Comments by "Stephen Villano" (@spvillano) on "Dr. John Campbell"
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In the US, we're fortunate, as we fortify milk with vitamin A and D.
I'd be quite guarded with megadosing vitamin D, fat soluble vitamins can get into all manner of trouble when one overdoses, compared to water soluble vitamins, which essentially get urinated out. I get that impression from doctor here as well. Blind dosing isn't a good idea, as doctor well knows.
The US fortifies milk, most yogurts, breakfast candy, erm, cereals and margarine. Fairly commonly consumed, eggs (not a great source, but it adds up), various meats, Virtually extinct in the US diet, cod liver oil. Some orange juices are also fortified, but not all and orange juice is the number 1 consumed breakfast juice.
Doctor, is there any definitive test(s) to diagnose a cytokine storm? Or is it a constellation of results that lead to the educated opinion that that is the only bloody thing going on?
This was in my e-mail this evening from the county where I grew up and most of my family lives in.
This week Delaware County reported a high number of positive COVID-19 cases and COVID-19 deaths.
On Monday, April 13-
117 new cases and 1 death was reported.
On Tuesday, April 14-
101 new cases and 5 deaths were reported.
On Wednesday, April 15-
84 new cases and 15 deaths were reported.
On Thursday, April 16-
120 new cases and 11 deaths were reported.
On Friday, April 17-
226 new cases and 3 deaths were reported.
This brings the total number of cases in Delaware County to 2281 and the total number of deaths to 74.
When I hear deniers, I get angry that their parents would've poked them so hard and so often in their fontanelle.
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Dr Fauci referred to it as modified quarantine. Odd term, to be sure, but he did explain it a bit as he'll largely be at home, with some office presence.
I was unaware that hydroxychloroquine caused ionophores to be created that would admit zinc, but I vaguely recall other drugs that are known to do that for zinc. Still, I do (again, vaguely) recall zip1 transporting zinc from the interstitial space through the plasma membrane. Still, I'm aware of two high quality studies that show no effect for HCQ in patient outcomes and one that showed higher morbidity and mortality, the latter seemed to hint that cardiac conduction anomalies might have been exasperated.
Yesterday, we learned that our youngest, who was working in hospital housekeeping on COVID floors took ill. She briefly placed us on hold, where her physician had called with her SARS-CoV-2 test results. Positive. She sounded horrible last evening, severe coughing, which seems to have abated today, sounds like she's moving air well, held longer sentences than last night, but retained a fever and now has purple toes.
Fortunately, she's now staying with her sister, who is an RN.
I've been hearing chatter that initial viral exposure levels may possibly play a role in initial disease severity. We'll have to see if any studies are being conducted and of course, await peer review.
If there's one thing I've learned personally about peer review is, peers love little better than to savage shoddy work. That induced me to rapidly produce high quality work!
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OK, US expectation, regardless of reality is, fever s bad, kill the fever, kill the malady.
That's the social construct in the US.
I am aware of viral testing that is effective for live virus, we both are, it's call cell culture. But, remember, Trump is literally a lawful superior of those treating him, so can give a lawful order to report anything he wants and doctor, nurse or spokesperson is required to report what the imPOTUS requires.
Would that I could be able to accept a statin, I'm a 1% type who utterly cannot do so, as in full blown rhabdo, Repeatedly.
What has been observed is early on dexamethasone and heparin. The rest, gravy, maybe he muddled, maybe the antibody cocktail worked, also, we don't know the full treatment path.
He could as easily claim that playing Tiddly Winks worked for him, his medical officers, upon order, would be required to report such, per US law and US UCMJ.
The rest, that's still open research.
But, dexamethasone and heparin was, back in April, a golden standard. I know that firsthand, due to a thyroid crisis and hypertensive crisis, with "ground glass" and pneumonia signs, due to the condition.
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All the Afghanistan problems were a turd buffet set by the previous maladministration.
As for "military grade equipment", most are trucks and firearms, not worth the cost of repatriating. Are you implying that China doesn't know how to make trucks and guns? That they don't have Cisco routers and switches? That they had no access to computers?
But, no, it's all this administration, the god-king, emperor wannabe was perfect and didn't set anything up to fail. Well, anything beyond every damned thing that he could sabotage.
Sorry son, you worship a flawed man, not a god. A man who set the timetable for withdrawing US forces that the incoming administration was saddled with. A withdrawing of forces that was scheduled, not briefed to those who needed to implement it and as the date approached, we'd be leaving our forces abrogating the previous maladministration's agreement. Hell, the only one that administration briefed was China and Russia, FVEY got to suck vacuum, as usual for that maladministration.
And who, by the way, put roadblocks in the way of issuing green cards to translators and other allies again? Oh yeah, the previous maladministration.
But, what would I know, it's not as if I was with CENTCOM for most of the war - oh wait, I was! What would I know, I don't know nothing, I'm fucking ignorant and you're the shining voice of wisdumb for the entire benighted planet.
Hey, I hear Putin calling you, better run quick!
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It's a lot worse than emotionally scarring, it's destabilizing of what few governments remain stable in the famine afflicted regions. That spreads outward, both due to refugee flight and genuine anger over their needs not being met, their loved ones dying and they'll strike out at whoever appears or is doing better than they are.
With plenty of online fingers pointing exclusively to the west, ignoring Russia stealing most, if not all of Ukraine's grain stocks as we speak.
As far as I'm concerned, send those pirate vessels to the bottom, switch them with US excess grain, paint over the vessel names and fly no flag. If something needs to be on the hull, put a banner up saying MV Grain Fairy. Pull it from what I'll use, I'll not be alone volunteering it and I can stand losing another 20 pounds.
One fee for the grain - recipes.
We've had enough food to not only feed the entire planet, we've had enough food for my entire 60+ years of life to literally make the entire planet morbidly obese.
Oddly, those against feeding those who hunger claim ever so loudly to be fine, upstanding Christians, who as Gandhi said, are ever so unlike Christ.
Now, a bit of homework for most. Look up "Scarcity economics", which is the actual economic system we live under. Add in lean practices, such as just in time delivery keeping stocks low, it's no wonder that the US has an infant formula shortage due to 30% supply halting for contamination issues at the main plant. Not stocking warehouses means, any interruption in the supply chain leads to shortages and in scarcity economics, increased profits at everyone's expense.
And there will always be interruptions in the supply chains, an earthquake here, typhoon there, volcano blowing its top diverting traffic over there, pirates in the underwear...
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Meh, not necessarily being given bad information, but perhaps a lag getting the most current, non-peer reviewed data percolated up.
Or, as common, an acute burst of intracranial flatulence results in old data being repeated. We've all had one of those moments. :/
I will say, that virus is good at adapting to our species, dammit. Still, I'm waiting for more mature numbers to guide actions, rather than a still fairly small sample set. Give it a couple of weeks for the data to properly firm up. Still, I suspect a second booster may well be found warranted.
Sigh, life... Nobody makes it out of that alive.
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@peetsnort the only problem is, even if we're lucky and only 10% contract COVID-19, that's 25000 newly sick, on top of the current average of 40 - 45k new cases per day and they're spreading that farther along, at a minimum of 1.7 infections, possibly more. The hospitals are already stressed in areas that are still rising, some area hospitals are full and have no more medical beds, let alone ICU beds, all while waiting for patients to heal enough to be sent home so that they can bill and get screwed by the insurance companies. That will result in hospitals going bankrupt and being forced to cease operations - while they're still full of patients, most COVID-19 cases! Once we're at capacity and bankrupting hospitals, the case fatality rate will increase dramatically and we'll quite literally have people dying in the middle of the streets, like had happened during the 1918 influenza pandemic. That's when you'll see at a minimum, ten times the current death rate, as we don't install ICU equipment and nurse monitoring inside of private homes, so no O2 for people who need it to survive a moderate case of COVID-19, let alone installing ventilators inside of private homes.
Currently, conditions are basically turning this pandemic into an Acme dynamite kit and we're all sitting on the pile of explosives while Trump keeps whaling away with a seldgehammer.
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@peetsnort actually, there are several comparisons to be made. Both had circulatory damage, both have cytokine storms wreaking havoc. This bugger just happens to trigger a touch more widely distributed of a cytokine storm, complete with cardiac and kidney damage, making it a fair bit higher in the fatality department.
Now that we've got a handle on some effective treatments, the CFR should drop down by a lot.
A couple of months back, I was hospitalized with respiratory distress with SPO2 bouncing around 83 - 85. CXR revealed atelectasis with infiltrates. So, while working up the differential, TX was initiated for presumptive COVID-19 pending further testing and DX. First up, dexamethasone, followed with heparin. Sputum and nasal membrane swabs were taken. Speaking with doctor, I simply asked, "Presumptive pending differential and testing proving otherwise, huh". Doctor, shocked simply confirmed my suspicion.
What had made me ill, thankfully was not infectious, but a full blown thyroid storm with hypertension and decompensation resulting in the pulmonary issues.
Never before had I ever thought that the words, "Thank God it's only a type of heart failure!" would leave my lips. Oversimplified, that's what happened with me, loosely resembling part of the symptom set of COVID-19 and I entirely agreed. Were I still treating military patients, that'd have been my approach while ordering testing and getting doctor on the radio, as well as scheduling MEDEVAC in a New York minute, then decontaminating my treatment and waiting area of my BAS.
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@peetsnort one calculates not on total global population, but per capita so that apples to apples are compared.
Currently, for hospitalized patients, the CFR for COVID-19 is higher than for 1918 influenza. That said, there are confounders present for both, as both have cases that never are hospitalized and that skews the numbers.
One upside is, we've yet to have people expiring on city streets, whereas with the 1918 influenza pandemic, that was a regular occurrence. We also now have dexamethasone to tamp down cytokine storms and heparin to prevent clotting issues, where in 1918, we only had hopes and prayers.
Downside, thus far, per capita, Coronavirus has a higher per capita CFR than the 1918 influenza pandemic. Upside, as I said, we now have treatments, although I really would have a much warmer and fuzzier feeling in regards to one antiviral with additional studies on the efficacy, as the studies I've reviewed are rather weak tea.
That all said, at the beginning of any pandemic, all studies are weak tea or non-existent, we learn as we go along, as life isn't a Doctor Who episode where one has a time machine to violate physics with. ;)
A couple of months ago, we were embracing dexamethasone and heparin for preventing cytokine storm and clotting cascade failure, resulting in DIC, which has proved quite effective in preventing worse sequelae advancing and some studies suggest cardiac, CNS, peripheral circulatory and nephritic damage is far more limited when such treatments and possibly one antiviral treatment is initiated. At the time, I was hospitalized with dyspnea, SPO2 on room air 83 - 85, swiftly improving to 95 - 99 SPO2 on 5 LPM nasal cannula.
Admitted for that and a hypertensive crisis, atelectasis with infiltrates. Immediate TX, dexamethasone and heparin, doctor was surprised that I asked if that was presumptive to possible COVID-19, pending labs and differential and shocked, he concurred. That's been the gold standard initial treatment.
I was dubious that it was COVID-19, due to any possible exposure was over 30 days previous, due to one burst of intracranial flatulence on my part and since, I've been my usual cautious self in regards to contamination. Additionally, I have a HX of Grave's disease and hypertensive crisis and had fallen complacent on monitoring my BP and pulse, as well as remaining afebrile, retrograde or common fever at all and no precursor symptoms of a respiratory infection. A few allergy attacks, but those aren't unusual with me upon return to the US after five years.
Well, the usual battery of tests, including nasal membrane swab drilling for oil in my sinus, a sputum test and my FT3 and FT4 being ridiculously high, it was confirmed to be a decompensation after initiation of a thyroid storm.
Honestly, I never before thought I'd ever utter, "Oh, than God it's only a form of CHF!". But, the protocol matched and the dexamethasone also would be effective for limiting damage from the circulatory inefficiencies present due to the hypertensive crisis that turned things into an acute decompensated state.
It's also right at the edges of my understanding and capabilities from when I was treating military patients in the field and I'd be getting doctor on the radio, after scheduling a New York minute MEDEVAC (basically, I'd brook no delay, urgent means what I *@&!%!!! said), TX to stabilize and advance doctor's efforts before arrival.
And I've actually performed cut downs to gain circulatory access in some cases.
So, I'm rather adept at knowing my limits, I'm also quite adept at anticipating what doctor will call for at a SF military level. I've also responded to more than a few outbreaks of infectious diseases and raced to get in front of them.
Where I excel is, I know when to call in an SME and that's always before I'm well and truly in trouble - it's far less damned work! Even today, now that I'm retired from the military, I have my network of SME's available by telephone, personal visit or e-mail, counting PhD epidemiologists, some personal friends who my wife and I have enjoyed many fine meals with.
Still, there are comparisons. Cytokine storms, DIC seems to have been present with both due to probable peripheral circulatory system damage, high unmitigated R0 and the only real difference is COVID-19's unmitigated hospitalized CFR being twice the CFR for hospitalized 1918 influenza pandemic patient rates, adjusted for per capita, rather than total number of ill.
For, comparing outside of a per capita rate adjustment isn't even an apple to apple comparison, it's apple to bowling ball.
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@peetsnort there was no concern at that time about overdose, the patent was confiscated from a German company, something about enemies and a World War, you might've heard a little something about that. Aspirin does not cause a cytokine storm, try looking up the germ cytokine storm, then look up what cytokines are. That's medical knowledge, not hypochondria, which is a psychiatric condition involving a pathological fear of being ill. We don't hospitalize people for hypochondria, we do hospitalize them for major illnesses.
Nobody had antibodies for smallpox until they contract the disease, the same for influenza, which is most commonly carried by birds, which the Native Americans were most certainly familiar with. Measles, mumps, varicella and smallpox were unknown to them.
Peanut butter allergy has already been figured out, underexposure when young resulted in allergy when exposed when older, it was repeatedly written up in every pediatrics journal in the world.
Not microdosing, but microexposures to promote tolerance to the allergen, which is a standard desensitization method that's been in use for decades.
No, COVID-19 isn't some emotional overreaction, we don't put people on ECMO or ventilators for emotional illnesses, we put them on such invasive technologies when their respiratory system is so badly damaged that they'd die otherwise. Even then, a fair number still die, which most assuredly is not an emotional overreaction!
It's been globally, even within Sweden, to be acknowledged that the Swedish approach was a dismal, abject failure that resulted in excessive deaths. Only one political leader in Sweden supports that failed view, well, that leader and Russia, who's always contrary to those not their friends.
Again, we don't hospitalize people for a mental condition as minor as hypochondria, we do hospitalize people for life threatening illnesses.
So, why do you go on at such length about things that you repeatedly prove with your own words, of which you know nothing whatsoever about? Are you proud of such alarming and excessive ignorance?
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If we discarded all studies that run contrary to the conventional wisdom, as espoused by other large authorities, we'd still be treating patients for miasma related illness.
What we do now is have peer review, the peers finding any faults or flaws in the assessment of the data or erroneous data. If there is no faults or flaws, the data looks good and not tinkered with, then a new question is found.
Yeah, just what we need, even more questions!
Or should we ignore blood clot cascades that are strongly suggestive of DIC, as World Health didn't report such findings? Just to make that puzzle more fun, D-dimer was only elevated in some patients, just to ensure one's drive to tear one's hair out. TF is an unknown, but I'm willing to bet that it'll be elevated and that could be something or just another bucket full of noise, due to the level of destruction that's ongoing with the infection.
Finally got everything ready to gin up a mask for going out, as we're finally getting low on food.
Cloth diapers (nearly indestructable, are cotton and inexpensive), some scrap leather for lacework and jewelry for ties, got most of the way assembled with pins to realize I couldn't find the blasted bias tape for the edges. I'll get fancy tomorrow on the thing, as I still have to have some pleats to have a rectangle match my non-rectangular face.
I imagine it's far easier for blockheads.
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@tamaraspink4201 a new study knocked the hydroxychloroquine and azithromycin out as contenders for treatment of COVID-19. Utterly ineffective.
Started last week with burning cold sensation in the area that would correspond with the upper bronchus (where the windpipe splits to go into the lungs), that's consistent with bronchitis, but I remained afebrile. My wife spiked a temp a few times, last evening hitting 102 F (she didn't bother waking me up or she'd likely still be in the hospital, as she's diabetic and has asthma).
This week, it's moved up into the lower trachea. Less pressure in the sternal area, the spike feeling between my shoulderblades is gone this week as well.
But then, my immune system is quite strong, it even has a hobby of attacking the TSH receptors in my thyroid, giving me hyperthyroidism. A number of symptoms of which overlap with the damned virus.
Still, it all isn't anything that a full body transplant wouldn't fix. ;)
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