Coronavirus

[AlanSubie4Life]

You can still be "cardiac insufficient" with a normal pulse ox. You see it all the time in heart failure patients.

Their blood is oxygenated, but the pump (heart) is not pumping sufficiently to meet demands of the tissues.

Oxygenation = lung O2/CO2 exchange.

Makes sense. Lots of cardiac damage out there too it seems.

 

[FoverM]

You can still be "cardiac insufficient" with a normal pulse ox. You see it all the time in heart failure patients.

Their blood is oxygenated, but the pump (heart) is not pumping sufficiently to meet demands of the tissues.

Oxygenation = lung O2/CO2 exchange.

My post above wasn't terribly clear. The examples I gave were showing how, even ten days after symptoms started and the people were feeling much better, a tiny bit of exercise would bring back the extreme fatigue. I should have emphasized that the extreme fatigue, without any exercise, was their *first* symptom.

On SuperBowl Sunday, my sister and her husband watched the game with another couple. On Tuesday, one of the friends became symptomatic and tested positive (the friend's husband tested + too). My sister woke up that Thursday with extreme fatigue. She could barely get out of bed and felt lightheaded and unsteady when she did. Yet no abnormal pulse ox, pulse rate, blood pressure, temperature, etc (they had been monitoring them for months because of her husband's preexisting conditions). I asked her if it felt like she was loaded down with a heavy blanket. Nope. It was like nothing she'd ever felt before and she really couldn't explain it.

How would you detect that someone was "cardiac insufficient" if they have normal pulse ox, pressure, and rate?

 

[bkp_duke]

My post above wasn't terribly clear. The examples I gave were showing how, even ten days after symptoms started and the people were feeling much better, a tiny bit of exercise would bring back the extreme fatigue. I should have emphasized that the extreme fatigue, without any exercise, was their *first* symptom.

On SuperBowl Sunday, my sister and her husband watched the game with another couple. On Tuesday, one of the friends became symptomatic and tested positive (the friend's husband tested + too). My sister woke up that Thursday with extreme fatigue. She could barely get out of bed and felt lightheaded and unsteady when she did. Yet no abnormal pulse ox, pulse rate, blood pressure, temperature, etc (they had been monitoring them for months because of her husband's preexisting conditions). I asked her if it felt like she was loaded down with a heavy blanket. Nope. It was like nothing she'd ever felt before and she really couldn't explain it.

How would you detect that someone was "cardiac insufficient" if they have normal pulse ox, pressure, and rate?

You have to do a full cardiac evaluation - cardiac echo (an ultrasound of the heart that looks at blood flow and takes precise measurements), cardiac enzymes (if there is damage to the muscle of the heart it "sheds" very specific proteins which can be detected in the blood), an EKG (measures electrical conductivity through the heart - if there is cellular damage or muscle damage this can/will be abnormal), and a cardiac stress test (which measures heart performance at baseline - resting conditions, and at "stress" - i.e. exercise).

I'm not a cardiologist, but the above is a pretty "basic" cardiac evaluation to check for cardiac insufficiency that most physicians (non-cardiologists) have to have a basic understanding of. @madodel 's wife I believe is a cardiologist, and could speak to the specifics more than I.

 

[madodel]

My post above wasn't terribly clear. The examples I gave were showing how, even ten days after symptoms started and the people were feeling much better, a tiny bit of exercise would bring back the extreme fatigue. I should have emphasized that the extreme fatigue, without any exercise, was their *first* symptom.

On SuperBowl Sunday, my sister and her husband watched the game with another couple. On Tuesday, one of the friends became symptomatic and tested positive (the friend's husband tested + too). My sister woke up that Thursday with extreme fatigue. She could barely get out of bed and felt lightheaded and unsteady when she did. Yet no abnormal pulse ox, pulse rate, blood pressure, temperature, etc (they had been monitoring them for months because of her husband's preexisting conditions). I asked her if it felt like she was loaded down with a heavy blanket. Nope. It was like nothing she'd ever felt before and she really couldn't explain it.

How would you detect that someone was "cardiac insufficient" if they have normal pulse ox, pressure, and rate?

I am not a doctor, just married to one. They would need to see a cardiologist and have testing done to see what if any injury has occurred. If it is a myocarditis (infection/inflammation) of the heart muscle, that can be temporary. If it is severe it could be a heart valve problem, blocked cardiac artery or dead/dying/weakened heart muscle. All these things decrease the pumping ability of the heart. @bkp_duke has described the basic testing and the reasons why this wouldn't affect blood oxygen saturation (PulseOx). Your lungs can be functioning quite fine and oxygenating the blood, but if the heart is not pumping well the oxygenated blood is not fully perfused throughout the body and organs can be easily starved for oxygen even without exercise. People report brain fog (possibly not enough oxygen to the brain) and chronic fatigue which could be related to that. My wife is seeing these people a lot over the past year. Using echocardiography they can actually visualize how well the heart is actually pumping. They can calculate ejection fraction which would tell how well your heart is pumping. Cardiac enzymes are a blood test that looks for the byproducts of muscle damage. A stress test is done to test the person's level of heart fitness usually with exercise on a treadmill, but can also be done chemically if the person is physically unable to do a test. I don't know if an EKG would show anything unless the person had some significant heart damage that affected electrical conduction of the heart. It has been decades since I dealt with any of this so I may be wrong on some of this. (I was a critical care RN 35 years ago). If I get a chance I'll ask my wife.

 

[EVCollies]

The fatigue could be directly from muscle injury without cardiopulmonary illness. Viral infections can directly affect the muscle function. Sometimes with catastrophic results (rhabdomyolysis) but also just with influenza a mild muscle weakness.

Bacterial, Fungal, Parasitic, and Viral Myositis

 

[MXLRplus]

Yesterday I was inoculated @ Riverside County, California, Indio Fairgrounds site:

Phase 1a now includes employees involved in the manufacture of COVID-19 response related equipment:
Updated COVID-19 Vaccine Allocation Guidelines -
"...workers who are manufacturing vaccine, therapeutics, devices, supplies or personal protective equipment supporting the COVID-19 response are included due to the adverse public health impact that delays in production would cause. ..." Our company has been doing extensive work with the respirators since March 2020.

I had the Moderna shot 24h ago. No side-effects yet. I have slight muscular pain at the injection site which is normal for muscle shots. My wife has significantly more pain at the injection site, and fatigue.
They will email me in ~7-10 days to set up second shot for 28+ days after initial shot.

By Monday, all my staff will be innoculated except one. One employee refuses to get the shot due to a history of severe reactions to flu vaccines. In such cases, COVID-19 vaccination is not suggested.

Everything went smooth, it was well organized.

 

[Jeff N]

I should have emphasized that the extreme fatigue, without any exercise, was their *first* symptom.

Not a doctor or an immunologist, but fatigue is a common symptom of viral infections including influenza. It probably can have multiple causes, but my impression is that a common cause is the immune system reaction rather than direct cardiac damage etc. For example, interferons can cause fatigue and they are released as part of the early immune response to a viral infection being detected.

 

[bkp_duke]

Not a doctor or an immunologist, but fatigue is a common symptom of viral infections including influenza. It probably can have multiple causes, but my impression is that a common cause is the immune system reaction rather than direct cardiac damage etc. For example, interferons can cause fatigue and they are released as part of the early immune response to a viral infection being detected.

The big difference we are seeing with COVID-19 is that these symptoms persist, many times for months or indefinitely, in people that have successfully fought off the infection. It is a very worrisome trend that does not track with other viral infections.

 

[NikolaACDC]

Press release
Moderna Announces it has Shipped Variant-Specific Vaccine Candidate, mRNA-1273.351, to NIH for Clinical Study | Moderna, Inc.
"Moderna, Inc. (Nasdaq: MRNA), a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines, announces that it has completed manufacturing of clinical trial material for its variant-specific vaccine candidate, mRNA-1273.351, against the SARS-CoV-2 variant known as B.1.351 first identified in the Republic of South Africa, and has shipped doses to the National Institutes of Health (NIH) for a Phase 1 clinical trial that will be led and funded by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID).
..."

 

[NikolaACDC]

Some single-dose results

Effectiveness of First Dose of COVID-19 Vaccines Against Hospital Admissions in Scotland: National Prospective Cohort Study of 5.4 Million People by Eleftheria Vasileiou, Colin R. Simpson, Chris Robertson, Ting Shi, Steven Kerr, Utkarsh Agrawal, Ashley Akbari, Stuart Bedston, Jillian Beggs, Declan Bradley, Antony Chuter, Simon de Lusignan, Annemarie Docherty, David Ford, Richard Hobbs, Mark Joy, Srinivasa Vittal Katikireddi, James Marple, Colin McCowan, Dylan McGagh, Jim McMenamin, Emily Moore, Josephine-L.K Murray, Jiafeng Pan, Lewis Ritchie, Syed Ahmar Shah, Sarah Stock, Fatemeh Torabi, Ruby S. M. Tsang, Rachael Wood, Mark Woolhouse, Aziz Sheikh :: SSRN
"...
Findings: The first dose of the BNT162b2 vaccine was associated with a vaccine effect of 85% (95% confidence interval [CI] 76 to 91) for COVID-19 related hospitalisation at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 94% (95% CI 73 to 99). Results of combined vaccine effect for prevention of COVID-19 related hospitalisation were comparable when restricting the analysis to those aged ≥80 years (81%; 95% CI 65 to 90 at 28-34 days post-vaccination).

Interpretation: A single dose of the BNT162b2 mRNA and ChAdOx1 vaccines resulted in substantial reductions in the risk of COVID-19 related hospitalisation in Scotland.
..."
-----------------
Would still appear that the UK plan of going with only one dose for the time being is the right one.

Also possibly aided by this data
Oxford COVID vaccine 'has better protection the longer second dose is delayed'
"The Oxford/AstraZeneca COVID-19 vaccine gives better protection the longer is left before a second dose, a government immunisation adviser has said.

Professor Anthony Harnden, deputy chair of the Joint Committee on Vaccination and Immunisation (JCVI), said data supports a delayed second dose of the Oxford jab, but that “we’re not so sure” about Pfizer's rival vaccine.
..."

 

[NikolaACDC]

'Long Covid' now has a name - Post-Acute Sequelae of SARS-CoV-2 infection (PASC)

And it's clear it will be a long story of pain and problems for many people, even those with minor initial symptoms.

Long-haul Covid: Clinics are springing up around the country - CNN

"The more than 100 symptoms reported by patients include fatigue, headaches, brain fog and memory loss, gastrointestinal problems, muscle aches and heart palpitations. Some have even developed diabetes.
"I just am so amazed by what comes through on a daily basis," said Dayna McCarthy, who treats Covid long haulers at New York's Mount Sinai. She hears a long list of symptoms, including brain fog, rapid heart rates and irregular blood pressure."
...
"Researchers who followed people infected with the coronavirus for up to nine months -- the longest follow-up to date -- found that 30% were still reporting symptoms, and more than that reported a worse quality of life than before they got the virus, according to a research letter published Friday.
Most of the people followed --150 out of 177 -- had "mild" disease and had not been hospitalized."

------
It really is clear it's a good idea not to get it - even if you're young and healthy and at low risk of developing a severe case.
Unless you're a gamblin' (wo)man...

 

[scottf200]

TN rep tweeted this:
@CDCgov launched a new tool to help you find vaccines available near you! TN is 1 of 4 states with data on all vaccine providers, including hospitals, clinics, and public health vaccination sites. More information added for more states in the coming weeks.

I found it listed them for states that are not listed in those 4. Probably just related to the nationwide places like Walgreens.

VaccineFinder

a) lets you pick a vaccine if you have a preference.
b) shows if they are in stock yet.

UPDATE:
It appears this site has been around a while but was used for Flu vaccines and other vaccines and mainly focused on Covid-19 for now. Text on it.

VaccineFinder is temporarily suspending information on flu and routine vaccination services. Call your healthcare provider or department of health if you are in need of a flu or routine vaccine.

 

[AlanSubie4Life]

'Long Covid' now has a name - Post-Acute Sequelae of SARS-CoV-2 infection (PASC)

And it's clear it will be a long story of pain and problems for many people, even those with minor initial symptoms.

Long-haul Covid: Clinics are springing up around the country - CNN

"The more than 100 symptoms reported by patients include fatigue, headaches, brain fog and memory loss, gastrointestinal problems, muscle aches and heart palpitations. Some have even developed diabetes.
"I just am so amazed by what comes through on a daily basis," said Dayna McCarthy, who treats Covid long haulers at New York's Mount Sinai. She hears a long list of symptoms, including brain fog, rapid heart rates and irregular blood pressure."
...
"Researchers who followed people infected with the coronavirus for up to nine months -- the longest follow-up to date -- found that 30% were still reporting symptoms, and more than that reported a worse quality of life than before they got the virus, according to a research letter published Friday.
Most of the people followed --150 out of 177 -- had "mild" disease and had not been hospitalized."

------
It really is clear it's a good idea not to get it - even if you're young and healthy and at low risk of developing a severe case.
Unless you're a gamblin' (wo)man...

Interestingly, there is preliminary, anecdotal evidence that perhaps 40% of long COVID patients are feeling better after getting their first dose of vaccine!!!

Here is a discussion about why - but it's speculated (if it even has any effect at all) that it either resets the immune system, or perhaps helps eliminate viral reservoirs in the body (for example in the central nervous system).

https://twitter.com/profshanecrotty/status/1365107279427760128?s=20

This presumably isn't going to do much good for people with heart damage, lung damage, etc., unless they also suffer from symptoms due to these other potential problems.

Of course it could be that the vaccine is doing nothing for long COVID, and it's either placebo (which is real), or the long COVID symptoms are easing over time in any case. But I'm sure there will be follow-up to try to figure it out!

 

[TespaceX]

So, with pending J&J 2-dose trial result data expected in May, anyone has a guess as to how much of a marginal benefit the extra dose would need to show for J&J and/or FDA to suggest making it a 2-dose regimen? Maybe they would also have to weigh the supply chain to the increased efficacy.

 

[AlanSubie4Life]

So, with pending J&J 2-dose trial result data expected in May, anyone has a guess as to how much of a marginal benefit the extra dose would need to show for J&J and/or FDA to suggest making it a 2-dose regimen? Maybe they would also have to weigh the supply chain to the increased efficacy.

It's probably going to be about 4x the antibody titer, so probably not quite the insane titers that the two-dose Moderna/Pfizer has (the second dose can increase titers by more than an order of magnitude, and close to two orders in some cases). But should be pretty good. To me, it looks like the second dose also reduces variability of the titer - and the minimum titer is probably the important part if there is a correlation to disease prevention. Look how tight they are, relative to HCS (natural infection). Of course, antibody titer is an imperfect metric. Though so far the correlation with efficacy appears to be not too bad. Immunology is complicated.

(For example, the lower titers in >65 might suggest less disease prevention - and that's what the results released today show for the single dose.)

I don't know what the FDA will decide. I guess it will depend on how much it actually helps.

https://twitter.com/profshanecrotty/status/1356692102113976320?s=20

 

[bkp_duke]

So, with pending J&J 2-dose trial result data expected in May, anyone has a guess as to how much of a marginal benefit the extra dose would need to show for J&J and/or FDA to suggest making it a 2-dose regimen? Maybe they would also have to weigh the supply chain to the increased efficacy.

I will "guess" - probably 20% additional efficacy, which is substantial.

I don't like tracking Antibody titers because they only loosely correlate with efficacy.

 

[jbcarioca]

The big difference we are seeing with COVID-19 is that these symptoms persist, many times for months or indefinitely, in people that have successfully fought off the infection. It is a very worrisome trend that does not track with other viral infections.

Among my relatives there are four who contracted COVID-19 in early April 2020, among the first people in Brazil to be infected all at a wedding reception that was held at a house a few meters from our property. We did not attend due to a conflict, luckily for us. Among the ~50 people incepted all had been close to an Italian relative who had come from Bergamo to the wedding and became ill the day after the event. Moving on...
among the six people I know who attended and were infected four have since been diagnosed with heart diseases. None had any prior problems. All had recovered from COVID-19 seemingly without difficulty. One was late 30's, the other three were all in their 60's-70's.

When I heard about these I had not been aware of any widespread connection and in fact none of them imagined a connection. The last few months seem to have shown a very common collateral effect that is often not linked to the original disease.

I wonder how much of that collateral damage has been happened but not linked to the COVID-19 event. Do you know? Do any of you have current epidemiological linkages formally reported? I wonder, because these linkages might not seem obvious when nobody is thinking of the linkage.

This reminds me of events in the late 1960's when I was an epidemiologist. It was mysterious unexplained subsequent morbities that ended out making advances, back then in the 'dark ages'. Have we advanced since then? That is not a rhetorical question.

 

[bkp_duke]

I wonder how much of that collateral damage has been happened but not linked to the COVID-19 event. Do you know? Do any of you have current epidemiological linkages formally reported? I wonder, because these linkages might not seem obvious when nobody is thinking of the linkage.

My understanding, is that these answers are not known beyond some "observations" and are active areas of research and follow up. There is a large enough population of post-infected people in the US that we should be able to obtain some very good statistics about this over the coming months/years.

 

[EVNow]

Maybe require vaccination as a condition for employment in any job that involves interacting with the public, or working in a group setting, and for traveling on public transport.

Now you know what the next elections “culture war” issue is going to be.

Most bewildering thing is the ease with which people switch from totally believing in crackpot theories/conspiracies/religions to “skeptics” when it comes to vaccines or climate change.

 

[TEG]

I wonder how much of that collateral damage has been happened but not linked to the COVID-19 event. Do you know? Do any of you have current epidemiological linkages formally reported? I wonder, because these linkages might not seem obvious when nobody is thinking of the linkage.

A Google search on "covid heart disease" turned up this:
What COVID-19 is doing to the heart, even after recovery

...
Nearly one-fourth of those hospitalized with COVID-19 have been diagnosed with cardiovascular complications, which have been shown to contribute to roughly 40% of all COVID-19-related deaths.
But two recent studies suggest heart damage among those infected may be more widespread. In JAMA Cardiology, an analysis of autopsies done on 39 COVID-19 patients identified infections in the hearts of patients who had not been diagnosed with cardiovascular issues while they were ill.

Another JAMA Cardiology study used cardiac MRIs on 100 people who had recovered from COVID-19 within the past two to three months. Researchers found abnormalities in the hearts of 78% recovered patients and "ongoing myocardial inflammation" in 60%. The same study found high levels of the blood enzyme troponin, an indicator of heart damage, in 76% of patients tested, although heart function appeared to be generally preserved. Most patients in the study had not required hospitalization...

(Note, targeted internet searches tend to turn up positive answers to almost any question... So be weary of "echo chamber" effects... )