Covid-19: Steroids and Other Therapies, & Covid Patients with Persistent Symptoms: What’s Going On?
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- Опубликовано: 29 июн 2024
- In this UCSF Medical Grand Rounds presentation (June 18, 2020), UCSF experts provide an update in treatments for COVID-19, with a particular focus on the new dexamethasone study. We also hear from two patients with persistent Covid symptoms, and discuss the epidemiology and science behind these so-called “long-haulers.” The session is hosted by UCSF Department of Medicine chair Bob Wachter.
Program
Bob Wachter: Introduction
00:03:13 - Sarah Doernberg, Associate Professor of Medicine, Division of Infectious Diseases - Updates in Therapies for Covid-19
00:20:35 - Q&A
00:30:27 - Followed by a Panel Discussion on Covid Patients with Persistent Symptoms:
• Timothy Henrich, Associate Professor of Medicine, Division of Experimental Medicine, ZSFG
• Coleen Kivlahan, Professor, Dept. of Family Community Medicine; Executive Medical Director of Primary Care Services at UCSF Health; Covid Patient
• Jeff Martin, Professor, Dept. of Epidemiology & Biostatistics
• Cliff Morrison, Former Clinical Nurse Manager, ZSFG; Covid Patient
• Michael Peluso, Clinical Fellow, Division of Infectious Diseases
01:16:53 - Bob Wachter: Closing
See previous Covid-19 Medical Grand Rounds:
• June 11: Covid-19: Update in Epidemiology, and, Are the Publication and FDA Approval Processes Moving Too Fast for Safety?
• Covid-19: Epidemiology...
• June 4: The Covid-19 Pandemic in the Context of the Healthcare System, Economy, Race, Politics, Ethics, and History
• The Covid Pandemic: In...
• May 28: Update on Covid-19: Testing, ICU Practices and Outcomes at ZSFG, and the Experience of Elders in the Covid-19 Pandemic
• Update on Covid-19: Te...
• May 21: Update on Covid-19: Epidemiology, Treatments and Vaccines, Thromboembolic Complications, and the Multisystem Inflammatory Syndrome Affecting Children
• Covid-19 Update: Epide...
See all UCSF Covid-19 grand rounds here: medicine.ucsf.edu/covid-19-ne...
Thanks a lot for this particular ground round. I learnt a lot about the post-COVID complications, especially the neurologic ones. Hearing from survivors who are themselves health care providers really made it practical and relatable. Looking forward to the outcome of the ongoing studies. Thank you.
We are still in the process of learning whether neurological complications are truly those or may be SARS Cov2 rhinoencephalitis in which case it is direct impact of the virus unlike the stroke or hemorrhages via the DIC like syndrome triggered by the cytokine storm which would be a true complication. One long term complication I predict is doubling of tripling of the dementia rates due partly to the sleep disruptions being inflicted by the pandemic. The metabolic syndrome is also getting winded and would balloon up. We are going to have a lot sicker humanity or a massive disease burden in the coming decades. Let’s plan for that.
Watch How the coronavirus is getting on our nerves
ruclips.net/video/dR6fFaBZ4J8/видео.html
Fascinating/informative discussion here. Not sure if possible, but I do think study is needed for people suffering from long haul COVID-like symptoms who don't test positive either through the initial diagnostic test OR via antibodies. Among COVID social media groups, there's a sizable group of these people who became sick at the start of the pandemic. Either some forms of COVID are not yet detectable (also test timing can be an issue) OR there's another novel disease that needs to be detected/understood. Please help them if you can by doing what you do.
I look forward to my UCSF Thursday nights.
Cliff, I had fog brain for 75 days. It started getting really better once I got back into learning a new language on Duolingo. It took 3 sessions before I even could pass level 1 again but once I did my brain took off. I've been trading, catching up on school work and studying for my real estate exam nonstop since. A nap middle day really helps as well. As far as the depression, I stopped watching the news and started watching comedies and going for small walks building up my cardio. Day 103 here and still have throat and chest pressure problems but I choose to look on the bright side and know it will leave my body soon.
I'm in the same boat Andy. Here's hoping you are right, cos it does drive you crazy a bit eh. I just had 3 weeks of virtually no symptoms, had a blood test which was clear, then just the other day I had a couple of hours of fever which has has repeated at the same time again tonight. Wishing you and everyone else a speedy recovery🙏👍
Andy, could you tell us if your symptoms have subsided yet now that another month has went by? Wishing you well. Take care.
I’d like to know that too, any improvement in the last month
Please have another presentation by George Rutherford following your July 4 break. Thank you for making this broadcast available to the public!
Excellent discussion, thank you!
Kudos for talking to patients.
Thanks for nice presentation and information
No reason to think remdesivir and steroids would not work well together: You have to give remdesivir as early as possible to affect viral replication. You have to start steroids later when they are in the inflammatory autoimmune phase.
You dont know what you dont know.!! Blind spots are all over. There might be reason to think remdesivir and steroids would not work well together
What evidence supports your view that they would have an addictive effect other than personal intuition? That is the biggest problem in mediicine. No more than 2-3% of physicians practice science based medicine. It is shoot from the head and that is why there are massive treatment linked fatalities
@ecwaufisxtreme REMDESIVIR WILL ULTIMATELY FAIL!
You must treat inflammation right away to prevent the need of intubation, remember is a flu symptoms disease. The is the key to reduce the mortality, specially in older patients with chronic conditions.
Read Dr. Paul Marik's protocol at www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf
Note that Figure 1 lists Remdesivir as a possible antiviral treatment during the viremia phase, and Marik's protocol recommends aggressive treatment with a particular steroid during the the inflammatory phase.
Initially Marik used hydroxychloroquine plus zinc as antiviral treatment during the viremia phase. More recently he has changed from this approach, I think at least partly because he wants to avoid the controversy about it; but he still recommends zinc plus quercetin (which, like HCQ, is a zinc ionophore) for prophylaxis and early treatment at home.
@@sleepsmartsmashstress740 The success of Paul Marik's protocol supports the use of Remdesivir during the viremia phase and aggressive treatment with steroids during the inflammatory phase. See Marik's protocol at the following link and pay particular attention to Figure 1.
www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf
What about whilst studying hydroxychloroquine it is given with high dose zinc due to the fact that there are indications that the benefit of hydroxychloroquine is that it is a positive ionophor for zinc, which, at least in vitro, prevents coronavirus replication. Why in the world would you give the portion of the treatment that had no direct effect on coronaviruses?
The Recovery trial also gave 4-8 x the long recognised standard dose, and yet this presenter uncritically presented the conclusion that HCQ increases/doesn't affect mortality?! Dr Shankara Chetty of S.Africa has given methylprednesone high dose (80mg/day) from the eighth day and has not needed 02 or hospitalisation in +6,000 patients.
Symptoms for 14 weeks... Weird discomfort in abdomin.. Dizziness. Nausea. And just general unwell day in day out. Been hospital 4 times had blood taken twice n had test 12 days ago came bk negative but don't no if I left it to late
Been waiting 4 weeks for it
Waiting for hospital to let me know.. And I live in Rotherham England
What symptoms did u have. If you’re negative could it be GIT disease?
Went for ct scan of abdomin 2 days ago so after see outcome
@@eddy45686 had ct scan all clear.. Yet still got bad breathing. Chest pains. Back pains. Bad headaches. Nausea. Abdominal pains
We know from Carlucci et al that the addition of Zinc is critical for the efficacy of HCQ. Can you comment on why you would eliminate HCQ rather than simply add Zinc supplementation to its use ? Thanks much for an excellent presentation.
Point to clinical trials or it’s just noise
Elaniago please read The article which I referred to. Search medRxIv under the authors name, HCQ and zinc. Failing to replete zinc or even to measure serum zinc levels is a flaw in the otherwise interesting studies. Carlucci’s study merits a re-visit
I'm not even a medical person and I heard about the study that didn't use zinc. I was like what?! That study had an agenda. There is plenty of anesdotal evidence from doctors on the frontlines that had amazing success with hydrochloroquine.
@@richawoman There must be a way for biostatisticians to analyse large scale observational studies & cases especially coming from the frontlines. There are probably a lot to learn from the frontlines that we're not getting.
John Peterson
Noise
Please any treatment for
1 chronic fatigue syndrome
Diarrhoea
County
Persistent cough
Tanks
Should those with good quality mood swings play mood golf for better score ? Or us this swinging of the mood is about sharing spouses with others ?
Is anyone thinking about vitamin D and other nutrients in these mysteries?
I started to take a turn for the better after 2 weeks of sleeping 18 hours a day during weeks 4 through 6. That's when I began taking vitamin d. I read a medical study from Ireland that said people with vitamin D deficiency got sicker during Covid-19 than people with normal or high levels of vitamin d. Made sense to me because I had PLE (Polymorphous Light Eruption) reaction a couple years back to the sun.
@@andycalderon8422 Interesting question Andy. I'm an internal medicine Hospitalist at a large urban hospital in Oakland. I've cared for several very ill Covid patients anecdotally about half of them have had severe vitamin D deficiency.
How are these symptoms different from H1N1? Neurological symptoms were well characterized in the 1918 pandemic.
Exactly! ppl don't like to use logic they think the government would never harm us🤣
Can IgM induce hemaglutination?
I'm aware that a positive PCR is very unreliable yet we're counting on it to make policies. I've also heard that when someone is tested over and over again and they have a positive reading, each of those tests is considered a new one, a new positive test result. Is this true? And how often is this done? How much is it throwing the numbers off?
Hi, can anyone speak to what the false positive rate of COVID pcr is? If the population of the bay area has a low incidence of COVID, then how much of the 3% positive rate by PCR are false positives? Thank you
Can dextran modify hemaglutination?
How can you put someone on a test when you only have days and sometimes hours to save these people?
Aha, random thought on a data point: Does tonsil history (gone, not gone) correlate to anything? As part of the immune system one might ask, look, research. Bone pain, does this have Vitamin D implications i.e. in isolation would bone pain open questions about D. and nutrition., common multi vitamin. THANK YOU!
ot was my understanding from other astudies that the Cytokines storm begin after the 49th something reproduction of virus whereupon it stops reproducing and rapid in as they fragment breaking up and forming quite an array of virus fragments that supposedly provoke the flaring toxic inflammatory stage as a response to exaggerated mass of antigen particles floating in blood stream. hope all the wise mean &woman that I just listened to hve something to say on this poing as I am depressed, confused and overread! Thanks for good video.
Early treatment is the key when no drugs works after cytokine.
Leronlimab seems to work post cytokine storm.
There is little data for HCQ plus zinc given early in the course of the infection. Why has this not been tested?
Maky Lemur big point - HCQ is an ionosphere for zinc allowing it to pass through the cell wall to halt virus replication. HCQ without zinc is like a gun without bullets!
Ionophore
Exactly! Where are the studies COMBINING hcq with zinc and early treatment!
@@luciakaufmann1631 Scientists seem to want to study HCQ by itself (which doesn't work) or when covid is in more advanced stages (too late) Hmmm. Sometimes studies of vitamins are done this way. To make them look ineffective choose the wrong dosage, the synthetic form rather than the natural form, etc.
How do you treat "case by case," as Sarah says, when the medical-industrial complex mightily pushes physicians to follow established protocol?
Excellent question!
I’ve had symptoms for 14 weeks now.
I am sorry you are sick. Are symptoms bad? Are you receiving out-patient treatment?
I have been having symptoms for 14 weeks aswell
Weird discomfort in abdomin.. Dizziness. Nausea. And just general unwell day in day out. Been hospital 4 times had blood taken twice n had test 12 days ago came bk negative but don't no if I left it to late
Can fever modify hemaglutination?
esst virginia medical school comment: "notwithstanding the very important result of the recovery dexamethazone study, methylprednisolone is the corticosteroid of choicefor the pulmonary phase of covid 19 ...pharmacokinetic better lung penetration) , genomic data specific for sars cov 2 , and a long track record of succesful use in inflamatory lung deseases "
Traducirlo
Right. The EVMS protocols for treatment of COVID-19 are highly effective, even for almost all very elderly patients with pre-existing conditions. Why isn't UCSF using the EVMS protocols? And why aren't they using the Zelenko protocol to treat people as outpatients and prevent most hospitalizations?
No zinc with that HCQ. Seems to be a massive effort not to use it as it might actually work. I also wonder about the Oxford paper's very high mortality rates. MATH+ protocol is getting MUCH lower mortality rates. UCSF is getting much lower mortality rates. What were they doing wrong?
Guess they did not watch Peak Prosperity. Neither should you.
@@Shelmerdine745 Why should you not watch Peak Prosperity?
I think there’s a little Pharma troll in here...
Sorry, but you are assuming, it seems to me, that you are talking as if the PCR tests are correct. My “drive through” swab and spit tests from Oregon Health Sciences University (OHSU) were found to be 48% error. I had 2 antigen tests and both showed negative, but I have been clinically assessed by my health insurance Kaiser Permanente Northwest in their COVID-19 clinic in Beaverton, OR as having reported the correct symptoms, long term, for this virus. Blood tests, CBC, Thyroid, A1c and others were flagged L and H, slightly off the normal. Since no one has the antibody tests that are reliable, I have not been tested yet. This is all so confounding in my life. I worked in health care research for KPNW at The Center for Health Research (CHR). I worked on clinical trials, and recruited patients for many studies, so I have a basis for studying this virus and the clinical implications. You did not mention the mental health implications, depression, etc. that are also being discovered with COVID-19 patients. Please add MH issues to your presenters. I am also entering my daily log into the ZOE study database. Thank you for your updates.
C A B Because of your medical background, I can understand why you would be frustrated by not getting the correct test results, however, I am confused as to why it would matter whether someone has it or not, because when I would get sick with pneumonia, I would show up at the hospital and they would treat the symptoms and get me better. It didn’t have to be identified to treat me.
That's not side effects. it's better if someone is totally cured. Yet anything could be better than death."v"
The screeching competitor critically race because writer nouzilly collect failing a tasty snowstorm. awake, fine powder
She's right about one thing, she is indeed being completely inconsistent. And this is a Professor of medicine???,...give me a break, I think my cat could give a clearer presentation than this.
d
I take my vitamin C (10g to 100 g, divided doses, as needed), a day during illness
ascorbic acid has 8x more bioavailability than previously thought.
Townsend Letter: Unexpected Bioavailability of Oral Ascorbic Acid
I take melatonin (10 mg to 100 mg a day, divided doses, as needed), and Lugols iodine, when I get sick
Dr Paul Marik
Dr David Brownstein
Dr Richard Cheng
Research of Doris Loh
A study conducted on a group of hospitalized COVID-19 patients in Manila found using high-dose melatonin as an adjjuvant could reduce disease severity, and shorten hospital stay. What was most important is that none of the patients in the high-dose melatonin group died, while 35% (12 of 34) of COVID-19 patients receiving the same standard treatment without melatonin died during the same period. Other patients required mechanical ventilation (MV) while none in the melatonin group was put on MV.
This is the first study on the efficacy of high-dose melatonin in a clinical setting. This landmark study is published in the prestigious medical journal, Melatonin-Research, on June 15 in the special issued called "Melatonin and COVID-19" [1].
In this same issue, you will also find my paper, which I have been calling the SUPERBIG One, "The potential of melatonin in the prevention and attenuation of oxidative hemolysis and myocardial injury from cd147 SARS-CoV-2 spike protein receptor binding" [2].
Have you had your AA and MEL today?
[1] www.melatonin-research.net/index.php/MR/article/view/88
[2]
newsinfo.inquirer.net/1294087/covid-19-study-sees-hope-in-melatonin?Social&Facebook&fbclid=IwAR39t03Ka5Rcx7gUSaEUaDiY2PEwD0xd9rl73XGpBBDdMcuAqRPnwCd74Xg#Echobox=1592525335
fkf
Melatonin is as good, if not better, than steroid for covid
Go watch MedCram channel videos for some top quality material on the subject.
@@DdrtAddh I already do and I think everybody should too because it's clear, informative and welcomes 'open discussion'.
Sunshine Butterfly - Thank you for this. I read your article and the paper. Very interesting. Any specific Melatonin? Some are more bioavailable?
Sorry what is AA?
So you're randomely putting some patients in a condition where they get steroids and NO antiviral, despite strong evidence that will cause more trouble, just so you can SCIENTIFICALLY see what it does? That is downright unethical. If I had covid in the downtown university medical center and you approached me with such an idea and I even MIGHT get that strategy I would turn you down flat. You should face ethics violations and criminal charges!
You might want to ask for an explanation before making accusations of ethics violations and criminality.
Aha, random thought on a data point: Does tonsil history (gone, not gone) correlate to anything? As part of the immune system one might ask, look, research. Bone pain, does this have Vitamin D implications i.e. in isolation would bone pain open questions about D. and nutrition., common multi vitamin. THANK YOU!