Inside Medicine. What Are You Seeing? [COVID-19 medical news]

Interesting data point: in the first few weeks that CU-Boulder has been open, about 1200 students tested positive for COVID. Of those, only one student had to be hospitalized (since recovered), significantly lower rate than average for this age group. CU students skew white and fit in general, but this made me think if perhaps masks also played a role. There were highly publicized cases of large parties without masks, but I think a lot of students do wear them.

Here is what I dont understand (as the credit union is still closed 6 months later and I was desperate to get a certified check so I was thinking), is that there is a lot of talk about the vaccine, and about increased testing (including dogs that can smell covid), and masks, and there is some talk about therapeutics, but I would think this is where we need the most work. I think we could get back to “normal” if we had a way to treat and prevent the majority of deaths that are taking place. I know there is a lot of research and work and trials in this area, but 6 months later I dont feel like we are reducing the deaths at a rate that we should be at. I could handle being sick , but I am scared of dying. And what causes one person to have a mild case and another person to die or or come close to it.

Are the vaccines really just a therapeutic?

Circling back with my daughter’s experience and now, test results. She’s on Day 8 and received the results from her self swab drive-through test today. Negative. The nurse told her that due to her symptoms, she should presume it’s a false negative and continue isolating. In a month or so, she’s hoping she can find a place to get a reliable antibody test. Getting that negative result really bothered her.

Symptoms began as GI symptoms, including nausea, then moved to headache, then fatigue. Evening of Day 2, she added chills, fatigue worse. Day 3, no new symptoms but worsening of existing. Day 4, she added in the chest tightness and just felt awful. Symptoms at their very worst. Day 5, test day, symptoms all continued and a fairly rotten day
but chills finally stopped that afternoon. Day 6, better, GI symptoms stopped, just the fatigue and some chest heaviness. Day 8 and the main issue is still the fatigue/brain fog. She said it’s not sleepiness and in fact, she can’t even nap. It’s just an exhaustion that makes it hard to concentrate. I am beginning to breathe a sigh of relief that perhaps it’s not going to take a turn for the worse. She has measured her pulse ox throughout and it’s been steady at 99, which was reassuring with her chest symptoms.

She had literally been out twice in the prior two weeks, beyond taking daily masked walks - once for the flu shot and once to go to the allergist at a hospital. At the allergist, she was sent to the lab at the hospital for some bloodwork. Due to prolonged time in an enclosed space, we believe the lab is the most likely source for the infection. However, that appt had been 10 days prior to her symptoms, and flu shot was 4 days prior. Either way, she was masked (with a surgical mask), as were medical staff
and she still became infected. So, seems to prove that masks are not a perfect prevention, although perhaps they did prevent a more severe infection.

are we sure that somehow even though she got the flu shot that this was not some form of the flu? I assume they ran the flu test?

The question would be, how would she have been any more likely to get the flu than to get COVID? And the flu is still circulating less than COVID at this point. She is 3/3 the past three years (despite getting the flu shot each year) for getting the flu, and she said this hasn’t been anything like those experiences. I asked the same. I did read that people who experience more GI symptoms than respiratory symptoms from COVID, are less likely to test positive.

The flu shot would not have had time to give her immunity, so it was a non-issue if she’d already been exposed or got exposed in the days following the vaccination.

Influenza usually doesn’t start with GI symptoms in adults and slowly morph into more symptoms
 It generally hits very fast with high fever, body aches, chills, sore throat.

It’s theoretically possible that she had the flu, but these symptoms sound far more consistent with COVID, or perhaps another unknown virus.

There are always many many viral illnesses circulating at any given time-with COVID in the forefront of all our minds, we can forget that other illnesses don’t take a vacation just because they are not getting the same press coverage.

But it sure sounds like she should consider she might have had a false negative COVID result. Can she get re-tested?

@Collegefortwins I can’t say it’s what’s happening to your daughter, but I know a person IRL who gets those symptoms every time he gets a flu shot and it’s delayed by a day or two (not sure about 4 though). This, of course, was prior to Covid. He no longer gets the shots because he doesn’t want the effects. The doctor told him a few people react to the shot the same way they do to the active virus even though they don’t have the flu (or anything else).

It will be interesting to see if she tests positive for antibodies later, because it’s entirely possible she’s had false negative tests, but if not, it’s also possible it’s something else, esp with the GI symptoms.

Best wishes to her regardless of what it is. I’m curious about the outcome when she goes for the antibody test. If she donates blood, she can get that for free.

Initially, we wondered if it was a delayed reaction to the flu shot as well. However, it has gone on for so long that it seems unlikely by this point. I actually had a “reaction” to this year’s shot, which left me with a terrible headache and also made me extremely tired for about 24 hours, but it started about 8hrs after the shot and was gone the next afternoon.

Not sure there is any point in a re-test at this point, since she’s on day 8 and symptoms have (mostly) resolved. I feel like she would be even less likely to test positive now. I think she may have had a better chance if she had tested on day 3 or 4, or if she had gone to a testing site where they did the long NP swab. She admitted that she didn’t put the swab up high enough to be “uncomfortable.”

From our research, it looks like up to 25% of patients with mild COVID cases exhibit primarily GI symptoms, without respiratory symptoms. And, they’re the ones that seem to be most likely to test negative in respiratory sampling, but then test positive for antibodies later. (Some countries have been comparing respiratory samples to fecal samples, and they catch the GI cases that way.) I’ll be very interested to see what an antibody test shows. Are they reliable now?

I would still get another test- but not a self-swab. I would go to an outdoor hospital testing site where they swab far up in the nasal passage. Is it possible her self-swab test was flawed?

Younger S’ friend who tested positive had the GI symptoms. But his started with a sore throat, headache and chills. And he also had breathing problems.

My co-worker’s daughter had a progression similar to your D’s. She also had a high fever that was worse at night. They couldn’t get her to test positive for anything (she had 3 Covid tests at 2 different facilities over a 3 day period) except a borderline result for Rocky Mountain spotted fever. She didn’t remember being bitten by a tick and she’s not the outdoorsy type, but given treatment for that, she got better.

Hard to imagine anything like Rocky Mountain spotted fever - she was home with us in FL this summer and trust me, we really do NOT go outside in the summer, but especially this summer. Lol. And then she moved to her apt in a very urban area three weeks ago!

How long did it take your co-workers’ daughter to recover? If it was COVID, it might have seemed that she was better with treatment for the RMSF, but it could have been that she just recovered from the virus? My D also said the chills were worse at night!

I’ve now spent too much time this afternoon reading about testing for COVID in someone with GI symptoms
 I’m not sure that we will ever see an accurate test here for someone exhibiting primarily GI symptoms, unless it’s for research purposes.

Where did you get the average rate for this age group? If you do screening tests at a campus, you will detect a lot of asymptomatic people who would not have been detected in a regime where only symptomatic people, their contacts, and people who volunteer to get tested are tested. We would expect, then, that at CU, a lower rate of infected people would be hospitalized. One in a thousand-ish sounds like the rates seen elsewhere for that age group.

@Collegefortwins yes, the recovery timeline would have also lined up with regular recovery for Covid. But my co-worker was so distraught at the time, I wasn’t going to bring it up. RMSF is common in our area, but she doesn’t spend time outdoors, nor do her parents. So that made it odd. But who knows.

I hope your D keeps progressing. This virus is so weird. Everyone I know has has a completely different set of symptoms/progression. But S’ friend had really bad GI symptoms in a 4 bedroom apartment with only 2 bathrooms. And all his roommates were strangers/random assignments. I felt so bad for him.

Here’ for example, the hospitalization rates for 0-19 years are listed between 1.6 and 2.5%, and we know young kids are lower risk than young adults so it’s likely higher for students.
https://www.statista.com/statistics/1105402/covid-hospitalization-rates-us-by-age-group/
It makes sense that screening tests catch more asymptomatic cases, but it would have to be more than 90% asymptomatic then. Is this possible without masks? I have no idea, just hope there’s more research.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32009-2/fulltext is a study of prevalence of antibodies indicating past COVID-19 infection in dialysis patients.

Estimated seropositivity of the US adult population, including subgroups as they list them:

9.3% Overall

27.6% Northeast
5.1% South
7.4% Midwest
4.2% West

8.0% Hispanic
9.9% Non-Hispanic Black
4.3% Non-Hispanic white
5.7% Other
12.5% Unknown (race/ethnicity)

11.3% ZCTA >=60% Hispanic
13.9% ZCTA >=60% Non-Hispanic Black
16.3% ZCTA >=60% Hispanic and Black
4.8% ZCTA >=60% Non-Hispanic white
8.9% ZCTA Other

ZCTA = ZIP code tabulation area

Seropositivity by state was also noted (map with states and seropositivity rates in paper).

The paper does acknowledge that “Uncertainty exists as to whether seroprevalence estimates in the dialysis population can be extrapolated to the US population more broadly” and notes how dialysis patients may under or over estimate seropositivity in the general population.

@yucca10, that graphic tells us nothing about the hospitalization rate of 0-19 year old people infected with covid. It instead tells us the hospitalization rate of 0-19 year olds who tested positive for covid between Feb. 12 and March 16. But asymptomatic children and children with mild illness would have been unlikely to have been tested for covid between Feb. 12 and March 16.

Why the coronavirus affects children much less severely than adults has become an enduring mystery of the pandemic. The vast majority of children do not get sick; when they do, they usually recover.

The first study to compare the immune response in children with that in adults suggests a reason for children’s relative good fortune. In children, a branch of the immune system that evolved to protect against unfamiliar pathogens rapidly destroys the coronavirus before it wreaks damage on their bodies, according to the research, published this week in Science Translational Medicine.

“The bottom line is, yes, children do respond differently immunologically to this virus, and it seems to be protecting the kids,” said Dr. Betsy Herold, a pediatric infectious disease expert at Albert Einstein College of Medicine who led the study.

In adults, the immune response is much more muted, she and her colleagues found.

When the body encounters an unfamiliar pathogen, it responds within hours with a flurry of immune activity, called an innate immune response. The body’s defenders are quickly recruited to the fight and begin releasing signals calling for backup.

Children more often encounter pathogens that are new to their immune systems. Their innate defense is fast and overwhelming.

https://www.nytimes.com/2020/09/25/health/coronavirus-children-immune.html

@ucbalumnus, that’s a survey heavily weighted to Black people. I guess the dialysis population is disproportionately Black?

The paper says that “Black Americans have a nearly four-times higher risk of end-stage kidney disease than white Americans” and refers to the 2018 edition of https://www.usrds.org/annual-data-report/ .

Talked to my Seattle RN kiddo just now. She has had the second round of a vaccine trial (“don’t worry mom it wasn’t the AstraZenica where one person had a problem”) She is pretty sure she got the vaccine. Dose one, arm soreness and muscle aches. Dose two - nausea, diarrhea, 101 temp for more than a day. I’m hopeful that she will have immunity since she meets mask to mask with a high risk population.