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

Boards.ie: Niamh

As above, our AMA guest here is a consultant in the HSE. I have verified his identity and that he is a consultant in HSE.

Hopefully his answers to questions will be a valuable resource for everyone and for that reason we are opening this thread for questions and a separate answers thread to keep all of the informative content in his answers together.

Please stick to this format for Qs & As as posts from anyone other than the OP in the answers thread will be removed.

ANSWERS can be found here.

Thanks all

Please note, as always do not ask for medical advice.

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Purple Mountain

I just have 2 more questions for you.

Are you aware of what Dr Phil (doctor of psychology in the US) said about reopening the economy?
Basically he says look at the figures for people who die in swimming pool accidents etc and the economy still goes on. He can't see the justification of an economic shutdowns.
How do you argue with his mentality?

Also, there's hints in the media, even from our leaders, that schools may return for one day a week.
But yet, I've heard that there are still some test centres or the proposed UL field hospital that hasn't even opened yet.
I just don't understand how we're near opening schools if that's the case.

Thanks.

Purgative

Well Dr Phil says what his network wants him to say. He's not a medical doctor, and neither does he hold a licence to practice psychology.

......

No. We're better than that.

Good post Doc. Not to say your others haven't been just these American Quacks really grind my gears.

No. We're better than that.

I think so too and I'd sooner be here facing this than any other country - Oh, and I'm an immigrant here

locohobo

Hello again...
Just like to get you're take on the migrant farm workers coming into the country to harvest crops..
I think that though it does pose a slight risk, (as we are told they have undergone medical checks in their home country and again on arrival. They will be isolated for the recommended 14days and will again be medically checked before being allowed to break isolation) that it is necessary otherwise the crops will go to waste leading to empty shelves, and as you say we're in this for the long haul so the probability of "familiar/local" varieties of food shortage could happen.
There is a lot of hype been kicked up on social media about this but when Keelings advertised for local workers they only got about 40/50 replies, it just has not sunk into peoples heads that there could be food shortages if this plays out longer than expected or that there could/would be a 2nd wave of infection. Also taking into account that the €350 P.W. covid payments the government are paying will also put people off any thought of helping out in the harvesting what with the attitude of why should I go harvesting at 4am for what I'm now getting paid to stay at home...

Roanmore

Purple Mountain wrote: »

I just have 2 more questions for you.

Are you aware of what Dr Phil (doctor of psychology in the US) said about reopening the economy?
Basically he says look at the figures for people who die in swimming pool accidents etc and the economy still goes on. He can't see the justification of an economic shutdowns.
How do you argue with his mentality?

Also, there's hints in the media, even from our leaders, that schools may return for one day a week.
But yet, I've heard that there are still some test centres or the proposed UL field hospital that hasn't even opened yet.
I just don't understand how we're near opening schools if that's the case.

Thanks.

Totally debunked.

FlipperThePriest

Pseudonym121 wrote: »

Over the next few days I'll be editing the mask/PPE post with some additional tips and links to cheap gear on Amazon which will help make masks much more effective.

I would strongly urge everyone who has seen the videos of how to put a mask on and take a mask off and so will benefit from wearing one to go out and buy one - even if it'll take a month or two to get here. Yes, do gloves and hand sanitiser etc also if you wish when out but there's a reason why the only piece of PPE I think is essential when out is an airtight mask. All of the rest is nice but can be compensated for by awareness and good routine on entering and leaving your house/work. But without a mask you are at the mercy of whoever passed through space you are now passing through over the last hour or so. If they were sick and coughed you are defenceless without a mask.

Any chance of a link to buy masks or are you still working on this? I've seen some for sale on Amazon, but I'm not sure on the quality and wouldn't be relying on reviews on there.

I have one at home that fits nicely, bought it in Woodies a year ago for spraying weeds... cost about 10eu... ffp2 according to the stamp on the side, Can I assume that this is the same effectiveness as a normal n95?

Would like to source a few more online all the same.

Conelan

Hi and thanks for your time,
I know a vaccine will be the longer term hope as a solution to this virus but could I just ask your opinion on the anti viral drugs being used/ being trialed at the moment? Is there any pattern of success emerging with one over another?? Hydroxychloroquine is getting alot of the media attention, less so Remdesivir. Are Irish hospitals using these or do you think is there anything out there that can help? I saw an Australian lab managed to kill the virus "in vitro" with Ivermectin. Is there a big difference in terms of success rate moving from "in vitro" into the human body??
Thanks.

voluntary

The Polish embassy in Dublin just announced the presidential election to take place in Dublin on May 10th. A personal vote in the Dublin 4 embassy itself. Tens of thousands of Polish living in Ireland. Will this be let run?

FlipperThePriest

zippy84 wrote: »

Any chance of a link to buy masks or are you still working on this? I've seen some for sale on Amazon, but I'm not sure on the quality and wouldn't be relying on reviews on there.

I have one at home that fits nicely, bought it in Woodies a year ago for spraying weeds... cost about 10eu... ffp2 according to the stamp on the side, Can I assume that this is the same effectiveness as a normal n95?

Would like to source a few more online all the same.

One more question, thank you again for all your information and dedication.

How can we advise family about the perils of becoming lax going forward or is there any idea what the reasonable expectation for family contact over the next months?

I and my siblings have young kids. We all get on very well and the kids have a great relationship with the grandparents, who are in their late 60s and thankfully, in good enough health. So far, everyone has been pretty strict keeping away. However, I've noticed little signs that this could slip. It's understandably very tough on the grandparents in particular. Our wee one has shed tears over missing them too. Of course this is infinitely more tolerable than the potential alternative.

I recently went back to working from home. My mother, knowing that I've been cautious with isolation, has asked if I'd like her to look after the child, since we haven't been going out. I refused, saying it would go against all the expert advise, particularly since the child could be infectious and asymptomatic, but thanks anyway. There have been a few signs like this that lead me to believe that things might slip, i.e. other siblings may not be as cautious.

Do you foresee a time-frame or any kind of guidance in relation to children with grandparents going forward? I am happy to keep things the way they are, but I fear in the future siblings may not stay the course, or my parents either.

JoChervil

I have a question. I’d already created a thread on it but it's died with only few bulling responses. Before I start I would like to point out that I don’t live in Dark Ages, yet I respect tradition and wisdom inherited from our ancestors. And I am not afraid to ask “silly” questions because they sometimes lead to wise answers.

Few days ago it was a video posted in the main thread made by a doctor from NY. In this video he suggested that in severe cases of COVID-19 there was an excessive amount of toxic Fe3+ iron ions in the blood plasma (he suggested that they were released from haemoglobin damaged by the virus in alveoli or at least I understood it in this way). If it was so, the remedy then should be the reduction of Fe3+ to Fe2+ and preferably removal of free iron ions from the blood.

So my question is: has anyone anywhere tried to apply “cupping-glasses” in case of alleged pneumonia caused by COVID-19? I mean parallel use to a standard treatment, not instead of it. Simply experimentally. (BTW this method is also used in Chinese traditional medicine, so maybe people in China were helping themselves in this way while being sick at their homes? - so maybe it was already checked there outside of the main stream treatment?)

I am not a physician but I suspect that BLACK SPOTS LEFT ON THE SKIN BY THE GLASS BUBBLES CONTAIN IRON (that is why they are black). And it happens only in case of very severe infections, otherwise spots are red or even pink (so they are not simple bruises). I know it from experience, that spots are not always black. What if “cupping-glasses” treatment is a method of "sucking off" a significant portion of toxic iron ions from the blood into the skin and thus reducing oxidative stress caused by toxic iron overload?

Now in hospitals there are a lot of patients with toxic iron ions in their blood causing damage to their vital organs. It creates a great opportunity to scrutinise this method. I think many people would prefer to try it than let their closest ones die. What if it could help? Especially if such therapy may prove effective in severe cases where a liver is no longer able to keep up with the process of haemoglobin degradation and produces insufficient amount of ferritin and haptoglobin capable of capturing excess of free iron ions.

As to “cupping-glasses” my mother used to say: "if spots are not black then there was no need for use of glass bubbles" (I suspect: there was no noticeable amount of free iron ions in the blood plasma) and also "the darker the spots are, the more severe and dangerous the disease is". This is due to centuries of human experience. I believe in therapeutic power of this method as the “cupping-glasses” helped my sister recover from severe pneumonia when she was a child. No antibiotics were used in her treatment and aftermath she looked like a huge pale ladybug with black dots on her chest and her back. Actually this hypothesis above is her idea.

The “cupping glasses” are not acknowledged by modern medicine, but has anyone ever tested their effectiveness of eliminating free iron ions (Fe3+) from the blood? Maybe the extravasated blood contains also some virus proteins transferred simultaneously to the skin, which tissue gives probably the strongest immune response in the body. So even, if the spots were only simple bruises with no iron but some virus, they could prod our immune system.

Why this kind of method can’t be tried and ruled out for good, if not working? Or approved and used, if working?

It is only a question of applying cups (bubbles) and then analyzing the content of these spots. The advantage of the “cupping-glasses” method is that the therapy is very cheap. Much cheaper and safer than ventilators.

I think it would be worth trying in face of such huge emotional and economical losses caused by this pandemic.

auspicious

Thank-you for all your work and that of your colleagues.

Going forward, should a conversation on diets which have strong scientific evidence of reducing the risk of developing comorbidities associated with Covid-19 be a priority to ease the burden of this disease on the healthcare system and increase the chances of ones ease of recovery?

JoChervil

JoChervil wrote: »

So my question is: has anyone anywhere tried to apply “cupping-glasses” in case of alleged pneumonia caused by COVID-19?

I think it would be worth trying in face of such huge emotional and economical losses caused by this pandemic.

I only would like to add that such a man like Michael Phelps wouldn't risk to become a laughing stock worldwide, if this method was of no use for him...

And this golden olympic swimmer must have had a team of professional doctors taking care of him, yet they allowed him to use this method. So at least it did no harm to him and his performance.

Hmmzis

Hi,

Thanks for all your hard work, it's very, very much appreciated. Please keep up the good fight for all of us.

When you get a chance and willingness to look into a question I have, that would be excellent.

The short version of my question is: "Asymptomatic cases, what's the story there, why are they asymptomatic?"

The long version is this.
From looking at some of the data where subsets of the general population have been tested for active infections and then monitored over time, there appears to be a rather large proportion of infected people that do not develop any symptoms (>50% in a lot of them). When looking at the Diamond Princess data, one could be forgiven for thinking that the asymptomatic rate is higher in the risk groups than in the non-risk groups. I haven't seen any similar breakdowns in the other studies, including our own nursing homes, so I can't be sure that's the overall trend.

Given that, are we missing something important here, something that could be used to save a lot of lives? What is that factor or collection of factors that allows a big part of the risk group getting away with an asymptomatic infection? Any chance we could do some comparison tests between the known asymptomatic cases and symptomatic ones, like antibody tests for other human coronaviruses (Common Cold ones), checks on the angiotensin system (not if possible even), lifestyle differences etc.? Maybe it has already been done? I just simply haven't been able to find anything like that.

Here is the link to the Diamond Princess study: https://www.niid.go.jp/niid/en/2019-ncov-e/9417-covid-dp-fe-02.html

Thanks again and all the best!

2u2me

JoChervil wrote: »

I think it would be worth trying in face of such huge emotional and economical losses caused by this pandemic.

Sounds like you're describing Pascal's wager.

locohobo

Hello again!!..
Noticed you've not posted since 20/04//Hope all is ok and that the HSE have'nt nobbled you...
Just reading today that investigators in China noted, and now the French have noted also that there seems to be surprisingly a lot less smokers affected by coronavirus than non-smokers.. They are to conduct trials using nicotine parches to see if nicotine may be an inhibitor of the infection..
Am just wondering here that maybe its not the nicotine itself but rather the deposit from smoking that is built up in the lungs that may be causing this inhibition. As in that the virus cannot connect with the receptor in the lungs because of this coating..
Would like to hear you're thoughts on this....

Tails142

Thanks for the info you've been providing, hope your radio silence the last while isn't a bad sign. I've followed a lot of your advice and suggestions.

I ordered some masks off aliexpress and wish.com - as you say they may take 30 days+ to get here but we're in for the long haul and I will be glad when they do arrive I'm sure. I'm working from home the last couple of months but will probably be expected to attend the office from time to time as restrictions ease. Have basically been cocooning with wife and kids since 13th March.

Can I ask you about covid-19 and asthma. I'm an asthmatic myself and while I wouldn't consider myself to have severe asthma the prescription I'm on puts me in the severe category going by the info on asthma.ie - although I don't always need the dose I'm prescribed, I usually manage ok on one puff twice a day instead of the two puffs twice a day of the preventer I'm prescribed. We are hitting pollen season now though so I'm up to two puffs the last while, anyway...

Are you seeing many complications arising for people with asthma contracting covid-19, is it affecting them more severely? Are patients with covid-19 and asthma at much higher risk?

I wasn't overly concerned at the start as asthmatics are generally used to their condition being overhyped, a blast of ventolin and you're normally good to go. But I suppose
I've been dwelling on it the past few weeks - I have psoriasis too and caught cocksackie virus (hand food and mouth) last year from one of my kids, it really took hold in the skin affected by my psoriasis, I.e. My lower legs and arms and gave me a real good doing. It's unusual for adults to get it so I had been wondering if the psorisasis was an opening in my body for that virus to take hold. And likewise, now I'm wondering the same thing about covid-19 and my lungs, could my asthma be an opening for that virus to take hold in me and hit me severely.

Would be interested in your opinion or recent experiences or if you knew of any papers that have looked at this.

eeeee

Hoping you're alright at the moment, and getting rest in what must be an insanely busy time.

I was just wondering what you think of how the virus has progressed, in terms of your predictions, where do you see things heading now that there's an exit plan? Are the measures premature? Are ye run off your feet in hospital? Do you believe we have seen a rounded peak of sorts or is this level of infection and hospital stress the new normal until a vaccine comes in?

barrymanilow

Hi thanks again for taking the time out to answer these questions. The answers thread has been a great source of information.

Just wondering what your casual opinion on this is , the Monday after the schools were closed I came crashing down with something , like one minute I was going about the day the next I felt like I had been run over by a truck , felt very very weak and very cold , had to wear a full set of clothes in bed. I was like this for the nest week bar the chill which didn't return after the first night. But basically a week where I was too weak to hold a conversation with anyone and making tea and a sandwich took so much out of me that I would have to watch a film on the couch to recover. It was very strange and I had never experienced anything like it , intense lethargy which almost as if on schedule lifted exactly a week later.

My GP and the helpline of that time didn't think I was a candidate for testing as I had nothing respiratory and hadn't been abroad or in contact with one of the then known cases.

I am living with my partner. If it was Covid I thought she would get sick also but she never did. We have been both self isolating and I didn't leave house for 3 weeks to be sure after.

I have been wondering since if it was possibly alight dose of Covid that I shook off before it got into the lungs and that my Girlfriend was non symptomatic. I read that the actor Tom Hanks and his wife tested positive but they had no symptoms apart from extreme tiredness and that Idris ELba also tested positive but had no symptoms at all. Is it in the realm of possibilty that I had some strain of Covid ?

Thanks,

B

PMBC

I see from one of your replies you expected the deaths to peak between 40 and 60 which looks to be what happened.

Where do you think Ireland's numbers are now heading and I appreciate that there are a lot of unknowns and variables?

Also, without being over critical of the decision makers, what mistakes were made regarding treatment of the nursing and care home sectors?

My own opinion is that mistakes have been made but decisions were made with the best of intentions

Thanks for the time you have taken and the information you have given here and wishing you well.

Arghus

Good to see you back and thanks for your good work.

s1ippy

It gives us immense happiness to see that you're back and we hope you're doing really well. I speak for both my household and I'd imagine anyone who has read your sensible information.

The cat got over not being left out, very quickly actually. Thanks for the tip, I knew you were right about keeping him in but I just needed somebody to blame :pac:

JoChervil

Thank you for your answer.

Please find below my explanations:

Pseudonym121 wrote: »

And here's a debunking article about what appears to be the basis of your post and putative treatment:
https://medium.com/@amdahl/covid-19-...y-ce27773d1096

No, I based my post on this video:
https://www.youtube.com/watch?v=k9GYTc53r2o

Also I'd love to see the research behind your claim that the skin "gives probably the strongest immune response in the body". It seems you really misunderstand the function of the skin.

https://www.upmc.ie/upmc-and-university-of-pittsburgh-school-of-medicine-announce-potential-covid-19-vaccine-candidate/

A quote from it:
“The researchers also used a novel approach to deliver the drug, called a microneedle array, to increase potency. This array is a fingertip-sized patch of 400 tiny needles that delivers the spike protein pieces into the skin, where the immune reaction is strongest. The patch goes on like a Band-Aid and then the needles — which are made entirely of sugar and the protein pieces — simply dissolve into the skin.”

This article was published in The Lancet.

Also I thought that vaccines are usually given into the skin just because of its strongest response.

JoChervil

And directly this article in The Lancet:
https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(20)30118-3/fulltext

And a quote from this article:
“The skin is an ideal target for immunization. It contains a rich population of antigen presenting and immune accessory cells capable of inducing a proinflammatory microenvironment favoring the induction of potent and durable adaptive immunity.”

“We tested the immunogenicity of these vaccine variants delivered either by traditional subcutaneous needle injection or using MNAs to more specifically target vaccine components to the immune fertile skin microenvironment.”

"The skin is immunologically reactive and contains a high density of antigen presenting and immune-accessory cells with innate immune function including keratinocytes, mast cells, and innate lymphocytes. Redundant skin immunoregulatory circuits can respond to a wide variety of damage or infection related signals to rapidly orchestrate an innate immune response."

Satturnfalls

Hope you are doing well

1. How are you gonna celebrate once this covid emergency is under control?

2. Regarding reusing disposal face masks. I own one disposable facemask and dont have access to any others. Would it be possible to disinfect it after each time im out using gentle methods. Like boiling the mask in hot water? A milton bath? Or a UV light sanatiser?

Keep up the fight!

ShineOn7

Hi

I've noticed you've been very quiet. Is everything ok, or was this a goodbye? https://www.boards.ie/vbulletin/showpost.php?p=113454875&postcount=4929

If you're still answering questions:

How do you feel about the current numbers as of today? (Monday May 25th). Do you still feel we could reach 15k total mortalities by April next year?

Thanks as always for your work

locohobo

Hey up Pseudo bud....
Yea...noticed you've not been on since 05/05...
Have you really given up the proverbial ghost on us???
Something I've been wondering......
Another thought....
Maybe its not the nicotine thats the protection..but rather that the lungs are so crapped up with gunge from smoking that there are many less cell receptors available for it to attach to...
Ok!...just so as we dont end up with a nation of smoking addicts..Maybe it would be more beneficial to try vaping as well as the patches and see if there would be any difference in the infection rate....

As I said...Just a thought!!....

JoChervil

Returning to my initial answer about cupping.

This method is still popular in folk Greek and Chinese medicine. Maybe this could explain why Greece or China are doing so well?

I have found such article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488563/

A quote from the link above:
“It also finds a mention in the famous Egyptian Papyrus Ebers (1550 BC) in the west and ancient Greek medicine. Hippocrates (Greece) preached the cupping based treatments related with musculoskeletal diseases of the back and extremities, gynecological complaints, pharyngitis, ear ailments, and lung diseases.”

JoChervil

Many physicians still take Hippocratic Oath, so why they can't use his knowledge, not only ethical rules?

JoChervil

You so dismissed not only my theory about iron overload and its treatment by using cupping.

So what will you say about this article:
https://pubmed.ncbi.nlm.nih.gov/30588142/

The title of this article:
Al-hijamah (Wet Cupping Therapy of Prophetic Medicine) Significantly and Safely Reduces Iron Overload and Oxidative Stress in Thalassemic Children: A Novel Pilot Study

They treated 20 thalassemic children (15 males and five females aged 9.07±4.26 years) with iron chelation therapy (ICT) plus Al-hijamah (using sterile disposable sets and in a complete aseptic environment) vs a control group treated with ICT only.

Results: Al-hijamah was quite simple, safe, effective, tolerable (with no side effects) and time-saving procedure (30-60 minutes). A single session of Al-hijamah significantly reduced iron overload in all thalassemic children. Al-hijamah significantly decreased serum ferritin by 25.22% , significantly decreased oxidative stress by 68.69%, exerted pharmacological potentiation to ICT and significantly increased total antioxidant capacity by 260.95%

Conclusion: Al-hijamah is a novel, safe, effective percutaneous iron excretion therapy through percutaneous iron excretion with minimal blood loss in agreement with the evidence-based Taibah mechanism. Al-hijamah is an effective outpatient hematological procedure that is safer than many pediatric procedures such as catheterization, hemofiltration and dialysis. Increasing the number of cups during Al-hijamah session or the number of sessions reduces iron overload more strongly. Medical practice of Al-hijamah is strongly recommended in hospitals.

I think there are many muslim physicians in Ireland, who would gladly use this method, if they were allowed to.

padser

Would it be worth moving the "cupping" it's own dedicated thread where anyone who wants to engage with it can do so?

I'd be interested in getting any update the AMA guy had on

1) how the last month has gone,
2) how he views the current numbers in Germany and South Korea (which have remained reasonably small but persistent over time)
3) his views on our current pathway to relaxing restrictions
4) his views on our evolving treatment options (any promising drugs / therapies, blood transfusion trials etc)
5) his views on the need (or not) to get back to routine medical care for all

JoChervil

But there is also less invasive method. Dry Cupping Method, which can also help with iron overload. Black spots on the skin after using it are not bruises because they fade it time. They don’t change colour to yellow, what would suggest it was blood.

It looks like it is only a question of using 4 cups. Three on the back and one on the front. If dying of COVID19 people are turned on their stomach to help them breathe, why 3 cups can't be put on their back for 8 minutes as the last resort?