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ICU Doctor: Top 10 Things I learned Treating Coronavirus Patients | COVID-19


ICU Doctor: Top 10 Things I learned Treating Coronavirus Patients | Coronavirus Intensive Care

ICU Doctor: Top 10 Things I learned Treating Coronavirus Patients | Coronavirus Intensive Care
#coronavirus #covid19 #covid_19

Coronavirus | COVID-19 YouTube Video Playlist:

Some intensive care units in various hospitals throughout this county have designated units for COVID-19 patients. As an intensive care doctor, I’ve been seeing a lot of COVID-19 patients in our designated Coronavirus ICU. It's one thing to read about Coronavirus in the medical literature, but to be actually seeing real patients with this disease is another experience altogether. There are a lot of things I’ve learned, but for this video, I’ll focus on the top 10 that stand out to me.

So, starting at the bottom with number 10, is, signs/symptoms. The most common symptoms that I’m seeing are fever, cough, shortness of breaths, and body/muscle aches. I haven’t seen many patients with the other symptoms we often hear about, such as loss of taste and smell, or nausea, and diarrhea. I have not seen any rashes related to Coronavirus, probably because I only see adult patients. I will say that even though confusion and delirium are very common in the ICU in general, there does seem to be more of that with Coronavirus.

A lot of COVID-19 patients who require hospitalization have low levels of vitamin D. And this is consistent with what we are seeing in a lot of recent studies that have been coming out. But of course, correlation doesn’t necessarily mean causation, so does it just so happen that a lot of patients who have moderate or severe COVID, happen to have low vitamin D levels? Maybe, maybe not. And does that mean that we should give every hospitalized patient with Coronavirus big doses of vitamin D when they hit the door? Maybe. And does that mean people, in general, should supplement with vitamin D? And what is the ideal level of vitamin D for the population, especially when it comes to COVID-19? Should we be targeting the current general recommendation for everyone, irrespective of COVID-19, with a goal of 20 ng/ml? or should we aim for higher, like 30, or perhaps 40? No one knows for sure the answers to these questions. But there are studies being done on this. And as we speak there are 3 RCT for vitamin D and Coronavirus.

This virus is VERY contagious. One of my patients was in the hospital for unrelated reasons. She actually had sepsis due to infarcted gut, meaning part of her intestine was not getting enough blood flow. It was severe enough to the point that some of the tissue in her intestine had died. When this happens, the bacteria that live in the intestine can then invade the walls of the intestine, and get into the bloodstream. This is bad news because these bacteria can then spread throughout the body, and this is known as sepsis. Besides antibiotics, this treated with surgery, where the dead gut tissue is removed, meaning part of the intestine is taken out. And this is what happened to her. And she got better. But after she initially got better, she started having more difficulty with her breathing. Her oxygen levels were dropping, despite us giving her more and more oxygen. So we got a CXR, and later a CT scan of the chest, which showed bilateral infiltrates, meaning areas of inflammation in both lungs. And this is the pattern we typically see with COVID-19 pneumonia, where it tends to go to the periphery of the lungs and also more so at the bottom of the lungs.

Vitamin D3 (Cholecalciferol) and Vitamin D2 (Ergocalciferol) and Calcitriol
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Does Vitamin D help with Immunity?
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Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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#coronavirus #covid19 #covid_19

How to Treat Coronavirus Patients in the ICU (Intensive Care Unit) | Covid-19

How to Treat Coronavirus Patients in the ICU (Intensive Care Unit) | Covid-19

Coronavirus | COVID-19 YouTube Video Playlist:

#coronavirus #covid19 #covid_19

Coronavirus (COVID-19) has brought unprecedented challenges regarding the ability to generate timely evidence, all while this pandemic overwhelms hospitals and health care workers.

About 5% of patients with coronavirus require admission to the intensive care unit and mechanical ventilation.

Based on the recent epidemiological models, Coronavirus is going to hit all the areas in the USA.

Every ICU is preparing for the surge, there are a number of changes that intensive care units are making, including ours.

We are preparing anesthesiologists (who are not CCM trained) and nurse anesthetists, to help us manage patients with COVID-19. Even though they are not CCM trained, we have a lot of overlap of knowledge, especially when it comes to managing ventilators, and we have a lot of overlap with certain procedures.

By allowing anesthesiologists and nurse anesthetists to help in this manner, it will help other intensivists like myself handle the surge of patients coming our way.

And because they are helping us, that is the main reason for me making this video, so that they can watch this and be better equipped to handle the surge with us.

“Knowing, and implementing all of the info in this video does not guarantee you save a COVID-19 patient living in the ICU, but, it will give you the best chance of doing so”

If a patient with COVID-19 is coming to your ICU, they most certainly have pneumonia, and they probably have acute respiratory distress syndrome (ARDS) as well.

Patients with severe disease who require ICU admission are likely to have high oxygen requirements.
Although both High flow oxygen and noninvasive positive pressure ventilation have been used for COVID-19, the safety of these is uncertain, and they are considered aerosol-generating procedures that warrant specific isolation precautions.

Most patients who require ICU admission have ARDS, and they will likely have a better outcome if intubated sooner rather than later. That is another reason why it likely better to skip Hi-Flow oxygen and NIPPV and jump straight to intubation.

Acute Respiratory Distress Syndrome (ARDS)
ARDS is a clinical diagnosis, based on non-cardiogenic pulmonary edema, with bilateral patchy infiltrates on chest imaging and a PaO2/FiO2 ratio of less than 300.

In ARDS, there is this crazy, chaotic inflammatory response within the lungs, with damage to the alveoli and surrounding capillaries, which leads to excess protein and fluid accumulation in interstitial and alveolar spaces.

That means decreased lung compliance, increased V̇/Q̇ mismatch, and increases in shunt and dead-space ventilation.

Patients with ARDS are at high risk of mortality, which increases with ARDS severity. With that said, mortality is usually the result of the underlying disease that triggered ARDS, rather than refractory hypoxemia.

The severity of ARDS is important because it’s going to determine how we manage patients with ARDS.

With ARDS, the alveoli fill up with protein and fluid. This leads to at least partial alveolar collapse, and decreased lung compliance, with shunt physiology.

Increasing the PEEP minimizes the repeated opening and closing of distal airways and alveoli. It also improves the homogeneity of the lung parenchyma by reducing drastic differences in regional lung compliance.

What is the ideal level of PEEP?
No one knows for sure. Typically for ARDS, we set the initial PEEP between 10 to 15. Sometimes all the way to 20 if they have severe disease. You don’t want to go too high though, because this increases the risk of pneumothorax.
The recommendation is to give COVID-19 patients steroids only if they have ARDS.

Critically ill patients with coronavirus often develop septic shock. And for shock, we give IVF and vasopressors. But ARDS patients generally do better when you keep them in a negative fluid balance state.

COVID-19 patient, who is in shock and ARDS, what should you do?
Based on my experience of treating ARDS patients who are in shock, my recommendation would be to use minimal fluid possible and to start vasopressors early. In my experience, patients tend to respond better to albumin than crystalloids, especially if they have low albumin levels. Either way, you’re going to want to assess fluid resuscitation responsiveness, and if they don’t respond well to fluids, just stick with the vasopressors.

Note: To get the proper details please watch the video from first to last without skipping.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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#coronavirus #covid19 #covid_19

Italian doctor on treating COVID-19 patients

Infectious disease specialist Dr. Giovanni Guaraldi discusses lessons being learned by Italian doctors about the new virus – with advice for Canadian physicians.

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What Doctors Are Learning From Autopsy Findings of New CORONAVIRUS Patients

What Doctors Are Learning From Autopsy Findings of New CORONAVIRUS Patients

⏩ Timestamps, click to skip ahead!
00:00 - Common Systoms of COVID
01:40 - What we know about COVID
02:25 - Early findings of Multiple Cutopsy and Biopsy Reports of COVID
03:02 - Microscope Picture of the Coronavirus and Kidney Cells
03:20 - COVID Autopsy Findings

Once the SARS-CoV-2 virus is deeply embedded in the body, it begins to cause more severe disease. This is where the direct attack on other organs that have ACE2 receptors can occur, including heart muscle, kidneys, blood vessels, liver, and the brain. Early findings, including those from multiple autopsies and biopsy reports, show that viral particles can be found not only in the nasal passages and throat, but also in tears, stool, kidneys, liver, pancreas, and heart. One case report found evidence of viral particles in the CSF, meaning the fluid around the brain. That patient had meningitis.

So the coronavirus is sometimes going to all these different organs by means of attaching to the ACE2 receptors that are there, but that’s not even the whole story.

Because in some COVID-19 cases, by the time the body’s immune system figures out the body are being invaded, it's like unleashing the military to stomp out the virus, and in that process, there’s a ton of collateral damage. This is what we refer to as the cytokine storm. When the COVID gets into the alveolar cells, meaning the tiny little air sacs within the lungs, it makes a ton of copies of itself and goes onto invading more cells. The alveoli’s next-door neighbor is guessed who, yeah, the tiniest blood vessels in our body, capillaries. And the lining of those capillaries is called the endothelium, which also has ACE2 receptors. And once the coronavirus invades the capillaries. It means that it serves as the trigger for the onslaught of inflammation AND clotting. Early autopsy results are also showing widely scattered clots in multiple organs. In one study from the Netherlands, 1/3rd of hospitalized with COVID 19 got clots despite already being on prophylactic doses of blood thinners. So not only are you getting the inflammation with the cytokine storm, but you’re also forming blood clots, that can travel to other parts of the body, and cause major blockages, effectively damaging those organs.

So it can cause organ damage by
1) Directly attacking organs by their ACE2 receptor - Yes!
2) Indirectly attacking organs by way of collateral damage from the cytokine storm - Yes!
3) Indirectly cause damage to organs by means of blood clots - Yes!
4) Indirectly cause damage as a result of low oxygen levels, improper ventilator settings, drug treatments themselves, and/or all of these things combined - Yes!

Endothelial cells are more vulnerable to dying in people with preexisting endothelial dysfunction, which is more often associated with being a male, being a smoker, having high blood pressure, diabetes, and obesity. Blood clots can form and/or travel to other parts of the body. When blood clots travel to the toes, and cause blockages in blood flow there, meaning ischemia or infarction, that can cause gangrene there. And lots of times patients with gangrene require amputation, and “COVID toes”

So is antiphospholipid antibody syndrome, the cause of all these blood clots in patients with severe COVID? Maybe. Some patients with APS have what’s called catastrophic APS, where these patients can have strokes, seizures, heart attacks, kidney failure, ARDS, skin changes like the ones I mentioned. Viral infectious diseases, particularly those of the respiratory tract, have been reported as being the triggers for CAPS.

Various factors increase the risk of developing arterial thrombosis. Classically, the cardiovascular-dependent risk factors implicated in clotting have been hypertension, meaning high blood pressure, high levels of cholesterol, smoking, diabetes, age, chemotherapy, and degree of infection. All of these contribute toward developing arterial thrombosis.

A lot of patients with severe COVID 19 have certain labs that resemble DIC, such as increased PT/INR, increased PTT, decreased levels of platelets. But the reason why these Coronavirus patients who developed clots in the study I mentioned earlier, the reason why they don’t have DIC, is actually 2 reasons, one, they weren’t having extensive bleeding, and two, they did not have low fibrinogen levels. And if its truly DIC, you would have both of those things.

Anyway, you can probably glean from this video why it's so hard for doctors to figure out what is going on with this virus. Between the variable ways this disease can present in different patients, and the different ways that organs can suffer damage, yeah, this is really, really really, complicated.

Are BLOOD CLOTS the reason why COVID-19 patients are dying?
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Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

What happens when you’re in the ICU with COVID-19

A look at how sick someone has to be to be taken to the ICU, what the treatment might be and what recovery could look like.

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ER doctor treating coronavirus shares grim details of dying patients, lack of ventilators

In New York, where nearly half of the U.S.'s reported coronavirus cases are, one hospital saw 13 deaths in just one day. An ER doctor at the hospital told The New York Times that they had to get a refrigerated truck to store the bodies of dying patients as they scramble to keep up with the wave of cases. David Begnaud reports on the doctor's grim account and the hospital's struggle to get more life-saving ventilators.

Homemade ICU for COVID-19 Patients | Dr. Sanjeev Kumar | Sunshine Hospitals

Dr. Sanjeev Kumar, DM Cardiology at Sunshine Hospitals, speaks about how you can create an ICU at home for family members with symptoms. Do tune in!

#covid19 #covid_19 #icu #quarantine #covidathome #stayhome #covidpatient #covid #coronavirus #treatment

Home Care Tips For Mild COVID-19 Cases | Dr. Sushila Kataria

Dr. Sushila Kataria, Senior Director, Internal Medicine, Medanta Gurugram shares home care tips for patients with mild COVID-19 symptoms, who have been advised home isolation by their doctors.

To know more about Medanta COVID Home Care, call us on +91 124 4834566

ICU Care in COVID-19 (2 of 3): Management of the critically ill COVID patient

Background: The CMC Vellore COVID PUblic Lecture SEries (COVID PULSE) were instituted with the aim to: a) Provide clinicians with up-to-date knowledge on integral aspects of COVID-19 management to inform clinical care and improve patient outcomes b) Bring together doctors from various backgrounds so that questions regarding the feasibility of interventions and/or barriers to implementation across diverse care scenarios are examined and addressed c) Provide ideas for further innovation and d) Help clinicians design or refine protocols in the context of available resources.
This is the fourth lecture in the CMC Vellore COVID PUblic Lecture SEries (COVID PULSE). Speaker: Dr. Binila Chacko, Professor, Medical ICU and Division of Critical Care, Christian Medical College, Vellore. Moderator: Dr. Pritish Korula, Associate Professor, Surgical ICU and Division of Critical Care, Christian Medical College, Vellore.

Outline of the full lecture:
1. How did we get COVID ready? - The CMC Vellore Medical ICU story
2. Management of the critically ill COVID patient - pharmacotherapy, ventilation
3. Outcomes in critically ill patients - the CMC experience
4. Questions from the audience

Do Ventilators Save Coronavirus (COVID-19) Patient's Lives?

Do Ventilators Save Coronavirus (COVID-19) Patient's Lives?

Ventilators are not a cure, but instead are a form of life support.

Most COVID-19 Patients, who need a breathing tube, meaning mechanical ventilation, do not live. Based on a recent study, only 14% live. To understand why this is, let’s take a look at what intubation and mechanical ventilation really mean, and we also have to understand what COVID-19 does to the lungs.

When we intubate someone, meaning put a breathing tube down into their upper airway, and have that person on a ventilator, meaning mechanical ventilation, there are only 4 main reasons why we do that. So it’s sometimes its one, two, three, or all 4 of these reasons.

1. Indications for Intubation (at least one of following)
a. Hypoxia
b. Hypercapnia
c. Increased WOB
d. Reduced level of consciousness

2. COVID-19 patients who are intubated (mortality rate)
a. COVID-19 patients die because it triggers a chaotic inflammatory response within the lungs
i. Causes (EVALI, Trauma, Pneumonia, Aspiration, Sepsis, blood transfusions)
ii. Diagnosis
1. Low paO2 to FiO2 ratio
2. Bilateral infiltrates on CXR or CT scan (GGO)

3. Non-cardiogenic
iii. keys to managing ARDS patients
1. LTVV and PEEP
2. What is PEEP?
3. Risk of PEEP
4. Prone positioning
5. Steroids
6. Paralysis
7. Different mechanical ventilation strategies
c. average length of mech ventilation: 17 days
d. the mortality rate for those who required intubation: 86% (based on a study done a few weeks ago in the Lancet)

3. Course for intubated patients
a. Get better, extubate
b. Don’t get better, trach
c. Don’t get better, extubate and die in peace/comfort
d. Get worse and die with a breathing tube in, connected to the ventilator

a. What is ECMO?
b. 30% risk of bleeding
c. 5% risk of thromboembolism
d. Only 250 centers
e. Not accepting transfers

a. The patient and/or family decides on wishes
b. DNI
c. DNR
d. CPR for COVID-19 patients?
e. Teams determining code status based on SOFA scores

Dexamethasone for Coronavirus (COVID-19) - GOOD NEWS! ???? | Coronavirus Medicine

Dexamethasone for Coronavirus | Coronavirus Medicine

Dexamethasone is being called a “Major Breakthrough” based on a recent RCT in the UK. Dexamethasone (Decadron), is an example of a glucocorticoid. Glucocorticoids are sometimes referred to as corticosteroids. Other examples of glucocorticoids include Hydrocortisone, Methylprednisolone, Prednisolone, Prednisone, Betamethasone, and Triamcinolone. Glucocorticoids are a class of steroid hormones that bind to the glucocorticoid receptor in the body. Cortisol (hydrocortisone) is the glucocorticoid we naturally make in our body. It is essential for life, and it regulates or supports various cardiovascular, metabolic, and homeostatic functions. It also plays a big role in our immune system, especially when it comes to reducing certain aspects of inflammation.

This is why we use them all the time in medicine. We sometimes give these steroids for asthma, COPD, rheumatologic type diseases, and countless more diseases. Sometimes we give steroids for meningitis, and also for some forms of cancer. We give them in the early course of severe ARDS, acute respiratory distress syndrome, whether that ARDS is due to infection such as pneumonia, or vaping lung injury, or whatever the cause.

For severe ARDS, we typically give methylprednisone, at a dose of 1 mg/kg per day. So for most people, that ends being around 80 mg per day. This is the equivalent of 15 mg of dexamethasone for covid 19. The idea here is to suppress the cytokine storm that is taking place, meaning that massive amount of inflammation that causes lung damage and can indirectly cause damage to other organs as well. Our body naturally makes cortisol in our adrenal glands, specifically, in the zona fasciculate of the adrenal cortex. The adrenal gland then secretes cortisol into the bloodstream, and travels to different tissues of the body, and then binds to the glucocorticoid receptor inside cells. It then stimulates the cell to make more anti-inflammatory proteins and reduces the number of pro-inflammatory proteins being made. But giving someone glucocorticoids (steroids) who has an infection is somewhat of a tricky thing because the fear is that if you suppress the body’s immune system, it has the potential to make the infection worse. But sometimes the body’s immune system does more damage than the actual infection. For example, in cases of meningitis that is due to streptococcus or tuberculosis, we give steroids because the medical evidence shows that they have better outcomes when we do so.

Giving someone steroids for viral pneumonia, such as influenza, is more controversial because doing so generally leads to a worse infection. With that said, if the viral pneumonia is so bad to the point of causing severe ARDS, most doctors including myself will give steroids in that situation. This is why the general medical guidelines thus far recommend against giving steroids for COVID pneumonia unless the patient has severe ARDS. We’ve been waiting for RCT to come out for steroids and COVID-19, and here we are now. In March 2020, the RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial was one of that RCT that actually looked at several different potential treatments for COVID-19, which included low-dose dexamethasone (a steroid treatment). This trial was done in the UK and had over 11,500 patients in it.

So this trial has not been peer-reviewed as of the making of this video and has not been published in a journal yet. So everything I know so far is based on what has been released to the general public. In this trial, over 2100 patients were randomized to receive dexamethasone 6 mg once per day for ten days and were compared with over 4300 patients randomized to standard care alone. So 6 mg of dexamethasone is the equivalent of 32 mg of methylprednisolone, so this is about half the dose we would typically use for someone with severe ARDS.

Among the patients who received standard care alone, 28-day mortality was highest in those who required mechanical ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any supplementary oxygen (13%). For patients on ventilators, dexamethasone reduced mortality from 41% to 28%. For patients needing supplemental oxygen, it reduced mortality from 25% to 20%. There was no benefit among those patients who did not require supplemental oxygen. In other words, if someone only has mild disease, there is no point in giving dexamethasone. Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients, and around 25 patients requiring oxygen alone. So these preliminary results, are significant but do not mean that dexamethasone is a miracle drug. It's certainly not a cure. But it does seem to help, based on these numbers. And dexamethasone could be of huge benefit in poorer countries with high numbers of Covid-19 patients, because the drug is very cheap & widely available.

An inside look at a Texas hospital overwhelmed by coronavirus patients

For the second time in a week, Texas hospitalized over 10,000 virus patients as officials worry about the lack of ICU beds in the entire state. Mireya Villarreal gives us an inside look at a Rio Grande Valley hospital where they've had to rent beds to accommodate the influx of patients.

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Coronavirus medical update: How to treat Covid-19? | COVID-19 Special

As millions of people aroung the globe continue to suffer during the coronavirus pandemic, the entire world is holding out for a cure. The coronavirus pandemic is a test for national governments,the global scientific community and the pharmaceutical industry. The stakes could hardly be higher. How close are we to curing Covid-19?

One drug that's attracted a LOT of attention during the pandemic is Hydroxychloroquin, used to treat malaria. US President Donald Trump claimed he was taking it to help ward off the coronavirus, a course of action scientists do not recommend. That said, there still appears to be some confusion about the drug's effects.


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Doctors warn of potentially deadly blood clots in COVID-19 patients

Doctors are warning about the mysterious and dangerous problem of blood clotting among some coronavirus patients. CBS News senior medical correspondent Dr. Tara Narula explores the new symptom and a potential new treatment that can help.

Top Covid-19 Doctor Explains Hong Kong's Low Death Rate

Hong Kong’s top coronavirus pandemic doctor sees a way out of intensive care for thousands of Covid-19 patients: keeping them from entering in the first place. After sobering experiences 17 years ago with the outbreak of severe acute respiratory syndrome (SARS), Yuen Kwok-Yung is advocating early, aggressive hospitalization and treatment to minimize ravaging disease and death. Hong Kong’s 2% Covid-19 fatality rate as of Friday, well below the global average, lends weight to the approach.

Most therapies for SARS-CoV-2 are authorized for use in severely ill patients, in some cases backed by research that’s still in question. Yuen, the Henry Fok professor in infectious diseases at the University of Hong Kong for 15 years, is admitting patients with minimal disease so they can be isolated, monitored and treated if needed.

“In places like the U.K. and U.S., usually if you have mild symptoms, you are not admitted to a hospital at all -- you just wait at home until you feel very bad or you have shortness of breath,” he explained over Zoom from his office. “But we basically admit any patients, even without much symptoms, into the hospital for isolation.”

The strategy reduces transmission in the community, and enables patients to enter a clinical trial and receive experimental treatment soon after developing a fever or showing other signs of worsening illness, Yuen said. That’s critical because the amount of SARS-CoV-2 virus or “viral load” in patients peaks at around the time symptoms appear -- similar to influenza.

Yuen, who graduated from the University of Hong Kong in 1981 and has the rare distinction of being a microbiologist, surgeon and physician, has been at the forefront of the city’s response to infectious outbreaks for decades. In 1998, he and colleagues described the first dozen patients afflicted with the H5N1 strain of avian influenza. Five years later, they reported SARS in a patient visiting Hong Kong from Guangzhou, China.

“All this is an extension of our experience in the year 2003,” Yuen said. “We have nothing to brag about because we learned bitterly from 2003 SARS.”

The appearance of an unknown virus to which no one has immunity created a desperate need for effective treatments. Hong Kong doctors are using several experimental treatments, including infusions of convalescent plasma -- a mix of factors extracted from recovered patients’ blood -- and injections of interferon, an immune-system protein.

They’re also using the antivirals ribavirin and Kaletra, although preliminary results released Thursday from a World Health Organization-led trial involving 11,266 patients in 30 countries found they don’t decrease patients deaths. Yuen said he wasn’t surprised by the results of the WHO’s study because the drugs weren’t administered soon after patients became ill.

“No antiviral will work if given late,” he said. The drugs were also administered singly, rather in combinations that could add to their impact, he said.

“We know that one drug is not good because all of these are very modestly active,” Yuen said. “We need early cocktail therapy to get good results.”

Giving a combination of ribavirin, Kaletra and interferon to patients in the first week of illness reduced the time to clear the virus by six days and shortened hospitalization by a week, when compared with giving Kaletra alone, Yuen and colleagues showed in a study in May.

The trial, published in The Lancet medical journal, recruited 127 patients from Feb. 10 to March 20 -- more than half of the Covid-19 cases reported in Hong Kong during that period. Patients began treatment about five days after developing symptoms.

“With the memory of the 2003 SARS pandemic, most patients with Covid-19 in Hong Kong accepted antiviral treatment, which explained our high recruitment rate,” Yuen and his team wrote.

Hong Kong took rapid and decisive action in response to Covid-19 because of the legacy of SARS, Yuen said. He hopes others will learn from the current crisis about the need to prepare for and mitigate the risks of future pandemics.

“It’s the 2003 experience that allowed us to walk another mile early,” Yuen said. “I hope that everybody in the world will learn this time that emerging infectious disease is something that would happen more and more frequently.”

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What doctors are learning from recovering coronavirus patients

As more coronavirus cases are reported in the U.S., doctors are hoping stories of recovery could help them learn more about how to treat the disease. Dr. David Agus joins CBS This Morning to explain what the road to recovery looks like and how doctors can use that information to help future cases.

COVID-19 | Coronavirus: Epidemiology, Pathophysiology, Diagnostics


Ninja Nerds,
What is Corona virus? What is COVID-19? Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronavirus disease (COVID-19) caused by SARS-COV2 is a new strain that was discovered in 2019 and has not been previously identified in humans.
Coronaviruses are zoonotic, meaning they are transmitted between animals and people.  Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. It is believed that COVID-19 was transmitted from pangolin to humans (current theory).
Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death (WHO, 2020).
Ninja Nerd Lectures has compiled the most up to date and recent data on COVID-19 as of March 15, 2020. Please follow along with this lecture to understand the origin and zoonosis of COVID-19, the routes of transmission, epidemiology (current as of 3/15/2020), pathophysiology, and diagnostic tests used to identify COVID-19.
As new information and research is published we will continue to provide updates on COVID-19 and ensure all of our viewers are kept up to date on the most recent data.


REFERENCES: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC).

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Nutrition Support for Critically Ill Patients with COVID-19 Disease: Top 10 Key Recommendations

A review of the top 10 key expert opinion recommendations for nutrition support for the critically ill patient with COVID-19.

These recommendations should be used to help guide the professional judgement of healthcare professionals, whose judgement is the primary component of quality medical care. The information presented is not a substitute for the exercise of this judgement by the healthcare professional.

This presentation has been reviewed and approved by the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN).

Additional Resources

Recognizing Day to Day Signs and Symptoms of Coronavirus

Before proceeding, please note that this general overview is compiled for initial self-assessment only and may vary for each individual. If you're not feeling well, you should immediately consult a medical practitioner to have an accurate diagnosis and proper treatment of COVID-19.
The typical daily symptoms are concluded from the study of 138 patients at Zhongnan Hospital of Wuhan University and another study involving 135 patients from Jinyintan Hospital and 56 patients from Wuhan Pulmonary Hospital.
These symptoms are broken down into:
The beginning symptoms are similar to the common cold with a mild sore throat and neither having a fever nor feeling tired. Patients can still consume food and drink as usual.
The patient's throats start to feel a bit painful. Body temperature reads at around 36.5° celsius. Although it's uncommon, other symptoms like mild nausea, vomiting or mild diarrhea are possible to set in.
Throat pain becomes more serious. Other symptoms like feeling weak and joint pain start to manifest. The patient may show a temperature reading between 36.5° to 37° celsius.
DAY 5 TO 6
Mild fever starts. The patients show a temperature reading above 37.2° celsius. The second most common symptom, dry cough, also appears. Dyspnea or breathing difficulty may occur occasionally. Most patients in this stage are easily feeling tired. Other symptoms remain about the same. These four symptoms are among the top five key indications of COVID-19 according to the final report of the initial outbreak conducted by the joint mission of China and WHO.
The patients that haven't started recovering by day 7 get more serious coughs and breathing difficulty. Fever can get higher up to 38° celsius. Patients may develop further headache and body pain or worsening diarrhea if there’s any. Many patients are admitted to the hospital at this stage.
DAY 8 TO 9
On the 8th day, the symptoms are likely to be worsened for the patient who has coexisting medical conditions. Severe shortness of breath becomes more frequent. Temperature reading goes well above 38°. In one of the studies, day 9 is the average time when Sepsis starts to affect 40% of the patients.
DAY 10 TO 11
Doctors are ordering imaging tests like chest x-ray to capture the severity of respiratory distress in patients. Patients are having loss of appetite and may be facing abdominal pain. The condition also needs immediate treatment in ICU.
DAY 12 TO 14
For the survivors, the symptoms can be well-managed at this point. Fever tends to get better and breathing difficulties may start to cease on day 13. But Some patients may still be affected by mild cough even after hospital discharge.
DAY 15 TO 16
Day 15 is the opposite condition for the rest of the minority patients . The fragile group must prepare for the possibility of acute cardiac injury or kidney injury.
DAY 17 TO 19
COVID-19 fatality cases happen at around day 18. Before the time, vulnerable patients may develop a secondary infection caused by a new pathogen in the lower respiratory tract. The severe condition may then lead to a blood coagulation and ischemia.
DAY 20 TO 22
The surviving patients are recovered completely from the disease and are discharged from the hospital.

Primary sources:

#Coronavirus #WuhanCoronavirus #SignsandSymptomsCoronavirus #StayHome


Find out everything you need to know about coronavirus, SARS-CoV-2 and COVID-19.

0:30 - What is coronavirus?
1:13 - Where did the virus come from?
1:50 - How long does it stay on surfaces?
2:08 - What happens inside your body?
2:50 - Incubation period
3:10 - The spread of the virus in China
4:30 - Symptoms
5:25 - What should you do if you develop symptoms?
8:07 - Who is at risk?
9:02 - How can we stop the spread?
11:58 - Should you wear a mask?
12:36 - Treatments and Vaccines

???? GOOD RESOURCES about Coronavirus:
1) World Health Organization:
2) Centers for Disease Control and Prevention:

3) Johns Hopkins: Map Tracker

4) Vaccine Maker Project (all about viruses/vaccines)

For those of you who are new to my channel, my name is Siobhan and I'm an internal medicine resident in Canada. In the coming weeks, I'll be working in the emergency department, inpatient hospital units and outpatient clinics.

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Animations created by and for the Vaccine Makers Project. Copyright © 2016, Medical History Pictures, Inc. All rights reserved.

Maps used with permission from

ARDS photo: By Altaf Gauhar Haji et al. doi:10.1186/1752-1947-2-336, CC BY 2.0,



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