COVID-19 presenting with diarrhea, loss of appetite have a higher risk of death


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Diarrhoea and loss of appetite could be early signs of coronavirus as scientists find almost half of patients experience one or more digestive symptoms

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  • Study of 204 Wuhan residents reveals 48.5 per cent had digestive symptoms

  • Most also had the normal respiratory issues but seven people did not

  • Those with digestive symptoms are less likely to be successfully treated and discharged compared to those with just respiratory symptoms

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The study, conducted by Chinese researchers, has been scrutinised by other academics and published this week in the American Journal of Gastroenterology.

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Researchers studied 107 men and 94 women with an average age of 55 that had all tested positive for COVID-19 between January 18 and February 28.

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Ninety-nine had digestive symptoms and 92 of these also suffered with respiratory problems as a result of the infection.

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The researchers add: ‘Among the 105 patients without digestive symptoms, 85 presented only with respiratory symptoms, and 20 neither had respiratory nor digestive symptoms as their chief complain.’

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The study also found the digestive issues worsened as the severity of the disease increased.

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Patients without digestive symptoms in this study were more likely to be cured and discharged than patients with digestive symptoms, the scientists say.

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Around a third (34.3 per cent) of patients that did experience digestive problems were discharged by March 5, when the study stopped collecting data.

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This figure for successful treatment rises to 60 per cent for people who did not experience digestive symptoms.

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The researchers write in their research: ‘We found that digestive symptoms are a common presenting complaint in patients with COVID-19.

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‘Compared to patients without digestive symptoms, those presenting with digestive symptoms have a longer time from onset to admission and a worse prognosis.

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Dr Brennan Spiegel, Professor of Medicine and Public Health at UCLA and co-editor of the journal the study was published in, said in a statement accompanying the release of the research: ‘In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of [death] compared to those without digestive symptoms, emphasising the importance of including symptoms like diarrhoea to suspect COVID-19 early in the disease course before respiratory symptoms develop.’

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WHY DOES CORONAVIRUS CAUSE DIGESTIVE SYMPTOMS?

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Chinese researchers believe COVID-19 appears to cause digestive symptoms because SARS-CoV-2 is similar to SARS-CoV and can invade the human body by binding to the human angiotensin converting enzyme 2 (ACE-2) receptor.

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This can cause liver tissue injury by making too many liver cells, called hepatocytes, derived from ells in the bile duct.

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Secondly, SARS-CoV-2 indirectly or directly damages the digestive system through an inflammatory response.

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The chain reaction may injure the digestive system.

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It is not legal for me to provide medical advice without an examination

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Symptoms in Kids of Novel Coronavirus, COVID-19


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New paper released early due to importance.

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Coronavirus looks different in kids than in adults.

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A study released this week in the journal Pediatrics provides the clearest confirmation yet that coronavirus infections are, in fact, generally less severe in kids, with more than 90 percent of 2,143 children in the study in China having mild to moderate disease or even being asymptomatic.

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But it contains worrisome information about one subset — infants — and suggests that children may be a critical factor in the disease’s rapid spread.

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Pediatrics associate editors Andrea Cruz and Steve Zeichner, both physicians, say the study suggests “children may play a major role in community-based viral transmission.”

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The data suggests children may have more symptoms that make them contagious, like a runny nose, and that they may have more gastrointestinal symptoms, which raises concerns about the virus being in the feces for several weeks after infection.

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Adam Ratner, a doctor in pediatric infectious diseases at NYU Langone Health, said the clear takeaway from the study is that the novel coronavirus “is still something that has the ability to cause severe disease across the age spectrum.”

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Study: Coronavirus is not sparing children — and they may play a ‘major role’ in its spread..A new study shows coronavirus infections are less severe in kids, but they may spread it more readily than adults...The first thing to know is that children are getting infected across all age groups and genders. Among the patients studied, half were from Hubei Province, the epicenter of the outbreak, while the others were from bordering areas. They ranged in age from newborns to 18 with the median age being 7 years.
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So what does coronavirus look like in children?

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According to the analysis by Shanghai Children’s Medical Center researchers Yuanyuan Dong, Xi Mo and co-authors, mild cases (52 percent) were marked by the typical symptoms of a cold — fever, fatigue, cough, sore throat, runny nose and sneezing. Some patients had no fever and only digestive symptoms such as nausea, vomiting, abdominal pain and diarrhea.

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Those with moderate infection (39 percent) had pneumonia with frequent fever and cough, mostly dry cough, followed by a wetter cough. Some had wheezing but no obvious shortness of breath.
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Severe cases were rare (5 percent) as were those who required critical care (0.4 percent.) The severe cases began with early respiratory symptoms which were sometimes accompanied by gastrointestinal issues. Around one week the children have more difficulty breathing. Those cases sometimes quickly progressed to critical illness with acute respiratory distress or failure which in turn sometimes led to other organ dysfunction — heart failure or kidney injury.
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One boy, a 14-year-old, died on Feb. 7. No further details on the patient were revealed in the study.
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Of special interest to pediatricians is a group of seven infants (11 percent of the total number of infants in the study), and two children in the age 1 to 5 range (15 percent), who progressed to critical condition. The study suggests, the authors wrote, that “young children, particularly infants, were vulnerable.”.

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The luckiest group — 4 percent — did not have any symptoms at all even as nasal or throat swabs showed they were positive for coronavirus infection…..................

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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California: Coronavirus testing cost zero if insured, employee & employer benefits


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 Only leaves tens of millions uninsured. Does nothing about cost for medical care or home health care after testing positive..

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Governor Newsom, State Health Officials Announce More than 22 Million Californians Now Eligible for Free Medically Necessary COVID-19 Testing

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Today, under the direction of Governor Gavin Newsom, the Department of Managed Health Care directed all commercial and Medi-Cal health plans regulated by the Department to immediately reduce cost-sharing to zero for all medically necessary screening and testing for the COVID-19 in theAll Plan Letter (PDF). This includes waiving cost-sharing for emergency room, urgent care or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. The need for COVID-19 testing is based on medical necessity, a clinical determination made on a case by case basis by medical professionals.

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“Californians shouldn’t have to fear a big medical bill just because they took a test for COVID-19,” said Governor Newsom. “This action means that Californians who fit the testing requirements can receive the test at no cost. We’re all in this together, and I’m grateful to those health providers who have already stepped up and heeded our call.”

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“This action will ensure that Californians who need a test will receive one at no cost,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency. “This doesn’t mean every Californians should be seeking a test. If you are experiencing symptoms of COVID-19 and may have had contact with a person with COVID-19 or recently traveled to countries with apparent community spread, call your health care provider or local public health department first before seeking medical care.”

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Today the California Department of Insurance issued similar direction providing cost free medically necessary testing for an additional 2 million Californians. Combined these announcements ensure that 24 million more Californians are eligible to receive testing, should their health care provider deem it medically necessary.Insurance Bulletin COVID-19 Screening and Testing (PDF).

 

The Department of Managed Health Care also directed health plans to increase capacity to screen and treat COVID-19 as needed to minimize further transmission by encouraging health plans to expand telehealth services and to take steps to ensure patients receive medically necessary medication if there is a shortage of a particular drug.

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These orders from the Department of Managed Health Care and the Department of Insurance do not apply to individuals in self-insured health coverage products.

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Support Now Available for Employers and Workers Impacted by COVID-19

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Also today, the California Employee Development Department announced support services to individuals affected by COVID-19 in California. For faster and more convenient access to those services, the use of online options is encouraged.

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Individuals who are unable to work due to having or being exposed to COVID-19 (certified by a medical professional) canfile a Disability Insurance (DI) claim.

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Disability Insurance provides short-term benefit payments to eligible workers who have full or partial loss of wages due to a non-work-related illness, injury, or pregnancy. Benefit amounts are approximately 60-70 percent of wages (depending on income) and range from $50 – $1,300 a week.

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Californians who are unable to work because they are caring for an ill or quarantined family member with COVID-19 (certified by a medical professional) canfile a Paid Family Leave (PFL) claim.

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Paid Family Leave provides up to six weeks of benefit payments to eligible workers who have a full or partial loss of wages because they need time off work to care for a seriously ill family member or to bond with a new child. Benefit amounts are approximately 60-70 percent of wages (depending on income) and range from $50 – $1,300 a week.

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Employers experiencing a slowdown in their businesses or services as a result of the Coronavirus impact on the economy may apply for the UI Work Sharing Program. This program allows employers to seek an alternative to layoffs – retaining their trained employees by reducing their hours and wages that can be partially offset with UI benefits. Workers of employers who are approved to participate in the Work Sharing Program receive the percentage of their weekly Unemployment Insurance benefit amount based on the percentage of hours and wages reduced, not to exceed 60 percent.

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Visit the Work Sharing Program to learn more about its benefits for employers and employees, and how to apply.

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Governor Proclaimed State of Emergency

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Governor Gavin Newsom yesterday declared a State of Emergency to make additional resources available, formalize emergency actions already underway across multiple state agencies and departments, and help the state prepare for broader spread of COVID-19. The proclamation comes as the number of positive California cases rises and following one official COVID-19 death.

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The emergency proclamation includes provisions that protect consumers against price gouging, allow for health care workers to come from out of state to assist at health care facilities, and give health care facilities the flexibility to plan and adapt to accommodate incoming patients.

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View a copy of the emergency proclamation (PDF).

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COVID-19 in California by the Numbers (as of 10 a.m. Pacific Time):

60– Positive cases

1 – Death

24 – Cases of positive tests related to federal repatriation flights

36 – Cases not related to repatriation flights

  • 18 – Travel-related

  • 10 – Person to person

  • 4 – Community transmission

  • 4 – Currently under investigation

9,400+ – number of people self-monitoring who returned to the U.S. through SFO or LAX

49 – Number of local health jurisdictions involved in self-monitoring

15 – Labs with test kits

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How Can People Protect Themselves:

Every person has a role to play. So much of protecting yourself and your family comes down to common sense:

  • Washing hands with soap and water.

  • Avoiding touching eyes, nose or mouth with unwashed hands.

  • Avoiding close contact with people who are sick.

  • Staying away from work, school or other people if you become sick with respiratory symptoms like fever and cough.

  • Following guidance from public health officials.

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What to Do if You Think You’re Sick:

  • Call ahead: If you are experiencing symptoms of COVID-19 and may have had contact with a person with COVID-19 or recently traveled to countries with apparent community spread, call your health care provider or local public health department first before seeking medical care so that appropriate precautions can be taken.

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California’s Response to COVID-19:

We have been actively and extensively planning with our local public health and health care delivery systems. Here are some of the things we are already doing:

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  • As in any public health event, the California Department of Public Health’s Medical and Health Coordination Center has been activated and is coordinating public health response efforts across the state.

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  • California continues to prepare and respond in coordination with federal and local partners, hospitals and physicians.

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  • California activated the State Operations Center to coordinate response efforts across the state.

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  • Governor Gavin Newsom requested the Legislature make up to $20 million available for state government to respond to the spread of COVID-19.

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  • California made available some of its emergency planning reserves of 21 million N95 filtering facepiece masks for use in certain health care settings to ease shortages of personal protective equipment.

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  • The Public Health Department is providing information, guidance documents, and technical support to local health departments, health care facilities, providers, schools, universities, colleges, and childcare facilities across California.

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  • It is coordinating with federal authorities and local health departments that have implemented screening, monitoring and, in some cases quarantine of returning travelers.

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  • In coordination with the CDC, state and local health departments, we are actively responding to cases of COVID-19.

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  • The Public Health Department is supporting hospitals and local public health laboratories in the collection of specimens and testing for COVID-19.

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  • The California Department of Public Health’s state laboratory in Richmond and 14 other public health department laboratories now have tests for the virus that causes COVID-19.

 

 

 

 

 

 

 

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me.

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The advertising below is not mine.

In exchange, this blog is less expensive.

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How long does COVID-19 last? Resource Centers on Coronavirus


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Lancet offers free public access on coronavirus. The Lancet resource center on coronavirus is here

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There is also The comprehensive Ars Technica guide to the coronavirus 

 

How long does COVID-19 last?

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“On average, it takes five to six days from the day you are infected with SARS-CoV-2 until you develop symptoms of COVID-19. This pre-symptomatic period—also known as “incubation”—can range from one to 14 days.”

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“From there, those with mild disease tend to recover in about two weeks, while those with more severe cases can take three to six weeks to recover, according to WHO Director-General Dr. Tedros Adhanom Ghebreyesus, who goes by Dr. Tedros.”

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From Wuhan, they followed CT of lungs. Two weeks after recovery patient discharged negative, if CT lesions appear to get worse, pneumonia symptoms recur. It’s not over til it’s over. 

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I do not have the reference and cannot verify the source. I have read that recurrence two weeks later is the overactive immune system creating a cytokine storm with excessive mucous secretions that create mucous bolts. Bolts plug airways and kill. One hospital had 50% reduction in deaths from aggressive suction of mucous.

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Dont forget to isolate and quarantine yourself even if mild. It’s wildly contagious.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me.

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The advertising below is not mine.

In exchange, this blog is less expensive.

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Coronavirus “is like the angel of death for older individuals,” do not downplay or minimize


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Jerusalem Post, March 8, 2020:

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….Pence’s speech is a departure from the guidelines the CDC posted to their website on Friday, which told older adults and those with serious medical conditions such as a heart, lung or kidney disease – rather than just the elderly with a serious health condition – to “stay home as much as possible” and “take actions to reduce your risk of exposure.”

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Last week, Dr. Peter Hotez, dean of tropical medicine at Baylor College of Medicine, warned lawmakers not to downplay or minimize how severe the coronavirus risk is for vulnerable Americans. Speaking at a congressional hearing, Hotez explained that the coronavirus “is like the angel of death for older individuals,” AP reported.

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According to Vanderblit University infectious diseases expert Dr. William Schaffner, “The clear message to people who fit into those categories is:

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‘You ought to become a semi-hermit. You’ve got to really get serious in your personal life about social distancing, and in particular avoiding crowds of any kind….’”  

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The material on this site is

for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me….

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The advertising below is not mine. In exchange, this blog is less expensive.

 

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Italy’s Healthcare System on Brink of Collapse – Coronavirus


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Italian doctor begs not to underestimate coronavirus threat

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An Italian doctor said: ‘Our hospitals are on their knees: Italian doctor’s dire warning over coronavirus has driven his country’s healthcare system to brink of collapse – and warned colleagues in other nations not to underestimate the threat.

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China does not charge for healthcare needed for coronavirus.

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Om Tat Sat Om

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The material on this site is

for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me….

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The advertising below is not mine. In exchange, this blog is less expensive.

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Coronavirus Tsunami Unlike Anything Before – fibrosis of lungs, death by sputum bolts


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First, see the PDF at bottom from Lancet: Mitigating effects of home confinement on children during the coronavirus outbreak.

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Then will see a summary of the Lancet report of how doctors treat the sickest coronavirus patients. So many die.

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It is now surely one of the most-read medical reports among caregivers in intensive care units around the world who are bracing for the novel coronavirus.

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Next, quoting Cuomo today, “I’m not urging calm. I’m urging reality.”

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An Italian doctor said: ‘Our hospitals are on their knees’: Italian doctor’s dire warning over coronavirus has driven his country’s healthcare system to brink of collapse.

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I truly fear for the safety of all when I hear people are already bored, fatalistic, saying “Well, it’s everywhere. There’s nothing I can do.” They don’t have a clue: A tsunami is coming and we are not the slightest prepared. No equipment. No masks. No gowns. No beds. Not the basics! No test kits for another two weeks…..maybe. There are things you must do to protect others. Don’t say, “It doesn’t matter, we will all get it.” Here is what’s coming.

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“more than 100 out of 120 people admitted with the virus also developed pneumonia.”

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We know from early stage COVID-19 autopsies published February 29, 2020, the two prominent lethal features are

  • severe fibrosis of distal lungs  – oxygen does nothing at scar tissue

  • sputum bolts that kill due to cytokine storm, an over-responsive immune system that kills with a surge of inflammatory cytokines that produce copious sputum.

  • “The influence of COVID-19 on the human body is like a combination of SARS and AIDS as it damages both the lungs and immune systems,”

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“…most important thing now is to take measures at an early stage of the disease to protect patients’ lungs from irreversible fibrosis,” Peng noted.”

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This Lancet article may wake you up if not too bored. It’s scares me like nothing I could imagine.

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From Lancet, February 24, 2020

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

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A summary, below, from The Washington Post, March 7, 2020, of a portion of the Lancet article, above:    .

How Doctors Treat the Sickest Coronavirus Patients

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It is now surely one of the most-read medical reports among caregivers in intensive care units around the world who are bracing for the novel coronavirus. The paper, published in the British medical journal the Lancet last month by a team of doctors working at the center of the outbreak, is the first study to characterize the clinical course, treatment and mortality of a group of critically ill patients infected by the new SARS-CoV-2 virus.

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The report is highly valuable, say clinicians in the United States and Europe, because it details the course of the disease in critically ill patients — that small but worrisome subset who end up in ICUs. The 52 patients were treated at the Jinyintan Hospital in Wuhan, China, during the first month of the epidemic, from the end of December through January.
The authors tracked the constellation of life-threatening symptoms, what drugs patients were given to try to combat the infection’s assault on the lungs, how supplemental oxygen was administered, and the outcomes — whether patients survived or died in the ICU.

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The grim conclusion: For patients infected with the novel coronavirus who became critically ill with pneumonia and entered their ICU, the doctors recorded “high” numbers of fatalities. Of the 52 people included in the sample, 32 died in the 28-day span of the study, revealing a death rate of 61 percent. Most died within seven days of being admitted to the ICU.
For comparison, mortality rates generally ranging between 30 and 40 percent are observed for patients who are sickened by ordinary seasonal flu and are fighting pneumonia and acute respiratory distress syndrome in ICUs.


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Specialists outside of China applaud the treatment given by the Chinese doctors to their patients in the study, saying that similar levels of care would be found in American and European critical care units.


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Like the doctors in China before them, health-care workers in South Korea and Italy are seeing their ICUs filling with critically sick patients. In Lodi, in northern Italy, one infectious-disease doctor told The Washington Post that coronavirus had hit “like a tsunami” at his hospital, where more than 100 out of 120 people admitted with the virus also developed pneumonia.

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Breathtaking. I am absolutely kicked in the gut sickened by what I know will be unfolding here. It is unlike anything we have seen before. As a physician, I cannot imagine how it is possible we will be even half prepared but even then, no respirators, not enough of a tsunami of respiratory therapists to handle the lungs that get blasts of sputum bolts and kill.

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We don’t have nowhere near enough critical care beds.

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We simply do not have the barest of necessities, already not enough masks and respirators, not to mention the flimsy gowns I’ve seen Health workers in Kirland Washington are wearing. I’ve not seen a single American Health worker wearing anything like the fully enclosed space suits even street workers wear in Wuhan.

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My mind is stunned reading what it was like there, what will get here soon, just like that and we will see what is unlike anything we have ever seen before in medicine; it is a tsunami and deadly serious.

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We’ve had 6 wasted weeks watching it come and did nothing. Test kits cannot be promised in two weeks, said Dr. Anthony Fauci on March 6. Contradicting the expert, trump on the same day said we had test kits now, but on Thursday March 5, Pence had already said we did not. 

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Just published is why seniors are more likely to die. Because they lost ability to turn off immune system when full blast no longer needed.

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Children can test positive to coronavirus but may have few to no symptoms.

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Lancet offers free public access on coronavirus. The Lancet resource center on coronavirus is here

Such as

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(Chinese translation | 附中文翻译, PDF)...

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China does not charge for healthcare due to coronavirus.

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Om Tat Sat Om

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The material on this site is

for informational purposes only.

.
.
It is not legal for me to provide medical advice without an examination.

.
It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please ignore the ads below. They are not from me….

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The advertising below is not mine. In exchange, this blog is less expensive.

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