Now ye're talking - to a consultant in the HSE [Questions thread]

Yester · 18-03-2020 2:35pm

How can we help? At the moment we are taking this seriously and avoiding all unnecessary contact with others. We do ring older people to see if they need anything but they have been ok so far. When things get worse, will there be volunteers needed or is continuing to isolate the best thing we can do?

Edit: Do you think things like this interactive map connecting volunteers with the self-isolated are a good idea?
https://www.limerickleader.ie/news/community/526492/interactive-map-connects-volunteers-with-self-isolated-in-limerick-during-covid-19-crisis.html

Goldenkt · 18-03-2020 4:37pm

Quick question regarding self-quarantine, should someone whos in remission from hodgkins lymphoma for just over a year and received 6 months of ABVD chemo be travelling into work on public transport & work in a busy office in the city centre or do they fall under the at risk group advised by HSE to self-quarantine?

Olaz · 18-03-2020 4:43pm

JustAThought wrote: »

Given that Arklow in particulr is a hotbed for Crona and you like the rest of the population have been specifically warned that children are at high risk and specifically asked to observe social distancing it is difficult to figure out why you think this does not apply to you and your family and children.

Your answer is entirely irrelevant to me, in every way. Have a safe day.

con747 · 18-03-2020 5:08pm

More clean up needed on answers thread Mods

rubberdungeon · 18-03-2020 5:21pm

I don’t have a question for you but just wanted to thank you for your commitment to providing information particularly in the early days of this. I’d read your posts in the other threads and saw the pushback you experienced. Thanks for persisting and sharing, I’ve learned a lot and am grateful to you for all you are doing.

As an observation I was a little taken back when I seen the words interstitial pneumonia in relation to covid19. It’s been a long time since I seen those words, they were written on the death cert of a family member many years ago.

I didn’t understand it then and I won’t pretend to understand it now. At the time, we told people the family member died of a heart attack as no one knew what interstitial pneumonia was and we couldn’t explain it.

Anyway sorry for rambling, my thoughts are with you and all the front line staff and your families who will support us all through this.

RiseAbove4 · 18-03-2020 6:34pm

I’ve been reading your posts with both interest and high anxiety. I believe all your facts and thank you for doing this.

Question:

I’m a 44 year old male with Cerebral Palsy. In addition I’ve early Osteopenia and I’ve picked up some kidney stones in the last couple of years. I’m also allergic to Penicillin which is used to fight off lots of bugs. .

My CP is mild compared to others. I can still walk and I try to exercise as much as possible.

Am I at any higher a risk than another 44 year old male?

I’ve been distancing myself from most people for about 10 days now and I’m going to focus on looking after my immunity with high dosage Vitamin C, Zinc and more.

Cheers again.

faceman · 18-03-2020 8:18pm

As the Americans say to the veterans, “thank you for your service sir”

My question is probably more complex than I think but here goes

Viral loads and contagions. How does it work with this virus. We know that there are drugs for example that can suppress viral loads of HIV to levels that make it virtually not transmittable. What is it that makes this virus so contagious? Is it it’s ability to replicate itself? Or have I oversimplified it?

dummy_crusher · 18-03-2020 9:40pm

First off, I wish you all the best in what you are preparing for and my thoughts are with each and every person who are on the front lines for this. I also have a tremendous amount of respect for you taking the time to do this, understanding the involved risk.

I posted this elsewhere but maybe if you have time you could answer...

EDIT: It looks like you have addressed my question in your most recent answers and I don't expect you to be repeating yourself so I don't see the need for you to answer this - your time here may be best spent answering others! The person in question has decided to self-isolate.

Someone I know who has an underlying condition is still working and using public transport daily to travel to and from work. I've checked the stats HERE (section: Case fatality rate of COVID-19 by preexisting health conditions)...

They have diabetes and are between 20-40 yrs old. Am I reading this correctly that if you have diabetes you are ~7 times more likely to die from the virus? i.e. 7.3% vs 0.9%? I notice that this doesn't factor in age (like the previous data), so it is also possible that the majority of these diabetes cases are older people. Are these assumptions correct?

I have been looking for more detailed data regarding this but have not yet found any, if you know of any other sources, I would be very grateful.

I have suggested to this person that they should probably be self-isolating but I don't want to scare or worry them by presenting any figures, especially ones I don't fully comprehend.

They work in retail and their employer has stated that they will be keeping the place open even if non-essential retail outlets are ordered to close - I believe they have applied for special status in this regard based upon the products they sell. Their employer has informed them that they have the option to not come to work if they are not comfortable (which will be treated as unpaid leave) so this obviously has a bearing on their decision to isolate.

I just want this person to be fully informed and not putting themselves at undue risk for financial reasons.

What are your thoughts?

On a separate note (not directed to OP since it is not their field), does anybody know how higher risk people who choose to self-isolate are treated when it comes to Welfare? Looking HERE, it would appear that you may claim more if you are diagnosed or suspected of having the virus. Does anything similar apply if you are in a high risk category and told to isolate by your GP? I am not certain but I would assume that any decent employer would be able to declare that a certain individual was not required at the moment and temporarily laid off if needed...

Imreoir2 · 19-03-2020 12:24am

Is there a reason for the high mortality rate experianced in Italy to date as compared to other countries?

The One Doctor · 19-03-2020 12:44am

No questions, just thank you for your forthrightness, bravery and determination. If we ever meet, I will buy you a beer. Several beers.

Pseudonym121 · 19-03-2020 4:32am

Edited because I'm clearly a moron and managed to post my answer to the questions thread. Sorry

Agus · 19-03-2020 8:55am

From my understanding the median time for symptoms to start after getting infected is 5 days, and almost everyone that gets symptoms will have them before 14 days. Do you have equivalent figures for how soon after getting infected a person becomes infectious even if they don't have symptoms yet, and for how soon after getting infected a person will test positive even if they don't have symptoms yet?

Drumpot · 19-03-2020 10:56am

https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf

————————————————-
Conclusion: We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings.

—————————————————-

There are some reports that Gastro problems (like diarrhoea) can be an advance warning and in a small study of Hubei patients, just under 50% had this as their primary symptom. Have you heard anything regarding this or is there any sign that this has been a symptom from what you have seen thus far?

Thanks for answering all these questions, it really helps...

Standman · 19-03-2020 1:04pm

I'm a bit confused about the advice regarding hygiene/social distancing - HSE website says masks are unlikely to be effective for healthy people and seems to advise against gloves, but you reckon it's irresponsible to go to a supermarket without gloves and masks? Also, if we're worried about touching surfaces in a supermarket then what about the things we buy and take home? Should we be disinfecting packaging? Thanks.

Skygord · 19-03-2020 1:15pm

My wife finished chemotherapy 6 months ago, and had a splenectomy 3.5 years ago.

We understand she is in an at risk group.

Are there any extra precautions that we should follow - over and above the guidelines for self-isolation?

Drumpot · 19-03-2020 1:44pm

My sister smokes but had leukemia when she was a child. ( not had problems or check ups in decades). She works in a hospital up north and when I asked her if she had spoken to a doctor about her risk factor she said she didn’t see it being a problem. She’s also refusing to buy these personalized masks they are offering. Would a person who has , I think, fully recovered from this illness theoretically not be anymore at risk then the average person? I appreciate you cannot give medical advice here, I am just wondering how insistent I should be with my sister that she should talk to a doctor regarding her risk profile, especially while she’s working in a hospital....

Fluorescence · 19-03-2020 1:57pm

Thank you for taking the time to answer the questions, and for continuing to work despite being at considerable risk. This really is a war.

I work in the veterinary sector. Many of our clinics and hospitals have ventilators. In the UK, the AHT is compiling a list of veterinary ventilators and liasing with officials to coordinate their potential donation/use in the hospitals in the weeks to come. I don't know if the Irish bodies are aware that these facilities may be available to draw upon?
It's not a standard piece of kit in every hospital but there are many around, which may be worth investigating.

Aside from ventilators, is there anything veterinary staff in particular can do to assist in the coming crisis?

Hobgoblin11 · 19-03-2020 9:16pm

Is sex ok during this crisis or should we be avoiding that also?

When can we go back to this type of thing if it's not recommended?

Do you contact trace your partner?

19-03-2020 9:30pm

I see that having high blood pressure is one of the risk factors. If you are on medication for it and your BP is now ok, is an underlying risk still there?

r93kaey5p2izun · 19-03-2020 9:32pm

In your opinion, how high risk is someone (aged 40) with Inappropriate Sinus Tachycardia requiring 7.5mg bisoprolol daily and suffering fairly significant exercise intolerance? They are an ex medical scientist and looking to volunteer - is their risk of further burdening the health service if they get sick low enough to go ahead? It's impossible to get any response at the moment from gp or cardiologist. Obviously this would be just your theoretical opinion on this condition generally, without knowing full details.

Thanks for all you are doing both in the hospital and in spreading awareness here. Your posts are scary but I believe them to be realistic. Thanks for trying to get people to wake up to reality.

lillycakes2 · 19-03-2020 10:08pm

I am a nurse, I live with my mum who is over 70,self caring. I am not going near her, I am using just one room (my bedroom), with door closed, I am using my own toilet, my own cutlery and I just walk out front door when I go to work, she is not allowed to use this door , she uses the back door.i am not using any room in the house ,I am showering etc in work....
Does this sound ok to you ?.

supermouse · 20-03-2020 12:17am

Firstly, thank you for doing this AMA. Furthermore, thank you so very much for everything you have done to date and will no doubt continue to do well into the future to protect us all.

Why do you think we haven’t been put in lockdown yet? As we’ve all heard and seen, social distancing is working for some but so many are ignoring the rules. Mr Varadkar has access to the same data as you, is a medical doctor himself and is surrounded by some of the brightest minds we have in this country. Why are we delaying the inevitable do you think?

Stay safe. I truly mean that.

Whiplashy · 20-03-2020 1:21am

I live with my elderly parents and I myself am on weekly benepali injections. When the government recommends cocooning, would I need to follow that recommendation as well as my parents? We live in the country with no family nearby so would need to be thinking about trying to put arrangements in place if necessary.

Xertz · 20-03-2020 3:51am

A genuine question, and I know it might be impossible to answer, but do you foresee this going on for a few months or are we looking at a new normal well into 2021?

r93kaey5p2izun · 20-03-2020 5:17am

Pseudonym121 wrote:

Thanks for the question. I don't wish to be difficult but there's no such thing as inappropriate Sinus Tachycardia. I think I know what whoever used that term meant though and I would think that this would qualify as Cardiovascular Disease and thus put them in a high risk category.

Thanks so much for your response. It was very helpful. I will pass on your advice about volunteering for a role with no or little contact and he will hopefully eventually get a specific response too from one of his doctors to be safe. (IST is the official diagnosis written in medical reports from a cardiologist specialising in electrophysiology and was deemed to be a type of SVT and possibly a form of dysautonomia or SA node malfunction.)

Best of luck and thanks to you and all your colleagues.

Agus · 20-03-2020 9:28am

Agus wrote: »

From my understanding the median time for symptoms to start after getting infected is 5 days, and almost everyone that gets symptoms will have them before 14 days. Do you have equivalent figures for how soon after getting infected a person becomes infectious even if they don't have symptoms yet, and for how soon after getting infected a person will test positive even if they don't have symptoms yet?

I really appreciate what you're doing to provide information and raise awareness, so I was disappointed not to get a response to my question above - just quoting it above to bring it up again as you might have missed it among all the questions you did provide great answers for? Would love to know if there are in fact any estimates out there for how soon someone will test positive and how soon someone will become infectious.

Also as you mentioned in one of your answers it would be really useful if you get a chance to write up the post you were considering about how to avoid bringing the virus into the home!

up for anything · 20-03-2020 10:27am

Based on our figures today, 20th March, and the lack of proper social distancing going on, what do you think our best, medium and worst case scenarios are going to be regarding deaths? Are there going to be enough ventilators, do you reckon, for say the medium case scenario? I assume, probably wrongly, that as we are a manufacturer of them we may get first dibs on them.

Are patients who are within some hours of inevitable death actually in any sort of condition to say goodbye to family via phone or iPad like I've heard they've been doing in Italy?

LadyMayBelle · 20-03-2020 11:14am

Thank you so much for your advice and info, as well as your dedication. I'm glad you gave example of how you managed food delivery and wiping down items, as I worry about this as well as good intentioned people leaving items and bags of things at people's doors, esp elderly. I made clear in another thread that it's not about stopping kindness but a need to be mindful that more harm could be done than good? Once proper measures are in place then it's ok..ish.

Would love your broken down list you referred to..we would have been chuckled at for being preppers but took a lot of advice from your posts. Thank you.

Funsterdelux · 20-03-2020 4:34pm

Howdy doody Pseudy,

I was up on scaffold there starting to get the battens ready for slating the back of my cottage, the east wind is eating the face and hands off me. It got me thinking, with the measures of social distancing/isolation in place for months perhaps, other viruses such as the cold and flu would also find it hard to spread(i know we're going out of season). Would this have a positive or negative effect on our collective immune system? If a majority of us dont catch sars cov2 and other viruses, when/if things go back to normal would we be more at risk from getting a more severe cold/flu?

The question always sounds better in my head, anyway thanks again and good luck!

trisha e · 20-03-2020 4:58pm

If suspected cases have to wait days for a test and,as a result, test negative because theyre better what is the point in testing if not testing for antibodies at the same time?
Surely these tests should be allocated to people on the list with symptoms.
A work colleague of mine was sick for 2 weeks
GP booked a test on Monday and still waiting. Says he's feeling better now and wonders should he give his slot to someone else on the list. Thanks to you all.

fjortal · 21-03-2020 8:00am

Hello and thank you so much for answering questions during this time. My dad found out he needs a triple Bypass a week and a half ago. He is meeting with the surgeon on Monday. He is 75 and will be tested for Cov 19. My question is, in your opinion, could I visit him in relative safety before and after the operation while keeping 6ft between us, wearing gloves and mask? I am in good health, no symptoms whatsoever. I do have children. I am extremely close to my parents and other family members have visited, keeping their distance. I am torn between fear of passing something on and the negative mental health effects not seeing them is having. Many thanks Fjortal

Potentially · 21-03-2020 11:25am

Firstly, thanks, no words could say it enough

Secondly: I am a single Mum with 12yo. Ex wants to continue contact, he has just collected her and has gone off for the day. He has been working as a salesman to pharmacies and has continued his normal socialising routines, with his new partner (nurse who home-cares for newborns) and others home recently from abroad....
I have been really careful to keep social isolation but is all that down the drain now?
My elderly parents and aunts rely on me; and if I get ill, there is no where for my child to go.
Please advise.

Notsomindful · 21-03-2020 11:49am

Thanks for all you are doing.
My local testing centre is a drive through centre.
I have been referred for testing awaiting appointment.
Can I walk to test centre- as I dont have access to a car and dont want to risk spreading it to others unnecessarily like taxi drivers etc...

RobbingBandit · 21-03-2020 12:52pm

Thanks for taking the time to do this.

I'm a diabetic I've just had my next couple of appointments postponed indefinitely I am currently dealing with several complications including foot and eye issues which require routine care and can turn nasty I am unable to contact anyone in the departments so far and really don't want to find myself going to a&e.

In short what is happening to patients with ongoing chronic issues in this current climate is my question.

Airyfairy12 · 21-03-2020 1:50pm

Hi I just have a question about coronavirus symptoms. Do they come on suddenly like in the case of a flu were you all of a sudden feel unwell or do they come on gradually, do you feel like youre coming down with something for a day or two before symptoms become obvious? Are swollen lymph nodes in the neck common with coronavirus like they are with cold and flu?

Thank you so much for taking the time to answer questions.

Purgative · 21-03-2020 4:23pm

I'm not religious, but God help us.

If they're tubed and sedated then they're not. If they are more conscious then a remote goodbye may be possible so long as staff aren't overwhelmed.

Silent Running · 21-03-2020 5:31pm

Hi,
For a few years I've had paroxysmal A-fib which is under control, taking Lanoxin (I couldn't tolerate Bisop). My doctor wants to put me on blood thinner this year as I reach the age where it is recommended. Is this condition considered as an underlying condition that would make infection more dangerous?

My wife and I have been isolating at home for a couple of weeks now, so we're doing our bit.

My heart goes out to you guys on the medical front line, and restores my belief in the goodness in most human beings. I could never offer enough thanks.

fishy_fishy · 21-03-2020 8:24pm

Thank you for taking the time to answer so many questions.

The main question I have is around asymptomatic people who have the virus. This idea really really frightens me. I have complete faith in my ability to survive it, but I'm terrified of giving it to my parents or my partner's parents (all 60+).

I'm aware that not enough information may be known to answer specifically to Covid 19, but maybe it's possible to answer in general about how exactly a virus can spread in someone who's asymptomatic?

The understanding one gets is that viruses spread via droplets from sneezes and coughs, but is there some other mechanism? I have to go to the shops weekly (no online slots left around here) for the folks and am otherwise self isolating, but it'd be nice to know if there's anything else a person can do to prevent it spreading. I'm working off the assumption that I (early 30s) have it but am not showing symptoms. I try not to breathe heavily in shops, only touch the item I'll purchase etc, wear gloves and don't touch my face. (Related note, it'd be helpful to know this for normal life also. I'm a total germ phobe and assume the air on busses is teeming with disease)

The second question (apologies for the already long post) is whether your level of preparations would be typical of the consultant group, if you know? It's been interesting to hear your precautions so just trying to put some context on it.

r93kaey5p2izun · 21-03-2020 8:25pm

Notsomindful wrote: »

Thanks for all you are doing.
My local testing centre is a drive through centre.
I have been referred for testing awaiting appointment.
Can I walk to test centre- as I dont have access to a car and dont want to risk spreading it to others unnecessarily like taxi drivers etc...

The HSE info page says not to attend a drive through testing centre unless you are in a car and have an appointment.

https://www2.hse.ie/conditions/coronavirus/testing.html

embraer170 · 21-03-2020 9:35pm

- I read a story a few days ago that only 1% of the Covid-19 patients in Italy put on ventilators actually survive. Is there any truth to that?

If there is interest in the routines and habits I'm trying to instill in myself to minimise the chance of bringing this into the home I would be happy to outline them in a post. Let me know.... you can't rely on yourself remembering these things willy nilly. You really need to think it out and have either a mental or written checklist. That's how we do things in surgery and when dealing with infectious or immunocompromised patients. We're learned that checklists work.

- Yes, I would be very interested.

Thanks for the great thread.

The One Doctor · 21-03-2020 11:56pm

Does the current low number of deaths from CoVid 19 in Ireland give you any cause for hope about this pandemic?

Thank you for your stalwart work.

digzy · 22-03-2020 12:03am

Hi
I’m a dentist. Like most of my profession I’ve shut my practice due to safety issues.
Unfortunately the chief dental officer made a statement that we’re to work as normal despite not having appropriate PPE.
Her advice is plain wrong. I don’t want to be a super spreader ( because I don’t have PPE) , nor put my staff or our families health at risk by remaining open. However I also feel a duty of care to my patients.
The hse needs to order all dental practices to shut down. We might save a tooth but loose a life!

Bidd · 22-03-2020 4:06am

If you’ve had the vaccine for pneumonia would this protect you from pneumonia if you get Covid-19.

begbysback · 22-03-2020 9:35am

Given that deaths can be kept at a minimum by early diagnosis and treatment, are you guys lobbying for this, or just waiting at the doors of hospitals for critical cases?

Notsomindful · 22-03-2020 12:39pm

Sergio Rough Grapevine wrote: »

The HSE info page says not to attend a drive through testing centre unless you are in a car and have an appointment.

https://www2.hse.ie/conditions/coronavirus/testing.html

Thanks for link.

That's reassuring for all of us who dont have access to a car/dont drive and dont want to risk.infecting others.in taxis/ high risk themselves...according to the hse, we" may be tested at home".

So we may not get tested at all.

Woohoo.

Beagslife · 22-03-2020 2:07pm

Hi Pseudonym121,

Thanks for doing this. It's very informative and thought provoking. Stay well.

My questions is regarding suppressants (not sure if that is the right term) like cold and flu medications/remedies. I used to typically get a couple chest infections (with harsh chesty cough and perhaps sore throat and sometimes fever) a year. For the last few years I find that at the onset of symptoms if I take echinacea capsules regularly I can usually hold it at bay and after a few days I am back to normal. Where I have let it get deeper I would add astragalus to help clear it up. By the way, I'm not advocating the above in any way, shape or form as regards Covid-19.

Could the use of any of the above remedies by the general public cause problems by perhaps masking the Virus (reducing the symptoms and as a result people not looking for testing or being less cautious)? I think I read somewhere that some products had been banned in China for this reason. Possible fake news of course but perhaps you have better knowledge of this.

Would you have an opinion on this?

Sorry if it's not really relevant.

Anyway keep up the good fight and take care of yourself.

Fleetwoodmac · 22-03-2020 2:11pm

Is there any truth in WHO giving directives regarding taking zithromax and chloroquine as prophilacs for covid?

Happy4all · 22-03-2020 2:25pm

Thanks for doing this and two questions if you don't mind:

1. My daughter works in a pharmacy and I fear for her health from additional exposure and then surely that impacts on the household's effort of social isolation, being made somewhat null and void. Should we be taken any additional measures?

2. The UK only reported 7 deaths today. A long way short of the daily 100+ prediction. Is this from lack of true testing numbers or signs that things are not as bad as feared?

leggo · 22-03-2020 3:23pm

Thanks for doing this OP, first thread I’ll check anytime I’m on now.

I’ve noticed a change in your tone and attitude towards the public over the past few days (not saying it’s unwarranted btw). Do you find yourself overwhelmed already with the workload and job ahead or do you feel it’s more your own personal anxiety about what’s to come? I’m trying to gauge what of this is based on your actual day-to-day work/lived experience and what is (educated) worry.

On a similar note how do you compare your own state of mind to that of the colleagues you’re working with on the front line: are you one of the few preaching concern or are the majority of frontline workers freaking out about the public too?

Nonoperational · 22-03-2020 5:59pm

Hi mate.

From reading your posts I suspect I know what speciality you are in but I appreciate you don't want to answer that publicly. I am heavily involved in GIM and have already completed numerous covid shifts in ED and have seen nearly 100 patients ?COVID. May I ask, will you actually be seeing COVID patients during this and be involved in their management?

I appreciate you not wanting to let people know your speciality but could you at least clarify if you are GIM/Surgery/Psych etc. A broad category. Just so people have some context.

Thanks

Now ye're talking - to a consultant in the HSE [Questions thread]

Comments