Covid19

[beeatnik]

Full disclosure, I've had Covid19 type symptoms since late January in three discrete episodes. I did a bit contact tracing and one friend had a serious month long upper respiratory infection in early January. Independent of my symptoms, in mid-to-late February, I began to limit my daughter's attendance at her preschool. About 30% of the kids in my daughter's class are the children of Chinese and South Korean business people who are in the US on long term assignments. Due to their extensive travel, I may have exercised an abundance of caution. And, if I'm honest, I was more concerned about my exposure than my daughter's. Short story long, it finally occurred to me, that no one in my immediate family has shown any symptoms. That said, I've been a hermit myself for about 8 weeks.

As for pushing it, after I read the Chinese studies on micro droplets and additional chapters on SARS and its spread through the Metropole, my desire to be outdoors vaporized. That resulted in marital discord; nightly fights about going out for 30 minute walks in our nearly abandoned neighborhood. Paranoia, they destroy ya.


Couple of good articles for self-diagnosis.
https://www.newyorker.com/magazine/2...together-in-la

Then, a couple of weeks ago, my wife started feeling strange, or “quivery,” as she put it. Quivery turned briefly into feverish before subsiding into complete exhaustion and an increasing tightness in the chest. Over the next several days, the feeling of being completely exhausted changed, though this hardly seemed possible, into even more complete—even deeper—exhaustion. There was hardly any coughing and no shortness of breath: both good signs, according to the doctor she spoke with, but her symptoms certainly fell within the broad spectrum of covid-19. Here in Los Angeles, there was only a dim hope of getting that suspicion verified by a test. The criteria to be met were so stringent that a test seemed all but indistinguishable from a postmortem. Since we’ve been keeping entirely to ourselves, the most reliable way of finding out if she has it is to see if I get it. So I am the test. I am the canary and our home is the coal mine.

Coronavirus may have been in California earlier than thought - Los Angeles Times


[QUOTE=houston;1001466

In mid February, I wasn't as vigilant as I probably should have been. I took a few business trips in early February but grounded myself by the 15th. Once I was stopped travelling, I have been a home office hermit with little contact with the outside world. I went on solo bike rides in the boonies right up until I started feeling like crap. That may have been too much in retrospect.

What are your thoughts? Did I push it?[/QUOTE]

[bigbill]

I'm in a huge county in AZ and we've had 51 confirmed cases with 2 deaths, both elderly with other risk factors. The medical center is only testing people with severe symptoms and so far 614 have been tested with 536 negatives and 37 pending. The largest group is 20-44 but all the other groupings are ten year spans so it averages out. 33/18 Female/male.

We delivered 4 intubation boxes to the anesthesiologists at the local medical center. We made them with folded Lexan to avoid seams.

[ElvisMerckx]

Full disclosure, I've had Covid19 type symptoms since late January in three discrete episodes. I did a bit contact tracing and one friend had a serious month long upper respiratory infection in early January.

I came down with C-19 symptoms in the third week of February. The virus was exploding on the West Coast at the time. I'm near DC, within 30 minutes of 2 major airports, I work downtown, and take very crowded metro trains into the city every day. But when I suggested C-19 to my GP, she said that it wasn't in DC yet, and I hadn't visited China, so contracting C-19 was out of the question. She diagnosed me with bronchitis/pneumonia but one major symptom that didn't fit was chest pain -- I could barely breathe and I couldn't sit up in bed without assistance due to the pain. I spent the next six weeks coughing, violently, all the time.

I'm so convinced I had it that I've volunteered to be part of an NIH blood sampling study. Fingers crossed I get selected.

[j44ke]

What is it in a doctor's mentality - because I've heard ^^this narrative^^ enough there must be some part of training that encodes it in the process of diagnosis - that prevents diagnosing something on the basis that it is not here yet?

In the face of this tendency, how does the first diagnosis occur?

First, to me, this seems to emphasize the 100% imperative of an accurate and readily available test.

Second, to me, this situation actually suggests that the chance that Covid 19 was here much earlier than originally suggested is greater than the chance that the estimated arrival date is correct.

Note: This is not a criticism of doctors. Just wondering about what part of diagnosis training is in action here. Is it - go with common over the rare always?

And Elvis - glad you are recovered or recovering. Sounds like a real beating.

[ElvisMerckx]

Thanks, Jorn. Whatever I had hit me really hard -- my wife worried a few nights that I'd stop breathing. My insurance approved a chest x-ray after 5 weeks of coughing, and my lungs were 'clear' on March 16th. I still coughed for another week.

Another interesting aspect of my diagnosis -- my GP asked if I'd been working around industrial chemicals (definitive no). This lends me to think they're trained to look for likely causes over previously unseen causes.

[bcm119]

If Covid was circulating in the San Francisco area for 2-3 months without any social distancing measures, why weren't the hospitals overloaded like everywhere else the virus has hit? The Bay Area isn't Manhattan, but it's a fairly densely populated area with more public transit use than anywhere except the northeast cities. I don't understand how that could occur.

[beeatnik]

I think I know what pneumonia related symptoms feel like; I spent two weeks in the hospital with pneumonia as a kid. I think I know what shortness of breath feels like; broken ribs after a bike crash. Last time I got a chest x-ray (post bike-auto collision), the urgent care doc said it looked like I had congestive heart failure but since I wasn't dead that couldn't be the case. Short story long, after my second episode of covidlike symptoms, I finally became concerned. I resorted to the canary in the coal mine method and asked my friend if she had been tested for influenza. Nope. And that was with a cough that was so violent she'd throw up daily. As j44ke, I'm curious about the "rule out" and differential diagnoses at the primary care level early in the epidemic. I had a therapist appointment on the first week of March and when I checked in at the kiosk in the lobby, the first question was "Have you been diagnosed with Covid19." That was likely before a single civilian in LA County had been tested. Strange times.

[beeatnik]

If Covid was circulating in the San Francisco area for 2-3 months without any social distancing measures, why weren't the hospitals overloaded like everywhere else the virus has hit? The Bay Area isn't Manhattan, but it's a fairly densely populated area with more public transit use than anywhere except the northeast cities. I don't understand how that could occur.

There's speculation that the virus has been circulation for months, if not years, in a less virulent form and the cases which resulted as pneumonia didn't raise any red flags. This theory holds that the virus didn't jump from bats to an intermediate host but directly infected humans, likely farmers, who brought it to the wet markets and other areas.

How did coronavirus break out? Theories abound as researchers race to solve genetic detective story - CNN

Racaniello offers yet another theory: The source of the outbreak is a farmer.

"In bats, these viruses are intestinal viruses, and they are shedding the bat feces, which we call guano," he said. "And if you go into a bat cave, it is littered with guano. And farmers in many countries harvest the guano to fertilize their fields."

Racaniello speculates that, after getting infected, a farmer or an associate came into Wuhan and started infecting other people.

"We do know that in China you can eat bats -- that's another scenario," he said. "But I don't think it's any more likely than a farmer harvesting guano or a farmer encountering a bat in his barn."

Anthony, also of Columbia, echoed Racaniello's skepticism of the wet-market theory.

"Early in the outbreak ... everyone was talking about the thing having emerged from the wet market," he said. "And now I think the data calls into question whether or not that's really true."

Anthony noted that not even the mystery of the 2003 SARS outbreak is settled.

For many years, it was widely believed that the SARS virus jumped from a bat to an intermediate host -- a cat-like civet -- that infected a person at a food market in China.

But a study in 2013 -- backed by a followup in 2017 -- suggested that the 2003 coronavirus could also have jumped straight from a bat into a human.
"We don't know which of those is actually true," Anthony said.

Perhaps, the most forceful rejection of the wet-market theory came from Ebright of Rutgers.

"It is absolutely clear the market had no connection with the origin of the outbreak virus, and, instead, only was involved in amplification of an outbreak that had started elsewhere in Wuhan almost a full month earlier," he told CNN.

[Too Tall]

Matt, I submitted my name to the NIH study as well. I had a 10 day ??? same timing as yourself with a 102.5 fever and body aches to beat the band, no cough some gastro. I came down with it two days after a very crowded yoga class. Who knows? Maybe yes maybe no, I'm exercising an abundance of caution. Mrs. Too never gets sick. Probably because she spent some years in Ped oncology and because nurses...

[Doug Fattic]

The only way I am connected to the health industry is because my wife is a nurse. In SW Michigan the only place to get tested for Covid 19 was in Grand Rapids 100 miles away. That was only after visiting your local doctor who asked if you had traveled recently and if you didn't you wouldn't qualify to get tested. Because so few tests were actually available the screening was really sever. I think because there were so few tests available, doctors were reluctant to prescribe them. Remember this was when there wasn't as much understanding of the causes and none of the doctors had much if any personal experience.

[ElvisMerckx]

Matt, I submitted my name to the NIH study as well. I had a 10 day ??? same timing as yourself with a 102.5 fever and body aches to beat the band, no cough some gastro. I came down with it two days after a very crowded yoga class. Who knows? Maybe yes maybe no, I'm exercising an abundance of caution. Mrs. Too never gets sick. Probably because she spent some years in Ped oncology and because nurses...

Uncanny, I had a 102.6 fever for about 48 straight hours -- hours I don't actually remember. Mrs. Elvis never gets sick, but both boys missed a week of school with classic "C-19 youngunz symptoms," ie, nausea, fever, general misery. You're lucky you didn't get the lung stuff -- felt like 12 cracked ribs, and I was flush with fear every time I felt a cough coming on.

[j44ke]

If Covid was circulating in the San Francisco area for 2-3 months without any social distancing measures, why weren't the hospitals overloaded like everywhere else the virus has hit? The Bay Area isn't Manhattan, but it's a fairly densely populated area with more public transit use than anywhere except the northeast cities. I don't understand how that could occur.

There were articles about different mutations of the virus, one of which was cited earlier in this thread. There were 5 different mutations at that point. East coast got the one linked to Europe with the precipitous pulmonary infection, though a friend of ours in NYC tested positive during a gastrointestinal virus that lasted 2.5 weeks. Perhaps the west coast presented differently - enough like flu that all the early cases were not diagnosed? And there was no testing, so how to check one’s diagnosis? The whole vaping thing preceded this - were any of those misdiagnosis?

But you are right - why didn’t medical pandemonium break out if indeed the virus was in the west as early as January?

So many questions still unanswered. Or unanswerable still.

[Arbolado]

Three days after Christmas my wife developed a cold that morphed into pneumonia that lasted until the third week of January. On MLK day my son went to swim practice and complained of being cold when he got home. Went to urgent care the next day with a 103 fever and they said he had the flu. Missed a week of school and two weeks of training, which for him is out of the ordinary, he gets sick like the rest of us, but he usually powers through a cold/flu in two to three days. On February 2, I was at work and started to develop a sharp pain in my chest on the right side. It started to get difficulty to inhale and I thought maybe it was a gas bubble or something. I went home thinking I could sleep it off, but I didn’t, it was worse, I could hardly breathe. There were no other symptoms. I went to work, came home at 8 and told my wife I needed to lay down before I ate. The pain was so bad to lay down that I went to the urgent care. The doc said she thought I had a muscle strain since I had no other symptoms, but she ordered a chest X-ray. Two days later the radiologist called and said I had fluid on my lung and to get to the doctor. My GP was flummoxed since I had no other symptoms. I shared about my wife and my son and he said “but you haven’t had any other symptoms”. He ordered a CT scan with dye and without. The results came back that the fluid was gone, but I had scar tissue on my right lung in the lower section. The pain has gone away, but every now and then I get a sharp pain there. A week after the CT scan I got a snotty nose, but that was it and it was gone in three days.

[Paul Jacobs]

On the subject of vaccine development here's Professor Frazer, one of the developers of HPV vaccine, on the challenges of developing a vaccine against a coronavirus:

We've never made a successful vaccine for a coronavirus before. This is why it's so difficult - Health - ABC News

Thanks for posting that article which I read with interest.

Here is another report which is a bit more optimistic.

Coronavirus vaccine: Target of a million doses by September, scientists say - BBC News

[Paul Jacobs]

What is it in a doctor's mentality - because I've heard ^^this narrative^^ enough there must be some part of training that encodes it in the process of diagnosis - that prevents diagnosing something on the basis that it is not here yet?

In the face of this tendency, how does the first diagnosis occur?

First, to me, this seems to emphasize the 100% imperative of an accurate and readily available test.

Second, to me, this situation actually suggests that the chance that Covid 19 was here much earlier than originally suggested is greater than the chance that the estimated arrival date is correct.

Note: This is not a criticism of doctors. Just wondering about what part of diagnosis training is in action here. Is it - go with common over the rare always?

And Elvis - glad you are recovered or recovering. Sounds like a real beating.

Those are interesting observations Jorn which I can not fully answer.

I completed a science degree (zoology) at Oxford University in the 1970's before completing a medical degree at the University of Liverpool. I found the courses fundamentally very different in approach. In the zoology degree the emphasis was very much on original thinking. I remember one of my friends (who ended up getting a top degree) having a piece of work returned with the stinging criticism - facts, facts, facts (i.e. no ideas).

It was a bit of a shock to me when I started to study medicine to find that, if I was going to pass the medical exams, facts (lots of them) and established principles were what the examiners wanted. This was the same for both university and higher medical and surgical examinations, which in the UK are run by the Royal Colleges for the respective medical specialities. As an examiner for three Royal Colleges for many years I was party to this. Obviously most medical breakthroughs involve new thinking and I do not want to suggest that we doctors are all unimaginative but, when originality occurs, this is in spite of rather than because of the nature of medical training (I am obviously speaking from a British perspective although I have both studied and taught in the USA).

Medico-legal considerations also constrain originality in my opinion and this is not necessarily bad.

[Tom]

Two years ago June I was in my doctor's office pleading for industrial strength antihistamines because my seasonal allergies of which they know my history were off the charts. The PA seeing me asked if I had the flu shot that year. I said yes but this can't be the flu, no gastrointestinal distress. She said she thought I should be tested. It was the flu. I think it depends on the practitioner whether they are going to think of the unusual. Never in a million years would I have thought it was the flu and I was the one experiencing it. Sometimes they haven't had the chance to look up and see the dark clouds on the horizon.

[j44ke]

Three days after Christmas my wife developed a cold that morphed into pneumonia that lasted until the third week of January. On MLK day my son went to swim practice and complained of being cold when he got home. Went to urgent care the next day with a 103 fever and they said he had the flu. Missed a week of school and two weeks of training, which for him is out of the ordinary, he gets sick like the rest of us, but he usually powers through a cold/flu in two to three days. On February 2, I was at work and started to develop a sharp pain in my chest on the right side. It started to get difficulty to inhale and I thought maybe it was a gas bubble or something. I went home thinking I could sleep it off, but I didn’t, it was worse, I could hardly breathe. There were no other symptoms. I went to work, came home at 8 and told my wife I needed to lay down before I ate. The pain was so bad to lay down that I went to the urgent care. The doc said she thought I had a muscle strain since I had no other symptoms, but she ordered a chest X-ray. Two days later the radiologist called and said I had fluid on my lung and to get to the doctor. My GP was flummoxed since I had no other symptoms. I shared about my wife and my son and he said “but you haven’t had any other symptoms”. He ordered a CT scan with dye and without. The results came back that the fluid was gone, but I had scar tissue on my right lung in the lower section. The pain has gone away, but every now and then I get a sharp pain there. A week after the CT scan I got a snotty nose, but that was it and it was gone in three days.

Arbolado - I am not a doctor but I have had pleurisy and based on your description, it sounds a lot like what I experienced. I don’t remember any residual scarring, but I do remember discerning where the fluid was located was key as pleurisy is fluid trapped between outer layers of the lung tissue, while pneumonia is inside.

[Mark Kelly]

Here is another report which is a bit more optimistic.

I sincerely hope your optimists are right and I will be lining up for this vaccine as soon as possible (and that's said by somone who has never had a flu shot in sixty odd years).

On the other hand I find the counterfactual fascinating: if we cannot develop a vaccine, how do we cope with this?

[j44ke]

I sincerely hope your optimists are right and I will be lining up for this vaccine as soon as possible (and that's said by somone who has never had a flu shot in sixty odd years).

On the other hand I find the counterfactual fascinating: if we cannot develop a vaccine, how do we cope with this?

Especially if there is no consistent immunity produced in survivors.

[beeatnik]

Arnoldo - I am not a doctor but I have had pleurisy and based on your description, it sounds a lot like what I experienced. I don’t remember any residual scarring, but I do remember discerning where the fluid was located was key as pleurisy is fluid trapped between outer layers of the lung tissue, while pneumonia is inside.

Emotional rollercoaster...hahah.

Causes

Pleurisy

Pleural linings and space

The pleural space can be invaded by fluid, air, and particles from other parts of the body, which fairly complicates diagnosis.[12][13] Viral infection (coxsackie B virus, HRSV, CMV, adenovirus, EBV, parainfluenza, influenza) is the most common cause of pleurisy. However, many other different conditions can cause pleuritic chest pain:[11]

Aortic dissections
Autoimmune disorders such as systemic lupus erythematosus (or drug-induced lupus erythematosus), Autoimmune hepatitis (AIH), rheumatoid arthritis and Behçet's disease.
Bacterial infections associated with pneumonia and tuberculosis
Chest injuries (blunt or penetrating)
Familial Mediterranean fever, an inherited condition that often causes fever and swelling in the abdomen or the lungs
Fungal or parasitic infections
Heart surgery, especially coronary-artery bypass grafting
Cardiac problems (ischemia, pericarditis)
Inflammatory bowel disease
Lung cancer and lymphoma
Other lung diseases like cystic fibrosis, sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma
Pneumothorax
Pulmonary embolisms, which are blood clots that enter the lungs
COVID-19