hii kitu inasemekana inapunguza a patient’s recovery time by 31%…yaani someone who would have otherwise spent 15 days in hospital gets to spend 11days…Fauci ameipitisha ianze kutumika pale kwa trump…madaktari akina @Purple ebu leteni more insights kwa layman
Before yesterday’s major announcement, Gilead was trialing the drug at our hospital. The inclusion criteria, who gets into the study, was very strict in order to limit confounding factors during their statistical analysis on drug efficacy.
What we noticed, sure, it may have helped some but it wasn’t a magic bullet. Some of those people have since died or are still on the ventilator. What we saw was a increased risk of severe bleeding from orifices, including the nose/mouth but mostly rectal bleeding. I remember this night being on call, this older gentleman bled so much! His blood was everywhere. We had to order several units of clotting transfusions (fresh frozen plasma, platelets, cryoprecipitate) to mitigate this issue. The guy was on a blood thinner too, called heparin, which may have contributed. He required heparin because his body was churning out clots which are detrimental to lung function. What scientists are discovering is that this virus is doing more than simply infecting the lungs. It’s also destroying the lining of blood vessels (vascular endothelium) causing inflammation and severe clotting. When they draw blood from covid patients, it clots in the tubes. When nurses insert catheters for kidney dialysis and IV lines to draw blood, the tubes quickly become clogged with clots.
The other downside we noticed was significant elevations in liver enzymes. Remdesivir can cause shock liver so you have to watch those labs carefully. Critically ill covid patients on ventilators are soooo sick, I don’t know how to explain it. I haven’t seen anything quite like it! Only about 30% recover when they get to this stage.
Here are two screenshots I took of our treatment protocol and clinical criteria to qualify for a Remdesivir trial. We have another ongoing trial looking at plasma therapy from recovered covid patients.
Its approval was fast tracked by the fda because there’s no other proven treatment. Of note, there was no control group for the “severe study.” In other words, all severe covid patients who qualified for the trial received Remdesivir because it would be considered unethical to exclude others, when there was some proven benefit in the moderately ill population. Because there’s no control arm in the severe group, obviously that introduces all kinds of observer bias.
There’s sort of a quiet desperation to get something that can alleviate this horrible suffering.
So while I didn’t see enough people get magically better after Remdesivir, I don’t have the benefit of seeing the forest from the trees. That’s why we go by the results of the overall study. Severe bleeding can always be controlled with transfusions. Not everyone gets to shock liver so that’s not enough reason to reject a drug that works. But does it really work for the sickest people? They’re saying it does so that’s what we’ll go by (until further notice).
It’s fallen out of favor especially in the older population with cardiac co-morbidities. We’re not using it on them because of the real risk of deadly arrhythmias. However there’s a lot of physician discretion which happens during a novel disease outbreak.
Since this virus likes to set up favorable conditions for a superimposed bacterial pneumonia and sepsis, broad spectrum antibiotics and oxygen therapy w/wo mechanical ventilation have become the mainstay treatment. Thereafter, we narrow down to the specific organism as fever subsides and after obtaining results from sputum cultures.
Thank you very much, even if I’ve had to google some of the medical terms! Have you seen a relationship between Vitamin D and Corona? I read somewhere that people with Vitamin D deficiency are more likely to die of Covid-19.
Sorry! There’s an infectious disease doctor who I respect very much. He told me a while back, to start taking daily vitamin D supplements to boost my immunity. However, there are no precise recommendations to use it on covid patients.
Thanks again. Sorry to ask a million questions but you’re about the most resourceful person I’ve met so far. Is it true that smoking reduces chances of contracting coronavirus, ati because it blocks the virus from accessing receptors in the lungs? How many smokers do you know have died from Covid?