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

IrishAlice · 27-03-2020 1:45pm

Thank you for everything you are doing.

I have seen an increased amount of coverage about the supplies of PPE dwindling.

Paddy Cosgrave has been particularly vocal about this on twitter and tweeted last night that one of Ireland's shipments was intercepted and taken by a larger EU country.

Are you concerned that there won't be enough supplies when we actually reach the peak of the curve?

Buford T. Justice XIX · 27-03-2020 2:25pm

I'd like to echo the many thanks from all of us here for what you are doing and the risks you're taking for us.

A small question if you get time, I'm curious about the strong male bias in the infection rate, some 55% versus 45% for females.

Would this be mostly due to males having riskier behaviour and not washing/disinfecting as often as women or is there a higher susceptibility in males to the virus?

feargale · 28-03-2020 3:43am

Could the virus be carried by paper? Should I cancel delivery of newspapers and magazines?

s1ippy · 28-03-2020 4:04am

Hi Pseudonym,

Just wanted to say thanks for everything. Reading your information has been a great consolation and help. I donated in to the local RCC and women's refuge in your name. Your input is so appreciated.

I was looking at UV lamps, this one says not to have humans or animals present when it's in use.
http://vi.raptor.ebaydesc.com/ws/eBayISAPI.dll?ViewItemDescV4&item=372985569977&category=20706&pm=1&ds=0&t=1585363933585&cspheader=1

Do you think this would be more or less risky to use than a bleach solution to sterilise shopping? Just to note that I don't spray the solution directly onto goods that will be consumed, just packaging, and once the veg are unwrapped, I scrub them thoroughly with warm water.

We follow protocols similar to what you outlined. We do click and collect for our shopping quarantining an area for when we return, adhering to rigorous IPC measures, disinfecting everything and then leaving area for a few hours and washing clothes and showering off any potential virus on skin. Even then, when we load the shopping into the cupboards and fridge, we use gloves to pack the stuff up and keep it separate and don't use it for a few days.

It's possibly overkill but we are exercising an abundance of caution. I wonder what your thoughts might be on this University of Nebraska study. It's as-yet not peer reviewed, to my knowledge, as it's only five days old.
https://t.co/ZpCXu3JBv2?amp=1

No worries if you can't get to it, I'm sure you are amply occupied at this particular juncture. Thanks again.

Purple Mountain · 28-03-2020 4:29am

Hi.

I just wanted to ask about what actually kills a CoVid patient?
I read today about a patient in another country who actually was stabilised in hospital after it but then got a superbug.
Is it a case of the fluid on the lungs gets too much and that's what takes the patient or in some cases does the virus travel to the heart and cause cardiac arrest?

I mentioned this in another thread but I'll ask here and I hope you don't take offence because none is intended.
With the Dept of Health quoting ICU beds going overcapacity, they don't seem (in my opinion) to take into account people leaving ICU and going back to a regular isolation ward or unfortunately god forbid dying.

Many thanks for your information and of course your service.
Wishing you a good night's rest hopefully if you're off.

avalidusername · 28-03-2020 6:59am

Hi Pseudonym,

Just a couple of questions.

1) Long term, do you think the lockdown/social isolation could have a beneficial effect on Irish society in general? By this I mean an increased awareness of hygiene, maybe reducing the winter vomiting bug outbreaks. Or people generally having more respect for the health services and not running to the hospital for minor ailments?

2) A former colleague of mine has recovered from the virus. He's from Bergamo and we think he contracted it at the Atalanta v Valencia Champions League game they're calling Game 0 now. With this game being possibly linked to the massive outbreak, what was your view on Cheltenham going ahead this year?

Personally I was aghast they let it go ahead, protect the economy of one town ahead of the national health, international health including visitors. Thousands of people hugging, crying, shouting (droplets galore) cash changing hands, extremely close proximity to one another. If there was a cluster**** of how to pass on a virus, that would be it, and they let it proceed.

Finally, many thanks for your input. You will be blessed for your efforts, if not by a higher being, then by science for protecting your nearest and dearest with your isolation.

leggo · 28-03-2020 8:17am

What are your thoughts on doctors in NYC using antibodies of recovered patients or patients in Norway and Spain being trialled with new medication? Obviously the point of these trials means you don’t have an answer for whether they’ll work or not, but with industry knowledge do you see how quickly these are being developed as a positive sign or would this be standard fare expected of a situation like this? And say one of these treatments were to have initial success, how would you anticipate that playing out and affecting the overall global fight against this?

dermob · 29-03-2020 4:15pm

Hi, and thanks for all your help!

Is there a specific test for Covid 19

Purple Mountain · 29-03-2020 5:01pm

I just thought of another question, sorry maybe this isn't a medical question really!

If Ireland is very successful with curtailing the spread of this with our restriction measures and in a few weeks/months, it's all but eradicated here - great.
But then if our airports and ports are open and we have traffic from countries that haven't taken the same measures or been successful, then we just go back to square one again?

dermob · 29-03-2020 10:02pm

“Yes and tests for antibody presence are also being developed/deployed so soon we will be able to tell if you've ever had it, not just if you have it now”

does the current test test for corona virus or Covid 19? Does it differentiate between the two, and does it test viral load?

RodVelvet · 29-03-2020 10:05pm

feargale wrote: »

Could the virus be carried by paper? Should I cancel delivery of newspapers and magazines?

According to the WHO, newspapers are very low risk.
https://www.post-gazette.com/news/health/2020/03/27/WHO-says-holding-a-newspaper-in-your-hands-is-safe-coronavirus-safe-handling/stories/202003270099

Thanks for your insight, it is very informative. Also many thanks for you and your colleagues hard work at this time.

Would a welder type cheap plastic mask be more effective than a standard facemask at preventing community transfer through coughing or sneezing?

feargale · 29-03-2020 10:33pm

Hi Pseudonym,
Your contributions here are much appreciated.

We are told that the virus is contacted via the nose, mouth and eyes.
How about cuts, lesions and abrasions?

Bobeagleburger · 29-03-2020 10:48pm

Buford T. Justice VI wrote: »

I'd like to echo the many thanks from all of us here for what you are doing and the risks you're taking for us.

A small question if you get time, I'm curious about the strong male bias in the infection rate, some 55% versus 45% for females.

Would this be mostly due to males having riskier behaviour and not washing/disinfecting as often as women or is there a higher susceptibility in males to the virus?

Was wondering that myself.

Intrerested to know is there a correlation with smoking. 56% of smokers are male, 44% Female (In Ireland)

Good points you make there too. Definitely curious to find out in time.

ironwalk · 29-03-2020 11:13pm

Psuedonym thank you for the coherent and informative posts. This isn't a fawning heroes rubbish post; I find that stuff just yuk.
Just genuine thanks for giving clear, evidence based information.
And want to wish you and staff around you the very best.

Do you think there is anything that we could do to support the mental health of front line staff now and when the surge comes? I'm thinking about a dedicated counselling service or confidential listening service for staff to just talk and get it out of their system with experienced counsellors.

*Edit to add: most resources that I am aware of in disaster response, emphasise the importance of social networks and that these provide a protective effect for mental health. So, it seems to be that there is a bit of a catch22 i.e. the need for social networks, contact and support in the midst of a pandemic that requires distancing from those resources.

barrymanilow · 30-03-2020 11:48am

Hi thank you for taking the time to do this.

My Question is if you were going to go to the trouble of wearing a properly fitted suitable mask in public then should you not also be wearing goggles ? could droplets get in through the eyes as easily as through the mouth or nose ?

I think I'd feel too self conscious to wear goggles in a shop for example , I might wear a mask but what would be the point of doing one without the other?

Also do you think that members of the public who have PPE should donate it to front line health care workers who might need it more once it comes down to that?

volchitsa · 30-03-2020 2:55pm

barrymanilow wrote: »

My Question is if you were going to go to the trouble of wearing a properly fitted suitable mask in public then should you not also be wearing goggles ? could droplets will get in through the eyes as easily as through the mouth or nose ?

I think I'd feel too self conscious to wear goggles in a shop for example , I might wear a mask but what would be the point of doing one without the other?

Just related to this question, would normal glasses for sight be of any use?

I've been assuming that my normal glasses would be of some use there, although TBH as I don't wear a mask when I go out, it might be a moot point anyway.

I do try not to go out much though. I just can't work out whether wearing a mask is a sensible precaution or complete selfishness when anyone not directly in the front line but still exposed, like delivery men or shop workers, often seem not to be able to get as many as they need.

MonkieSocks · 30-03-2020 7:26pm

I posted this on main thread

Wifes great Aunt (89) got a fall and was taken into hospital a week ago.

She was taken in ICU and put on oxyegen and tested for COVID-19

The test was negative and she was moved to a Normal Ward.

6 days after the first test, she had a high temperature and breathing difficulties.

They tested her again and the test was positive for COVID-19 and now she's back In ICU

So either first test was wrong or she got it in the hospital.

One reply stated

it's already been said before, if in the early stages the test is done there is not always enough virus payload to register a positive.

How much of a virus payload is needed for a test to be Positive?

I mean you either got it or you don't got it, if the present test is that ambiguous it very worrying going forward with diagnosing this virus

Mwengwe · 31-03-2020 1:08am

You say:

"This sort of stuff is what makes virology/epidemiology and the study of pandemics so fascinating. So, bottom line, the vast majority of the world's population will be just fine and 20 to 40 years from now even if this is seasonal it will be massively attenuated and people not born now won't understand what all the fuss is about when people alive now are anxious about getting their yearly vaccine. I look forward to that day."

Sounds optimistic in isolation, but by your own reckoning earlier in the same post, we'll probably have another pandemic before then? Am i right? Do you think the next one will be worse?

Mr Magnolia · 01-04-2020 9:59am

Hi there, like so many others, I've been following your posts and advice for weeks now so another sincere thanks, it’s been hugely helpful albeit scary at times. In case you haven't noticed, your answers thread has been viewed circa 27k times at the time of writing this post, you're having a massive effect and that should be acknowledged – thanks again!
I work in the pharma sector and have done for >10yrs so would have a decent knowledge of donning & doffing, bioburden and decontamination techniques - just for context wrt the queries below.
Friday March 20th I started experiencing a sore throat which lasted about 4 hours. Saturday, Sunday and Monday I experienced bouts of weakness and shaky limbs also a touch of diarrhoea, no fever at any time. Tuesday evening I was really wiped out and had a slight cough and a circa 10% chest restriction. Wednesday morning I was still fairly wiped out but started to improve from there. I called the doctor Wednesday morning and a test was scheduled but the criteria changed on the Thursday and as I didn’t have a fever my criteria weren’t sufficient to warrant testing. I started to feel much better after this and on the Friday, one week after the first symptoms displayed I was back to myself. I know I’ll not know for sure if I had it until the antibody testing but how likely do you think it is that I had the virus. Apologies if I’m asking an impossible question. For context, I’m a healthy 41yo male, non-smoker with a very good lung function (tested annually with work). My wife displayed similar symptoms though perhaps not as severe. I’ve been working from home since March 18th.
Also, I’ve a number of face masks. When I do need to use them I was thinking of storing a used mask for a number of weeks away from use in case replacement masks aren’t available. My thinking is that any after a period of a couple of weeks the mask should be safe to handle/use again. I appreciate it’s not ideal but better than nothing, no?

ShineOn7 · 03-04-2020 2:43pm

1) In your medical opinion; how many strains of this are there and is this why we’re seeing everything from none/mild symptoms to death in healthy people?

I’ve read everything from there been two strains of this to twelve

2) There is so much doom in your Answers thread. Can you give us at least a bit more hope? Truthful hope though

3) I’m in Dublin, the epicentre of this in Ireland. If you could (if you weren’t in your current job obviously), would you move to a county where the amount of cases are very low?

Thanks

Gynoid · 04-04-2020 8:30am

Hi,

Having read your posts a couple of weeks ago I bought the UV light box you recommended. Question - Does the light have to fall on all parts of items inside box? So for eg if there are tins in there, do they have to be turned after the 11 minute cycle?

Do you know any more definite things on issues like Type A blood susceptibility, why there is gender difference in susceptibility, if some people are more vulnerable like Mediterranean populations due to genetic factors, that kind of thing?

Last maybe silly question, if I go out to shop, which is rare, I wear an outer layer that I take off in hall and bring to wash immediately because I have this sort of old fashioned idea about the possibility of lingering miasmas in supermarket aisles. Suspended micro particles might be the more modern description. I also wear a mask and a hat, which I wash also on return. Am I being a silly billy?

Cork Boy 53 · 04-04-2020 12:02pm

Hi.

Sorry if you answered this already but which light steriliser would you recommend for use as in how high a spec does an effective one need to be ?

I can only imagine the strain you and your colleagues are under now. Take care.

Gynoid · 04-04-2020 1:57pm

Thank you very much Pseudonym 121 for answering my questions comprehensively. I feel relieved that I am not being over-particular. It is a narrow path between properly careful and neurotic in these days!
I will turn over stuff in the UV box. I have a going out outfit as I just have to go out once a week now for groceries. Which comes off and to the washing machine on return.
It is a horrible state of affairs. But I think it is worth practising all the odd-seeming habits now in case a worse virus or a bad mutation of this one comes in the future

Thanks again and best of luck and everything.

Silent Running · 04-04-2020 4:41pm

Hi again,
I'm constantly looking for 'bridges' where contamination can cross without being killed by washing/decontamination/time.

In your last post, section 13 where you're clean and then pick up your potentially dirty mask to put it in the UV unit, would you not wash your hands after this step?

Sorry for nitpicking, but to me, that's a bridge.

Pseudonym121 · 04-04-2020 8:17pm

Silent Running wrote: »

Hi again,
I'm constantly looking for 'bridges' where contamination can cross without being killed by washing/decontamination/time.

In your last post, section 13 where you're clean and then pick up your potentially dirty mask to put it in the UV unit, would you not wash your hands after this step?

Sorry for nitpicking, but to me, that's a bridge.

No problems at all. Sometimes we all forget to mention stuff we consider so obvious as not needing mentioning... and a post like yours reminds us that it isn't obvious to people who haven't been trained in this sort of thing.

You're absolutely correct and I will amend the post accordingly.

I have about 500 pairs of disposable vinyl, powder-free gloves but because I thought they were going to become difficult to replace in a worst case scenario what I actually use are 2 Ply C Fold Hand Towels.

I got about 5,000 pieces of the above back in late February/early March and treat them as single use - Pick up a towel in my hand and then handle anything I'm putting in the UV light steriliser with that towel. Once i've put what I want to sterilise in that batch in I throw the paper towel into a dedicated "dirty bin" I have beside the sterilisation area. I don't have to wash my hands then because I never touched the strap and each C fold towel costs less than a cent so that's fine.

I throw the contents of that bin out every weekend, wearing gloves for that purpose as I assume the bin is riddled. I don't touch the bin apart from that for the rest of the week.

Stheno · 04-04-2020 10:52pm

What is your view on the increasing number of reports that there appear to be a significant minority of people who have tested positive but were asymptomatic? Some of them came from Italy, and Iceland, another out today found that 40 of 60 Italians who donated blood and said they'd not had Covid were found to have antibodies in their blood

Secondly do you have any insight into when an antibody test that is reliable will be available and if available do you think it should be made widely available to identify the true rate of infection in society?

Thanks

Roanmore · 05-04-2020 12:37am

Hi,

My wife is a chronic pain sufferer and approx every 4 to 5 months she gets a procedure in a private hospital that alleviates this pain to a certain extent.
She was due to have this procedure done last Thursday but 3 days beforehand the government announced the public / private hospital deal and the next day the procedure was cancelled.
We are being told that it could now take up to 3 months before she can have the procedure. They are unsure what is going to happen.
She is in awful pain as she can’t take any opioid based painkillers due to them messing up her system and this procedure is critical to her.

Do you think Procedures like this may get the go ahead any time soon? It’s a day procedure, over and released in about 4 hours.
I understand the seriousness of this virus but the pain is only going to get worse and the lack of information is adding to the Whole situation.
Are the HSA / Government looking at situations like these?

Thanks for taking the time to answer people’s questions / concerns.

Drumpot · 06-04-2020 1:14am

Thanks again for answering all questions.

I don’t understand why people are suggesting you are scaring anybody, some people really can’t face the truth. For what it’s worth I find the blunt honesty of your responses so refreshing. I also find, as an anxious person in general, that trusting what I read and understand about what’s going on is more important then being told a fairytale about how everything will be fine. I find your posts comforting and they actually relax me... So thank you again for your honesty, I for one have read every word you have posted here and have taken steps to follow your guidelines.

There are some suggestions that treating this like a pneumonia can be dangerous. That using ventilators can damage the lungs because it’s the oxygen levels that are an issue. I watched one doctors YouTube clip there say that he has patients that he thinks are starved of oxygen as if they are on top of a mountain without acclimatising to the height. I thought that was hypoxia but he didn’t use that word. Are you finding it that this may not be the kind of disease you thought? This doctor seemed to be implying every hospital was gearing up to treat this as a pneumonia but it’s not that?! Does this also explain why there are so many people in ICU with no underlying medical conditions in some hospitals or is there a chance that different countries are being hit with different strains of virus? (There were suggestions that the original strain was most potent).

Is it a case that this virus can attack in multiple ways depending on the person/strain? Is it also the case that it might also effect a person differently based on an underlying medical condition? Would this explain why smokers are not necessarily showing up as a big risk because it doesn’t necessarily attack the lungs but affects oxygen getting into the body? (Perhaps my layman understanding is off there).

Lastly , I bought a blood presssure monitor and oximeter to go with our digital thermometer (also got them for my mum and parents in laws). Would the oximeter in particularly help diagnose the lower oxygen levels quicker ? That is, if you were monitoring them for days and were phoning up your doctor , would this be a potential early warning tool for him to know you were deteriorating? It seems some people deteriorate quickly after looking like they were improving.

I’ve been also monitoring myself and my wife’s BLood pressure and temperatures daily. Would having these stats (along with oximeter) potentially lead to us getting medical treatment quicker because it can give a doctor or healthcare person a better idea of where we are at internally and how this has been progressing daily? (As opppsed to just phoning up a Gp and saying “I feel awful” but having no readings).

Lastly I had a temp (as did my wife) of 39oC a few weeks ago but not for long only day or two. Would it be too optimistic to think that could of been our COViD bout ? We had been battling coughs for weeks so can’t say if the cough with temp was cough that we had been battling before.

mountai · 06-04-2020 2:01pm

What is your opinion of the latest HSE contract foisted on Doctors working in the Private sector , whereby , they MUST place their patients into the Public system , thus taking control for their ongoing treatment protocol out of their hands ? . how can this be justified when Drs who are seeing private patients in public hospitals ( which is allowed under their contract) can carry on as before ??.

anewme · 07-04-2020 2:00am

How do I endure my parent in a nursing home is not discriminated against re treatment.

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

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