Atypical pneumonia, like a lot of medical terms, doesn’t obviously mean what it seems to mean. There is an indeterminate basket of pneumonias that fall into the catagory, some very common (mycoplasm, chlamydphila) which are mostly an annoyance, and a herd of esoteric types that are rare and on occasion dangerous. Ignoring those, the VAST majority of patients with atypical pneumonia tend to have a somewhat indolent course, generally treated with antibiotics (the famous Z-pak) and feel like crap but do OK. Where you get into trouble are the elderly/severe comorbidity population, who can get a lot sicker. And NONE of this has anything to do with viral pneumonia. That’s a whole nother complicated area of stuff.
“Given nobody really knew the natural course of the illness when his CXRs looked like pneumonia they feared could be one of the bad pneumonia’s that kill people (bacteria that colonize hospitals) and started broad spectrum antibiotics, tests came back negative so they stopped those. They gave an experimental antiviral for a short time, but not entirely clear how big a role that played as seems patient was spontaneously improving anyway.”
This was well written, IMHO. Understand that pneumonia on CXR can look all sorts of things to a doc in terms of viral vs bacterial vs mycoplasm - some patients have a pretty characteristic cxr, but a lot don’t - so the clinician needs to made a scientific wild ass guess as to what you’re treating until your labs and ESPECIALLY cultures come back - which take time. In fact, pneumonia on a cxr may not actually be pneumonia at all - it’s just an area of streaky whiteness than could be due to infection OR bleeding OR inflamation OR previous scarring or probably a dozen other things. Since doctors are going to generally going to be conservative, you’re going to shoot with more “potent” antibiotics until you can determine what (if any) the “right antibiotic” is. Likewise, if you’re worried about some sort of uncertain viral pneumonia, you may toss in an agent until you’ve gotten negative viral studies (or if the patient was obviously improving) - then shut them off.
Not to leave anyone out, because there are obviously some other people here with knowledge, but between Beetlejuice and Hobbes and just other people researching and following the news, this thread is probably just about the best coverage around.
And if you have an otherwise healthy patient with a case of atypical pneumonia and a positive test for Chinese coronavirus, how likely are you to be all hey bro sounds like you just need to rest up for a week or so?
Complicated topic. I’m going to assume we’re not in Wuhan.
Generally I’d put the patient on a Z-Pak (or IV azithro, I suppose - although I’d probably talk to one of my ID guys) and we’d put them into an isolation room and try to sort this out.
This stuff gets VERY complicated because you’re going to have a tough time determining whether or not your patient actually has coronovirus - I haven’t seen just how accurate the testing is, and that can be a real issue especially if the patient in question has a really low pre-test possibility. (one of the stats guys could chime in) Most likely, they’re going to be very cautious until we get a better handle on just how contagious this stuff is - and I think (hope) that the large majority of people who GET coronavirus will likely do fine anyway.
Right but I guess my point is that this is something that seems to have a 2% mortality rate in China. And a 10% mortality rate for folks who find themselves admitted to hospitals. Both of which are pretty powerful Bayesian priors.
yeah… there was one video that I saw(there it is below!), that may have also been posted up-thread, that detailed 3 measures found to reduce lethality by half.
1 was to induce paralyzation and the other was prone positioning in bed. The 3rd was a very technical thing called low tidal volume ventilation, which the paralysis assists with.
none of these 2 stark devices were employed per what I read.
There’s a reason ESPN says the guy on your fantasy team is out with “flu-like symptoms” instead of just “the flu.” There’s like a jillion things that can produce flu-like symptoms and it’s not easy to figure out which one he’s got.
As the West is pretty much where Wuhan was 2+ months ago in terms of number of infections I hope this is being seriously considered, but using the UK as an example over a million people work in the NHS, another million employed by the big 4 supermarkets, a further million in financial services, 500,000 in utilities, 400,000 civil servants, hundreds of thousands in the police and armed forces etc all of whom can catch and spread the virus, while telling the remaining 20+ million “non essential” workers to take unpaid leave for at least two weeks, most of whom are already in debt thanks to sky high rents and low wages isn’t going to wash.
Meanwhile the government is up to its own neck in debt and won’t be keen to put a £2Bn sized hole in its finances to cover their wages for 2 weeks.
Question for the medical type folks on the forum. Is it fair to assume that a virus like this one will mutate and weaken over the generations? Like if someone in China passed it to another person, and that person passed it to someone else, etc. etc., will it be the same virus when it gets 10 people or more down the line?
As I said, hopefully it’s just bad science at an awful time and the proximity to the #1 virus incubation centre in China is just a coincidence. Hopefully.
I concur with this. Here’s another takedown I read while reading up on the article and the relevant biology that furthers the case that this is making a mountain out of what is almost certainly coincidental sequence homology.
I don’t think it’s nothing. Under normal circumstances, this wouldn’t be a paper, it’d be a potential idea for a project that might get published in the future if they followed through and found those sequences are actually expressed.
They did some sequencing and some bioinformatics. It’s not bullshit that they did that, but there was no experiment to prove anything.
