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COVID-19 technical discussion

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  • Posts: 8,647 Toby Elegant Wrinkle


    https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3548774

    This makes for grim reading if you are over 70 and have co-morbidities.


  • Registered Users Posts: 3,333 ✭✭✭amandstu


    I understand that gargling with salt water is considered a myth in connection with Covid-19.

    Does this also mean that it has no beneficial effects at all on the evolution of the illness?

    It seems that Chlorine is said to kill the virus and Salt does contain chlorine (I am no chemist) ...

    Could there be any benefit to this practice ? (I also snort it up the nostrils whenever I have a cold)


  • Registered Users Posts: 6,756 ✭✭✭sporina


    whats with the stock piling though please? i don't get it - at all..


  • Registered Users Posts: 18,069 ✭✭✭✭fryup


    ^^ news images of Wuhan i guess

    ...how often should we wash our hands?


  • Registered Users Posts: 6,756 ✭✭✭sporina


    fryup wrote: »
    ^^ news images of Wuhan i guess

    ...how often should we wash our hands?

    wer there images of people stocking piling in China?


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  • Registered Users Posts: 6,026 ✭✭✭grindle


    sporina wrote: »
    wer there images of people stocking piling in China?

    Images and videos of stockpiling, people dropping dead and others being locked into their apartments by the local constabulary are on the internet.

    Panic buying is retarded, but people are thinking "They could announce tougher protocol tomorrow!", especially in an excessive authoritorian state like China. Makes less sense here but even then if we're given a couple of days notice the shops would be proper bananas if there was a full lockdown. But the situation would have to be much much worse than currently. Like, maybe in a couple of weeks or a month or something.

    This is a more serious forum I think though, this chat is OT and probably belongs in the main COVID thread.


  • Registered Users Posts: 7 Vanar



    Thought this was an interesting article. An out of range d-dimer denotes a poor prognosis. Wonder what the pathophysiology is, is a side effect of COVID-19 due to increased PEs/DVTs? As an aside. I've found the Lancet articles as of late to be top notch.

    Re the D-dimer levels

    "Contributory mechanisms include systemic pro-inflammatory cytokine responses that are mediators of atherosclerosis directly contributing to plaque rupture through local inflammation, induction of procoagulant factors, and haemodynamic changes, which predispose to ischaemia and thrombosis. In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is expressed on myocytes and vascular endothelial cells, so there is at least theoretical potential possibility of direct cardiac involvement by the virus."


    Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.


  • Registered Users Posts: 3,227 ✭✭✭Breezer


    Vanar wrote: »
    Re the D-dimer levels

    "Contributory mechanisms include systemic pro-inflammatory cytokine responses that are mediators of atherosclerosis directly contributing to plaque rupture through local inflammation, induction of procoagulant factors, and haemodynamic changes, which predispose to ischaemia and thrombosis. In addition, angiotensin converting enzyme 2, the receptor for SARS-CoV-2, is expressed on myocytes and vascular endothelial cells, so there is at least theoretical potential possibility of direct cardiac involvement by the virus."


    Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

    Have ACE inhibitors been used in treatment at all? I’ve only heard about hydroxychloroquine and some antivirals, and to avoid steroids and NSAIDs. I’m more trying to keep up with the day to day primary care side of things to be honest, I haven’t been looking at the pharmacology.


  • Registered Users Posts: 2,021 ✭✭✭Miike


    Breezer wrote: »
    Have ACE inhibitors been used in treatment at all? I’ve only heard about hydroxychloroquine and some antivirals, and to avoid steroids and NSAIDs. I’m more trying to keep up with the day to day primary care side of things to be honest, I haven’t been looking at the pharmacology.

    As I understand it ACE inhibitors up-regulate ACE2 - hypothetically increases risk of severe disease.


  • Registered Users Posts: 7 Vanar


    Miike wrote: »
    As I understand it ACE inhibitors up-regulate ACE2 - hypothetically increases risk of severe disease.

    Yes theoretically there may be a link, but currently it's not recommended to change medications on this basis. More information here

    nephjc.com/news/covidace2


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  • Moderators, Recreation & Hobbies Moderators, Society & Culture Moderators Posts: 9,994 Mod ✭✭✭✭sullivlo


    Miike wrote: »
    As I understand it ACE inhibitors up-regulate ACE2 - hypothetically increases risk of severe disease.

    Which is why people who take ace inhibitors for blood pressure are a higher risk factor.


  • Posts: 8,647 Toby Elegant Wrinkle


    sullivlo wrote: »
    Which is why people who take ace inhibitors for blood pressure are a higher risk factor.

    I don't believe we can say that with any certainty. In fact, the expression of ACE2 has shown to have vasodilatory effects in lung tissue due to angiotensin 1-7.

    The big problem.is they we.dont have the studies yet to actually figure out out a lot of these answers.


  • Registered Users Posts: 7 Vanar


    I don't believe we can say that with any certainty. In fact, the expression of ACE2 has shown to have vasodilatory effects in lung tissue due to angiotensin 1-7.

    The big problem.is they we.dont have the studies yet to actually figure out out a lot of these answers.

    Yes if you look at the link in my previous post it goes into further detail on why we can't say for sure either way yet, and why these medications might actually be beneficial. The European Society of Cardiology has issued a position statement noting that there are cases of people discontinuing meds because of the speculation, and that this is definitely not to be recommended given the adverse effects of stopping and the fact that we don't know yet if the medication is actually beneficial or harmful for Covid-19.


  • Moderators, Recreation & Hobbies Moderators, Society & Culture Moderators Posts: 9,994 Mod ✭✭✭✭sullivlo


    I don't believe we can say that with any certainty. In fact, the expression of ACE2 has shown to have vasodilatory effects in lung tissue due to angiotensin 1-7.

    The big problem.is they we.dont have the studies yet to actually figure out out a lot of these answers.
    Vanar wrote: »
    Yes if you look at the link in my previous post it goes into further detail on why we can't say for sure either way yet, and why these medications might actually be beneficial. The European Society of Cardiology has issued a position statement noting that there are cases of people discontinuing meds because of the speculation, and that this is definitely not to be recommended given the adverse effects of stopping and the fact that we don't know yet if the medication is actually beneficial or harmful for Covid-19.

    I was basing it off a paper I read last week comparing the method of action of the current Coronavirus strain and the 2002 SARS strain, and how they have similar mechanisms in terms of ace activation.


  • Posts: 8,647 Toby Elegant Wrinkle


    sullivlo wrote: »
    I was basing it off a paper I read last week comparing the method of action of the current Coronavirus strain and the 2002 SARS strain, and how they have similar mechanisms in terms of ace activation.

    So. It's hard to quantify. The risk factors for severe disease tend to be diabetes/cardiovascular disease/been immunocompromised/existing resp diseases/ chronic kidney disease. So you are right that it seems to attach to ACE2 and theory is that by using ACEi we are increasing the amount of ACE2 so theoretically that might mean that there is more ACE2 receptor to facilitate infection.

    However, some studies have shown that increased ACE2 receptors has a respiratory protective feature through ANG1-7 which causes vasodilation.

    It certainly warrants further research but I would tend to think there is no substantial evidence at the moment they stopping ACEi/ARBs would be beneficial.


  • Registered Users Posts: 7 Vanar


    In relation to the ACE / ARB discussion I see there is actually a pilot trial in Guangzhou to test recombinant human ACE2 as a treatment, and an ARB (losartan) is one of the drugs to be trialled in the US





    clinicaltrials.gov/ct2/show/NCT04287686


    startribune.com/university-of-minnesota-to-test-three-drugs-for-covid-patients/568766632/


  • Registered Users Posts: 3,227 ✭✭✭Breezer


    Miike wrote: »
    As I understand it ACE inhibitors up-regulate ACE2 - hypothetically increases risk of severe disease.

    Cheers. It’s been a long time since I’ve done pharmacology; I accepted long ago that they’re good at lowering blood pressure and that’s served me well till now!


  • Registered Users Posts: 1,725 ✭✭✭lalababa


    Apologies if I am out of my depth on this thread, but I have a question:
    What respiratory illness killed 30 people in Ireland in Dec/Jan?? I and some relatives had it. It had exactly the same symptoms as covid-19. I had all the symptoms except difficulty breathing, though the relatives had difficulty.


  • Registered Users Posts: 962 ✭✭✭darjeeling


    lalababa wrote: »
    Apologies if I am out of my depth on this thread, but I have a question:
    What respiratory illness killed 30 people in Ireland in Dec/Jan?? I and some relatives had it. It had exactly the same symptoms as covid-19. I had all the symptoms except difficulty breathing, though the relatives had difficulty.

    Flu - mostly type A strain H3N2, for which the vaccine apparently mismatched the circulating H3N2 strain.

    I've posted more on this in the coronavirus forum in a thread asking about this subject.
    Links:

    https://www.boards.ie/vbulletin/showpost.php?p=112868604

    https://www.boards.ie/vbulletin/showthread.php?p=112903763

    Edit: I had it too, and the symptoms were exactly like the last time I had flu over a decade earlier.


  • Registered Users Posts: 1,725 ✭✭✭lalababa


    Many thanks ...are there any differences in symptoms between the flu and covid-19?


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  • Posts: 8,647 Toby Elegant Wrinkle


    Hot take: I don't believe the addition of azithromycin to hydroxychloroquine adds any benefit. The study was flawed and I don't how how pharmacologically azithromycin would have an effect on SARS-CoV-2.


  • Registered Users Posts: 962 ✭✭✭darjeeling


    https://www.reddit.com/r/COVID19/ is good for following the science.

    Posts are mostly about scientific papers, covering clinical reports, drug trials & lab studies, epidemiological studies, tests for active / previous infection, virology etc.
    Comments are moderated to keep mostly to discussion of facts, and can be quite well informed.


  • Moderators, Science, Health & Environment Moderators Posts: 2,881 Mod ✭✭✭✭Kurtosis


    Hot take: I don't believe the addition of azithromycin to hydroxychloroquine adds any benefit. The study was flawed and I don't how how pharmacologically azithromycin would have an effect on SARS-CoV-2.

    It seems to have been roundly panned, e.g. [url] Only thing I can think of for azithromycin is if there was secondary bacterial pneumonia...


  • Registered Users Posts: 290 ✭✭lozenges


    Yeah, I presumed that the azithromycin was for secondary prevention of bacterial pneumonia also. Have no idea of a mechanism by which it would affect the viral infection?


  • Posts: 8,647 Toby Elegant Wrinkle


    Kurtosis wrote: »
    It seems to have been roundly panned, e.g. [url] Only thing I can think of for azithromycin is if there was secondary bacterial pneumonia...

    Problem with azithromycin, it is rarely used in clinical practice apart from for prophylaxis in patient's with recurrent chest infection ( and even here, the evidence is weak for the benefit)


  • Registered Users Posts: 2,021 ✭✭✭Miike


    Yesterdays news today:

    https://www.sciencedirect.com/science/article/pii/S0924857920300947?via%3Dihub

    I can say with all honesty, this is by far the most scared I've been going to work in my life. I would give anything to turn back the clock on this virus :(


  • Registered Users Posts: 246 ✭✭palmcut


    The attached video is well worth a read. It is a presentation from South Korea. It is in sub-titles and takes a little over half an hour to read. It will be the best half hour that you spend.

    https://www.youtube.com/watch?time_continue=1&v=gAk7aX5hksU&feature=emb_logo


  • Moderators, Category Moderators, Science, Health & Environment Moderators, Society & Culture Moderators Posts: 47,212 CMod ✭✭✭✭Black Swan


    Across the pond (and globally) ventilators are in short supply; the need vastly exceeding the supply. Are Irish hospitals also lacking the necessary number of ventilators for COVID-19, or is Ireland keeping up with the demand?


  • Registered Users Posts: 246 ✭✭palmcut


    Hydroxychloroquine (Plaquenil) and COVID. Summary of the recent French study published
    Summary of the recent French study published from Marseille (Gautret and colleagues)
    36 participants, 6 lost to follow up
    20 had hydroxychloroquine 200mg three times daily for 10 days.
    6 of this group received azithromycin for presumed secondary bacterial infection.
    They looked at clearance of the virus from the body at day 6 by using PCR, nasopharyngeal swabs and looking for a previously positive swab that then turned negative

    Results
    At day six 12.5% of the control group were clear of the virus
    57% of the hydroxychloroquine group were clear of the virus
    100% of the hydroxychloroquine plus azithromycin group were clear which suggested a synergistic response of these agents

    What this study adds (Gautret and colleagues)
    1. Highlights issues such as side effects and contraindications - there is a higher risk of side effects in the presence of renal and liver impairment, and there have been isolated reports of COVID-19 disease-causing renal and hepatic injury.



    Limitations of study (Gautret and colleagues)
    1. Sample size was underpowered to provide conclusive results which may cause exaggeration of effect sizes and false-positive results - 48 patients were necessary to achieve 85% power
    2. Six patients were lost to follow up (large % as only 36 patients) - the authors excluded these six patients and did not perform intention-to-treat analysis, which may have introduced bias
    3. Not a blinded or RCT so potential for bias. The trial did not randomise patients to the control and treatment group, thus potentially introducing allocation bias.
    4. With viral PCR status at Day 6 as the primary outcome, the trial lacks medium and long-term follow-up data. The authors report that one patient tested negative for the virus on Day 6, but subsequently tested positive on Day 8 - Such recurrences of positive test results demonstrate that long-term data is necessary to properly assess whether chloroquine/hydroxychloroquine are effective treatments.




    Ventricular arrhythmia risk (American College of Cardiology 29/3/20 (3 days ago))
    Both hydroxychloroquine and azithromycin prolong QT
    Azithromycin – there are 47 cardiovascular deaths which are presumed arrhythmic per 1 million completed courses

    see this link which is useful re QT prolongation crediblemeds.org/blog/recommendations-re-covid-19-treatments/

    Moderate risk of drug associated QT prolongation if score 7 (high risk if scores 11)
    • 68 year old female on a loop diuretic scores 3
    • Serum K 3.5 or below scores 2
    • Corrected QT interval on ECG scores 2
    • Heart failure scores 3
    • One QT prolonging drug scores 3

    Therefore need a baseline ECG/bloods (renal function with Magnesium levels) before azithromycin and hydroxychloroquine used.


    Conclusion
    These medications should not be started in the community as there is not enough evidence to state they are effective in this cohort of the population. Hydroxychloroquine and azithromycin are both QT prolonging medications so unless ECG and bloods are performed prior to starting there may be a risk of ventricular arrhythmias in starting these medications.
    Given these considerable limitations of the current evidence, further clinical trials are required. More than twenty clinical trials are already registered for this purpose currently. No data from Chinese research on hydroxychloroquine and COVID has been published as of yet so results and conclusions can therefore not be peer-reviewed.
    Hydroxychloroquine is used in Ireland mainly for Systemic lupus erythematosus and rheumatoid arthritis. If these patients are deprived of this medication triggering a flare requiring po steroids they are immunosuppressed during a COVID pandemic.


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  • Registered Users Posts: 110 ✭✭dermob


    Out of my depth a bit here, but looking for answers:



    The current testing methods that we are using for this virus, can someone answer these questions in relation to it:

    What does the test specifically detect, as in does it detect prescence of coronavirus, Sars-Cov-2, or Covid 19


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