A dude with a mild case of #COVID19 received great government-paid health-care,
but what does it mean for the rest of us?
short story: m.stamfordadvocate.com/opinion/articl…
long story: (recommended reading) (16 parts, link at the bottom)
hometownstation.com/santa-clarita-…
1/x
but what does it mean for the rest of us?
short story: m.stamfordadvocate.com/opinion/articl…
long story: (recommended reading) (16 parts, link at the bottom)
hometownstation.com/santa-clarita-…
1/x
I am grateful toward Carl, the patient, who has been writing a detailed recount on his experience on the cruise ship and the Nebraska hospital. We can make some reasonable extrapolation from his experience to project what kind of healthcare the rest of us can expect.
2/x
2/x
First, Carl's #COVID19 is a mild case,
his fever was short-lived
no vomiting/diarrhea
no short of breath.
no dip in blood oxygen
He would not have been qualified for hospitalization without the cruise ship connection in the US
3/x
his fever was short-lived
no vomiting/diarrhea
no short of breath.
no dip in blood oxygen
He would not have been qualified for hospitalization without the cruise ship connection in the US
3/x
in a city with an acute outbreak (Wuhan in its first 3 weeks), he would have been sent home for isolation.
so we should not expect the level of intensive care he received is applicable for the rest of us in the event that we develop a mild case of COVID19
4/x
so we should not expect the level of intensive care he received is applicable for the rest of us in the event that we develop a mild case of COVID19
4/x
Intermittent fever: Carl did have this hallmark of COVID19, recurrent low-grade fever days after his first fever broke.
His initial overly optimistic reaction to the resolution of the initial brief high fever is typical among patients/doctors, using their intuition from flu. 5/x
His initial overly optimistic reaction to the resolution of the initial brief high fever is typical among patients/doctors, using their intuition from flu. 5/x
COVID19/SARS/MERS is NOT like flu!
breaking a fever from a flu --> recovery is 75% done
breaking the first fever from COVID19 -> even the severe/critical cases had that (in China). but ARDS can develop in 2-3 days with no or recurring low fever! 6/x
breaking a fever from a flu --> recovery is 75% done
breaking the first fever from COVID19 -> even the severe/critical cases had that (in China). but ARDS can develop in 2-3 days with no or recurring low fever! 6/x
Carl has the luxury of a big team of doctor + nurses monitoring him 24/7. I don't think an average joe will have that luxury at all. and both patients/doctors can be complacent with the initial breaking of the fever: going back to work, infecting others, and not getting rest 7/x
Chest CT/Xray: interestingly, he did not mention chest CT or even an xray.
maybe his case is too mild.
maybe there is a worry for contamination.
but if chest CT is not available even in the best CDC facility, COVID19 will be underdetected. 8/x
maybe his case is too mild.
maybe there is a worry for contamination.
but if chest CT is not available even in the best CDC facility, COVID19 will be underdetected. 8/x
Treatment: CDC stuck to their gun and provided only supportive care: IV drip of electrolyte, advil for fever, and oral re-hydration via gatorade.
no prophylactic antibiotics or antiviral
consistent with my categorization of him as a mild case.
9/x
no prophylactic antibiotics or antiviral
consistent with my categorization of him as a mild case.
9/x
Favorable conditions for Carl to recover (that we may not have)
He has a lot of time to sleep and rest (low stress, low cortisol)
He did not need to cook and take care of sick family members
He had no mental stress about income or cost of healthcare (he is on medicare) 10/x
He has a lot of time to sleep and rest (low stress, low cortisol)
He did not need to cook and take care of sick family members
He had no mental stress about income or cost of healthcare (he is on medicare) 10/x
He may be one of the luckiest COVID19 patients, assuming that we all get it sometime in the next 24 months:
1. he got it on vacation (low-stress environment --> immune system not suppressed)
2. he is young enough to recover, and yet old enough to have medicare to cover most costs
1. he got it on vacation (low-stress environment --> immune system not suppressed)
2. he is young enough to recover, and yet old enough to have medicare to cover most costs
3. he will soon have the antibody to safely travel the world at bargain-basement prices.
4. Plus the cruise is fully refunded to him.
12/x
4. Plus the cruise is fully refunded to him.
12/x
For an average American who needs to recover from COVID19 from home, the outcome is certain to be a bit worse:
1. unlikely to receive thorough and 24/7 monitoring, lab work at this level
2. unlikely to be relaxed about it (work deadline etc)
13/x
1. unlikely to receive thorough and 24/7 monitoring, lab work at this level
2. unlikely to be relaxed about it (work deadline etc)
13/x
3. financial stress on cost of healthcare, missed work, child care will further exacerbate anxiety which tends to suppress immune system and slow recovery.
4. likely to have to take care of sick family members too.
So don't be fooled by "Gatorade cured COVID19" propaganda. 14/x
4. likely to have to take care of sick family members too.
So don't be fooled by "Gatorade cured COVID19" propaganda. 14/x
What we can learn from Carl:
Optimism helps a lot (lowering cortisol)
Lite exercise helps
Good nutrition (protein, electrolyte and vitamins) and low stress helps
15/x
Optimism helps a lot (lowering cortisol)
Lite exercise helps
Good nutrition (protein, electrolyte and vitamins) and low stress helps
15/x
Things we don't know:
How severe his case has ever got? lymphocyte count, CRP, etc?
How bad was his pneumonia from chest xray?
Was he ever at risk of developing ARDS?
16/16
How severe his case has ever got? lymphocyte count, CRP, etc?
How bad was his pneumonia from chest xray?
Was he ever at risk of developing ARDS?
16/16
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