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Offlinelifeiswhatyoumake
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Re: Viral outbreak in China [Re: Niffla] * 1
    #26603784 - 04/15/20 06:55 PM (3 years, 9 months ago)

A guy was jump roping outside my apartment building entrance yesterday.
I roller bladed around my building today a lil.


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Re: Viral outbreak in China [Re: morrowasted] * 1
    #26603812 - 04/15/20 07:05 PM (3 years, 9 months ago)

First thread in the new subforum

https://www.shroomery.org/forums/showflat.php?Cat=0&Number=26603807&page=0&vc=1#26603807

COVID-19: The disease process

Quote:

COVID19 basics:

COVID-19 is a disease caused by the virus SARS-CoV-2. It is a type of coronaviruses. Coronaviruses are responsible for approximately 1/3 of the cases of what is called the "common cold", as well as certain very severe diseases like SARS and MERS. It appears that a bat acted as a reservoir for this virus, which mutated inside of a pangolin in such a way that it could be transmitted between humans. The name is intended to be descriptive of the virus, because corona is latin for crown, and the virus is covered in spikes.

The coronavirus consists of a single strand of RNA surrounded by proteins and sugars. The proteins protect the RNA and enable the virus to attach to receptors on cell surfaces. The sugars help the virus evade detection by the immune system. It uses its "s-spikes" to attach to cellular ACE-2 receptors at which point the virus injects its RNA into the cell. Cellular machinery then makes many copies of the RNA, and makes many of the proteins for which the RNA encodes. The newly synthesized RNA is packaged into the newly synthesize proteins, and the new viral particles are ejected from the cell to infect others.

The SARS-CoV-2 virus is about 1micron in diameter, meaning that it can be transmitted in water droplets small enough to float in the air for extended periods of time. The primary mode of transmission is uncertain, but SARS-CoV-2 viral particles have been found in saliva, sputum, blood, and feces.




Quote:

Pathophysiology:

This is a fancy word that refers to the various problems that the virus has the potential cause, the sequence in which they tend to occur, the connection between them, and their significance to patient outcomes.

Some aspects of the pathophysiology of COVID-19 are well understood; others are less well understood.

What is known:
A) The virus binds to "Type 2 pneumocytes" in the lungs. These cells are responsible for producing a chemical called surfactant, which reduces surface tension in the lungs. As the viral particles are released from the cell, it is destroyed, releasing inflammatory mediators in the process. When surface tension becomes critically low, the alveolus collapses entirely.

B) These inflammtory mediators attract immune cells called macrophages that release chemicals called cytokines into the lungs and bloodstream. These chemicals increase the permeability of the capillaries in the lungs. Over time, this causes fluid to accumulate between the alveoli and the capillary bed- an area called the interstitial space. The fluid trapped in this space makes it more difficult for oxygen and carbon dioxide to diffuse between the capillaries and the alveoli.

C) The same cytokines also attract neutrophils, which release reactive oxygen species and chemicals that break down proteins (proteases) in an attempt to destroy the virus. These chemicals act like a machine gun with bad aim and also damage your own tissues, including type 1 pneumocytes, which are responsible for gas exchange.

D) These damaged tissues accumulate and form what is called consolidation- a collection of debris in the lungs which further impedes function.

E) These cytokines travel through the bloodstream other organs. When they reach the hypothalamus, your body temperature increases. They cause all of your blood vessels to dilate, causing fluid to leak out of them. This reduces blood pressure. When blood pressure is reduced, blood and oxygen cannot perfuse the organs well. Over time, this leads to what is called multi-system organ failure. The liver and kidneys cannot adequately function, which leads to disturbances with blood and platelet production, electrolyte excretion and retention, and regulation of blood pressure.


Hypothetical pathology:

Doctors have noted that COVID19 patients often present with very low levels of oxygen in their arteries, but very little respiratory distress. Furthermore, carbon dioxide levels in these patients are often normal. The level of fluid in the lungs is less than what is typically seen in pulmonary edema caused by pneumonia. COVID19 patients almost always present with highly elevated levels of a chemical called ferritin, which is indicative of the level of iron in the blood. Patients also have evidence that their blood is clotting inside the blood stream, a condition called disseminated intravascular coagulation. In fact, a heart attack or pulmonary embolism caused by one of these clots is a very common cause of death for COVID19 patients. Sometimes patients appear to have recovered from the virus, only to die suddenly of a heart attack 4 days later.

This has led doctors to suggest that the virus is damaging red blood cells such by interfering with the ability the molecule that carries oxygen to incorporate iron into its structure, which is necessary for function.

Thus, the low oxygen levels in the blood may result from a combination of both damaged lungs and damaged blood; however, the principle contributor to low O2 levels in any given patient may vary. Those with pre-existing anemia, may be more likely to experience hypoxemia as a result of the viral effects on the blood, where as those with right-sided heart failure or asthma may be more likely to experience it as a result of effects on the lungs.

The accumulating iron, in conjunction with the inflammation caused by the cytokines released by macrophages, is hypothesized to interfere with the liver and kidneys' ability to control blood clotting, pressure, and heart rhythm (via intravascular electrolyte modulation). These blood clots hinder perfusion to all organs, but they precipitate death when they lodge into a pulmonary or coronary artery.

COVID-19:Attacksthe1-BetaChainofHemoglobinandCapturesthePorphyrintoInhibitHumanHemeMetabolism




Quote:

br />



Quote:


COVID19  Coronavirus: Epidemiology, Pathophysiology, Diagnostics

The best video explaining the "what is known" part

Signs and symptoms of COVID19:

Hypoxemia and respiratory failure, often without altered breathing pattern, especially in the elderly
Cough, usually dry
50% of patients have fever on presentation
10% of patients have GI symptoms on presentation
Loss of taste/smell
May have runny nose, sore throat, headache
about 50% of patients have weakness/lethargy
some patients report lower back pain




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InvisibleCrazy_Horse
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Re: Viral outbreak in China [Re: morrowasted]
    #26603837 - 04/15/20 07:11 PM (3 years, 9 months ago)

:kimjongil:


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Re: Viral outbreak in China [Re: lifeiswhatyoumake] * 1
    #26603854 - 04/15/20 07:17 PM (3 years, 9 months ago)

I thought we might be turning the corner. We aren’t. Look at this testing data from New York. The reduction in new cases looks  like it’s almost entirely a function of the number of tests being run. The percentage of positives is actually rising. An improving situation would mean its harder to find new infections. At best we are treading water. Barely containing a level of infection that’s going to result in 2500 deaths a day for the foreseeable future.

The number of tests run in the US over the past week had dropped 30%, but the the number of new infections was down the past few days by only 20% which means the percentage of positive tests is increasing. We’ve been locked down for more than two weeks, why are cases increasing still?



Edited by koods (04/15/20 07:19 PM)


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InvisibleCrazy_Horse
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Re: Viral outbreak in China [Re: koods] * 1
    #26603863 - 04/15/20 07:22 PM (3 years, 9 months ago)

Trump


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Invisiblecannabinated
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Re: Viral outbreak in China [Re: koods]
    #26603867 - 04/15/20 07:23 PM (3 years, 9 months ago)

it takes 2 weeks to get symptoms


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Offlinesusurrador
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Re: Viral outbreak in China [Re: koods]
    #26603891 - 04/15/20 07:31 PM (3 years, 9 months ago)

Quote:

koods said:
I thought we might be turning the corner. We aren’t. Look at this testing data from New York. The reduction in new cases looks  like it’s almost entirely a function of the number of tests being run. The percentage of positives is actually rising. An improving situation would mean its harder to find new infections. At best we are treading water. Barely containing a level of infection that’s going to result in 2500 deaths a day for the foreseeable future.

The number of tests run in the US over the past week had dropped 30%, but the the number of new infections was down the past few days by only 20% which means the percentage of positive tests is increasing. We’ve been locked down for more than two weeks, why are cases increasing still?






We've known since the idea of lockdowns originated in terms of this coronavirus that it was not going to stop the illness from spreading, only slow it.

Hence the "15 days to SLOW the spread" not stop the spread. Or 45 days or however many days it's going to turn into.

But everyone is aware that this maneuver was not intended to stop the virus in its tracks so let's not make it about Trump.

Haven't they also said the number of people expected to be infected total once this runs its course will be the same no matter how fast or slow it spreads?

The slowing is just to keep healthcare from imploding.


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Re: Viral outbreak in China [Re: cannabinated]
    #26603901 - 04/15/20 07:36 PM (3 years, 9 months ago)

The median incubation period is 5.1 days and 95% of patients develop symptoms between 2 and 11 days. (~ 2 standard deviations left and right of the median.) from this we can extrapolate that 70% (1 standard deviation) of patients develop symptoms between 3.5 and 8 days.

Only 2.5% take more than 11 days


--------------------
NotSheekle said
“if I believed she was 16 I would become unattracted to her”


Edited by koods (04/15/20 07:38 PM)


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Re: Viral outbreak in China [Re: susurrador]
    #26603936 - 04/15/20 07:49 PM (3 years, 9 months ago)

Quote:

susurrador said:
Quote:

koods said:
I thought we might be turning the corner. We aren’t. Look at this testing data from New York. The reduction in new cases looks  like it’s almost entirely a function of the number of tests being run. The percentage of positives is actually rising. An improving situation would mean its harder to find new infections. At best we are treading water. Barely containing a level of infection that’s going to result in 2500 deaths a day for the foreseeable future.

The number of tests run in the US over the past week had dropped 30%, but the the number of new infections was down the past few days by only 20% which means the percentage of positive tests is increasing. We’ve been locked down for more than two weeks, why are cases increasing still?






We've known since the idea of lockdowns originated in terms of this coronavirus that it was not going to stop the illness from spreading, only slow it.

Hence the "15 days to SLOW the spread" not stop the spread. Or 45 days or however many days it's going to turn into.

But everyone is aware that this maneuver was not intended to stop the virus in its tracks so let's not make it about Trump.

Haven't they also said the number of people expected to be infected total once this runs its course will be the same no matter how fast or slow it spreads?

The slowing is just to keep healthcare from imploding.




We also have to reduce the number of new infection to a level that is manageable with our testing and contact tracing resources before we can open the economy back up. What this means is whatever our capacity for testing is, a huge majority of those tests need to be negative. Right now, for example New York has a rate over 40% positve. That’s at least 11,000 new infections a day despite pretty severe measures. If you opened up again with that many cases, it would be a disaster.


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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Re: Viral outbreak in China [Re: koods]
    #26603942 - 04/15/20 07:53 PM (3 years, 9 months ago)

Don't forget that many never develop symptoms at all...


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Re: Viral outbreak in China [Re: InfiniteDreams]
    #26603959 - 04/15/20 07:59 PM (3 years, 9 months ago)

which is why you have to test as many people as possible and have a very low rate of positives, so that you have the minimal number of silent spreaders as possible. The only way to find the asymptomatic spreaders is through testing, and currently we barely have enough tests for people who are showing symptoms. We have to get to a situation where most of our testing is on people who have no symptoms.

27% of US tests have been positive. In South Korea its 1.9%


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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


Edited by koods (04/15/20 08:04 PM)


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Re: Viral outbreak in China [Re: koods]
    #26604100 - 04/15/20 08:56 PM (3 years, 9 months ago)

Things are getting serious. Trump went grey overnight



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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Offlinesusurrador
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Re: Viral outbreak in China [Re: koods] * 1
    #26604137 - 04/15/20 09:06 PM (3 years, 9 months ago)

:offtopic:


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Re: Viral outbreak in China [Re: susurrador] * 1
    #26604140 - 04/15/20 09:07 PM (3 years, 9 months ago)

Task force press conference. On topic.


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NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Offlinesusurrador
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Re: Viral outbreak in China [Re: koods] * 4
    #26604148 - 04/15/20 09:09 PM (3 years, 9 months ago)

Whatever Trump has done to his hair is not on topic.

Talk about the press conference then in terms of the virus.


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Re: Viral outbreak in China [Re: morrowasted] * 1
    #26604156 - 04/15/20 09:12 PM (3 years, 9 months ago)

Second thread in COVID Index

COVID-19: Disease Management

Quote:

This thread is about medical management of COVID-19. It will contain medical jargon but I am happy to answer any questions you may have.

Assessment

The treatment process begins with an assessment in order to determine the best course of treatment. Information about symptom onset and progression along with baseline vital signs provide information about severity. Immediate signs of disease that may require hospitalization are fever over 103, respirations over 30, O2sat <= ~93. A patient admitted with any of these signs will be started on supplemental oxygen immediately.

Blood will be drawn to provide more data about how to proceed. These are the labs you can expect to have drawn: (A) A Complete Blood Count with differential. These provides information about the amount of red and white blood cells and platelets in your body. Reduced white blood or red count are indicators of higher mortality risk. Most patients present with reduced white blood count, but the extent to which it is reduced correlates with the expected outcome. (B) General markers of inflammation: C-Reactive protein and ferritin are standard. Elevations in both positively correlate with poor prognosis. (C) Liver Function tests:  liver enzymes may be normal or elevated, and elevations may be predictive of donwstream coagulopathy, (D) Arterial Blood Gases: Hypoxemia with eucapnia or mild hypercapnia are common. (E) Electrolytes: Elevated potassium may reflect hemolysis and/or acute renal failure and be predictive of future cardiac arrest. (F) Blood cultures: to check for bacterial superinfection.

A baseline 12-lead EKG may be obtained to determine the risk for cardiac complications.

A chest x-ray will be performed.  Rarely, the doctor may order a CT scan as well.



Quote:

Supportive Treatment:

(1) Avoid rapid fluid administration to correct hypotension, use vasopressors instead. Fluids exacerbate pulmonary edema

(2) Supplemental oxygen does not improve O2 saturation as much as you would expect but provides significant patient comfort.

(3) patient positioning should maximize comfort unless patient is intubated. after 12-24 hours of intubation, prone positioning is preferred

(4) Information for doctors seeking detailed information regarding intubation and ventilation of COVID19 patients. This is a fiercely debated topic and I am not qualified to speak on it.

(5) MONITOR FOR S&S of impending PULMONARY EMBOLISM/CARDIAC ARREST.





Quote:

Common Drug Therapy:

Tylenol: Antipyretic

Vitamin C: given in IV boluses every 6 hours. appears to improve recovery time and reduce signs and symptoms of pulmonary inflammation, but the mechanisms remain debated

Zinc: 75mg orally.

Remdesivir: May interfere with the viral replication cycle by inhbiting RNA-dependent RNA polymerase. Early anecdotes indicate moderately promising results

Hydroxychloroquine: appear to inhibits viral entry into the cell, may also act as a zinc ionophore, facilitating intracellular inhibition of viral replication cycle by zinc. contraindicated in patients with long-QT, ventricular dysrhythmias, renal failure or acutely elevated potassium

Retonavir: a protease inhibitor

Tocilizumab: IL-6 inhibitor. interferes with stimulation of alveolar macrophages to prevent progression to Systemic inflammatory response system and multi system organ failure

methylprednisolone: inhibit inflammation. appears to helps severe covid patients but it is being debated because these patients are already lymphopenic (low White blood cell count, bad immunity, which is impaired by this drug)

vasopressors: as needed to maintain SBP > 90 or mean arterial pressure over 65

I know I am forgetting a really important one. I'll have to come back to it later.






Edited by morrowasted (04/15/20 09:17 PM)


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Offlinekoods
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Re: Viral outbreak in China [Re: susurrador] * 2
    #26604170 - 04/15/20 09:16 PM (3 years, 9 months ago)

Quote:

susurrador said:
Whatever Trump has done to his hair is not on topic.

Talk about the press conference then in terms of the virus.




Now we have four off topic posts because you decided to whine about it.

You going for five?


--------------------
NotSheekle said
“if I believed she was 16 I would become unattracted to her”


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Re: Viral outbreak in China [Re: koods] * 1
    #26604175 - 04/15/20 09:18 PM (3 years, 9 months ago)

Quote:

koods said:
Trump went grey overnight






I thought so.
https://www.shroomery.org/forums/showflat.php/Number/26603462#26603462

And yes, Trump dying his hair for his Covid presser/campaign rally IS on topic.:tongue2:

:stonedjerk: . . . :peace:


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"All mushrooms are edible; but some only once." Croatian proverb. BTW ...
  Have You Rated Ythans Mom Yet ?? ... :taser:  ... HERE'S HOW ... (be nice) .  :mod: ... :peace:


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Re: Viral outbreak in China [Re: koods]
    #26604184 - 04/15/20 09:22 PM (3 years, 9 months ago)

Hey koods if you want to, you can make a thread in the other forum as well with the basic statistical information about transmission rates, mortality rates. no pressure it just isnt my strong suit and it would take me a long time.


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Offlinesusurrador
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Re: Viral outbreak in China [Re: koods] * 1
    #26604202 - 04/15/20 09:28 PM (3 years, 9 months ago)

Seems right on topic, Koods.

Quote:

koods said:
Quote:

susurrador said:
Whatever Trump has done to his hair is not on topic.

Talk about the press conference then in terms of the virus.




Now we have four off topic posts because you decided to whine about it.

You going for five?




Thanks for agreeing that your post was off topic.

Let's move on.


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