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

Parents Forum Parent Cafe
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1521

@JustaMom , I’m very sorry that your dear friend is so sick. Stroke symptoms are so scary. The cytokine storm we’ve been talking about on this thread can be part of the sepsis progression.

I actually thought sepsis was when bacteria get in the blood, but I was wrong—that’s bacteremia. (Bacteria in the blood used to be called septicemia, but now doctors use the term bacteremia to avoid confusion with sepsis. Sepsis is a damaging full-body immune response to an infection such as bacteremia, or more commonly, pneumonia.

About Sepsis:

1522

@3SailAway - pneumonia - correct, that diagnosis for her came yesterday. I also learned she was tested for covid yesterday. There were no tests available prior to that.

Terrible all around.

1523

One of my patients (in his 50’s) ONLY symptom was a stroke.

1524

Do that many patients truly die of Sepsis, or is Sepsis a “catch-all” for complications causing death that are unknown? Sepsis was listed as cause of death for one of my relatives, but I actually think it was due to other factors that were never confirmed without an autopsy.

1525

I think much sepsis is AKA death from being in hospital. Iatrogenic hospital death and hospital acquired infections are not on your average persons radar. Sepsis is a big deal because it is a big payer in the insurance marketplace. It is also secondary to probably over treating people that were going to die anyway, in pre coivd times anyway, when there were ICU bed begging to be filled. How many pts? More than you will find in the stats.

“Nearly 270,000 Americans die as a result of sepsis. 1 in 3 patients who die in a hospital have sepsis.”
https://www.cdc.gov/sepsis/datareports/index.html#:~:text=Each%20year%2C%20at%20least%201.7,in%20a%20hospital%20have%20sepsis.

1526

Because most vaccines are tested over years - with people that have all kinds of issues and the long time frame can show long term effects (if there are any). With the Moderna vaccine, specifically, they are using new vaccine technology (not just using the ‘dead’ virus like most vaccines). Again, don’t know the long term effects. For people that already have a medical issue, if (God forbid) there is a negative side effect later, its one more thing that someone that already has a medical issue has to deal with. As you know, almost every single illness is made worse by diabetes. Its always depressing to hear that, especially for people with young Type 1s. I’d rather not have my Type 1 have to worry about that- especially if ‘most’ others are getting it, which will hopefully stop the virus in its tracks.

1527

@Mwfan1921 my question was rhetorical and referred to another post (by Suzy Q7) that stated that a family member with type 1 diabetes “won’t get” the vaccine. Reading it again, I can see that she meant the relative chooses not to get it, not that the relative won’t be able to obtain it.

I guess the idea is that with that preexisting condition, any risk from vaccine would be greater, but then again, the risk from the virus is huge.

I don’t need to talk to my doctor :slight_smile:

1528

A coronavirus vaccine will likely be multi-dose, Bill Gates says
CNN

Early data on a coronavirus vaccine shows that it will take more than one dose to protect people from the virus, Microsoft founder and philanthropist Bill Gates told CNN tonight.

Gates, who along with his wife Melinda, runs the Bill and Melinda Gates foundation which pledged up to $100 million in February to help contain the coronavirus outbreak around the world.

These funds have also been used to help find a vaccine for the virus, limit its spread and improve the detection and treatment of patients.

“None of the candidates that we have much data on look like they’ll work with a single dose. So these are all multi-dose vaccines. If we look at the elderly, some of the constructs might require more than two doses to get the protection we want,” Gates said during CNN’s town hall Thursday. “The vaccine has to be safe, it’s got to reduce transmission, and then it’s got to protect the health of the individual. And these vaccines, the FDA laid out how they want these trials to be done. Fortunately, they required a proof of efficacy. But they set the bar pretty low at 50% efficacy. So the first vaccine that gets approved may be fairly weak in some of these criteria.”
Gates said that his foundation is funding not only the first generation of vaccines and the capacity for those, “but also a second generation that will be ready four to six months later that may get us closer to 100% protection or 100% transmission reduction.”

“So there’s a lot of uncertainty in the vaccine enterprise, which is hard to explain, you know, when people want to summarize is the vaccine miracle on its way,” Gates added.

Here’s what the next year will look like, according to Bill Gates
Microsoft founder Bill Gates believes there could be some advances in testing and therapeutics in the next year.

“I think the therapeutics is actually the most promising thing and not talked about as much as the vaccines because if you have multiple therapeutics that, between them, are reducing the death rate and the amount of serious sickness by over 80%, probably over 90%, that does start to reduce the horrific burden,” the philanthropist said.
“So I think by the end of the year, therapeutics will be making a big difference,” he said.

Gates said by the first half of 2021, the first round of vaccines could be approved.

“Then by the end of 2021, if people are willing to take the vaccine, we’ll be able to stop the transmission in the rich countries and maybe within nine months after that in the world at large,” he said.

1529

Covid-19 transmission from mothers to babies unlikely with proper precautions, study finds
From CNN’s Marisa Peryer

Mothers infected with Covid-19 are unlikely to pass the infection to their newborns when appropriate health precautions are taken, according to a study published Thursday in The Lancet Child & Adolescent Health.

Researchers reported no cases of viral transmission among 120 babies born to 116 Covid-positive mothers, even when both shared a room and the mothers breastfed.

Still, precautions were taken: Babies remained in enclosed cribs and six feet apart from their mothers, except while breastfeeding. Mothers were also required to wear surgical masks when handling their child and followed proper hand and breast washing procedures.

All babies included in the study were tested for Covid-19 via a nasal swab within 24 hours after birth. After, researchers conducted follow up exams and tests.

Of the original 120 babies, 82 completed a follow up five to seven days after birth. The majority, 68 babies, had roomed with their mothers and 64 were still breastfed. Seventy-nine of these babies were tested again at five to seven days, and 72 were tested two weeks after birth.

None of the results were positive, and none of the babies showed Covid-19 symptoms, the team at Weill Cornell Medicine-New York Presbyterian children’s hospital reported.

They noted that blood, fecal and urine Covid-19 tests had not been approved at the time of the study. If a baby was infected in the womb, the nasal swab test might not have detected the virus. The researchers also relied on what the mothers reported themselves about their hand hygiene and mask usage.

Recommendations for mothers with Covid-19 and their newborns vary. The study affirms current guidance by the World Health Organization and the American Academy of Pediatrics. The pediatricians’ group updated its guidance Wednesday.

1530

Antitrust restrictions waived for companies making coronavirus antibody treatments
From CNN’s Maggie Fox

The US Department of Justice said Thursday it would waive its usual antitrust restrictions for companies trying to work together to speed antibody-based treatments for coronavirus.

It said it would not challenge proposed efforts by Eli Lilly and Company, AbCellera Biologics, Amgen, AstraZeneca, Genentech, and GlaxoSmithKline to share information, including about manufacturing facilities and raw materials, to make monoclonal antibodies to treat or prevent Covid-19.

“The demand for monoclonal antibodies targeting Covid-19 is likely to exceed what any one firm could produce on its own,” the DOJ said in a statement. “Moreover, waiting until regulators approve specific treatments before scaling up manufacturing might delay access to these potentially life-saving medicines by many months, which adversely could affect the nation’s efforts to fight Covid-19.”
More details on the science and law: Monoclonal antibodies are natural or lab-made immune system proteins that home in on and neutralize a single specific target on a virus, or a cell. They’re being made in this case to try to stop coronavirus from infecting cells in people’s bodies.

Antitrust restrictions are meant, in part, to stop companies from coming together to fix prices or to make agreements on carving up markets and forcing out competitors.

The DOJ said the biotechnology and pharmaceutical companies had agreed not to do this.

“Among other competitive safeguards, they have committed that they will not exchange information related to the prices of those treatments or the costs of inputs for or production of those treatments,” the DOJ said.

1531

Uh-oh… a patent battle is brewing in Moderna’s house.

https://finance.yahoo.com/m/32e0f2f5-9f78-39ed-8423-2fa49ea746b0/moderna-dives-on-patent.html

1532

About 41% of adults may be at higher risk for severe Covid-19 infection due to underlying conditions
From CNN’s Jen Christensen

In the United States, about 41% of adults had at least one underlying medical condition that may put them at a higher risk for severe Covid-19 outcomes, according to a new report published Thursday by the US Centers for Disease Control and Prevention.

The research, published in the Morbidity and Mortality Weekly report, looked at five conditions that tend to put people at greater risk for more severe disease from the coronavirus: chronic obstructive pulmonary disease (COPD), cardiovascular disease, diabetes, chronic kidney disease and obesity. It did not include other conditions, such as sickle cell disease or organ transplants.

What the study found was that the numbers of adults with these conditions varied by county –– from almost 1 in 4 adults to as many as two-thirds of adults in a county.

In half of US counties, almost 1 in 2 adults were estimated to have an underlying condition.

There were higher proportions of people with these health conditions living in rural areas, and in Appalachia and in the Southeast. 
The most common underlying condition was obesity, followed by diabetes, COPD, heart disease and chronic kidney disease.

What this means: The CDC authors said the data on these conditions is limited at the county level. They hope the report can help public health leaders use the information to help them make decisions about what areas might need more health resources that may be overlooked otherwise.
Rural areas, that already had been struggling with a lack of health care resources prior to the pandemic, for example, may need even more help. These areas may have smaller populations, but they have communities that have more people with underlying health conditions that may put them at greater risk of needing to be hospitalized for the disease.

1533

This likely won’t affect the development of the vaccine. Worst case if the vaccine launches, Moderna may have to pay out a percentage royalty to Arbutus.

This NYT article is more detailed: https://www.nytimes.com/reuters/2020/07/23/business/23reuters-moderna-patent.html

1534

Regarding transmission to babies of women infected with COVID. Wouldn’t the early colostrum contain antibodies?

1535

I have a high level of respect for Bill Gates and don’t disagree that the therapeutics in development are really promising.

What always seems to not be said or reported is that the availability of treatments will not allow us to stop social distancing and wearing masks. We still wouldn’t be able to let the virus spread in an uncontrolled manner because treatments won’t work for everyone, and their supply will likely be constrained.

Hopefully, though, availability of a good treatment(s) would allow people to be more confident to leave their homes, teach face to face school, go to jobs, and things of that nature. Time will tell.

The US will be in depression by then. (Pessimistic today, please show me the light!)

1536

I think the process the body goes through during sepsis is fairly well documented and understood, so a sepsis death is not a mystery death. However, the hospital criteria for sepsis has been criticized for resulting in a diagnosis of sepsis for patients who do not have severe, systemic infection or organ dysfunction. DH jokes that he is septic when he goes to the gym because his temperature, heart rate and breathing rate go up. As @Sybylla mentions, this definition benefits hospitals because coding for sepsis brings higher payment.

Still, the concept of sepsis is important because it highlights the fact that people with overwhelming infections do not die simply from the bacteria/virus/fungus. The pathway to death involves the body’s reaction (sepsis). For example, take patients with uninfected trauma wounds versus those with abdominal infections. These two groups can follow the same clinical course, with the immune system causing self-destructive inflammation leading to multi-organ failure. So, both infectious disease and trauma care need to take into account the potential for an imbalanced immune response, cytokine storm etc. In fact, in animal infection studies, the severity of the host response was a better predictor of death than the bacterial load.

TL/DR Hospitals are known to use a loose definition of sepsis so they can code for it and earn more money. However, the concept of sepsis is important because it describes a dysfunctional immune response which is harmful to the point of deadly, and must be addressed to save the patient.

1537

I agree, @Mwfan1921 ! I always want to edit the news. Dexamathasone reduces deaths, but that’s not helping us open the country. Even if we had a very effective anti-viral, you need to take it immediately after infection. Our test results are taking a week or longer. Treatments are great because fewer people die, but we need to stop the virus at a society level rather than just an individual level. That’s why I think we need cheap, fast, frequent testing.

Apparently, HHS intends to buy 75,000 Quidel rapid antigen tests, and 750,000 from BD, plus the machines to read them, for use in nursing homes in hot spots. (These are the 15 minute tests approved by the FDA.) https://www.360dx.com/immunoassays/hhs-purchasing-quidel-rapid-antigen-tests-systems-covid-19-detection-nursing-homes#.Xxrg4C2z3ow

The fishing industry in Alaska is also receiving rapid tests from HHS.

I found this on the HHS website:

Apparently, the federal government’s plan is to use rapid testing in select at-risk populations, but not as a strategy to safely open schools or businesses (other than the Alaskan fishing industry).

On April 5th, Governor Cuomo said, "I think you see the return to normalcy when we have an approved rapid testing program that can be brought to scale. That is going to be the answer, I believe.” I’d like an update. I’ve written D19’s college and the school district for my high school kids. I assume they know about rapid point-of-care testing, but it doesn’t come up in any of their extensive plans.

1538

Probably because they are not widely available. How many do they produce a day? If we have to test many people almost everyday, we need hundreds of millions a day. If I remember correctly, they were producing 60K a day. That can test about 0.02% of population.

1539

Possible progress in the rapid test arena?

https://www.dailycamera.com/2020/07/23/cu-boulder-perfects-fast-covid-saliva-test/

1540

@doschicos what are “proper breast washing techniques”? :slight_smile: