and Moderna may have ALSO gotten a little lucky in those first 10 days or so after vaccination in their trial) - but mostly it is the first factor:

https://twitter.com/michaelmina_lab/status/1340087821768536067?s=20