Im a COVID ICU nurse. Ask me (almost) anything.

[AndrogenHacker]

Rules:

1. I will not be sharing any specific patient personal details that even comes close to violating HIPPA.

2. I will not answer questions that could potentially deface my place of work.

Example of a good question:

"How often do you see patients with covid recover after being intubated"


Example of a question I won't answer:

"What protocols does your hospital use for every covid patient"

 

[Sean Mosher]

What are your thoughts on the Yale epidemiologist coming out and saying that the data is 100% clear on hCQ?
More clear than anything he's seen supposedly in his entire life?
There seems to be an ungodly amount of misinformation out there.
Any insight?

 

[AndrogenHacker]

First off - great question!

Is this the statement you're referencing?

YSPH Statement Regarding Hydroxychloroquine

Dr. Harvey Risch is a distinguished cancer epidemiologist who has opined on the topic of hydroxychloroquine (HCQ) and COVID-19 out-patient therapy. He has

medicine.yale.edu

Regarding the second part of his statement discussing super sick patients (the demographic I work on):

My personal experience has been that once a patient gets to gets point, there is no one silver bullet (including HCQ) that consistently works or doesn't work. It seems to be completely random honestly.

I will say that the trend with HCQ over the past few months has been to not use it anymore at all, but I still do very occasionally see it.

I agree with his statement regarding this patient population.

On the other hand:

Regarding outpatient I tend to disagree that it is a 100% viable treatment. Keep in mind, I'm not near as qualified as this guy, nor do I take care of "healthy" covid patients.

My personal opinion (unrepresented by any sort of science) is that HCQ is complete bullshit and that these outpatient types would get better with or without it.

Hope this gives some insight!

 

[UCFguy01]

What is the percentage of younger patients(under 50) do you see in critical ICU care?

 

[AndrogenHacker]

What is the percentage of younger patients(under 50) do you see in critical ICU care?

It's pretty uncommon.

There's been a handful that comes to mind who have been in their upper 30s and 40s but, they usually have some sort of underlying medical condition -

Patients with diabetes and obesity seem to be most common, but diabetes in particular.

There is one case of a young patient (early 20s) who had no known medical problems who didn't make it. It was extremely sad...

But that was one time in the 6 months I've been doing this. I'm sure there have been others elsewhere.

Generally speaking, if you're under 50 with no preexisting condition, I wouldn't be too worried - especially now that the virus has mutated to a weaker version.

I would still take precautions, social distance, and do your part to reduce the spread because regardless of a weaker virus, people are still dying every day.

 

[Vince]

The new Abbott Laboratories 15 minute covid test, sounds like a game changer. But is it really only 80% accurate?

 

[Vince]

I just heard on CNBC the old rapid test was 80% accurate. The new one is 97% accurate and you still need a nasal swab to confirm. So maybe it is a game changer.

 

[sammmy]

Generally speaking, if you're under 50 with no preexisting condition, I wouldn't be too worried - especially now that the virus has mutated to a weaker version.

There is no proof that the virus has become weaker. The reduced mortality is simply explained by the fact that the new infected currently are predominantly teens and 20-40 years old adults that do not follow social distancing at parties, bars, and beaches, and their immune systems are more capable of dealing with the virus than a 70 year old diabetic with a heart disease.

 

[Golfboy307]

By late April scientists identified three identified strains of the virus, named "A,B and C". Each strain seemed to be slightly different in virulence then the other.

Coronavirus Has Three Strains According to Study; Type A Prevalent in the US

They are distinct but closely related.

www.techtimes.com

Now they are closing in on six possible strains and mutations. It will be interesting to see, but the overall trend with respiratory viruses over time is they become weaker (for a variety of reasons, one of which is that many people will have some level of immunity). The other four known strains of Corona virus in humans all cause cold like symptoms at worst. Lets hope this one goes that way eventually.

 

[sv1000]

Is there a correlation between hormone levels in men and or women and recovery of overal ability to fight off the virus?

thank you!

 

[pyater]

What are the primary treatments you are seeing? Remdesivir, Interluken 6, Dexamethasone, Proneing, convalescent plasma, ECMO vs ventilator? Any more promising anecdotally? Timing matter?

 

[AndrogenHacker]

The new Abbott Laboratories 15 minute covid test, sounds like a game changer. But is it really only 80% accurate?

Yes. It's scary actually... And dangerous.

So many times a patient has come back "negative" only to be tested again 3 days later to come back positive.

Health care works exposed for 3 days because no PPE was required.

Ugh.

 

[AndrogenHacker]

Is there a correlation between hormone levels in men and or women and recovery of overal ability to fight off the virus?

thank you!

It's not common practice to test for hormones in the critical care type setting...

Ever...

In the 6 years I've been an ICU nurse, I've seen testosterone levels checked once. And that was only because I pushed for it.

The patient was a young bodybuilder who has an ischemic stroke because of his steroid abuse.

He had been there laying in bed intubated several days before I took care of him for the first time.

I asked the Doc about his hormone levels and doc was like " I had dent even thought about that, yeah go ahead and check em"

*shrug*

It's just not on anyones radar, unfortunately. In their defense though if a patient is in icu, there are other much more important medical issues that need to be addressed first - like saving their life.

All that to say:

I have no clue if there is a correlation...

But I have a hunch.

 

[AndrogenHacker]

I just heard on CNBC the old rapid test was 80% accurate. The new one is 97% accurate and you still need a nasal swab to confirm. So maybe it is a game changer.

I really hope so!

 

[AndrogenHacker]

There is no proof that the virus has become weaker. The reduced mortality is simply explained by the fact that the new infected currently are predominantly teens and 20-40 years old adults that do not follow social distancing at parties, bars, and beaches, and their immune systems are more capable of dealing with the virus than a 70 year old diabetic with a heart disease.

I'm not here to argue science. I'm here to give you a first hand account of what I'm seeing "in the trenches".

I'm telling you:

There is, without question, a noticable difference in the clinical course of covid positive patients today vs. those from 3 or 4 months ago.

I suppose it could be related to treatment, but despite what you may hear in the news, treatment has not changed significantly in this time. We are doing the same things today that we were doing then.

Too many variables to know for sure.

Does anyone know if there is science looking into this?

 

[AndrogenHacker]

What are the primary treatments you are seeing? Remdesivir, Interluken 6, Dexamethasone, Proneing, convalescent plasma, ECMO vs ventilator? Any more promising anecdotally? Timing matter?

I've typed up an answer to this question several times and each time I feel like its crossing the line (rule 2 in OP).

Sorry man! I just don't feel comfortable answering this.

 

[sammmy]

I'm not here to argue science. I'm here to give you a first hand account of what I'm seeing "in the trenches".

I'm telling you:

There is, without question, a noticable difference in the clinical course of covid positive patients today vs. those from 3 or 4 months ago.

I suppose it could be related to treatment, but despite what you may hear in the news, treatment has not changed significantly in this time. We are doing the same things today that we were doing then.

Too many variables to know for sure.

Does anyone know if there is science looking into this?

The difference in clinical course can be due to different patients not a different virus. The typical patient demographic shifted significantly towards younger people in the summer or people without chronic conditions because they do not care of the social distancing measures and drive the infection rates up. The people with chronic conditions to whom the virus tends to be deadly, learned to become extra vigilant to avoid it.

 

[AndrogenHacker]

The difference in clinical course can be due to different patients not a different virus. The typical patient demographic shifted significantly towards younger people in the summer or people without chronic conditions because they do not care of the social distancing measures and drive the infection rates up. The people with chronic conditions to whom the virus tends to be deadly, learned to become extra vigilant to avoid it.

I tend to agree with most of this.

The spread of the virus is definitely correlated with summer/younger people being careless, I can't say that the age of the patients I see in ICU has been lower (on average). As mentioned above, I'm only very occasionally seeing patients < 50 who end up sick sick.

It's interesting:

You have to realize where my perspective is coming from - The pulmonologists I work with talk about this mutated virus notion like it's common knowledge and 100% fact.

Are they right? Maybe?

There are just so many variables to say definitively without hard science.

Personally, where I see it most is in the patient's labs and length of illness:

Months ago it seemed like things like D-Dimers and CRPs just stayed stupid elevated endlessly. It just dragged on and on and on.

These days I'm frequently seeing these numbers drop a lot quicker than they used to (Even though "quicker" still means several weeks to a couple of months)

@sammmy, it sounds like you have done your research on this topic. I'd love to hear more about what you have found out. Feel free to PM me anytime.

 

[Seth]

I've heard that the H1N1 virus most likely infected millions of people, but few actually got sick from it. I wonder if Covid isn't all that different, except now, we are hearing about it non stop from the media and people are freaked out. From what I see, Covid averages about a 2 percent death rate. I wonder how that compares to H1N1? In other words, are we suffering more from mass hysteria that an actual threat, excluding the elderly and immune compromised that is.

 

[sammmy]

The problem with that logic is that you can't isolate vulnerable people in a bubble from all the rest infected so such half-baked measures will not protect them.

Without effective measures the virus will infect by geometric progression (exponentially), not by arithmetic progression (linearly) and by now the whole Earth would have been infected.

2% of the current Earth population of 7.8 billion people is 156 million people dead. For comparison, the World War II fatalities were 75 million.

The measures are not 'mass hysteria'. They are calculated to slow down the infections (currently increase linearly not exponentially) so a vaccine is made and a large part of these people are saved. CDC knows their job.