If a patient becomes severely ill with COVID, the course is long and the outcome uncertain for weeks. COVID is cruel. We have no crystal ball for a patient with early signs of severe COVID where they will be come November. They may be intubated. They may be fine. They may not be.
Care progresses from needing oxygen to high flow oxygen to non-invasive ventilation to intubation/mechanical ventilation to sometimes ECMO.
Many patients do quite well with oxygen alone. Those who need intubation do much more poorly.
Progression through the stages of oxygen support can be slow and steady. Some patients though can change quickly. They may look quite well medically, until they don't, and rapidly decline. Outcomes though are usually not quickly determined.
As COVID cases rise in China and protestors challenge policies, note:
the country does not have the immunity the rest of the world does - no mRNA vaccines, little infection-derived immunity.
Of those most vulnerable, over 80, only 40% have had the 3 vaccine doses needed 1/n
Immunity derived from vaccination and infection cushions the rest of the world
China does not have the same immunity
It also has an older population
Two populations of similar sizes - China (1.44B) and India (1.38B) - and China, after decades of 1 child policies - is older
An even more extreme age distribution difference can be seen between China and the whole of Africa, 1.44B and 1.34B, respectively. populationpyramid.net/china/
Age remains the greatest common risk factor for severe disease.
San Miguel de Tucumán, Tucumán, Argentina
- 8 healthcare workers and 1 patient ill
- Symptoms: fever, myalgia, abdominal pain, dyspnea
- 6 cases with bilateral pneumonia
- Multiple requiring technical ventilation
- 3 of 9 have died
Testing has included common viral causes of illness to account for bilateral pneumonia and myalgias (muscle aches) but not necessarily viral. Testing was described as completed with a FilmArray for 25 pathogens. This appears to be a Biofire Multiplex PCR
What are the caveats of the ACAM2000 vaccine (replication-competent vaccinia virus) for monkeypox/smallpox? The stocks are much larger but why not used?
- Contraindications for many (see next tweets)
- Need to cover vaccine site to avoid spread to others (given contraindications)
So for whom would ACAM2000 be a concern?
From the US CDC:
These include those at high risk for heart disease (given risk of myocarditis), eczema or other exfoliative skin conditions, immunosuppressed, HIV+, use topical ophthalmic steroids, pregnant, breastfeeding, under 1,
If you've never seen what diphtheria, tetanus, or polio can do, you're lucky.
Your parents or grandparents or great grandparents weren't so lucky.
These are horrible diseases with no good treatments. This is why there are vaccines.
A little reminder of the reality:
Tetanus - each movement leads to painful waves of twitching. the patient is smiling sardonically, taking shallower and shallower breaths. others say they're fine. They look happy, not struggling for breath, just slowly silently suffocating, unable to move. it's a horror film.
Diphtheria - a choking choking, strangled by the layers of phlegm in their throat. it was the strangling angel, so horrifying to watch that doctors first invented tracheostomies, sticking knives and needles into children's necks desperately to keep them alive
+ cases also outside of metropolitan area
? suspected
^ likely includes separate introduction from endemic area, unrelated to main European transmission chain
Some cases may be reported as confirmed when test positive for orthopoxvirus but monkeypox not specifically confirmed
Although cases have a genetic link to Nigeria, this would be from past case(s). There are no reported outbreaks in Nigeria. Sporadic cases, likely related to animal reservoirs and not continued human transmission, have been reported in 2022, with 21 confirmed cases and 1 death.
Current monkeypox cases detected do not correspond to real time transmission 1) We are playing catch up identifying patients not recognized before 2) Monkeypox serial intervals* are much longer than say for COVID
Rising cases can still mean we are finding what we've been missing
*Serial Interval - time from illness onset in primary case to illness onset in secondary case
With some diseases this is short. 2 cases today may mean 4 new cases in 2 days. Other diseases have short incubation periods. With monkeypox 6-13 days(5-21 range) who.int/emergencies/di…
Study tracing person to person transmission of a different monkeypox clade (in the DRC). Incubation period on average 8 days (4-14) ncbi.nlm.nih.gov/pmc/articles/P…