6 ms·

Differences in health systems and infrastructure also matter. The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perha

by fxj 7y ago

Differences in health systems and infrastructure also matter. The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perhaps most, were not caused by the influenza virus itself, but by secondary bacterial infections. Morens et al (2008) found that during the Spanish flu “the majority of deaths … likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria. Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.

OJFord 7y ago
Haven't many of the COVID-19 deaths also been due to pneumonia?
- rimliu 7y ago
  Yes, but this time its viral pneumonia.
  - etiam 7y ago
    Not only viral pneumonia though. According to a professor, specializing in pandemics, I heard interviewed while the outbreak was still focused mainly in Wuhan, many ultimately get killed off by bacterial secondary infection. Encouraging in some ways, under the horrifying circumstances, with the catch that in many parts of the world that secondary infection will be caused by multiple resistance bacteria. I'd say this pandemic is going to be by far the biggest single consequence post to date for the antibiotic resistance problem, despite being driven by a pathogen that was never sensitive to the antibiotics.
    - grabbalacious 7y ago
      Yes, and isn't this cause for some optimism since many people have now received vaccines such as Prevnar-13 and Pneumovax-23?
      - wbl 7y ago
        The CDC still isn't recommending them for all adults. At this point I probably won't go to the doctor's office due to transmission risks.
    - nostrademons 7y ago
      I heard (from a doctor who just received an e-mail summarizing clinical results from Wuhan and Seattle) that actually the primary killer is cardiac arrest. "This virus is way smarter than I'd imagined. Apparently people don't mostly die of respiratory failure, but of cardiac arrest. Doctors have noted that right as patients begin to recover from their ARDS (severe respiraotry failure requiring intubation), they suddenly develop acute heart failure (dilated cardiomyopathy with EF going from normal to <10% acutely, for the doctors on here) and go into VF/VT or asystole." The mechanism for that is unknown, but apparently the virus is attacking the heart directly.
      - thinkingemote 7y ago
        I heard that the virus isn't attacking the lungs or the heart, rather it's the immune systems response after the main infection has done it's business? Probably makes it more bizarre.
        nostrademons 7y ago
        That's the "cytokine storm" theory, right? I've heard that but also heard conflicting and inconclusive evidence about it. Some evidence against it is that lymphopenia (abnormally low white blood cell count) is seen in 83% of patients and that patients with lymphopenia have significantly worse prognosis as far as death rates are concerned; this would seem to indicate that it's not the immune system doing the damage. It doesn't conclusively rule it out - you can develop cytokine storms with a depressed immune system, and Spanish Flu was another disease that also caused both lymphopenia and cytokine storms - but it does waggle its eyes suggestively in favor of looking for other causes.
        thinkingemote 7y ago
        Thanks!
        LifeLiverTransp 7y ago
        Large scale tissue damage (to the lungs) can lead to a change in blood chemistry that disrupts the hearts rythm. Remember doctor houses infarcted muscle leading to cardic arrest? Among porteins and shredded cell dna-rna, potasium is disloged from dead tissue, and weakens/disables the powerplants in muscles. The effect may be hidden beneath the general achiness of a viral malaise. https://www.webmd.com/digestive-disorders/hypokalemia#1 https://www.webmd.com/digestive-disorders/hypokalemia#1
  - hinkley 7y ago
    When I learned diaphragmic breathing years ago, there were some studies around suggesting that it helped clear the lungs, especially the lower lungs, of debris and fluid, which can help prevent bacterial pneumonia. Anecdotes != data, but I've had 1 'chest cold' in the intervening years, whereas as a child and teen most of my colds were chest colds and clearing my lungs was a major step in every recovery.
- malandrew 7y ago
  I'm also curious about how many were due to a cytokine storm and multiple organ failure.
onetimemanytime 7y ago
can the system dispense as many as needed antibiotics in time? Or, I guess, they just drop them via helicopter...even if it means that some will be taken for no reason
dragontamer 7y ago
> The Spanish flu hit the world in the days before antibiotics were invented; IIRC: Antibiotics and germ theory were invented. But the scientific community and the medical community weren't fully on board yet.
- eloff 7y ago
  Germ theory goes back a lot longer. It was well accepted by 1918.
  - Balgair 7y ago
    The Broad Street Pump in 1854 London was the thing that really got germ theory going. Before that, people reasonably were suspicious of germ theory based on their understanding of chemistry. If you dilute a bad substance in the Thames, there is just no way it can be that deadly, dilution wins. They had no idea that the substance could self-replicate. Dr. John Snow started out knowing nothing, but in a feat of science that still amazes, he helped the world learn a lot. His dogged persistence has saved billions of lives by now. Fun Fact: After they realized London needed a proper sewer system, they knew that just digging up the streets would never again happen. So they built the sewer system at well above max capacity. Nearly 150 years later, London is now starting to think about improving that capacity. Great overview here: https://www.youtube.com/playlist?list=PL3jY7zdQgRU5EHJ_MMyEetAE_KPF0XTZR https://www.youtube.com/playlist?list=PL3jY7zdQgRU5EHJ_MMyEe...
    - kragen 7y ago
      People did know about self-replicating substances; they'd been using them for making beer and bread for millennia. The nature of yeast was a mystery, but the capacity of fermentation to spread through a nutrient medium was well-known. An edition of Cooley's Cyclopedia I read from around that time attributes fermentation to a particular kind of molecular excitation, which is only true in the sense that it's true of all physical processes on materials made out of molecules. He gives some recipes for producing yeast by spontaneous generation (or, as we now know, from airborne or foodborne spores). Amusingly, among the numerous recipes for deadly medicines made from mercury, arsenic, and lead, Cooley also gives a number of quite effective disinfectant recipes. He rejects the "contagion" theory that infectious diseases require contact to spread, preferring the "miasma" theory. I think Pasteur's experiments with the beef broth in the 1860s were what really convinced all philosophers of the germ theory. Snow already believed something similar (contagion from "morbid matter"), but the Broad Street Pump results did not convince the doubters quite as effectively.
wusher 7y ago
Continuing with that thought, the correct dosages of drugs like aspirin were still being worked out. Aspirin was common treatment for the Spanish Flu, but an overdose of aspirin causes a build up of fluid in the lungs making pneumonia worse. https://www.sciencedaily.com/releases/2009/10/091002132346.htm https://www.sciencedaily.com/releases/2009/10/091002132346.h...
deleted 7y ago
[deleted]
all_blue_chucks 7y ago
We can now treat bacterial pneumonia, but COVID-19 causes pneumonia directly, unfortunately.

by fxj 7y ago

OJFord 7y ago

Haven't many of the COVID-19 deaths also been due to pneumonia?

rimliu 7y ago
Yes, but this time its viral pneumonia.
- etiam 7y ago
  Not only viral pneumonia though. According to a professor, specializing in pandemics, I heard interviewed while the outbreak was still focused mainly in Wuhan, many ultimately get killed off by bacterial secondary infection. Encouraging in some ways, under the horrifying circumstances, with the catch that in many parts of the world that secondary infection will be caused by multiple resistance bacteria. I'd say this pandemic is going to be by far the biggest single consequence post to date for the antibiotic resistance problem, despite being driven by a pathogen that was never sensitive to the antibiotics.
  - grabbalacious 7y ago
    Yes, and isn't this cause for some optimism since many people have now received vaccines such as Prevnar-13 and Pneumovax-23?
    - wbl 7y ago
      The CDC still isn't recommending them for all adults. At this point I probably won't go to the doctor's office due to transmission risks.
  - nostrademons 7y ago
    I heard (from a doctor who just received an e-mail summarizing clinical results from Wuhan and Seattle) that actually the primary killer is cardiac arrest. "This virus is way smarter than I'd imagined. Apparently people don't mostly die of respiratory failure, but of cardiac arrest. Doctors have noted that right as patients begin to recover from their ARDS (severe respiraotry failure requiring intubation), they suddenly develop acute heart failure (dilated cardiomyopathy with EF going from normal to <10% acutely, for the doctors on here) and go into VF/VT or asystole." The mechanism for that is unknown, but apparently the virus is attacking the heart directly.
    - thinkingemote 7y ago
      I heard that the virus isn't attacking the lungs or the heart, rather it's the immune systems response after the main infection has done it's business? Probably makes it more bizarre.
      - nostrademons 7y ago
        That's the "cytokine storm" theory, right? I've heard that but also heard conflicting and inconclusive evidence about it. Some evidence against it is that lymphopenia (abnormally low white blood cell count) is seen in 83% of patients and that patients with lymphopenia have significantly worse prognosis as far as death rates are concerned; this would seem to indicate that it's not the immune system doing the damage. It doesn't conclusively rule it out - you can develop cytokine storms with a depressed immune system, and Spanish Flu was another disease that also caused both lymphopenia and cytokine storms - but it does waggle its eyes suggestively in favor of looking for other causes.
        thinkingemote 7y ago
        Thanks!
      - LifeLiverTransp 7y ago
        Large scale tissue damage (to the lungs) can lead to a change in blood chemistry that disrupts the hearts rythm. Remember doctor houses infarcted muscle leading to cardic arrest? Among porteins and shredded cell dna-rna, potasium is disloged from dead tissue, and weakens/disables the powerplants in muscles. The effect may be hidden beneath the general achiness of a viral malaise. https://www.webmd.com/digestive-disorders/hypokalemia#1 https://www.webmd.com/digestive-disorders/hypokalemia#1
- hinkley 7y ago
  When I learned diaphragmic breathing years ago, there were some studies around suggesting that it helped clear the lungs, especially the lower lungs, of debris and fluid, which can help prevent bacterial pneumonia. Anecdotes != data, but I've had 1 'chest cold' in the intervening years, whereas as a child and teen most of my colds were chest colds and clearing my lungs was a major step in every recovery.
malandrew 7y ago
I'm also curious about how many were due to a cytokine storm and multiple organ failure.

onetimemanytime 7y ago

can the system dispense as many as needed antibiotics in time? Or, I guess, they just drop them via helicopter...even if it means that some will be taken for no reason

dragontamer 7y ago

> The Spanish flu hit the world in the days before antibiotics were invented; IIRC: Antibiotics and germ theory were invented. But the scientific community and the medical community weren't fully on board yet.

eloff 7y ago
Germ theory goes back a lot longer. It was well accepted by 1918.
- Balgair 7y ago
  The Broad Street Pump in 1854 London was the thing that really got germ theory going. Before that, people reasonably were suspicious of germ theory based on their understanding of chemistry. If you dilute a bad substance in the Thames, there is just no way it can be that deadly, dilution wins. They had no idea that the substance could self-replicate. Dr. John Snow started out knowing nothing, but in a feat of science that still amazes, he helped the world learn a lot. His dogged persistence has saved billions of lives by now. Fun Fact: After they realized London needed a proper sewer system, they knew that just digging up the streets would never again happen. So they built the sewer system at well above max capacity. Nearly 150 years later, London is now starting to think about improving that capacity. Great overview here: https://www.youtube.com/playlist?list=PL3jY7zdQgRU5EHJ_MMyEetAE_KPF0XTZR https://www.youtube.com/playlist?list=PL3jY7zdQgRU5EHJ_MMyEe...
  - kragen 7y ago
    People did know about self-replicating substances; they'd been using them for making beer and bread for millennia. The nature of yeast was a mystery, but the capacity of fermentation to spread through a nutrient medium was well-known. An edition of Cooley's Cyclopedia I read from around that time attributes fermentation to a particular kind of molecular excitation, which is only true in the sense that it's true of all physical processes on materials made out of molecules. He gives some recipes for producing yeast by spontaneous generation (or, as we now know, from airborne or foodborne spores). Amusingly, among the numerous recipes for deadly medicines made from mercury, arsenic, and lead, Cooley also gives a number of quite effective disinfectant recipes. He rejects the "contagion" theory that infectious diseases require contact to spread, preferring the "miasma" theory. I think Pasteur's experiments with the beef broth in the 1860s were what really convinced all philosophers of the germ theory. Snow already believed something similar (contagion from "morbid matter"), but the Broad Street Pump results did not convince the doubters quite as effectively.

wusher 7y ago

Continuing with that thought, the correct dosages of drugs like aspirin were still being worked out. Aspirin was common treatment for the Spanish Flu, but an overdose of aspirin causes a build up of fluid in the lungs making pneumonia worse. https://www.sciencedaily.com/releases/2009/10/091002132346.htm https://www.sciencedaily.com/releases/2009/10/091002132346.h...

deleted 7y ago

[deleted]

all_blue_chucks 7y ago

We can now treat bacterial pneumonia, but COVID-19 causes pneumonia directly, unfortunately.