COVID-19

COVID-19 in the Elderly (case study and literature review)

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Summary

Age is a risk factor for increased morbidity and mortality in COVID-19 infections.

Elderly men have increased mortality compared to elderly women.

Elderly patients can present differently. Delirium can be the primary symptom of COVID-19 infection, as can persistent hypoxia.

Consider COVID-19 in the setting of altered mental status and geriatric falls.

Elderly patients in the ED who live in nursing homes should undergo COVID-19 testing.

Elderly individuals with COVID-19 tend to have increased lesions and lobar involvement on chest CT.

Laboratory diagnostics may differ based on age, and the geriatric population may have lymphopenia, higher CRP values, and increased D-dimer on testing.

COVID-19 in the Elderly — http://www.emdocs.net/covid-19-in-the-elderly/?utm_source=feedly&utm_medium=rss&utm_campaign=covid-19-in-the-elderly

The full article takes some time to read but it’s well worth it if you are into the clinical stuff.

Vaccine Distribution SNAFU – Blame it on the Algorithm or “It Looked Good on Paper”

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Residents are the lowest-ranking doctors in a hospital. Stanford Medicine has about 1,300 across all disciplines. Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.

“Residents are patient-facing, we’re the ones who have been asked to intubate, yet some attendings who have been face-timing us from home are being vaccinated before us,” said Dr. Sarah Johnson, a third-year OB-GYN resident who has delivered babies from COVID-positive patients during the pandemic. “This is the final straw to say, ‘We don’t actually care about you.’”

Only Seven of Stanford’s First 5,000 Vaccines Were Designated for Medical Residents – https://www.propublica.org/article/only-seven-of-stanfords-first-5-000-vaccines-were-designated-for-medical-residents

Stanford Medicine demonstrates how much they care about their residents.

Here’s an interesting breakdown of lessons learned.

In its earliest attempts at explaining the problem, Stanford’s administrators laid blame with the algorithm. Despite best intentions, they explained, the algorithm had made a mistake that the humans had to answer for.

This is a bit like blaming the hammer for missing the nail.

3 lessons from Stanford’s Covid-19 vaccine algorithm debacle — https://www.statnews.com/2020/12/21/stanford-covid19-vaccine-algorithm/

Operation Warp Speed also experienced some hiccups.

“It looked very good on paper,” Perna said. “Paper plans are very good. Execution is where we learn, and we adapted accordingly.”

‘I failed’: Operation Warp Speed leader takes responsibility for Covid-19 vaccine distribution confusion — https://www.statnews.com/2020/12/19/operation-warp-speed-leader-takes-sole-responsibility-for-covid-19-vaccine-distribution-confusion/?utm_campaign=rss

Remember “Everybody has a plan until they get punched in the mouth”

ATTENTION Non-Anti-Vaxxers – A side-by-side comparison of the Pfizer/BioNTech and Moderna vaccines

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The most common side effects are injection site pain, fatigue, headache, muscle pain, and joint pain. Some people in the clinical trials have reported fever. Side effects are more common after the second dose; younger adults, who have more robust immune systems, reported more side effects than older adults.

To be clear: These side effects are a sign of an immune system kicking into gear. They do not signal that the vaccine is unsafe. To date there are no serious, long-term side effects associated with receipt of these vaccines, which will be closely monitored as their use expands.

A side-by-side comparison of the Pfizer/BioNTech and Moderna vaccines — https://www.statnews.com/2020/12/19/a-side-by-side-comparison-of-the-pfizer-biontech-and-moderna-vaccines/?utm_campaign=rss

Post and link for informational purposes only. I will not waste my time trying to convince people that a virus doesn’t care about your gender, age, sexuality, religion, skin color, politics, net worth, personal freedoms, dietary preferences, or anything else.

A virus merely wants a host organism to infect.

FDA Authorizes 1st OTC Covid-19 Test

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The test is performed using a mid-turbinate nasal swab designed for comfortable self-sampling.  The sample is inserted into a single-use cartridge that returns results in 15 minutes. The at-home test analyzer connects to the user’s smartphone through Bluetooth and pairs with a downloadable app that provides step-by-step instructions and displays results.

Users can share real-time results from the test, selling for approximately $30, with healthcare professionals, employers, and schools for efficient COVID-19 tracking. Ellume plans to scale-up manufacturing to deliver millions of home tests per month in 2021.

NIH-funded COVID-19 home test is first to receive over-the-counter authorization from FDA – https://www.nih.gov/news-events/news-releases/nih-funded-covid-19-home-test-first-receive-over-counter-authorization-fda

I wonder if this test works without a smartphone? I wonder if the app can share real- time results with local government agencies that are tracking test numbers? I wonder if low income people can take advantage of this test due to cost considerations? I wonder if applicants for life or health insurance will use this test, get results then apply for insurance thus creating another channel for anti-selection?

I wonder a lot nowadays but I truly don’t wonder about my last point. Of course people will self-test before applying for insurance. My local CVS has shelves full of at home tests that people are using now for lots of other things like nicotine, non-prescription drugs, etc.

Retirement can’t come soon enough for this old warrior.

Severe Allergic or Anaphylactic Food Reactions and the COVID-19 Vaccine — The Skeptical Cardiologist

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As one who has suffered the severest of allergic reactions, anaphylaxis, on several occasions after nut ingestion, I was quite worried when I heard that the British FDA-equivalent had announced that “any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer BioNTech vaccine.” The UK began vaccinating…

Severe Allergic or Anaphylactic Food Reactions and the COVID-19 Vaccine — The Skeptical Cardiologist

Thank you Dr. Pearson.

Consistently Inconsistent With the Virus (as with life)

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I’d thought long and hard about what I wanted to do when Will — and, soon after, his brother, Theo — returned home. The by-the-book Dr. Anthony Fauci approach would have been to have the boys keep on their masks, send them upstairs for a couple of weeks, and open all the windows in the house in the meantime.

But as the pandemic has taught us, there are things we value more than perfect protection from the virus. When it comes to them, we’re willing to puncture our bubbles, because without them, living feels like something less than being fully alive…

I admit that, at least to an outsider, my behavior seems inconsistent. But to me, it makes perfect sense. The risks I’m choosing to take are the ones where the payoff is biggest relative to the risk I perceive. (Yes, even the haircut! I love a good high-and-tight, and my barber is applying the clippers in his open-air home workshop.)

Before you argue with me, I get it. These aren’t the choices you would make. And that’s my point.We all have things we value. And risks we are willing to take for them. Neither of these two categories will be exactly the same for any one of us.

When it comes to the virus, we are all consistently inconsistent
Adam Cohen Published: Sun, December 13, 2020 1:07 AM Updated: Sun, December 13, 2020 1:36 AM — https://oklahoman.com/article/5678132/cohen-when-it-comes-to-the-virus-we-are-all-consistently-inconsistent

Exposed to grandchildren? Why take the chance?

reader comment

A reader’s comment above stopped me in my tracks. The past nine months have been spent mostly in the house with minimal forays out of the house for essentials like food and beer. I didn’t get a real haircut for months. The insides of a restaurant are now foreign to me. I cancelled my gym membership. So the comment made me think, why did I take the chance to spend time with Tiny Human Petri Dishes? When I stumbled upon the Cohen article I realized I was not alone. Nine months have disappeared and we all struggle with our own individual risk/reward scenarios.

The Grandchildren Bubble is unique. Risk was reduced to zero for six months. After six months all of the adults decided the Covid risk was minimal for several reasons. Two of the four adults (the most cautious and conservative ones) caught the virus. Thankfully both were fairly mild cases on the spectrum of asymptomatic to death and both have fully recovered. So two people have antibodies. The third adult is a front line HCW who deals with Covid each and every time he goes to work. The doctor has gotten tested multiple times all with negative results. One Tiny Human attends preschool and if a child has anything near a small sniffle they have to stay home and cannot rejoin the class until they have a negative Covid test. She recently received a negative test. Tiny Human Too just started crawling and doesn’t get out the house much. Not much to worry about here.

And for readers who have been counting that leaves yours truly. I lived with one of the infected before we knew she was infected. I tested negative the day before she got her test results. One of our neighbors asked if I left the house to live in a hotel. No I didn’t. Living apart while under the same roof was an interesting experience that I hope never to repeat. And despite having Covid in the house I didn’t catch it.

So I spent some time in my only trusted bubble mask less and I end up catching one or two non-Covid-19 coronaviruses. Next time I’m wearing a mask.

“There are people close who are in need”

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Several churches joined forces to distribute food on Friday as part of the “Simultaneous Free Food Giveaway.

“The Rev. Derrick Scobey, senior pastor of Ebenezer Baptist Church, helped coordinate the event, partnering with World Vision and Joey Abbo, chief executive officer of the Needs Foundation. The humanitarian aid organization and the foundation supplied the food that was distributed on Friday.

Oklahoma churches, leaders join forces for ‘simultaneous’ food distribution — https://oklahoman.com/article/5678143/oklahoma-churches-leaders-join-forces-for-simultaneous-food-distribution

If you have the means to help please help others in need.

Long Covid…(yeah, it’s real)

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A total of 669 people were followed (mean age 43 years, 60% female, 25% of healthcare professionals and 69% without underlying risk factors that could be related to complications from COVID-19). At 6 weeks from diagnosis, nearly a third of participants still had one or more symptoms related to COVID-19, mainly fatigue (14%), shortness of breath (9%) and loss of taste or smell (12%). In addition, 6% reported a persistent cough and 3% reported headaches. Dr. Mayssam Nehme, Senior Resident in Professor Guessous’s team and first author of this work, also explains how these patients felt: “In addition to the physical distress of their symptoms, many were very worried: how much longer would it last? Were some after-effects irrecoverable? Even without a clear medical answer, in the current state of knowledge, it is important to accompany concerned patients and to listen to them,” she adds. With this in mind, the HUG has set up a specific consultation for long COVID patients in order to improve their care and guide them through the health system.

Université de Genève. “COVID-19: persistent symptoms in one third of cases.” ScienceDaily. http://www.sciencedaily.com/releases/2020/12/201208111551.htm (accessed December 8, 2020) — https://www.sciencedaily.com/releases/2020/12/201208111551.htm

Journal Reference

  1. Mayssam Nehme, Olivia Braillard, Gabriel Alcoba, Sigiriya Aebischer Perone, Delphine Courvoisier, François Chappuis, Idris Guessous. COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings. Annals of Internal Medicine, 2020; DOI: 10.7326/M20-5926

I’ve been quiet for a few days, no writing, no posting. I conducted a small experiment of allowing contact with tiny human petri dishes while not wearing a mask. Naturally I caught whatever those tiny disease vectors had. The good news? My life partner wore a mask during the encounter. She’s fine.

Masks work.

Meanwhile in Oklahoma – 12.04.20

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Meanwhile at the CDC…

We don’t have enough vaccine yet for all health care workers. We will eventually, but we don’t yet.

Helen Keipp Talbot — who is known by her middle name — raised serious concerns during the meeting of the Advisory Committee on Immunization Practices about using the vaccines in the frail elderly, noting there are no data yet to suggest the vaccines work in this population.

CDC advisory panel’s lone dissenter on why long-term care residents shouldn’t receive Covid-19 vaccine first — https://www.statnews.com/2020/12/03/cdc-advisory-panels-lone-dissenter-on-why-long-term-care-residents-shouldnt-receive-covid-19-vaccine-first/

Talbot is an associate professor of infectious diseases at Vanderbilt University. Despite the fact no one seems to be listening to her opinions, she makes some excellent observations.

Meanwhile back in Oklahoma

I’m confused as to why people are confused.