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

[TucsonJJ]

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!

My understanding is that it is NOT very effective for patients in the critical (ICU) stage... but is VERY effective for those who initially get symptoms. It also needs to be co-administered with zinc and Azithromycin.
I also have heard that if a person's vitamin D3 levels are above 40ng/ml, they will very likely never get COVID...
Has your ICU ever used IV vitamin C in large doses? If not... you might try it on failing patients...
Stay safe!

 

[AndrogenHacker]

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.

Yes and no.

If you look at the statistics you're quoting in isolation, you are correct.

One major difference that immediately comes to mind from personal experience is resource utilization.

Unlike H1N1, once a patient with COVID reaches the point of intubation, it's essentially game over.

The keyword of that sentence being "essentially" - meaning some small percentage of patients do eventually make it and can proceed to a step down unit, medical unit, and eventually start the rehabilitation process.

The large majority of patients I see inevitably end up on the ventilator and are never able to be liberated. They sit there for sedated and chemically paralyzed (to ensure complete ventilatory compliance) for weeks or months on end as the families try to cope with the reality of the situation.

I'm not saying its wrong of the families. Hell, I'd probably do the same if it was my wife or one of boys. I'd want to give them every chance.

But I can't even being to explain to you the amount of resources these patients are eating up...

Some of these people are on 6-12 different iv infusing drips at a time just to maintain life, SLED/CRRT or continuous dialysis that takes special training only a few nurses can do, electrodes, code blue carts, etc. etc.

Not to mention man hours...

Feel like I'm ranting. You get the point though.

I've attached an image I found on Google to give you an idea of the amount of machines and resources these patients utilize for months on end.

And honestly this patient isn't near as complex as it can get.

Here's another picture (again found on Google)

 

[AndrogenHacker]

My understanding is that it is NOT very effective for patients in the critical (ICU) stage... but is VERY effective for those who initially get symptoms. It also needs to be co-administered with zinc and Azithromycin.
I also have heard that if a person's vitamin D3 levels are above 40ng/ml, they will very likely never get COVID...
Has your ICU ever used IV vitamin C in large doses? If not... you might try it on failing patients...
Stay safe!

Your knowledge of non-ICU patients is more than likely superior to mine.

With the exception of this thread, up to this point since COVID, I do everything in my power not to think/talk about COVID when I'm not at work.

No comment on Vitamin C.

 

[AndrogenHacker]

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.

I'm not sure how I overlooked this comment.

Thank you for sharing this!

 

[TucsonJJ]

Your knowledge of non-ICU patients is more than likely superior to mine.

With the exception of this thread, up to this point since COVID, I do everything in my power not to think/talk about COVID when I'm not at work.

No comment on Vitamin C.

I don't blame you... I am not mentally strong enough to handle all you do. Kudos.

You might pass this along to a few of your ICU MDs... my thought would be... what do ventilated patients have to lose? take care...

 

[Vvs1]

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"

Do any patients complain of symptoms of low T, or any persistent side effects?

I saw a study that said covid altered gut microbiome.

 

[AndrogenHacker]

Do any patients complain of symptoms of low T, or any persistent side effects?

I saw a study that said covid altered gut microbiome.

90% of the patients I'm assigned to are either paralyzed or in a medically induced coma. The other 10% are at a very minimum intubated and sedated.

I can't remember the last time a patient was able to talk to me.

 

[sammmy]

Do Remdesivir or blood plasma with antibodies help save intubated people in critical condition at all or most of them die anyway?

 

[TucsonJJ]

This just in:
Over the weekend the Centers for Disease Control dropped a bombshell report on coronavirus/COVID deaths:

of the approximately 165,000 "COVID deaths", less than ten thousand died from COVID.

 

[Golfboy307]

This 6% number is getting a lot of internet traffic. Our news last night did a bit of "debunking" of this stat. First, the CDC has been reporting these numbers 2 per month since April. So not a bombshell. More importantly, most death certificates list more than one cause of death. Medically speaking: co-morbidities. For 94% of the cases a second cause of death is listed: respiratory failure, heart failure, blood clot, pnuemonia etc. All things that can be made worse or caused by Covid.

All this is telling us is what we already know: older people with pre-existing conditions are much more likely to die of Covid or from complications thereof.

How many of those 165,000 would have died during this time period without covid? Hard to tell, certainly some.

That is why the excess death number is important. For 2020, the US has over 200,000 "excess deaths" compared to the average of prior years. To me, that is the telling stat.

 

[TucsonJJ]

Perhaps... and not my dog in the fight... but I think there is plenty of reason to question assigning "COVID" as cause of death in the first place, as apparently, hospitals receive extra funding per COVID death.
Tons of corruption in Big Pharma, IMO, as evidenced by the appalling disinformation and restrictions on early use of HCQ/zinc/Azithromycin and its effectiveness... and the hysterical push for a vaccine (anyone trust Bill Gates?), possibly to be released and even forced (become mandatory) on the public before trials are finished? And what is the effectiveness rate of any flu vaccine so far? How about the serious side effect percentage?

Does COVID trigger the death of many very elderly, many obese/diabetics, many with compromised immune systems? Sure, as does seasonal flu.
I would think it interesting to see a report of COVID deaths with ZERO known co-morbidties. Is this why people under a certain age rarely die of "COVID"?

More info:

If Coronavirus Threat’s So Great, Why’s U.S. Overall Death Rate Down?

In a pandemic, you’d expect a surge in overall deaths. Has the number of COVID-19 deaths has been inflated?

issuesinsights.com

 

[Cataceous]

...
That is why the excess death number is important. For 2020, the US has over 200,000 "excess deaths" compared to the average of prior years. To me, that is the telling stat.

The problem is that this is death from all causes. The economic and social damage from the pandemic are significant stressors that could be contributing to excess deaths.

 

[mooseman109]

Yes and no.

If you look at the statistics you're quoting in isolation, you are correct.

One major difference that immediately comes to mind from personal experience is resource utilization.

Unlike H1N1, once a patient with COVID reaches the point of intubation, it's essentially game over.

The keyword of that sentence being "essentially" - meaning some small percentage of patients do eventually make it and can proceed to a step down unit, medical unit, and eventually start the rehabilitation process.

The large majority of patients I see inevitably end up on the ventilator and are never able to be liberated. They sit there for sedated and chemically paralyzed (to ensure complete ventilatory compliance) for weeks or months on end as the families try to cope with the reality of the situation.

I'm not saying its wrong of the families. Hell, I'd probably do the same if it was my wife or one of boys. I'd want to give them every chance.

But I can't even being to explain to you the amount of resources these patients are eating up...

Some of these people are on 6-12 different iv infusing drips at a time just to maintain life, SLED/CRRT or continuous dialysis that takes special training only a few nurses can do, electrodes, code blue carts, etc. etc.

Not to mention man hours...

Feel like I'm ranting. You get the point though.

I've attached an image I found on Google to give you an idea of the amount of machines and resources these patients utilize for months on end.

View attachment 10601


And honestly this patient isn't near as complex as it can get.

Here's another picture (again found on Google)

View attachment 10602

My wife is an NP in a 60 bed acute rehab hospital. She has had many patients that have come from a ventilator into her care. They are VERY sick according to her, most have scaring in lungs and or liver. But.... they go home

 

[Seth]

Perhaps... and not my dog in the fight... but I think there is plenty of reason to question assigning "COVID" as cause of death in the first place, as apparently, hospitals receive extra funding per COVID death.
Tons of corruption in Big Pharma, IMO, as evidenced by the appalling disinformation and restrictions on early use of HCQ/zinc/Azithromycin and its effectiveness... and the hysterical push for a vaccine (anyone trust Bill Gates?), possibly to be released and even forced (become mandatory) on the public before trials are finished? And what is the effectiveness rate of any flu vaccine so far? How about the serious side effect percentage?

Does COVID trigger the death of many very elderly, many obese/diabetics, many with compromised immune systems? Sure, as does seasonal flu.
I would think it interesting to see a report of COVID deaths with ZERO known co-morbidties. Is this why people under a certain age rarely die of "COVID"?

More info:

If Coronavirus Threat’s So Great, Why’s U.S. Overall Death Rate Down?

In a pandemic, you’d expect a surge in overall deaths. Has the number of COVID-19 deaths has been inflated?

issuesinsights.com

Good points!

 

[S1W]

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.

What is your hunch?

 

[ERO]

Do you have any insight on the upcoming vaccinations as a medical professional that are not making the news? I ask because depending upon the news source, either we are going to have a very effective vaccination (or several from different pharma companies) fairly soon, or new vaccinations take years to develop, often only have an effective rate of 30-40 percent like the flu vaccine, etc...

 

[CROM]

I’ve read that if you’ve recently been sick with one of the common coronaviruses that have been circulating for years then one might have some level of immunity to SARS-2. Any solid evidence regarding this? Cuz if that’s the case maybe we just infect ourselves with the common cold/coronavirus.

Also, does your normal WBC predict severity of COVID? For example, if someone’s WBC count before infection is 10, will they fair better than someone who has a WBC count of 6?

 

[GreenMachineX]

Bump...no update here in a while. Curious as to what your seeing now, thoughts on outcomes, etc.

 

[Vince]

Bump...no update here in a while. Curious as to what your seeing now, thoughts on outcomes, etc.

Last seen Sep 15, 2020

 

[GreenMachineX]

Last seen Sep 15, 2020

I know; I was hoping he’d get an email notification of the reply in his thread. Probably not, but hopeful.