COVID Medical questions Q & A.

[Snaggy]

Will try to provide answers to clinical concerns.

I’m an Internal Medicine doc, practicing Urgent Care exclusively the last 2 years.

 

[Snaggy]

With the new antibody test coming to determine ones exposure / immunity, I have a few questions.
1. Can one be naturally immune even though one was never exposed ?
(I know with HIV they found that 22 African prostitutes carried full natural
Immunity against AIDS ; Is this possible with SARS / COVID viruses as well ?)
2. Will they use blood of those immune to help others as a “natural vaccine ?”
3. If I give blood now , will they run this immunity test or test at all before draw? If not, is the blood good if one has COVID 19 or is it solely isolated in the respiratory system?
4. How does Hydroxychloroquine potentially work to combat or lessen this virus ?
Does it have to be “loaded “ in ones system prior to exposure like in Lupus patients or can it be used once exposed ? And for how long ?
Finally , 5. are all Quinolines potentially of benefit or effective? ( Such as Mefloquine ?)

I believe innate immunity to HIV is related to a CCR-5 receptor on lymphocytes. A mutation keeps the virus from entering the cell and cause infection. It's a resistance to infection confined to the patients own lymphocytes.
It's not really activating any part of the immune system, so there is no immunity conferred by transfusion. HIV and CV have VERY different replicative strategies, the same type of mutation wouldn't work for CV.

They won't use "immune blood" as a "natural vaccine". They have used convalescent plasma, and high doses of gamma globulin to treat active infections, with some encouraging results.

No, they will NOT run a CV antibody test with a blood donation. They won't. They won't test you for CV infection either. They will exclude you for respiratory symptoms, maybe check a temp.

I don't know of any formal trials of prophylactic plaquenil, though surely somebody is trying it. There's no data, and and the study would take more time and resources. The drug can be toxic though, not such a good idea really.

Don't know about Mefloquine, but the interest in Plaquenil(hydroxychloroquine) is around the anti-inflammatory activity.

 

[Snaggy]

can a mask be cleaned by using microwave steam?

Many of them have a metal strip over the nose or a clip on the strap. Nuke it with care. A variety of cleaning techniques have been proposed. Isopropyl dunks have been tried.

The studies which performed actual virologic and fit testing afterwards are beyond the home user, though I guess you could wrap one in a paper bag and Insta-Pot it for 12 minutes, then dry. That approximates an autoclave.

The CDC recommends what I'm doing. I have a half dozen N95's. I wear one for a few hours, then hang it up, not touching anything and let it dry for 24 hours, at least. Drying destroys the virus and it happens fairly quickly on porous surfaces. Who knows?

 

[Killroy1999]

No, they will NOT run a CV antibody test with a blood donation. They won't. They won't test you for CV infection either. They will exclude you for respiratory symptoms, maybe check a temp.

Yikes! So, if you need blood you may get blood from a person with CV that is asymptomatic? I would guess that getting CV blood would also infect you, but perhaps CV is more in the lungs and infects the lungs.

 

[chuckwarren]

Many of them have a metal strip over the nose or a clip on the strap. Nuke it with care. A variety of cleaning techniques have been proposed. Isopropyl dunks have been tried.

The studies which performed actual virologic and fit testing afterwards are beyond the home user, though I guess you could wrap one in a paper bag and Insta-Pot it for 12 minutes, then dry. That approximates an autoclave.

The CDC recommends what I'm doing. I have a half dozen N95's. I wear one for a few hours, then hang it up, not touching anything and let it dry for 24 hours, at least. Drying destroys the virus and it happens fairly quickly on porous surfaces. Who knows?

Dr Fauci was on PBS Friday evening and said that in the real world (not the lab) the virus can infect you from a surface for 2 or maybe 3 hours. After that the virus has degraded to a point that it lacks sufficient ________, ( I think he said rigor but I am not sure. Would you know what ________ is?

Thanks

 

[Snaggy]

Is it true that a CPAP machine can substitute for a ventilator in a pinch?

CPAP, and BiPAP deliver positive pressure humidified oxygen through the nose. Some of that comes out the mouth, and could contain a lot of viral particles. It's to be avoided for worker safety.

Other techniques like HiFlow Nasal Cannula or HiOX mask release less aerosols but still pose a risk to workers.

ECMO, which oxygenates the blood in a machine and doesn't really utilize the lungs at all, may be available on a limited basis in some circumstances.

Once intubation is performed, a high risk procedure, ventilator care is fairly safe for workers. Availability aside, that would be performed early.

Hard numbers for the US aren't in, but global mortality for ventilator support and ECMO is between 1/3-2/3 of patients. We will probably be on the low end of survival, unless we restrict vent use in the older and sicker patients, who are more likely to die.

 

[Snaggy]

Dr Fauci was on PBS Friday evening and said that in the real world (not the lab) the virus can infect you from a surface for 2 or maybe 3 hours. After that the virus has degraded to a point that it lacks sufficient ________, ( I think he said rigor but I am not sure. Would you know what ________ is?

Thanks

When referring to clinical studies, "rigor" means a tight study, good methodology, good controls, good data, lots of subjects, high statistical significance.

He's saying the evidence isn't great, but...

 

[chuckwarren]

When referring to clinical studies, "rigor" means a tight study, good methodology, good controls, good data, lots of subjects, high statistical significance.

He's saying the evidence isn't great, but...

Thanks for your response. Just one more question. Does what DR Fauci said mean that if I go to bed for 8 hours when I wake I don't need to be worried about contracting the virus from objects in my house because the virus has degraded?

Thanks

 

[Snaggy]

Medical question: Is it likely cough syrup might relieve the dry cough when someone catches this thing?

I would guess that phenergen or guaifenissin, especially with Codeine, would be pretty effective if you can get it. Tessalon is easier to get, might work but probably less effective. Those are the only 2 prescription cough meds. Dextromephorphan(DM) is OTC cough suppressant, it's better than nothing

Increasing the humidity might help, either with a vaporizer or just putting some water on your stove.

For a shallow cough, cough drops or some combo of honey/lemon/hot tea/brandy might help.

 

[Snaggy]

Thanks for your response. Just one more question. Does what DR Fauci said mean that if I go to bed for 8 hours when I wake I don't need to be worried about contracting the virus from objects in my house because the virus has degraded?

Thanks

I think Dr Fauci would lapse into DocTalk and say, "yes we think it's probably safe. Most likely".

First, as Dr SLO said, theoretically the risk is never zero, and the idea is the virus has been destroyed logarithmically until the remainder is no longer likely to cause infections. I don't think "rigorous studies" indicating that number for CV19 exist yet, though other Corona viruses have been studied and are used for inference. Also the surface matters. The virus is relatively stable in liquid suspension, so a moist surface would be less safe. A porous surface would dessicate the virus, damage the lipid envelope it picked up from the cell it destroyed, and inactivate it.

I am using a commercial quaternary ammonium salt cleaner, either as a wipe or as a spray, on the counters, door knobs, keys, phone, wallet, fridge and that stuff 2 or 3 times a day at home. Eyeglasses, I'm using an Isopropyl spray. At work, I'm wiping keyboards, mice, my badge/RF ID etc too. I'm using soap on my hands and surfaces liberally.

 

[Snaggy]

Whenever I have had the flu or a bad cold, I always felt better after taking a hot shower and eating spicy soup.

Would you agree that this a regimen to take for Covid-19 patients and anyone with flu-like symptoms, taking hot showers to help dislodge phlegm from lungs and spicy soup to open sinus cavities?

This is an excellent way to treat sinus congestion and bronchitis. The sticky mucus absorbs water from humid air so you can blow it out or cough it up easier. It can help a sore throat IF it's caused by post nasal drip. You can use a bedside or cabinet coolmist Humidifier/vaporizer to great effect, or just steam up your house with a pot on boil. The pepper stimulates mucus flow. IMHO, far more effective than OTC meds. I dislike decongestant meds because they dry mucus too much.

Good home remedy. Unfortunately, ARDS is not a mucus problem, and inhaled oxygen is already humidified.

 

[chuckwarren]

I think Dr Fauci would lapse into DocTalk and say, "yes we think it's probably safe. Most likely".

First, as Dr SLO said, theoretically the risk is never zero, and the idea is the virus has been destroyed logarithmically until the remainder is no longer likely to cause infections. I don't think "rigorous studies" indicating that number for CV19 exist yet, though other Corona viruses have been studied and are used for inference. Also the surface matters. The virus is relatively stable in liquid suspension, so a moist surface would be less safe. A porous surface would dessicate the virus, damage the lipid envelope it picked up from the cell it destroyed, and inactivate it.

I am using a commercial quaternary ammonium salt cleaner, either as a wipe or as a spray, on the counters, door knobs, keys, phone, wallet, fridge and that stuff 2 or 3 times a day at home. Eyeglasses, I'm using an Isopropyl spray. At work, I'm wiping keyboards, mice, my badge/RF ID etc too. I'm using soap on my hands and surfaces liberally.

Thank you!

 

[Snaggy]

Yikes! So, if you need blood you may get blood from a person with CV that is asymptomatic? I would guess that getting CV blood would also infect you, but perhaps CV is more in the lungs and infects the lungs.

The virus actually targets receptors on the cells lining blood vessels. The lung tissues happen to have a lot of those receptors and are an easy door to kick in. It's damage to the small vessels that destroys the integrity of the cellular barrier that keeps the plasma from leaving the circulatory system. It leaks into the alveoli/air sacs, where it inhibits oxygen diffusion and blocks small airways. Those secretions are expelled in cough, a diabolically efficient way to spread virus. Perfect little bastards, viruses.

I would not want to get a blood transfusion right now. It's one of several reasons to avoid surgery now, go easy on the bike and generally don't get hurt.

 

[Climber]

The virus actually targets receptors on the cells lining blood vessels. The lung tissues happen to have a lot of those receptors and are an easy door to kick in. It's damage to the small vessels that destroys the integrity of the cellular barrier that keeps the plasma from leaving the circulatory system. It leaks into the alveoli/air sacs, where it inhibits oxygen diffusion and blocks small airways. Those secretions are expelled in cough, a diabolically efficient way to spread virus. Perfect little bastards, viruses.

I would not want to get a blood transfusion right now. It's one of several reasons to avoid surgery now, go easy on the bike and generally don't get hurt.

Doesn't drinking a lot of fluids help your cells to transport a bunch of the byproducts of virus' attack on your cells through your blood stream into your kidneys and and into your urine?

I know that lots of fluids helped to significantly improved the chances of surviving ebola.

 

[Yakoo752]

Doesn't drinking a lot of fluids help your cells to transport a bunch of the byproducts of virus' attack on your cells through your blood stream into your kidneys and and into your urine?

I know that lots of fluids helped to significantly improved the chances of surviving ebola.

It wasn't water/fluids, it was ORS

Ebola had vomiting and diarrhea, both of which significantly dehydrate you. If you could manage the dehydration and thus electrolyte imbalance, outcomes improved.

 

[wannabe]

The virus actually targets receptors on the cells lining blood vessels. The lung tissues happen to have a lot of those receptors and are an easy door to kick in. It's damage to the small vessels that destroys the integrity of the cellular barrier that keeps the plasma from leaving the circulatory system. It leaks into the alveoli/air sacs, where it inhibits oxygen diffusion and blocks small airways. Those secretions are expelled in cough, a diabolically efficient way to spread virus. Perfect little bastards, viruses.

I would not want to get a blood transfusion right now. It's one of several reasons to avoid surgery now, go easy on the bike and generally don't get hurt.

So, how long can the viruses live in the donated blood? In other words, is there a length of time when you would feel that our donated blood supply is safe?

 

[wannabe]

Sorry if this is not a medical question, but I'm running out of hand sanitizer, and I was thinking about making my own. My issue is that I don't have any more rubbing alcohol, but I still have lots of denatured alcohol. Can I use that to replace the rubbing alcohol in the homemade hand sanitizer recipies?

 

[Yakoo752]

I feel denatured is a broad satement. Do you know what it was denatured with?

The FDA requires hand sanitizer manufacturers to denature their end product. ie, put shit in it that will make you sick so you don't drink it to get drunk. It's why you can't use denatured alcohol to clean electronics, it leaves a residue behind.

https://www.fda.gov/media/136390/download

Unless you know what process your bottle went through, it would be hard to say.

 

[matty]

If someone has had it, survived and acquired an immune response or antibodies to covid 19, can they subsequently still be a carrier of it?







Thanks in advance.

This is not well understood at this point and the answer is probably complicated.

Active, cultured virus has been found in recovered in persons even 4 weeks after infection though that doesn't mean that it's present in transmissible amounts. As virus is difficult and expensive to culture, the presence of viral RNA with PCR studies is being used to infer persistent transmissibility. That is probably not always true, the presence of RNA may not prove the presence of contagious quantities of viable virus. It's going to create huge headaches for people that have recovered during hospitalization, but are still shedding viral RNA and need a nursing home. Nobody will want them, though they might not be infectious. At some point we will establish a rational timeframe beyond which transmission will be very unlikely, maybe 14-21 days after symptoms begin.



Antibodies(IgM) generally appear the first week, and IgG follows a few days later. COVID is an enveloped virus and may not be easily neutralized by antibodies.

https://images.cntechpost.com/2020/03/6b8cb94d542fdaf71774c69d78790ec7.jpg

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

 

[wannabe]

I feel denatured is a broad satement. Do you know what it was denatured with?

The FDA requires hand sanitizer manufacturers to denature their end product. ie, put shit in it that will make you sick so you don't drink it to get drunk. It's why you can't use denatured alcohol to clean electronics, it leaves a residue behind.

https://www.fda.gov/media/136390/download

Unless you know what process your bottle went through, it would be hard to say.

edit: Nevermind. I found a few articles telling me not to use denatured alcohol.