COVID-19 medical discussion

[GRHorn 105]

For the providers out there who are worried about PPE for their jobs. My wife ended up asking on a neighborhood group if anyone had extra N95 masks from old home improvement projects or anything. She scored 20 in a day. Worth a shot if you’re going to be at risk. 

[Anastasis 23485]

New diagnosis code issued for COVID-19, effective April 1: U07.1

[gmr548 16616]

Something hit me like a ton of bricks today. Kind of odd.

Felt chills and such setting in. "Uh oh." Took my temp and the thermometer reads 93.0. Took it again and 93.0. Okay, I'm just cold as fuck. Bundle up and try to keep working.

Chills remain and making it really difficult to work. Take temp maybe 30 mins later - 97s. Hmm. Decide to sit in the sun on the patio for 15-20 minutes. 100.3. Okay, that was kind of on purpose. Go back inside and immediately lay down. Fluctuate between 99s and low 100s.

Still hungry, that's good. Make a little soup with some tortilla chips, drink water. Still hanging out in the 99s to low 100s. Still feeling a bit chilled but try to get through some work for maybe an hour. 101.7 lolfuck.

All of my symptoms are flu/covid overlap. Headache that's gone from barely noticeable to 3 or 4 or of 10 with the fever. Body chills/lethargy/aches. Took an uncharacteristically wet shit.
General public can't get a test in Travis County so I'll probably never know. Definitely been on the right side of the curve instead of social distancing for two weeks but I went to my elderly mom's for an essential visit about a week ago. Kept our distance but still. Bout to make a fun phone call.

It came on almost immediately after I got a call with some really bad family medical news (non covid related). I've also just been generally on edge lately and am actually totally slammed at work, so I'm hoping it's just a stress related thing but the the escalating fever is doing away with that theory.

[InkaUtexas 26108]

Man, hope you feel better soon. I felt crappy today. took my usual allergy meds and felt better. Had not been taking them being careful I did not mask anything. be smart. 

[Kyle 207]

Would there be any value to mobile screening stations? My kid had surgery today, and everybody on staff had big "Tuesday" stickers. I asked what that was, and basically they were screened today, and they get a sticker every day they're screened. No it does not replace testing, and no we could not support everyone getting it, but could mobile screening stations be setup at select CVS stores for people still working and those that need to get out for extended periods? Copying the hospital procedure, they asked a few questions, took temperature, and did visual evaluation. Maybe you get a wristband with a punch or something, I don't know - stickers likely too low tech but maybe not.

Obviously not perfect and too late now, but next time maybe - at least the guy you know brining you food was screened today and at least was not symptomatic.

 

 

[tantric superman 4667]

Yeah, I take a non-steroid nasal spray for allergies and I'm being religious about that -- have had the sniffles now and then and a tiny sore throat but I think it's just allergies.  Both me and my wife have both had very intermittent chills over the last two weeks but nothing has stuck.  She's feeling good and involved in a new job.  I'm just blue as fuck.  I feel bad for the dog.  He keeps looking at me like "what's your deal, pops?  Your head is a million miles away".

[gmr548 16616]

Man, hope you feel better soon. I felt crappy today. took my usual allergy meds and felt better. Had not been taking them being careful I did not mask anything. be smart. 

God damn I meant to post in the "I might have covid" thread.

Thanks for the well wishes. I've had some pretty brutal allergy days too as of late. Fortunately those symptoms are different, but if you've got a mild or asymptomatic case and don't know, could be spraying everywhere. Really hope I didn't.

[RMac5 1551]

I work for a medical surgical distributor, they told us we typically sell 15K N95 mask a week, last week we had over 1.5M ordered. 
15 thousand or 1.5 million, we don’t have em!

[F250 28818]

4 hours ago, tantric superman said:

Yeah, I take a non-steroid nasal spray for allergies and I'm being religious about that -- have had the sniffles now and then and a tiny sore throat but I think it's just allergies.  Both me and my wife have both had very intermittent chills over the last two weeks but nothing has stuck.  She's feeling good and involved in a new job.  I'm just blue as fuck.  I feel bad for the dog.  He keeps looking at me like "what's your deal, pops?  Your head is a million miles away".

I feel you, brother.

My son had a cold a little over a week ago and I caught it last week.

The moment my nose started running and I had a small temperature.

[NoName 16406]

13 hours ago, gmr548 said:

Something hit me like a ton of bricks today. Kind of odd.

Felt chills and such setting in. "Uh oh." Took my temp and the thermometer reads 93.0. Took it again and 93.0. Okay, I'm just cold as fuck. Bundle up and try to keep working.

Chills remain and making it really difficult to work. Take temp maybe 30 mins later - 97s. Hmm. Decide to sit in the sun on the patio for 15-20 minutes. 100.3. Okay, that was kind of on purpose. Go back inside and immediately lay down. Fluctuate between 99s and low 100s.

Still hungry, that's good. Make a little soup with some tortilla chips, drink water. Still hanging out in the 99s to low 100s. Still feeling a bit chilled but try to get through some work for maybe an hour. 101.7 lolfuck.

All of my symptoms are flu/covid overlap. Headache that's gone from barely noticeable to 3 or 4 or of 10 with the fever. Body chills/lethargy/aches. Took an uncharacteristically wet shit.
General public can't get a test in Travis County so I'll probably never know. Definitely been on the right side of the curve instead of social distancing for two weeks but I went to my elderly mom's for an essential visit about a week ago. Kept our distance but still. Bout to make a fun phone call.

It came on almost immediately after I got a call with some really bad family medical news (non covid related). I've also just been generally on edge lately and am actually totally slammed at work, so I'm hoping it's just a stress related thing but the the escalating fever is doing away with that theory.

you should be able to get a flu test btw...can't hurt to call and ask for it. if you are negative it increases the chance you have it, if not then you may be early enough to get tamaflu?

[gmr548 16616]

you should be able to get a flu test btw...can't hurt to call and ask for it. if you are negative it increases the chance you have it, if not then you may be early enough to get tamaflu?

Actually waiting in the car for my appointment, hoping to do just that.

[triplehorn 2664]

Good review of studies that need to be done - NEJM: Defining the Epidemiology of Covid-19 — Studies Needed

Quote

he epidemic of 2019 novel coronavirus (now called SARS-CoV-2, causing the disease Covid-19) has expanded from Wuhan throughout China and is being exported to a growing number of countries, some of which have seen onward transmission. Early efforts have focused on describing the clinical course, counting severe cases, and treating the sick. Experience with the Middle East respiratory syndrome (MERS), pandemic influenza, and other outbreaks has shown that as an epidemic evolves, we face an urgent need to expand public health activities in order to elucidate the epidemiology of the novel virus and characterize its potential impact. The impact of an epidemic depends on the number of persons infected, the infection’s transmissibility, and the spectrum of clinical severity.

Thus, several questions are especially critical. First, what is the full spectrum of disease severity (which can range from asymptomatic, to symptomatic-but-mild, to severe, to requiring hospitalization, to fatal)?

Second, how transmissible is the virus?

Third, who are the infectors — how do the infected person’s age, the severity of illness, and other characteristics of a case affect the risk of transmitting the infection to others? Of vital interest is the role that asymptomatic or presymptomatic infected persons play in transmission. When and for how long is the virus present in respiratory secretions?

And fourth, what are the risk factors for severe illness or death? And how can we identify groups most likely to have poor outcomes so that we can focus prevention and treatment efforts?

The table lists approaches to answering these questions, each of which has shown success in prior disease outbreaks, especially MERS and pandemic H1N1 influenza.1

Counting the number of cases, including mild cases, is necessary to calibrate the epidemic response. Conventional wisdom dictates that the sickest people seek care and undergo testing; early in an epidemic, case fatality and hospitalization ratios are often used to assess impact. These measures should be interpreted with caution, since it may take time for cases to become severe, or for infected persons to die, and it may not be possible to accurately estimate the denominator of infected people in order to calculate those ratios.2 As in past epidemics, the first cases of Covid-19 to be observed in China were severe enough to come to medical attention and result in testing, but the total number of people infected has been elusive. The estimated case fatality ratio among medically attended patients thus far is approximately 2%, but the true ratio may not be known for some time.2

Simple counts of the number of confirmed cases can be misleading indicators of the epidemic’s trajectory if these counts are limited by problems in access to care or bottlenecks in laboratory testing, or if only patients with severe cases are tested. During the 2009 influenza pandemic, an approach was described for maintaining surveillance when cases become too numerous to count. This approach, which can be adapted to Covid-19, involves using existing surveillance systems or designing surveys to ascertain each week the number of persons with a highly sensitive but nonspecific syndrome (for example, acute respiratory infection) and testing a subset of these persons for the novel coronavirus. The product of the incidence of acute respiratory infection (for example) and the percent testing positive provides an estimate of the burden of cases in a given jurisdiction.3 Now is the time to put in place the infrastructure to accomplish such surveillance. Electronic laboratory reporting will dramatically improve the efficiency of this and other public health studies involving viral testing.

More generally, it is useful to synthesize data from simultaneous surveillance studies, epidemiologic field investigations, and case series.1 Conducting cohort studies in well-defined settings such as schools, workplaces, or neighborhoods (community surveys) can help in describing the overall burden and the household and community attack rate; perhaps most important, it can permit rapid assessment of the severity of the epidemic by counting the number of illnesses, hospitalizations, and deaths in a well-defined population and extrapolating that rate to the larger population.4 Understanding transmissibility remains crucial for predicting the course of the epidemic and the likelihood of sustained transmission. Several groups have estimated the basic reproductive number R0 of SARS-CoV-2 using epidemic curves, but household studies can be superior sources of data on the timing and probability of transmission and may be useful in estimation of R0.5

Household studies can also help define the role that subclinical, asymptomatic, and mild infections play in transmission to inform evidence-based decisions about prioritization of control measures; measures that depend on identification and isolation of symptomatic persons will be far more effective if those persons have the primary role in transmission. On the other hand, if persons without symptoms can transmit the virus, more emphasis should be placed on measures for social distancing, such as closing schools and avoiding mass gatherings. To evaluate whether the risks that school closure poses to children’s well-being and education — and to productivity if working parents are needed for child care — are justified, we must learn whether children are an important source of transmission. Household studies can also be used to conduct viral shedding studies that can help determine when patients are most infectious and for how long they should be isolated.

A key point of these recommendations is that viral testing should not be used only for clinical care. A proportion of testing capacity must be reserved to support public health efforts to characterize the trajectory and severity of the disease. Although this approach may result in many negative test results and therefore appear “wasteful,” such set-aside capacity will permit a far clearer understanding of the spread of the epidemic and wiser use of resources to combat it. Testing in unexplained clusters or severe cases of acute respiratory infections, regardless of a patient’s travel history, may be a sensitive way to screen for chains of transmission that may have been missed. Such findings are relevant particularly in light of evidence that even Singapore, with one of the world’s best public health systems, has found cases that have so far not been linked to known cases or to Chinese travel. If such undetected introductions are happening in Singapore, it is prudent to expect they are happening elsewhere as well.

Early investments in characterizing SARS-CoV-2 will pay off handsomely in improving the epidemic response. If sustained transmission takes off outside China, as many experts expect, the urgency of the epidemic will necessitate choices about which interventions to employ, under which circumstances, and for how long. Starting these epidemiologic and surveillance activities promptly will enable us to choose the most efficient ways of controlling the epidemic and help us avoid interventions that may be unnecessarily costly or unduly restrictive of normal activity.

Many urban centers in China are or will soon be overwhelmed with the treatment of severe cases. It may be difficult for many of them to perform the kinds of studies described here. One exception is systematic surveys of persons who are not suspected to have Covid-19 or who have mild respiratory illness, to assess whether they are currently subclinically infected (viral testing), have been infected previously (serologic testing), or both. These studies, which will inform estimates of the severity spectrum, will be most informative in the settings that have the most cases.

Fortunately, the numbers of detected cases outside China remain manageable for public health authorities — and too small for the conduct of such studies. But it is vital for jurisdictions outside mainland China to prepare to perform these studies as case numbers grow.

 

[triplehorn 2664]

Am J Med. A cured patient with 2019-nCoV pneumonia

moxifloxacin and oseltamivir

Quote

PRESENTATION

A 57-year-old woman from Wuhan, China visited our hospital with a 5-day history of fever and dry cough. On the day of her visit, she presented with slight chest tightness, chills, and muscle soreness of the lower limbs.

ASSESSMENT

On examination, she was conscious with a body temperature of 38.3°C and vital signs were stable. Small moist rales were heard in both lungs. Laboratory tests of the blood revealed 4.49 × 106 white blood cells per μL, with increased proportion of neutrophils (78.1%) and decreased proportion of lymphocytes (18.0%). C-reactive protein elevated to73.4 mg/L. Chest Computed tomography (CT) indicated multifocal ill-defined nodular ground-glass opacities (arrow) and patchy consolidations lesions (arrow head) distributed in the middle-lateral zone and subpleural regions (Figure 1A), but tests for chlamydia pneumoniae, mycoplasma pneumoniae, respiratory syncytial virus, adenovirus and coxsackie virus, influenza A and influenza B viruses were all negative, while quantitive real-time polymerase chain reaction (PCR) of the patient's sputum showed positive for 2019 novel coronavirus (2019-nCoV) nucleic acid.

[...]

MANAGEMENT

The patient received moxifloxacin (400 mg once daily intravenously for 8 days then switch to oral treatment), oseltamivir (75 mg twice daily orally for 5 days) and supportive therapy. The patient recovered with improved symptoms, and on treatment evaluation of chest CT obtained 7 days later showed decreased extent and intensity of the lesions, although irregular consolidation (asterisk) emerged in the subpleural regions of the right lower lung (Figure 1B). The patient was discharged after her body temperature returned to normal for at least 3 days and two consecutive negative tests for 2019-nCoV nucleic acid. A repeat chest CT performed 10 days later showed significantly improved lesions (Figure 1C). Currently, the patient is still under follow-up with favorable condition.

 

[Mrs Whiggins 13050]

Has the blood type theory been disproven yet? I'm B- and had to have the 'shot' when I had my babies, but I was seeing various places posit something regarding type A with respect to severity? It's a more common type (A is) anyway so with the lack of testing data in the overall population of US, I'm wondering if you all have seen anything one way or the other?

Edited March 25, 2020 by Mrs Whiggins
Clarification

[HRSchenker 2273]

Hydroxychloroquine and azithromycin have all been on backorder since late last week. Now you can add albuterol HFA inhalers to the list. All of my wholesalers are limiting me to 2 boxes per day. Understand that influenza is still in the neighborhood and I have regular asthmatics as well. 

[Mrs Whiggins 13050]

My spouse has allergy induced asthma and I made sure he had his backup inhaler last month in case supplies became stressed. Fortunately he has only had to use it a little considering the season thus far has been brutal. We both had flu shots, actually everyone in our family gets them but I think that has helped us immensely this year, moreso than other years.

[triplehorn 2664]

Clinical features and chest CT findings of coronavirus disease 2019 in infants and young children

Quote

Abstract

OBJECTIVE:

To study the clinical features and chest CT findings of coronavirus disease 2019 (COVID-19) in infants and young children.
METHODS:

A retrospective analysis was performed for the clinical data and chest CT images of 9 children, aged 0 to 3 years, who were diagnosed with COVID-19 by nucleic acid detection between January 20 and February 10, 2020.
RESULTS:

All 9 children had an epidemiological history, and family clustering was observed for all infected children. Among the 9 children with COVID-19, 5 had no symptoms, 4 had fever, 2 had cough, and 1 had rhinorrhea. There were only symptoms of the respiratory system. Laboratory examination showed no reductions in leukocyte or lymphocyte count. Among the 9 children, 6 had an increase in lymphocyte count and 2 had an increase in leukocyte count. CT examination showed that among the 9 children, 8 had pulmonary inflammation located below the pleura or near the interlobar fissure and 3 had lesions distributed along the bronchovascular bundles. As for the morphology of the lesions, 6 had nodular lesions and 7 had patchy lesions; ground glass opacity with consolidation was observed in 6 children, among whom 3 had halo sign, and there was no typical paving stone sign.
CONCLUSIONS:

Infants and young children with COVID-19 tend to have mild clinical symptoms and imaging findings not as typical as those of adults, and therefore, the diagnosis of COVID-19 should be made based on imaging findings along with epidemiological history and nucleic acid detection. Chest CT has guiding significance for the early diagnosis of asymptomatic children.

 

[Newdoc 3453]

Welp, the controversy begins. Small study without statistical significance. We really need some good data on these treatments.

 

hydroxychloroquine-no-better-than-regular-covid-19-care-in-study

Quote

The report published by the Journal of Zhejiang University in China showed that patients who got the medicine didn’t fight off the new coronavirus more often than those who did not get the medicine.

 

Edited March 25, 2020 by Newdoc

[Anastasis 23485]

5 minutes ago, Newdoc said:

Welp, the controversy begins. Small study without statistical significance. We really need some good data on these treatments.

hydroxychloroquine-no-better-than-regular-covid-19-care-in-study

This is harshing my buzz and simultaneously reassuring. 27/30 were recovered after one week. 

The study involved just 30 patients. Of the 15 patients given the malaria drug, 13 tested negative for the coronavirus after a week of treatment. Of the 15 patients who didn’t get hydroxychloroquine, 14 tested negative for the virus.

[Anastasis 23485]

Here's the direct link, abstract is translated to english. http://subject.med.wanfangdata.com.cn/UpLoad/Files/202003/43f8625d4dc74e42bbcf24795de1c77c.pdf

[triplehorn 2664]

8 minutes ago, Anastasis said:

Here's the direct link, abstract is translated to english. http://subject.med.wanfangdata.com.cn/UpLoad/Files/202003/43f8625d4dc74e42bbcf24795de1c77c.pdf

Also note that Chinese study dosed at 400mg/d HCHQ while the recent French study dosed at 600mg/d HCHQ.  

The saying goes, "the dose makes the poison."  Or the response, as it may be.

[2300 Nueces 163]

2 hours ago, gmr548 said:

Actually waiting in the car for my appointment, hoping to do just that.

You have it.  The pain should be in your neck and back mainly but could be anywhere you have lymph nodes.  Fatigue?  Cough incoming.

Edited March 25, 2020 by 2300 Nueces

[Newdoc 3453]

27 minutes ago, triplehorn said:

Also note that Chinese study dosed at 400mg/d HCHQ while the recent French study dosed at 600mg/d HCHQ.  

The saying goes, "the dose makes the poison."  Or the response, as it may be.

I think we see why Fauci is being very neutral with this therapy. I would be willing to give it a shot as long as toxicity is not a high risk and it doesn't interfere with other intensive care or standard ARDS regimens.  This virus is definitely a different bug with shades of multiple pathologies mixed into one. Mother Nature threw out a doozy.

[triplehorn 2664]

5 minutes ago, Newdoc said:

I think we see why Fauci is being very neutral with this therapy. I would be willing to give it a shot as long as toxicity is not a high risk and it doesn't interfere with other intensive care or standard ARDS regimens.  This virus is definitely a different bug with shades of multiple pathologies mixed into one. Mother Nature threw out a doozy.

Also keep in mind the French study results suggest combining with Azithromycin may augment results compared HCHQ alone.  One proposed antiviral mechanism for Azith is that it stimulates interferon production within an active/ongoing immune response.  Interestingly, news is coming out now about successful application of a treatment initially engineered in Cuba - Interferon Alpha-2B:

Cuban ‘wonder drug’ being used worldwide: officialThe drug, called Interferon Alpha-2B Recombinant (IFNrec), is jointly developed by scientists from Cuba and China

 

[Newdoc 3453]

1 minute ago, triplehorn said:

Also keep in mind the French study results suggest combining with Azithromycin

I would like to see some data with this combined with the protease inhibitors. Any data reliable with a triple cocktail?

[gmr548 16616]

You have it.  The pain should be in your neck and back mainly but could be anywhere you have lymph nodes.  Fatigue?  Cough incoming.

Flu test was negative so the writing is on the wall.

To my surprise the doc tested me for covid on the spot, but evidently it's going to be a week or two before CDC comes back with a result.

[Newdoc 3453]

4 hours ago, gmr548 said:

it's going to be a week or two before CDC comes back with a result.

CPL and Quest are private labs running the Covid test. CPL’s turn around time is much better than a week. Baylor Scott and White, while limiting testing, has a quick turn around time as well.

[zork 629]

11 hours ago, Newdoc said:

CPL and Quest are private labs running the Covid test. CPL’s turn around time is much better than a week. Baylor Scott and White, while limiting testing, has a quick turn around time as well.

Quote

Development of Small-Molecule MERS-CoV Inhibitors

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) with potential to cause global pandemics remains a threat to the public health, security, and economy. In this review, we focus on advances in the research and development of small-molecule MERS-CoV inhibitors targeting different stages of the MERS-CoV life cycle, aiming to prevent or treat MERS-CoV infection.

Keywords: MERS-CoV; mechanism of action; small-molecule inhibitor

 

snip

3.1. MERS-CoV Entry Inhibitors

MERS-CoV S protein plays a key role in mediating virus entry into host target cells. This process includes binding to host receptors, viral fusion, and final entry into host cells. MERS-CoV pseudovirus expressing S protein, which allows for single-cycle infection in cells expressing receptor DPP4, can be used for screening MERS-CoV fusion/entry inhibitors.

HR2P, spanning residues 1251–1286 in the HR2 domain, with low or no toxic effect in vitro, can effectively inhibit MERS-CoV replication by interacting with the HR1 domain to block spike protein-mediated cell–cell fusion and MERS-CoV pseudovirus entry (Table 1; Figure 3) [16]. To increase its stability, solubility, and anti-MERS-CoV activity, Lu et al. introduced a Glu, Lys, or Arg residue into HR2P, generating a new peptide, HR2P-M2 (Table 1). HR2P-M2 was indeed found to be more stable and soluble than HR2P. It blocked fusion core formation between HR1 and HR2 peptides by binding to the viral S protein HR1 domain and inhibiting S protein-mediated membrane fusion with an EC₅₀ of 0.55 µM (Figure 4) [16,23]. HR2P-M2 is highly effective in inhibiting MERS-CoV infection in both Calu-3 and Vero cells with an EC₅₀ of about 0.6 µM. Intranasal application of HR2P-M2 could significantly reduce the titers of MERS-CoV in the lung of Ad5-hDPP4 (adenovirus serotype-5–human dipeptidyl peptidase 4)-transduced mice [16,18]. Furthermore, intranasal administration of HR2P-M2 before viral challenge fully protected hDPP4-transgenic mice from MERS-CoV infection, whereas all untreated mice died 8 days after viral challenge [24]. Furthermore, by combining HR2P-M2 with interferon β, protection was enhanced for Ad5-hDPP4-transduced mice against infection by MERS-CoV strains with or without mutations in the HR1 region of the S protein, with >1000-fold reduction of viral titers in lung [18].

snip

WTF is HR2P-M2 referenced in the bold?

https://www.mdpi.com/1999-4915/10/12/721/htm

[Newdoc 3453]

32 minutes ago, zork said:

WTF is HR2P-M2 referenced in the bold?

 

Best I can tell right now it is a type of substance that inhibits nasal absorption of the virus particles.

Some products are developed with peptides that actually enhance absorption of substances through the nasal mucosal surface.

[Mrs Whiggins 13050]

46 minutes ago, zork said:

WTF is HR2P-M2 referenced in the bold?

https://www.mdpi.com/1999-4915/10/12/721/htm

Here is something that discusses it:
 

Quote

 

A group of Chinese scientists have made significant progress in the research of anti-MERS drugs.

From 2013 to 2014, Jiang Shibo and his colleagues from the School of Basic Medicine of Fudan University designed and tested an anti-MERS polypeptide called HR2P. They found HR2P can effectively restrain infectivity of MERS-CoV. Jiang and his group then got a new polypeptide HR2P-M2 through researching and upgrading HR2P, which is much better in stability, solubility, antiviral activity and broad-spectrum activity.

They worked together with coronavirus experts to test HR2P-M2 on animals to see its treatment effects. It turned out that HR2P-M2 can protect animals from the attack of MERS-CoV.

Relative papers on the research have been accepted by an international infectious disease magazine, and will be published soon.

Jiang Shibo told journalists that based on the results of the research, this polypeptide can be used through nasal cavity as mist spray for emergency prevention. It can also be used on MERS-infected patients to control the infection source. ----People's Daily Online, 2015

 

It was weird to see interferon mentioned in the earlier abstract. I had to give myself a weekly shot of that for my cancer treatment. Ugh. The target therapies have advanced a lot since I was on that regimen.

Also, sorry for bringing up the blood type bit; I didn't know if it was on the 'essential oils' spectrum or there was actually something to it.

[triplehorn 2664]

1 hour ago, zork said:

WTF is HR2P-M2 referenced in the bold?

https://www.mdpi.com/1999-4915/10/12/721/htm

re: "HR2P, spanning residues 1251–1286 in the HR2 domain, with low or no toxic effect in vitro" - HR2P is a synthetic peptide (small molecule made of a short sequence of amino acids) designed to interact like a puzzle piece with a specific segment of viral protein (a much larger molecule also comprised of a sequence of amino acids) that is essential for host cell recognition/fusion.  The domain 1251-1286, which spans 35 amino acids, is a small but key segment of a large surface protein on healthy human respiratory cells that needs to be exposed for a virus to dock like a puzzle piece on the surface of a healthy cell for entry.  HR2P resembles a key portion of a healthy cell's "viral docking site" and chemically fits and binds to viruses' domain needed for cell infection.

The HR2P-M2 is just a further synthetically modified peptide where they introduced an additional amino acid (Glu, Lys, or Arg) into the peptide sequence.  Doing that slightly altered the chemical properties of the peptide to make it more chemically stable and soluble for use as a storable and deployable "medication" that can be administered.  Probably more importantly the stability modification probably allows it to "hang around" longer waiting for a virus to show up before it degrades, and to be more soluble which helps it get to and be where viral targets will arrive after administration.

This approach is opposite the drug "camostat mesylate", which we heard about a couple weeks ago that blocks the ACE2 receptor, the viral docking site on the surface of human cells.  So instead of gumming up the surface receptors of our healthy cells, the HR2P-M2 peptide only gums up the viruses' docking receptors, which seem like a better approach.  However a combination of the two approaches could further inhibit cell infection.

 

Edited March 26, 2020 by triplehorn

[zork 629]

Quote

NATURE BRIEFING 

 25 MARCH 2020

 

Daily briefing: New York City will start treating COVID-19 patients with the blood of survivors

Researchers hope that the antibody-laden blood of those who have recovered from coronavirus might reduce severe infections — but we don’t know yet if it will work. 

https://www.nature.com/articles/d41586-020-00899-4

[RomaVicta 30018]

Over in CR, someone posted a tweet of NYC hospital staff wearing garbage bags as protective gear. The tweet reports a death on the staff and a handful of infections.

I raised the following questions and was directed here. Forgive me if it's already been discussed. Here goes:

Does the corporate management of these hospitals get a walk on responsibility here? If the medical community was aware of a likely pandemic (plague), why didn't the decision makers there put money into a stock pile of protective gear for their staff on the front line?

If the hospital decision makers were assured that the feds would step in with equipment, then the fault lies with the feds. If not, how can we not put some blame on the directors of these corporations?

We've seen that HEB had a plan. Why not the hospitals?

I'd appreciate the perspective of medical professionals because I have little knowledge of how such things work.

[Newdoc 3453]

The garbage bags look crazy but they aren’t the critical missteps in ppe. They actually work because medical gowns only serve as barrier protection.

Proper respiratory gear is the problem whether that’s N95’s, pressurized helmets or isolation rooms for patients. The lack of respiratory protection is where people are most likely getting sick.

[gmr548 16616]

12 minutes ago, Dr. Beeper said:

Haven’t read this thread so SIAP but is there any truth to rumor of ibuprofen usage being a contributing factor to fatalities, or is that a hoax?

It's not a hoax in that it came from a national health department (French I think?) based on observations from their medical workers and not some FW: FW: FW: FW: email chain. Whether or not it's legit, I am not qualified to say.

[naija 2869]

4 hours ago, RomaVicta said:

Over in CR, someone posted a tweet of NYC hospital staff wearing garbage bags as protective gear. The tweet reports a death on the staff and a handful of infections.

I raised the following questions and was directed here. Forgive me if it's already been discussed. Here goes:

Does the corporate management of these hospitals get a walk on responsibility here? If the medical community was aware of a likely pandemic (plague), why didn't the decision makers there put money into a stock pile of protective gear for their staff on the front line?

If the hospital decision makers were assured that the feds would step in with equipment, then the fault lies with the feds. If not, how can we not put some blame on the directors of these corporations?

We've seen that HEB had a plan. Why not the hospitals?

I'd appreciate the perspective of medical professionals because I have little knowledge of how such things work.

Doctors don't run hospitals. For the most part

[Dbeasy 15092]

Read an odd report today from Bain Consulting (don’t have a copy to share). The report indicated a range of possible future scenarios, and the MOST likely scenario was that the government would deploy a
lightly tested vaccine and/or treatment broadly by May. Pretty shocking if true.

[gmr548 16616]

23 minutes ago, Dbeasy said:

Read an odd report today from Bain Consulting (don’t have a copy to share). The report indicated a range of possible future scenarios, and the MOST likely scenario was that the government would deploy a
lightly tested vaccine and/or treatment broadly by May. Pretty shocking if true.

I could see that. They're going to be desperate by then. That doesn't mean it'll be effective or without really bad side effects though. Big gamble.

[GRHorn 105]

5 hours ago, RomaVicta said:

Over in CR, someone posted a tweet of NYC hospital staff wearing garbage bags as protective gear. The tweet reports a death on the staff and a handful of infections.

I raised the following questions and was directed here. Forgive me if it's already been discussed. Here goes:

Does the corporate management of these hospitals get a walk on responsibility here? If the medical community was aware of a likely pandemic (plague), why didn't the decision makers there put money into a stock pile of protective gear for their staff on the front line?

If the hospital decision makers were assured that the feds would step in with equipment, then the fault lies with the feds. If not, how can we not put some blame on the directors of these corporations?

We've seen that HEB had a plan. Why not the hospitals?

I'd appreciate the perspective of medical professionals because I have little knowledge of how such things work.

It’s a safe bet that when they could’ve secured large amounts of PPE before things really blew up that the hospitals underestimated the necessity of it while also not wanting to pay up. Then when they realized urgency of it, it was too late.

[RomaVicta 30018]

Thanks for the responses. Bama chick had some interesting information in the other thread, too. Seems to me that we should have a federal stockpile. For the supplies that have expiration dates, ship them to needy hospitals or as foreign aid when they need to be replaced.

I am so horrified by this plague. We must be ready for this kind of shit in the future. It seems more important than spending the same sum on a defense item. I'd rather have one less carrier group or squadron of fighters if it meant being able to be up and running fast in the face of a plague.

[Brisketexan 105336]

21 minutes ago, RomaVicta said:

It seems more important than spending the same sum on a defense item. I'd rather have one less carrier group or squadron of fighters if it meant being able to be up and running fast in the face of a plague.

On  a "dollars per lives saved" scale, the math ain't even close.  As a species, we are very, very bad at risk assessment and risk management.  We'll spend a kajillion protecting against the most remote (but super scary) risk (seriously, we don't need a giant standing army to repel a foreign invasion of our shores), but we won't spend a million protecting against a risk that is actually CERTAIN to occur (seriously, we had two test runs of a similar potential pandemic -- SARS and MERS -- we KNEW that something like this would happen again).

It's the same reason we have anti-vaxxers, and people who refuse to wear their seatbelt because they think "it'll keep me from drowning if my car goes into a lake."  BAD AT MATH.  As a species, we're terrible at it.

[Anastasis 23485]

1 hour ago, Dr. Beeper said:

It was Frenchie. I heard that a week or so ago and filed it away. Then I heard this from an oncologist in San Antonio:

“Wanted to share latest news from my sister who is a nurse at Greenwich hospital. Their doctors are working with NYC doctors and are seeing that the vast majority of patients that are dying have ibuprofen in their system, now that autopsy reports are coming back. The virus seems to thrive on it and patients that otherwise would be healthy are having significantly worse reactions than others if they had taken Advil somewhat recently.  

Sarah's hospital currently has an otherwise completely healthy 28yr old on a ventilator that had zero preexisting conditions and they suspect Advil. 

This is starting to circulate in the news anyway but just wanted to communicate that 1. It is true and 2. Please just take Tylenol for ANY aches/pains/headaches even if they seem completely unrelated to virus.

No ibuprofen for any reason for the foreseeable future.”

This could also very easily be protopathic bias (reverse causation). COVID is associated with fever, ibuprofen is used to treat fever, fever is associated with severity of outcome, thereby ibuprofen is associated with severity of outcome.  The fever caused the ibuprofen exposure, ibuprofen did not cause the outcome.  The fact that cycling in ibuprofen may occur when treating more severe fever could amplify the effect.

I think that restricting ibuprofen use for headaches and pain is reasonable.  But push comes to shove and somebody is spiking a dangerous fever that tylenol ain't touching, man that's a tough call. 

[Thetexashammer 1062]

I'm gonna say science frowns on this.

 

[BrickTop 477]

This explanation of how the virus works is both fascinating and disturbing.
https://nymag.com/intelligencer/2020/03/the-story-of-a-coronavirus-infection.html?fbclid=IwAR14jR2mNZpLBhJZX29m9tRe8PTNM-pmsOmu5Mij6tFJt2we5QvkgIlvDuU

I’ve read some really horrifying shit and this may qualify as one of the most terrifying things I’ve ever read, think I’ll sell everything and go live in the mountains, glad to know you guys


Sent from my iPhone using Tapatalk Pro

[triplehorn 2664]

2 hours ago, Dr. Beeper said:

It was Frenchie. I heard that a week or so ago and filed it away. Then I heard this from an oncologist in San Antonio:

“Wanted to share latest news from my sister who is a nurse at Greenwich hospital. Their doctors are working with NYC doctors and are seeing that the vast majority of patients that are dying have ibuprofen in their system, now that autopsy reports are coming back. The virus seems to thrive on it and patients that otherwise would be healthy are having significantly worse reactions than others if they had taken Advil somewhat recently.  

Sarah's hospital currently has an otherwise completely healthy 28yr old on a ventilator that had zero preexisting conditions and they suspect Advil. 

This is starting to circulate in the news anyway but just wanted to communicate that 1. It is true and 2. Please just take Tylenol for ANY aches/pains/headaches even if they seem completely unrelated to virus.

No ibuprofen for any reason for the foreseeable future.”

German and French ICU docs made the same association about 3 weeks ago.  Seems like an easy choice.  Fauci at the podium said that even though causality has not been demonstrated, NSAIDS generally aren't vital by any stretch so might as well avoid them in the short term, then rec'd tylenol as a primary for fever.  

 

 

[Not that Bob 739]

What's the story on aspirin? 

[triplehorn 2664]

It's an NSAID, like ibuprofen or naproxen.  Not much out there, but the association probably has more to do with the NSAIDS as a class, and not ibuprofen alone.  If you're ok with not taking ibuprofen, might as well avoid the class.  Some people take aspirin for heart purposes by doc's order, so better for everyone to first ask their doc before stopping that.  May not be worth the risk of stopping it.  stay at home.

[squeegeedegg 723]

5 hours ago, RomaVicta said:

Thanks for the responses. Bama chick had some interesting information in the other thread, too. Seems to me that we should have a federal stockpile. For the supplies that have expiration dates, ship them to needy hospitals or as foreign aid when they need to be replaced.

I am so horrified by this plague. We must be ready for this kind of shit in the future. It seems more important than spending the same sum on a defense item. I'd rather have one less carrier group or squadron of fighters if it meant being able to be up and running fast in the face of a plague.

Hear you loud and clear.  Maddening thing is hundreds of millions of masks could be kept for the cost of just ONE F-35 or B-2/B-21, never mind a carrier group.  

[Armybrat 40911]

Serious question about alcohol consumption nsiap):

will one or two drinks twice a week make an olds (75) much more vulnerable to catching anything? I’m talking about each drink with 2 or 3 ounces of vodka. Myself pre-covid, only drink a couple of margaritas out at happy hour every two weeks, then maybe two stiff Bloody Marys on one Sunday each month. Haven’t had a drop of alcohol in three weeks, but that new bottle of Zing Zang mix and handle of vodka look better every day.

 

[Horn Dog 9932]

18 hours ago, Dbeasy said:

Read an odd report today from Bain Consulting (don’t have a copy to share). The report indicated a range of possible future scenarios, and the MOST likely scenario was that the government would deploy a
lightly tested vaccine and/or treatment broadly by May. Pretty shocking if true.

 

18 hours ago, gmr548 said:

I could see that. They're going to be desperate by then. That doesn't mean it'll be effective or without really bad side effects though. Big gamble.

As long as the side effects are minor then I don't have a problem with that.   Our understanding of vaccines is pretty good now, and they are not using live virus, just surface proteins or snippets of viral RNA,  so making a non-fatal vaccine should not be that difficult.  Now whether it works or not is another story, but I know that no vaccine doesn't work.   At least make it available to medical personnel.  They understand the risk/benefits and need it now.  If they wait 18-24 months, the vaccine will be useless.

Edited March 27, 2020 by Horn Dog