5 ms·
Stage of disease also is important. In the first symptomatic stage, makes sense to try antivirals and HCQ to reduce or eliminate the virus, and prevent a casca
by DocSavage 7y ago
Stage of disease also is important. In the first symptomatic stage, makes sense to try antivirals and HCQ to reduce or eliminate the virus, and prevent a cascade into the next stage. The problematic second stage - ARDS, a subset of patients who really go critical, seems to call for different approach because at that time, it’s the cytokine storm and our own immune reaction killing us.
- vhvjkyhkogvv 7y agoDo you have a source for the last part?
- rscho 7y agoThis doesn't need a source. It's common clinical knowledge and OP is right. Unfortunately, preliminary results using our usual immunomodulatory drugs have been catastrophic.
- ajross 7y agoNo, sorry, you still need a source. In fact cytokine storms aren't the only driver of pneumonia and we don't know yet exactly what the mechanism(s) behind ARDS is. Immunology is outrageously complicated, and not well suited to that kind of pronouncement. You just have to do the science, there's no way around it. And realistically we may not have time.
- rscho 7y agoI will reformulate, then. In the current state of knowledge about both ARDS and Covid and given the time available, clinicians rely on traditional teachings to care for covid-related ARDS until solid evidence can be provided.
- hnrodey 7y agoLast night I watched a YouTube video about COVID-19 symptoms and stages of the disease and it did touch on the points brought up by OP.
- agumonkey 7y agoCould you share the url ?
- stamps 7y agoMaybe OP is referring to this one? https://www.youtube.com/watch?v=BtN-goy9VOY https://www.youtube.com/watch?v=BtN-goy9VOY
- ayoubElk 7y agoNot GP but this video gives a good overview: https://www.youtube.com/watch?v=BtN-goy9VOY https://www.youtube.com/watch?v=BtN-goy9VOY
- hnrodey 7y agoThis is specifically the video I watched yesterday. https://www.youtube.com/watch?v=OOJqHPfG7pA https://www.youtube.com/watch?v=OOJqHPfG7pA
- agumonkey 7y agooh I should have guessed :) if you want some interesting details from American MDs there's this podcast http://www.microbe.tv/twiv/twiv-593/ http://www.microbe.tv/twiv/twiv-593/ lots of subtle details that you can't get on simplified stats
- mathgeek 7y agoNot OP, but here's a Lancet correspondence on the topic (includes references): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- DocSavage 7y agoA good synopsis of current understanding (as of last Friday) was a UCSF Medicine Grand Rounds broadcast. I've bookmarked the most relevant slide to our discussion in particular: https://youtu.be/bt-BzEve46Y?t=2349 https://youtu.be/bt-BzEve46Y?t=2349 Significant lung and myocardial injury and papers have honed in on ARDS as a real problem.
- bluenose69 7y agoThis is a wonderful resource. Thank you for pointing it out.
- ArnoVW 7y agoCytokine storm is generally observed with young patients. Their immune system is "too strong for their own good". My understanding is that most deaths are in the elderly, and that those deaths are due to pneumonia.
- bagacrap 7y agosource on cytokine storm age differences? all resources I can find indicate that it's more prevalent in older patients.
- joe_the_user 7y agoEither of you have links on this?
- throwaway_pdp09 7y agoThat's my understanding too, younger ones get it harder. If this helps https://en.wikipedia.org/wiki/Cytokine_storm https://en.wikipedia.org/wiki/Cytokine_storm "It is believed that cytokine storms were responsible for the disproportionate number of healthy young adult deaths during the 1918 influenza pandemic, which killed 50 to 100 million people.[16] In this case, a healthy immune system may have been a liability rather than an asset."
- getrealhonest 7y agoYoou're wrong dude. cytokine storm is addressed by HCQ. But, you can take other immunomodulators for cytokine storm. H1-receptor antagonists. Fexofenadine. n-generation antihistamines (n in 2,3)
- snazz 7y agoRegardless of whether the parent comment is wrong, you'd be much better received if you started your reply less dismissively.
- DocSavage 7y agoHence my comment, perhaps positioned less than optimally in my statement, about preventing the cascade to next stage. The degree to which these drugs address the various issues is still in flux. In the UCSF grand rounds recently, there was some question as to the role of immunomodulators.