SARS CoV-2 coronavirus / Covid-19 (No tin foil hat silliness please)

[Pogue Mahone]

Bit confused by this. I thought the deterioration from covid19 was gradual, even if it can very quick. So surely as a doctor, he would have known he was rapidly descending into the danger zone, and could have messaged a medical colleague or ambulance for help?

Or can covid19 also disable you very quickly, like a stroke or heart attack can?

Apparently people can get very hypoxic without realising it. So it’s possible he went to sleep in extreme oxygen deficit and didn’t wake up. Being a medic, he would probably be less inclined to seek medical help than a lay-man anyway. I guess it’s also possible he had a heart attack or stroke.

 

[Compton22]

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These Oxford scientists might have saved hundreds of thousands of lives by keeping their research open after the SARS outbreak

 

[Pogue Mahone]

So, lockdowns work, but all hell will break loose once they end? Doesn't sound good to me at all.

It’s not good, no. Nothing about this pandemic is good. It’s a fecking nightmare. The only positive you can take from this publication is proof that lockdowns are effective.

 

[Dante]

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I dare you to go down this rabbit hole thread

As of today, there have be more UK civilians directly killed by Covid-19 than were directly killed in World War 1.

https://en.wikipedia.org/wiki/World_War_I_casualties

 

[sammsky1]

Apparently people can get very hypoxic without realising it. So it’s possible he went to sleep in extreme oxygen deficit and didn’t wake up. Being a medic, he would probably be less inclined to seek medical help than a lay-man anyway. I guess it’s also possible he had a heart attack or stroke.

Gotcha. Is that why you bought that machine off eBay that you wrote about a few posts ago?

 

[0le]

These Oxford scientists might have saved hundreds of thousands of lives by keeping their research open after the SARS outbreak

What do you mean by open? Most universities have access to the relevant journals for each faculty and at least in my university we can also request access through the British Library for free if we did not have access and/or the publication was not available online.

 

[Pogue Mahone]

Gotcha. Is that why you bought that machine off eBay that you wrote about a few posts ago?

Exactly. Got it on Amazon actually.

iProven Pulse Oximeter Fingertip... https://www.amazon.co.uk/dp/B07CL1TM4D?ref=ppx_pop_mob_ap_share

 

[SalfordRed18]

As of today, there have be more UK civilians directly killed by Covid-19 than were directly killed in World War 1.

https://en.wikipedia.org/wiki/World_War_I_casualties

Perspective

 

[Shakesy]

Who here has an oximeter? I'm in two minds whether I should buy one for my family... Winter is coming where I live. And Westeros ain't got nothing on SA.

 

[Hound Dog]

Perspective

Actually, I think that that is a rather pointless stat, given that there were not that many civilian WWI casualties in England. Combat casualties, different matter.

 

[christy87]

According to worldometer 9k recovered today in Ireland

 

[Wolverine]

Who here has an oximeter? I'm in two minds whether I should buy one for my family... Winter is coming where I live. And Westeros ain't got nothing on SA.

I have two, one paediatric and one adult for family use. They are essential with this disease. If there are loads of elderly folks then I'd recommend a good BP monitor too.
There was some talk of Samsung Health App on their phones providing sats readings but they are considered unreliable.
Early on when this was progressing GPs thought there was a way to get an idea of how hypoxic someone was called the Roth score but that too has been found to be unreliable, low Sats reading <92% (or <88% if known severe COPD) especially at rest then pretty much a shoe in for being seen in hospital for me especially if coexistant COVID symptoms
Ebay and amazon have quite a few.

 

[Jippy]

Exactly. Got it on Amazon actually.

iProven Pulse Oximeter Fingertip... https://www.amazon.co.uk/dp/B07CL1TM4D?ref=ppx_pop_mob_ap_share

Urgh it's 'unavailable'.

 

[Dante]

I've started getting a bit obsessive about checking my vitals in the last few weeks.

Currently my BP is 120/68, my SpO2 is 98% with a PI% of 28, my body temperature is 36.1 degrees Celsius, and my heart rate is around 58 bpm.

I don't know why I keep checking myself so often when I hardly ever leave the flat.

 

[Scrumpet]

I've started getting a bit obsessive about checking my vitals in the last few weeks.

Currently my BP is 120/68, my SpO2 is 98% with a PI% of 28, my body temperature is 36.1 degrees Celsius, and my heart rate is around 58 bpm.

I don't know why I keep checking myself so often when I hardly ever leave the flat.

Those are suspiciously normal. All your equipment must be faulty.

 

[Shakesy]

I have two, one paediatric and one adult for family use. They are essential with this disease. If there are loads of elderly folks then I'd recommend a good BP monitor too.
There was some talk of Samsung Health App on their phones providing sats readings but they are considered unreliable.
Early on when this was progressing GPs thought there was a way to get an idea of how hypoxic someone was called the Roth score but that too has been found to be unreliable, low Sats reading <92% (or <88% if known severe COPD) especially at rest then pretty much a shoe in for being seen in hospital for me especially if coexistant COVID symptoms
Ebay and amazon have quite a few.

Thanks! I have two kids (5 and 4). Won't the adult one give accurate readings for them too?

 

[Shakesy]

Those are suspiciously normal. All your equipment must be faulty.

 

[Penna]

I've started getting a bit obsessive about checking my vitals in the last few weeks.

Currently my BP is 120/68, my SpO2 is 98% with a PI% of 28, my body temperature is 36.1 degrees Celsius, and my heart rate is around 58 bpm.

I don't know why I keep checking myself so often when I hardly ever leave the flat.

Look at Dante with good health.

 

[jojojo]

Urgh it's 'unavailable'.

I panic bought one of these https://www.amazon.co.uk/gp/aw/d/B06ZY1N4K5/ref=ya_aw_od_pi?ie=UTF8&psc=1
after pogue's post and the follow-up article that someone else posted (on how covid-infected people aren't necessarily breathless, even if they're low on oxygen) last night.

No idea if it's good, bad or indifferent but it's reviews looked ok. Maybe someone who knows better could suggest a few models that look right. Please.

 

[Shakesy]

Crazy. Over here oximeters are on discount in pharmacies.

 

[Sparky Rhiwabon]

I have two, one paediatric and one adult for family use. They are essential with this disease. If there are loads of elderly folks then I'd recommend a good BP monitor too.
There was some talk of Samsung Health App on their phones providing sats readings but they are considered unreliable.
Early on when this was progressing GPs thought there was a way to get an idea of how hypoxic someone was called the Roth score but that too has been found to be unreliable, low Sats reading <92% (or <88% if known severe COPD) especially at rest then pretty much a shoe in for being seen in hospital for me especially if coexistant COVID symptoms
Ebay and amazon have quite a few.

Will doctors really take any notice of a DIY test though?

 

[fergieisold]

I've started getting a bit obsessive about checking my vitals in the last few weeks.

Currently my BP is 120/68, my SpO2 is 98% with a PI% of 28, my body temperature is 36.1 degrees Celsius, and my heart rate is around 58 bpm.

I don't know why I keep checking myself so often when I hardly ever leave the flat.

Don't let it stress you out. I was the same with my temperature when this all started...there is no reason to be overly concerned. Your baseline vitals certainly look good to me! So even if you did have the bad fortune to contract the virus your odds are very very good!

 

[Dante]

Look at Dante with good health.

To be fair, this is also the longest I've gone without alcohol in the last decade.

I'm a social drinker; so without the social part of the equation to tempt me, I've been completely teetotal for the last couple of months. I'm sure that helps.

 

[Jippy]

I panic bought one of these https://www.amazon.co.uk/gp/aw/d/B06ZY1N4K5/ref=ya_aw_od_pi?ie=UTF8&psc=1
after pogue's post and the follow-up article that someone else posted (on how covid-infected people aren't necessarily breathless, even if they're low on oxygen) last night.

No idea if it's good, bad or indifferent but it's reviews looked ok. Maybe someone who knows better could suggest a few models that look right. Please.

Thanks- has reviews seem decent. I'm sure I read somewhere about a doctor worried he was going to catch coronavirus citing the oximeter as a crucial bit of kit.

 

[Shakesy]

Can someone please tell me if this article on oximeters is just another mask-fiasco or whether it carries some authority?

https://qz.com/1832464/pulse-oximeters-for-coronavirus-unnecessary-but-selling-strong/

Some pulmonologist is saying it's a waste of money. And my wife has been convinced.

 

[jojojo]

Thanks- has reviews seem decent. I'm sure I read somewhere about a doctor worried he was going to catch coronavirus citing the oximeter as a crucial bit of kit.

This was the article that made me go shopping:

Spoiler: article on the significance of oxygen saturation testing in covid

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.
So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.

On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”

He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.

Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.

And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?


We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps keep the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until their oxygen levels plummet. In effect, the patient is injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.

Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.

There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.
Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.

Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.

People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.

There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) opens up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.

To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.

But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.

It’s time to get ahead of this virus instead of chasing it.

Richard Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.

 

[Pogue Mahone]

Can someone please tell me if this article on oximeters is just another mask-fiasco or whether it carries some authority?

https://qz.com/1832464/pulse-oximeters-for-coronavirus-unnecessary-but-selling-strong/

Some pulmonologist is saying it's a waste of money. And my wife has been convinced.

They’re right that they’re pointless if you don’t have any symptoms. And shouldn’t be used to screen for infection. Definitely useful to have if you do get sick and feel super rough but are not sure if you should go to hospital or not.

 

[F-Red]

Interesting to read that the state of Missouri has launched a legal action against China for loss of life and economic damages.

Good luck to them and hopefully they will be successful.

Then the fun will begin.

A waste of time and some noisy statement for headlines, it needs to be done at an international level. There's no civil jurisdiction of such claims in US courts.

 

[Wolverine]

Will doctors really take any notice of a DIY test though?

It depends. There can be false pulse oximeter readings sure, in cases of hypoperfusion (e.g Raynaud's disease), nail varnish or incorrect use but finger tip sats probe are fairly easy to use, if somebody called me with COVID symptoms with repeated Sats readings in the 80s yeah I'd be confident they should be phoning 111 or an ambulance if symptoms suggestive of respiratory distress

There are some instances for example where we accept low Sats readings, e.g. COPD patients or a recovering infant with bronchiolitis. But its an important clinical vital sign, and in the case of COVID (after respiratory rate) probably the most important factor in deciding whether somebody needs an admission or not. There are plenty of clinical symptoms though however people need to be mindful of, severe shortness of breath and fatigue are red flags.

Thanks! I have two kids (5 and 4). Won't the adult one give accurate readings for them too?

I'd recommend the paediatric ones still, there's one for kids aged around 2-12 years old, neonatal ones for younger than that. Accuracy for adult ones on kids is less, I think its to do with finger diameter and the sensors

 

[Pogue Mahone]

It depends. There can be false pulse oximeter readings sure, in cases of hypoperfusion (e.g Raynaud's disease) or incorrect use but finger tip sats probe are fairly easy to use, if somebody called me with COVID symptoms with repeated Sats readings in the 80s yeah I'd be confident they should be phoning 111 or an ambulance if symptoms suggestive of respiratory distress

There are some instances for example where we accept low Sats readings, e.g. COPD patients or a recovering infant with bronchiolitis. But its an important clinical vital sign, and in the case of COVID (after respiratory rate) probably the most important factor in deciding whether somebody needs an admission or not.



I'd recommend the paediatric ones still, there's one for kids aged around 2-12 years old, neonatal ones for younger than that. Accuracy for adult ones on kids is less, I think its to do with finger diameter and the sensors

I’m probably just being tight but I got a “one size fits all” version. Probably going to be a few % out when doing our kids but the main thing is spotting a drop from baseline, so it doesn’t need to be perfect. Plus our kids are basically invulnerable anyway. Jammy gits.

 

[Jippy]

This was the article that made me go shopping:

That might have been what I read, not sure- guess we're on page 758.
I might still add it to the blood pressure monitor we have from previous health worries.
Do wonder what the hospital will say if you run in screaming that the reading was only 96%!

 

[Wolverine]

I’m probably just being tight but I got a “one size fits all” version. Probably going to be a few % out when doing our kids but the main thing is spotting a drop from baseline, so it doesn’t need to be perfect. Plus our kids are basically invulnerable anyway. Jammy gits.

That's true I've worked in practices with probes for both and never really had an issue.
I was in paeds minor injuries the other day, 3 cases between me and the A&E registrar in a 10 hour shift. Crazy.

 

[Drifter]

Warning after infection rate rises in Germany as lockdown measures eased

Health officials in Germany have warned the public not to be complacent after a rise in the country’s coronavirus infection rate.

Germany has been widely seen as a world leader in how to handle the spread of COVID-19, and this week eased lockdown measures.

However, its government agency responsible for disease control has warned there is no end in sight to the coronavirus pandemic and that the number of cases could increase again.

On Tuesday, the Robert Koch Institute (RKI) said Germany’s reproduction rate, or RO, had risen from 0.7 on Friday to 0.9, meaning someone with coronavirus is infecting roughly one other person.

Why it is to early to talk of opening up.

 

[Pogue Mahone]

That's true I've worked in practices with probes for both and never really had an issue.
I was in paeds minor injuries the other day, 3 cases between me and the A&E registrar in a 10 hour shift. Crazy.

Ha! Living the dream. I worked in an A&E in in a rural hospital in Aus and that often happened. Two of us on night shift, taking it in turns to have a kip. Friends back home couldn’t believe it.

 

[Dante]

Urgh it's 'unavailable'.

The specific one that I bought is also sold out.

However, looking at this:

https://www.amazon.co.uk/Oximeter-Saturation-Fingertip-Omnidirectional-Display（black/dp/B086Q142ZD/ref=lp_2826263031_1_15_s_it?s=drugstore&ie=UTF8&qid=1587504946&sr=1-15

... it seems to be built on the same hardware as mine. It was probably manufactured in the same factory, and all. But it obviously has a slightly different logo embossed on the outside.

Delivery seems a long way out, so you may want to look at an alternative. Assuming that they're all identical on the inside, I can recommend any of the oximeters that have the yellow/blue LED displays.

 

[Rado_N]

Warning after infection rate rises in Germany as lockdown measures eased



Why it is to early to talk of opening up.

I wonder if the US States who have talked of reopening bars etc will take note?











Don’t forget to tip your waiters, I’m here all week

 

[Jippy]

The specific one that I bought is also sold out.

However, looking at this:

https://www.amazon.co.uk/Oximeter-Saturation-Fingertip-Omnidirectional-Display（black/dp/B086Q142ZD/ref=lp_2826263031_1_15_s_it?s=drugstore&ie=UTF8&qid=1587504946&sr=1-15

... it seems to be built on the same hardware as mine. It was probably manufactured in the same factory, and all. But it obviously has a slightly different logo embossed on the outside.

Delivery seems a long way out, so you may want to look at an alternative. Assuming that they're all identical on the inside, I can recommend any of the oximeters that have the yellow/blue LED displays.

Wonder how much these were selling for in December.

 

[Maagge]

Warning after infection rate rises in Germany as lockdown measures eased



Why it is to early to talk of opening up.

What's the news here? Of course infection rate will rise when some restrictions are listed. It's literally the parameter they're looking at when trying to figure out how much of society they can open.

 

[Hound Dog]

It seems that NY is hit by a particularly nasty strain of the virus and that death rates vary a lot depending on strains:
https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v1

There has been an LA study suggesting a 0.12% death rate, similar to the Stockholm one from a few days ago.

Warning after infection rate rises in Germany as lockdown measures eased



Why it is to early to talk of opening up.

Why?

This will inevitably happen any time you open up.

 

[golden_blunder]

Heard from a few different people that live down in Cork. Quite a few English tourists came over to holiday homes during the Easter holidays.
how the duck is this allowed to happen?