COVID-19

[iolaire]

Here is a letter that I just received from my transplant center, you will need to look at the image, free online OCR solutions didn't result in readable text.  and sorry you will need to download it and rotate it to read... or try this link: https://photos.app.goo.gl/x8cz8NqN96gcX7Ae6

[MooseMom]

Thanks for that, iolaire.

I just got this from my transplant clinic:  https://coronavirus.uwhealth.org/covid-19-precautions-for-transplant-patients/

[Cupcake]

Thanks, those are very helpful. Haven't gotten anything from Barnes in St. Louis but I did have my 6 mo visit today via telemedicine; I actually got to talk to one of the drs - usually its a nurse practitioner- she says that recent data out of Italy seemed to see benefit from holding the mycophenolic acid if a transplant patient came down with COVID. She looked up to find the closest transplant center to where I am snowbirding--I hope that doesn't mean she thinks I'm gonna need one anytime soon! Like I hadn't already done that before I ever made the trip. Meanwhile I stay inside my hiding place; my family is gonna mail me some of those surgical masks I have left over at home from my old PD days. Best wishes to everyone to stay healthy.

[justagirl2325]

For anyone worried or in a panic about this contagion from hell, the following video should allay almost all of your concerns.  It is the most enlightening and reassuring information I have yet to come across.  Disseminate it far and wide, for it is meant for everyone.

https://vimeo.com/399733860

What a fantastic video, thank you

[enginist]

This is a disturbing video from Japan.  It shows that micro-droplets of the virus can hang suspended in a cloud for at least 20 minutes, a cloud that people can unknowingly enter.  The video recommends opening windows to disperse any lingering mist.  For the same reason, it's better to meet a friend or a date outside on a windy day.  If you live or work in a high-rise building, elevators could pose a serious risk.

https://www.youtube.com/watch?v=vBvFkQizTT4

[enginist]

A meta-study on PubMed concluded that supplementation with vitamin D reduces the risk of respiratory infection.

https://www.ncbi.nlm.nih.gov/pubmed/28202713

Supplementation is most effective in those with lower amounts of naturally acquired vitamin D; i.e., those who avoid the sun or live in northern latitudes. 

[Simon Dog]

I'm convinced the info we are being given is partially filtered for social engineering, especially the part about "masks don't help stop the spread unless you are a medical professional".  It's a matter of getting people to forgo behavior that is the best thing for them, but not the best for society at large.

[MooseMom]

I'm convinced the info we are being given is partially filtered for social engineering, especially the part about "masks don't help stop the spread unless you are a medical professional".  It's a matter of getting people to forgo behavior that is the best thing for them, but not the best for society at large.

That's a pretty incendiary statement, so could you elaborate?  I don't want to misunderstand.

It is my understanding that the CDC is now recommending that people use masks when they go out for essentials like groceries, etc.  Is this correct?

[Simon Dog]

You are correct on the CDC recommendation (as far as I know).

I suspect, but cannot prove, that the "do not wear a mask in public" order came out of a desire to preserve the masks for medical professionals, rather that actually being the best thing for the individual.   

For example, some leaked guidelines call for denying ventilators to dialysis patients with COVID-19 who need them and relegating them to comfort care.  This is beneficial in the aggregate (more life-years saved) but in direct conflict to the interest of the D patient who comes in and is told "you have to die since you are low on the priority list and not important enough for us to make an exception".

If you want a vent if needed, familiarize yourself with the guidelines and decide if you want to mention that solid tumor you had removed (kind of hard to hide dialysis).  For example, know if mentioning that "one thing" will cost you a point on the Charlson Cormobidity Index - it could cost you your life.


Then there is the matter of Trump's initial belittling of the problem in a futile attempt to keep the stock market from reacting.

[enginist]

I think they were overconfident and intentionally deceptive.   

[enginist]

The NYT has a dramatic visualization of the droplet spread by coughing, sneezing, and talking.   It demonstrates that six feet is nothing.   Besides wearing a mask, avoid other people like the plague.

https://www.nytimes.com/interactive/2020/04/14/science/coronavirus-transmission-cough-6-feet-ar-ul.html?utm_source=digg

[iolaire]

I’m less stressed about it these days as we are home one person goes shopping less than weekly.  Usually my wife goes but on Saturday I went to Safeway at 6:15 am to grab TP, because I could not tell if Amazon was sending it with my subscription. On Monday my two cases arrived so we have some to share in neighborhood. I’m wearing surgical mask in walks all the time. My wife will take if off for the few minutes we are not close to people.  I now have excess surgical masks and KN95 (Chinese) masks that are both a single step down from the good medical levels.  At this moment area medical facilities are not begging for masks so maybe it’s getting better now that I have some to donate.

Unfortunately I forecast this will be a fairly long term problem that we will worry about for years.  I expect I’ll be working from home for most or all of this year.

[MooseMom]

It sounds like you're quite well prepared.  Well done!  My husband runs any and all errands that require leaving the home.  We have some surgical masks from several years ago when I first got my tx.  We are not having much difficulty finding the things we need.  My husband will be working from home until at least 30 April.  The Geek Squad had installed a new printer for us several months ago, but we've just discovered that the fax function does not work.  Our printer is a brand new model, and I am thinking that it was not installed properly/completely.  Best Buy is not sending any techs out to anyone's home, so we are just hoping neither of us will need to fax anything any time soon!

I have been wondering about vaccines for covid that are being created and tested, and I've wondered if they will be made with the dead virus like Shingrex is for shingles.  I managed to find this article, and although it is a bit outdated by now, it at least addresses the question.

https://www.livescience.com/us-coronavirus-vaccine-trial-recruiting.html

I don't have time at the moment to do more research, but if someone else is inclined to do so, please do!

[enginist]

Kidneys are failing and dialysis is lacking.

https://www.nytimes.com/2020/04/18/health/kidney-dialysis-coronavirus.html?action=click&module=RelatedLinks&pgtype=Article

[fifal9]

Exactly - similar story but in video format:


PBS NewsHour - Why doctors are worried about severe kidney damage in some COVID-19 patients
Yale University's Dr. Alan Kliger talks about Covid-19 and Kidney failure
https://www.youtube.com/watch?v=nJtfesZlvcw

[enginist]

Nouriel Roubini, an economist at NYU who predicted the collapse of the housing bubble, is now predicting that food riots are only a step away. 

https://nymag.com/intelligencer/2020/05/why-the-economy-is-headed-for-a-post-coronavirus-depression-nouriel-roubini.html

[UkrainianTracksuit]

Québec has particularly suffered with the pandemic and now this is on the rotating loop on the news: 5 patients on the renal transplant floor have contracted the virus.

https://www.cbc.ca/news/canada/montreal/hotel-dieu-quebec-city-kidney-transplants-suspended-1.5766664

[MooseMom]

It sounds logical that transplant patients, being immunosuppressed, are particularly vulnerable to developing severe symptoms should they catch covid.  But I still wonder just how immunosuppressed we actually are.  Like most of you, no doubt, I have regular labs done which include a full wbc panel, and all of my results come back as "within normal range".  So, exactly how "vulnerable" am I?

So, I have to wonder how the 5 patients on the renal transplant floor will present with severe symptoms.  It doesn't surprise me that they got it, but is it because they are immunosuppressed, or is it because there are probably loads of people coming in and out of the ward?

[iolaire]

So, I have to wonder how the 5 patients on the renal transplant floor will present with severe symptoms.  It doesn't surprise me that they got it, but is it because they are immunosuppressed, or is it because there are probably loads of people coming in and out of the ward?

When I read I article I thought the same thing.  The post transplant parts of the ward should have better than normal infection controls due to the infection risks post transplant so it worried me that this virus was able to spread so widely.

[UkrainianTracksuit]

I've never been to a Québec hospital so I can't speak about any actual on the ground, however I know from following Transplant Québec that they have already made amendments to the transplant process in the appropriate hospitals, like not allowing family visits, etc, rather they are done by telephone. Hospitals are a lot "deader" now they they typically are (really bad pun) so I assume that that it wouldn't be "loads" of people in/out.

Québec City is in a "Red Zone" so a lot of stuff is closed down so I'm having so many questions.



With the screening and temperature checks at the door, it's making me wonder if it's asymptomatic spread in staff. It's often been expressed that tx patients typically present with diarrhea as their first symptom, but that it's difficult to pinpoint because that one thing could mean so much. Visitors can obviously play a part but they have tightened up on that, such as having to book in advance and one person per day. So, the hospital outbreaks are mainstay on the news. Can't escape it! https://toronto.ctvnews.ca/three-toronto-hospitals-confirm-new-covid-19-outbreaks-1.5150014

Even when paramedics come to your home, they screen ahead of time at the door, social distance (before any physical touch) and all that stuff. Witnessed it with my own eyes.

[MooseMom]

As I've mentioned earlier, I was in hospital in Michigan back in August for a few nights.  There were indeed "loads" of people coming in and out.  The doctor ($300 per 5 minute visit), nurses coming on and off shift, housekeepers, phlebotomists, the ladies who brought me my meals, and even someone from the hospital's insurance department came in with questions...any of these people could have been carriers yet were asymptomatic.  I don't know if the dinner ladies knew I was a transplant patient so was immunosuppressed, but it seems to me that if I was at particular risk simply because I was immunocompromised, so many people wouldn't have been allowed around me, you know?  They all had masks, but certainly they didn't have any other PPE.  And I was on a general ward, not a fancy pants sparkly clean tx ward.  So again, that made me wonder just how "immunosuppressed" I really am.  Enough to be really at risk of developing severe symptoms?

Interestingly (or maybe not), a few days after getting home, I developed a low grade fever that presented only at night and lasted only 2 nights, and a cough that lasted about a month.  I've had bronchitis only once in my life (2 years ago), and the cough I had was a lot like that.  I did wonder if maybe I had covid, but I wasn't ill enough to investigate.  But, maybe I DID have it!

[UkrainianTracksuit]

Ah see, my experience with a big teaching hospital was much different. It was like 5 people (4 medical: nurse, doctor + fellow, PSW that also did meal delivery for all meals when the food arrived + 1 housekeeper). I think I was the cause of a lot of PPE waste because I have contact precautions (MRSA, yes, it's been attempted to be treated) so even at my clinic appointments, they wear gowns and gloves prior. I know that is not the standard. Different set up, I guess.

But anyway, this is a really interesting article. It seems like how badly corona affects transplant patients is not a typical "immune suppressed + virus = OMG, bad news" but rather based on other factors, like age and overall health. Don't forget viral load: you can a little, or you can have a lot. The way my doctor presented it to me was that my outcome would be similar to a diabetic on dialysis (bad), but still in the safe age range. Doesn't mean I'll be out dancing, but it is something to consider.

Anyway, according to the findings: "Thus, 42% of patients with a kidney transplant and with COVID-19 were diagnosed on antibody testing without significant clinical symptoms", so in this one case, it is obvious to be immune suppressed and have mild symptoms. "Thirty-five of the 97 patients (36.1%) diagnosed by SARS-CoV-2 IgG did not recall having any symptoms suggestive of COVID-19 during the peak of the pandemic and the remaining patients had mild symptoms that did not require medical evaluation."

https://www.kidney-international.org/article/S0085-2538(20)31202-3/fulltext

[MooseMom]

Thanks so much for that link, UT, and thanks for the synopsis because I'm really tired and probably couldn't make heads or tails of the entire study right now. I'll give it a go tomorrow.

I don't think I understand your reference to MRSA; what do you mean by having "contact precautions"?  Did you have MRSA at some point?  Sorry, like I said, I'm tired and don't want to misunderstand your post.

[UkrainianTracksuit]

For the MRSA, I have never had an active infection of it, but I've been colonized, meaning I carry it around. It has been attempted to be "decolonized" but the treatment didn't take care of it. I'm not exactly sure where I got it - having any intrusive medical devices is one cause (dialysis catheter on dialysis, and then a whole slew of tubes for serious hospitalization) and prior to testing positive, I spent a lot of time in an old age home too (was looking after someone).

Anyway, on my file, it states contact precautions so nurses/doctors have gowned up and wore gloves ever since.

[MooseMom]

Ah, OK.  I understand now.