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Thread: Disease and pandemics thread (because it's science)

  1. #181
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    Quote Originally Posted by Noclevername View Post
    Is antibiotics a preventative for pneumonia?
    I don’t know how effective it is, but yes, I think that antibiotics are given to people with serious cases of influenza to prevent pneumonia.
    As above, so below

  2. #182
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    Quote Originally Posted by Noclevername View Post
    Is antibiotics a preventative for pneumonia?
    It is preventative, but making a diagnosis for pneumonia is not very clear. A lot of times zithromax is given when COPD is present, but I don't know if anyone even knows why it works so well.
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  3. #183
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    Generally a bad idea to give antibiotics to "prevent" bacterial infection - you just end up with a resistant strain causing the infection, and contribute to the global phenomenon of antibiotic resistance.
    Instead: a high index of suspicion, early sputum samples, a "best guess" antibiotic based on microscopy (which in the old days we used to do almost literally at the bedside), then an appropriate antibiotic based on the culture and sensitivities report, which takes a couple of days.

    Grant Hutchison

  4. #184
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    Quote Originally Posted by grant hutchison View Post
    Generally a bad idea to give antibiotics to "prevent" bacterial infection - you just end up with a resistant strain causing the infection, and contribute to the global phenomenon of antibiotic resistance.
    Yes. Unfortunately in Japan it’s still common, as far as I know, for doctors to prescribe antibiotics to even young adults with the flu, “just in case.” It may be changing though. The problem is that doctors are paid based on an insurance point system, so they get a fee for each drug the prescribe. The payment is not based on the amount of time they spend with a patient.


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    As above, so below

  5. #185
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    Quote Originally Posted by grant hutchison View Post
    Generally a bad idea to give antibiotics to "prevent" bacterial infection - you just end up with a resistant strain causing the infection, and contribute to the global phenomenon of antibiotic resistance.
    Instead: a high index of suspicion, early sputum samples, a "best guess" antibiotic based on microscopy (which in the old days we used to do almost literally at the bedside), then an appropriate antibiotic based on the culture and sensitivities report, which takes a couple of days.

    Grant Hutchison
    I don't do the prescribing, I just see what happens. People want those antibiotics. Our business is paid on patient satisfaction, which is rated by HCAHPS. Another whole can of worms, and a whole bunch of other metrics. Usually, if they don't know the organism, two broad spectrums are used. When the culture and sensitivity comes back, then the antibiotics are backed off. We used to think antibiotics were magic, but it is the end of the line for some of them now. The worst one is MRSA. There is so many staff infections and E coli infections. But there is a lot more than that. I don't know if doctors can tell if something is viral or bacterial, but I suspect not, until cultures come back. Many times patients can't even provide a decent sputum sample. If you know better techniques please message me.
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  6. #186
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    Quote Originally Posted by Copernicus View Post
    I don't do the prescribing, I just see what happens. People want those antibiotics.
    I was writing about effective and appropriate use of antibiotics. (And maybe to dissuade a couple of people here from requesting inappropriate antibiotics.) I'm certainly not going to get into the issue of a health-care system driven by patient satisfaction.
    I know quite a few techniques to obtain good sputum samples, but I suspect they'd be too invasive for patients who are still able to express medical opinions.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    I was writing about effective and appropriate use of antibiotics. (And maybe to dissuade a couple of people here from requesting inappropriate antibiotics.) I'm certainly not going to get into the issue of a health-care system driven by patient satisfaction.
    I know quite a few techniques to obtain good sputum samples, but I suspect they'd be too invasive for patients who are still able to express medical opinions.

    Grant Hutchison
    They do broch's, but they are pretty horrible sometimes.
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    Bronchoscopies? Brochs are something entirely different.
    No reason for bronchoscopies to be horrible, these days. We have the technology. But there are other less dramatic techniques.

    Grant Hutchison

  9. #189
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    Drones with loudspeakers and TV cameras are warning Chinese citizens to put on facemasks -- you have to see it to believe it.

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  10. #190
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    Is it that difficult to determine whether pneumonia is viral or not? If viral, why would antibiotics be given? I would expect insurance companies would not want to pay for inappropriate treatments.
    We know time flies, we just can't see its wings.

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    The reporting rate affects Ro, which may allow a value as high as 3.58 per here.
    We know time flies, we just can't see its wings.

  12. #192
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    Quote Originally Posted by George View Post
    Is it that difficult to determine whether pneumonia is viral or not? If viral, why would antibiotics be given? I would expect insurance companies would not want to pay for inappropriate treatments.
    Severity of disease, X-ray appearances, and C-Reactive Protein levels all help push the diagnosis one way or the other, but no diagnostic test, or group of diagnostic tests, is perfect.
    Your guess is as good as mine why someone would give antibiotics to a person with viral pneumonia.

    Grant Hutchison

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    Quote Originally Posted by grant hutchison View Post
    Severity of disease, X-ray appearances, and C-Reactive Protein levels all help push the diagnosis one way or the other, but no diagnostic test, or group of diagnostic tests, is perfect.
    That’s encouraging. I hope, as I age, that if I get pneumonia I won’t have to scrutinize any diagnosis.
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    State-run Chinese media is promoting "traditional" herbal medicine said to inhibit the novel coronavirus, sparking panic buying.

    https://www.cnn.com/2020/02/01/asia/...hnk/index.html

    Meanwhile, the internet is doing its usual terrible job of spreading misinformation and just plain lies.

    https://www.bbc.com/news/blogs-trending-51271037
    Last edited by Roger E. Moore; 2020-Feb-02 at 06:14 PM.
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  15. #195
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    Quote Originally Posted by grant hutchison View Post
    ... Your guess is as good as mine why someone would give antibiotics to a person with viral pneumonia.
    To supress co-incident secondary bacterial infections?
    PS: Just noticed your post #183. However all medical treatments target 'risk' mitigation .. surely consideration has to be given to complicating factors which can end up becoming the more significant risk factor(?) How does one weigh up community risks (like anitbiotic resistance) against patient (individual) potential mortality 'risk' factors in a procedure driven medical system?
    Last edited by Selfsim; 2020-Feb-02 at 09:06 PM. Reason: Added "PS"

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    China cannot catch a break. H5N1 bird flu killing thousands of chickens in new outbreak.

    https://www.newsweek.com/h5n1-outbre...ickens-1485274
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  17. #197
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    Quote Originally Posted by George View Post
    I would expect insurance companies would not want to pay for inappropriate treatments.
    They get their cut $$$ with every padded bill. The more the merrier.
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    I am super impressed that they recognized the new virus at all. How does anyone say, hay this is a new virus, when so many times we can't really tell what they have. Sometimes one can't even tell if the lungs have cancer or pneumonia or congestive heart failure or other problems.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

  19. #199
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    Quote Originally Posted by Selfsim View Post
    To supress co-incident secondary bacterial infections?
    PS: Just noticed your post #183. However all medical treatments target 'risk' mitigation .. surely consideration has to be given to complicating factors which can end up becoming the more significant risk factor(?) How does one weigh up community risks (like anitbiotic resistance) against patient (individual) potential mortality 'risk' factors in a procedure driven medical system?
    As a general rule (with some exceptions) if there's no indication that a patient has a bacterial infection, then there's no indication for an antibiotic. Generally, you don't give drugs that people don't need, because the drugs themselves carry risks. With "prophylactic" antibiotics, there is also the risk that you create an environment in which any subsequent infection is with a resistant organism that requires more toxic antibiotics to eliminate--you're not doing your patient any favours, and potentially putting them in harm's way.

    Grant Hutchison

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    I think someone asked this up-thread. Does anyone here know how they discover a new virus like this?

    In a typical year, if I showed up at my doctor’s office with these symptoms, I suspect she’d diagnose the flu and be done with it.

    Does China routinely do checks on the type of virus?


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    Well, this is disturbing.

    Coronavirus Can Also Infect Your PCs and Phones — Didn't Expect This, Did You!

    https://www.news18.com/amp/news/tech...u-2481039.html

    Before you "Oh, good grief!" this, the article explains, "A Kaspersky report has revealed that PDFs, documents and videos being shared as Coronavirus preventives are actually trojans and malware in disguise."

    So all those folks who were concerned about the latest viral outbreak giving a virus to their computers were right.
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    Disease and pandemics thread (because it's science)

    Bloomberg is repointing a potential fecal transmission mechanism for the Coronavirus.
    Is this path common for viruses that affect the respiratory system?

    https://www.bloomberg.com/news/artic...d?srnd=premium

    ETA: Apparently, the answer is “yes.”

    Many of the emerging coronaviruses are so-called pneumoenteric viruses, meaning they can replicate both in the respiratory tract and the gastrointestinal system, said Ralph Baric, professor of microbiology and immunology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill




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    Last edited by Extravoice; 2020-Feb-03 at 03:33 PM.
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  23. #203
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    Quote Originally Posted by Extravoice View Post
    I think someone asked this up-thread. Does anyone here know how they discover a new virus like this?

    In a typical year, if I showed up at my doctor’s office with these symptoms, I suspect she’d diagnose the flu and be done with it.

    Does China routinely do checks on the type of virus?
    If you have a viral or atypical pneumonia severe enough to require admission to hospital, then samples (tissue, secretions, blood) will be taken for PCR testing to identify the RNA or DNA of likely causative organisms. Since SARS and MERS, I'm pretty sure coronavirus RNA will be part of the screening panel, especially in China. Once a coronavirus pops up on screening, it's a matter of culturing it and then sequencing the RNA - at which point China confirmed it was a novel infective organism, and shared the sequenced genome with the rest of the world.

    So, no, it's not something your family doctor would do, but the first part of the process would be a routine thing if you were severely ill in hospital, at which point alarm bells would start to ring and samples would go off to some specialist laboratory.

    Grant Hutchison

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    362 deaths, all but one in China, and at least 17,386 infected. Figures now surpass SARS (349 dead in China and 5,327 infected over 9 months in 2003). Economic impact in China could be severe.
    Do good work. —Virgil Ivan "Gus" Grissom

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    But 98% of patients recover, this is similar to annual flu. There does seem to be a degree of over reaction. However, as it stands this can only get worse as economic effect. I do wish our radio reporters would stop talking about the epicentre when they mean centre. Another good specific word getting adulterated.
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    Quote Originally Posted by profloater View Post
    I do wish our radio reporters would stop talking about the epicentre when they mean centre.
    Apparently, a lot of people think it means "the very centre" (or something like that)

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    Quote Originally Posted by profloater View Post
    But 98% of patients recover, this is similar to annual flu. There does seem to be a degree of over reaction. However, as it stands this can only get worse as economic effect. I do wish our radio reporters would stop talking about the epicentre when they mean centre. Another good specific word getting adulterated.
    While I agree that there is the appearance of overreaction-gone-viral by Chinese authorities, namely putting 3 cities under quarantine (I think on January 22nd) early on without the (reported) infection/death rates, IMHO justifying it, it is important to note that about 96% of those reported infected have neither passed-on nor recovered yet as far as I can tell.
    Last edited by a1call; 2020-Feb-03 at 06:32 PM.

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    CNBC has a coronavirus story today with quotes from a Dr. Anthony Fauci of the NIH. He believes like many that actual cases are much higher than reported, with many people w/o symptoms or having mild issues. Of reported cases, 25% need intensive care. He said the number of new reported cases is escalating.
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    Quote Originally Posted by profloater View Post
    However, as it stands this can only get worse as economic effect. I do wish our radio reporters would stop talking about the epicentre when they mean centre. Another good specific word getting adulterated.
    Quote Originally Posted by Strange View Post
    Apparently, a lot of people think it means "the very centre" (or something like that)
    https://www.merriam-webster.com/word...g-center-usage

    We occasionally see epicenter used figuratively to mean “center”—essentially, the place where an activity is localized:
    [snip]

    Usage Criticisms
    While this use is very common, it has been the subject of criticism by usage commentators.
    [snip]

    ...But even though this sense of epicenter is defined as, simply, "center," it's still English we're talking about here: superfluous prefixes are rarely a disqualifying feature.
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  30. #210
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    Quote Originally Posted by Roger E. Moore View Post
    362 deaths, all but one in China, and at least 17,386 infected. Figures now surpass SARS (349 dead in China and 5,327 infected over 9 months in 2003). Economic impact in China could be severe.
    Could that be 15,327 infected with SARS instead, otherwise that is a very high CFR value and different than what I've seen?
    We know time flies, we just can't see its wings.

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