Covid19

[ldamelio]

is it the body’s own immune response to the infection in the blood?

In a word, yes. That's a good way to succinctly summarize it. The underlying mechanisms and pathways literally can fill a textbook, but it's a generally helpful teleological process (clotting in the face of disease) gone haywire. ARDS (the inflammatory component in the lungs that kills young people) is another example of this - the inflammation intended to kill the bugs goes haywire and inflames the lungs. Same thing with kidneys, liver in MSOF (multisystem organ failure). Modern medicine and bench research have been trying to mitigate this since I was in medical school (1979-1983). I spent my early career as an academic surgeon researching 'promising' ways of mitigating this problem in trauma patients (well, actually, rats and I owe you some of your tax dollars back from NHTSA grants). Thousands of people smarter than me have tried the same with little progress. We've improved supportive treatment (ventilatory care, dialysis modes, etc.) but nothing that fundamentally alters the pathophysiology.

[Mark Kelly]

If the immune response / cytokine storm was a significant factor in Covid-19 deaths, wouldn't we expect to see higher rates in females?

[ldamelio]

No. While there are differences in cytokine expression between the genders, they have generally not translated clinically to outcome differences in the types of responses we're talking about here. One gender is not more 'inflammation prone' than the other when you add it all up, at least not in ways that show up at the bedside. We have a few bench scientists on the forum who can expound. I'm a clinician/researcher/educator now turned administrator/very part-time clinician.

[beeatnik]

Became aware of the association between upper respiratory infections and strokes when a friend had a major stroke at 39. It's rare but a risk factor in younger stroke victims.

https://www.ahajournals.org/doi/full...78309.56307.5C

Infection-associated cervical artery dissection. Three cases. - PubMed - NCBI

https://www.mayoclinicproceedings.or...11)64811-8/pdf

[Too Tall]

No. While there are differences in cytokine expression between the genders, they have generally not translated clinically to outcome differences in the types of responses we're talking about here. One gender is not more 'inflammation prone' than the other when you add it all up, at least not in ways that show up at the bedside. We have a few bench scientists on the forum who can expound. I'm a clinician/researcher/educator now turned administrator/very part-time clinician.

Apparently there some effort to evaluate COVID positive folks who are not doing well for d/dimer (I will give a link below) so that early intervention(s) my be administered.
COVID-19 and Pulmonary Embolism - Hematology.org
The linked info. is current and accredited.

These are the sorts of method and treatments that precede any vaccine which will save many many lives.

*A few more links from Mrs. Too:
D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study | Research Square

Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis | Research Square

New research highlights blood clot dangers of COVID-19 -- ScienceDaily

[Doug Fattic]

I just read an interesting article in Time online about Japan's most northern island of Hokkaido opening up too soon after the 1st lockdown. I taught English in Sapporo, Hokkaido many years ago between my teaching degrees. It is a lot different than the rest of Japan being more sparsely populated and modern development began only about 150 years ago. They have this marvelous ice festival the 1st of February with huge ice sculptures that brings in a lot of tourists including the Chinese. Of course it didn't take long for the virus to spread from that event. The popular governor of Hokkaido wanted this more isolated island to serve as an example for the rest of Japan. Of course this lock down stopped the spread of the virus so the numbers got down into the single digits. Because the restrictions took a big toll on businesses the pressure was on to reopen. People were tired of being cooped up inside and everyone was losing money so they all moaned and complained and bitched so naturally the politicians listening to their constituents lightened up the restrictions but still encouraged social distancing and other measures to keep people apart. Of course everyone was anxious to get outside and enjoy spring (Hokkaido and Michigan have similar weather patterns) and the inevitable happened and now they have a 2nd wave and are back in lockdown again.

I'm willing to bet that a worse 2nd wave will happen in the US too where there is even more pressure to open. I remember being kind of surprised when I lived there that so many Japanese wore masks in public if they had any hint of a cold or any other sickness. While in the States nobody wants to look poorly in public so that will make it even more difficult for us to manage the spread of Covid 19 in public.

[ldamelio]

Apparently there some effort to evaluate COVID positive folks who are not doing well for d/dimer (I will give a link below) so that early intervention(s) my be administered.

Yep, D-dimer is the ticket in all of the clinical protocols from the relevant specialty societies to guide thromboprophylaxis and guide when/if to switch from prophylactic to therapeutic anticoagulant dosing. Pretty much everyone around the country has loaded these into their EMR order sets. Amazing how fast evidence-based best practice is evolving during the pandemic. Shows how inefficient academic medicine is in 'peacetime' circumstances.

[Too Tall]

Apparently there some effort to evaluate COVID positive folks who are not doing well for d/dimer (I will give a link below) so that early intervention(s) my be administered.

Yep, D-dimer is the ticket in all of the clinical protocols from the relevant specialty societies to guide thromboprophylaxis and guide when/if to switch from prophylactic to therapeutic anticoagulant dosing. Pretty much everyone around the country has loaded these into their EMR order sets. Amazing how fast evidence-based best practice is evolving during the pandemic. Shows how inefficient academic medicine is in 'peacetime' circumstances.

I love that about trauma docs. and ER in general.

[j44ke]

Apparently there some effort to evaluate COVID positive folks who are not doing well for d/dimer (I will give a link below) so that early intervention(s) my be administered.

Yep, D-dimer is the ticket in all of the clinical protocols from the relevant specialty societies to guide thromboprophylaxis and guide when/if to switch from prophylactic to therapeutic anticoagulant dosing. Pretty much everyone around the country has loaded these into their EMR order sets. Amazing how fast evidence-based best practice is evolving during the pandemic. Shows how inefficient academic medicine is in 'peacetime' circumstances.

Yes, this is impressive.

A friend is a research physician at UCSF and his team of interrelated researchers is global. Information moves pretty fluidly for them, but he was amazed during the Ebola surge at how fast info was moving around.

[j44ke]

No words.

Pandemic Praxis: Delivering PPE in NYC by Bicycle – Dinah Gumns | The Radavist | A group of individuals who share a love of cycling and the outdoors.

[Will Neide]

I should rephrase it - clotting gave it the opposite appearance not that it was the opposite disease.

So what typically is going when the blood starts coagulating like that - is it the body’s own immune response to the infection in the blood? Or is it a whole range of possibilities?

A virus, in this case COVID19, can cause endothelial destruction which can activate coagulation cascades or pathways. A cascade is made up many factors needed to form a clot. In isolation, not much will come of this, but in a systemic attack, there is enough activation of your clotting factors that you are essentially indiscriminately clotting, mostly micro clots. These micro clots consume factors and platelets needed to form large clots and thus stop bleeds. This consumption of micro clots leads to a state where your blood is clotting, HOWEVER, the consumption of the factors and platelets in these tiny clots which can’t function to stop actual bleeds leads to a state where your body doesn’t have an ability to form normal clots for real bleeds. One test to monitor DIC is a D-dimer level. D-dimers are a product of clot lysis, or destruction.

Soooo....DIC is a state where your body is clotting and breaking down clots all at the same time, and due to this your body can’t stop a bleed. Many things can trigger DIC. It’s a tricky thing to tackle.

[j44ke]

A virus, in this case COVID19, can cause endothelial destruction which can activate coagulation cascades or pathways. A cascade is made up many factors needed to form a clot. In isolation, not much will come of this, but in a systemic attack, there is enough activation of your clotting factors that you are essentially indiscriminately clotting, mostly micro clots. These micro clots consume factors and platelets needed to form large clots and thus stop bleeds. This consumption of micro clots leads to a state where your blood is clotting, HOWEVER, the consumption of the factors and platelets in these tiny clots which can’t function to stop actual bleeds leads to a state where your body doesn’t have an ability to form normal clots for real bleeds. One test to monitor DIC is a D-dimer level. D-dimers are a product of clot lysis, or destruction.

Soooo....DIC is a state where your body is clotting and breaking down clots all at the same time, and due to this your body can’t stop a bleed. Many things can trigger DIC. It’s a tricky thing to tackle.

Thanks very much for that explanation.

[Too Tall]

If you read New York Times do read the piece on the Oxford Study. This is a convergence of extraordinary foresight and being persistent. From the looks of it they could be in a (sanctioned) combined Phase II/III study in three or four months on a broad scale. There are too many good things about this to list including a functioning moderately sized production facility that could provide scaleability for massive production blah blah blah. It is not too soon to get excited about this one.

In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead - The New York Times

[htwoopup]

Not specific to the disease itself but perhaps interesting (like the electric meter thing) about the effects of the disease.

While bored, clicked on an email from Garmin.

Found this. It isn’t totally scientific as it is only Garmin and so many other statistical issues. Thought I should share it here as someone here may find it interesting. You know it intuitively, but hey data is fun especially when it is about something that is fun.

The Effect of the Global Pandemic on Active Lifestyles - Garmin Blog

And here is some other parts of the world.... The Global Pandemic and Active Lifestyles: Part II - Garmin Blog

[j44ke]

If you read New York Times do read the piece on the Oxford Study. This is a convergence of extraordinary foresight and being persistent. From the looks of it they could be in a (sanctioned) combined Phase II/III study in three or four months on a broad scale. There are too many good things about this to list including a functioning moderately sized production facility that could provide scaleability for massive production blah blah blah. It is not too soon to get excited about this one.

In Race for a Coronavirus Vaccine, an Oxford Group Leaps Ahead - The New York Times

This is really interesting. Reading between the lines a bit, but seems at least like a solid model for future success.

[Paul Jacobs]

Thank you all for your good wishes last week. My wife and I both tested positive for Covid 19. We now seem to be through it with resolution of all Coronavirus specific symptoms although neither of us has a great deal of energy yet. We are also both now allowed to leave the boundaries of our home although our 11 year old, having remained well throughout, is supposed to isolate for 14 days. This she will do, although I think it is likely that she has also been infected and has just not developed symptoms.

[j44ke]

Woohoo! Good news Paul. Really great.

[Too Tall]

Right on Paul.

[vertical_doug]

Thank you all for your good wishes last week. My wife and I both tested positive for Covid 19. We now seem to be through it with resolution of all Coronavirus specific symptoms although neither of us has a great deal of energy yet. We are also both now allowed to leave the boundaries of our home although our 11 year old, having remained well throughout, is supposed to isolate for 14 days. This she will do, although I think it is likely that she has also been infected and has just not developed symptoms.

Glad you are all right. You should watch Star Trek Original Series S1E8 Miri. The crew lands on a planet decimated by a virus that turns adults into old monsters and children are immune... You can tell your child , at least it wasn't this bad.

[j44ke]

My first reaction to designing an app that tracks people with Covid19 and informs others when they've crossed paths with those people was 1.) boy that's a good way to start a rampage of murderous mobs and 2.) what an entirely naive approach produced in a state of near total amnesia for past history of data and the Internet.

I still think that. Why not just go ahead and concentrate on improving performance of covid19 tests and producing the reagents required for comprehensive testing. All this other stuff is just so many kitty toys to distract the distractible.

A Scramble for Virus Apps That Do No Harm - The New York Times

I mean, it doesn't even matter if the security is reasonable and well thought out. The repository of information is bound to be stolen and used against the participants in some way. It is just too valuable.