On the front lines, here’s what the seven stages of severe Covid-19 look like | Hacker News Reader

On the front lines, here’s what the seven stages of severe Covid-19 look like

latimes.com

51 pointsrmason32 comments

> Stage 1. You’ve had debilitating symptoms for a few days, but now it is so hard to breathe that you come to the emergency room. Your oxygen saturation level tells us you need help, a supplemental flow of 1 to 4 liters of oxygen per minute. We admit you and start you on antivirals, steroids, anticoagulants or monoclonal antibodies.

Your chances of survival and healthy recovery greatly increase if you begin treatment early in the symptomatic phase with antivirals, corticosteroids, and antithrombotics.

Mistake number 1 is having severe symptoms and waiting for days before seeking treatment. Most people are seemingly unaware of this advice, but many front line doctors have been using these techniques to significantly reduce hospitalization and death since the beginning of the pandemic.

[1] Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19) https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?a...

[2] Timing of Antiviral Treatment Initiation is Critical to Reduce SARS-CoV-2 Viral Load https://ascpt.onlinelibrary.wiley.com/doi/pdf/10.1002/psp4.1...

[3] Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection

https://rcm.imrpress.com/EN/article/downloadArticleFile.do?a...

[4] Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents

https://www.sciencedirect.com/science/article/abs/pii/S03069...

I don't know why you're getting downvoted. I remember reading a story about a woman who thought she had worsening allergies before getting a covid test, and then going to the hospital. With the way this spreads, if you have any breathing symptoms, it's worth getting a covid test, and then trying to start treatment if it comes back positive instead of just waiting for it to get worse.

Yes it’s extremely important that people are aware of the benefits of beginning treatment early. Waiting for a positive test isn’t even strictly necessary.

Apparently some people here find that to be disagreeable? I would love to hear their perspective and reasoning.

>trying to start treatment

This is contrary to the directions given by the healthcare system, which generally tells covid-positive patients to wait until they have trouble breathing to seek medical care.

So they may be getting downvoted because they're essentially recommending cutting in line ahead of people that need more immediate care from strained ED / ICU infrastructure.

You don’t need to go to the ED / ICU, just about any clinic will write you a prescription. In fact early ambulatory treatment is one of the best ways to avoid straining healthcare infrastructure. No cutting in line necessary.

That's great to hear, it's just not what GPs are telling their patients.

The first symptom of many diseases is denial.

But how can one tell that they need treatment, just by o2 level? I’ve heard of cases where they felt terrible and then it cleared up and they were fine.

A decreased SpO2 doesn't necessarily indicate that you need treatment. It means you should get a diagnostic test and then consult with your physician on what if any treatment is needed.

Buy or borrow a fingertip blood oxygen level to see where you are at. Covid has been different (see below) in that people feel ok while their blood O2 levels are on the way down - they're breathing normally, CO2 does not build up in the blood and so no internal "feelings" appear. Thus, by the time you notice that you can't do much at all, you've been sick for a few days and are behind the curve on treatment. Pay f*ckin' attention when you think you have a cold or the flu right now...

https://www.science.org/doi/abs/10.1126/science.368.6490.455

Some modern smart watches from vendors like Garmin and Apple also have blood oxygen sensors. They're generally less accurate than dedicated fingertip sensors, but good enough to catch significant decreases. Both types can sometimes read way off depending on skin tone.

I've been using my Garmin for this and though the absolute numbers may be slightly off, it's useful to have a running track for reference to what it says you are.

Treatment... what is the standard of care?

I had it and have a letter from my Dr. that says so and that I have recovered. Dr. said the standard of care is to send people home until they choke, then rush to the hospital for a breathing tube.

The standard of care could be to lose weight now, before you get it.

Here is the treatment protocol.

https://www.covid19treatmentguidelines.nih.gov/about-the-gui...

https://archive.is/EBF79

The worst of these early COVID symptoms can be eliminated almost entirely by taking NAC (N-Acetyl-Cysteine).

NAC breaks down mucus (also good if you have COPD). Even better, there are no negative side effects with giving it a shot unless you have some sort of super weird medical condition.

Look into it. Take 500-600mg at the first sign of breathing issues.

Just stop.

Or just take the proven to work vaccine.

There are theoretical reasons to think that NAC might be a useful therapy. However a recent clinical trial failed to find any benefit.

https://academic.oup.com/cid/article/72/11/e736/5910353

Many of these stories would be prevented if ivermectin was more readily available. Yet the first thing that comes up when googling it is the FDA making baseless claims of it being dangerous. Of course it can be dangerous when people have to turn to questionable sources instead of being able to get it from their doctor with instructions for use.

That's possible, but the research studies showing clinical benefits from ivermectin have generally been small or had other methodology limitations. Other studies have shown no statistically significant effect. This is an area where we need some larger RCTs with multiple arms for variations in timing and dosage to definitively resolve the issue.

https://www.mdpi.com/1999-4915/13/6/989

For now the smart option for most people is to get vaccinated rather than expecting ivermectin to save them.

Could be political. It was for Hydroxychloroquine.

Hypocritical to call the FDA claims baseless when you provide no basis for your claim that it would prevent many of these stories.

From what I've read the in vitro response requires something like 100x the safe dose for a human, which causes many other health issues. The in vivo response hasn't even been studied, unless you have some information I don't?

I've personally seen it help someone who was getting significantly worse day after day. The effect was undeniable, and makes it infuriating to see claims of the drug as being dangerous or needing more study. Because the FDA is the FDA doesn't mean what they're publishing isn't misinformation. The dose used was about the same as would be used for malaria, within hours of the first dose there was already massive improvement in breathing and overall energy. After further doses it wasn't long before complete recovery. To deny easy access to this sort of thing, for doctors not to offer it as an option when a patient is found to have covid, is criminal.

Where is the basis of any of the FDA's claims? Because the mechanism of action isn't fully understood? Does it matter when it saves lives?

I don't really follow the debate, but team "pro" (e.g. you) says it works, and apparently team "anti" can cite studies that it has no effect. Could it be that the person you saw got cured would've recovered without the medication anyway? Team "anti" seems to have more data to say that it doesn't work.

To make a poor analogy, maybe this is like saying "buy lottery tickets to be wealthy, I saw it work for this one person!", although that person never won the lottery but was a shrewd businessman.

Of several covid stories of people around me, I've never heard of a recovery like this one. No long haul, nothing at all, everything fits a definition of having been cured. In a few days. Able to do strenuous activity without issue. All the no-treatment recoveries I'm aware of were fairly slow processes over weeks.

> I've personally seen it help someone who was getting significantly worse day after day. (...)

Some people do recover from Covid19 on their own. Ironically, a popular theme among covid deniers is to boast about covid's alleged 99% survivability rate. What leads you to believe that your anecdotal case was caused by taking ivermectin instead of simply correlated with its ingestion?

There's a famous Simpsons scene where Lisa shows Homer a Tiger-repelling rock. That's what ivermectin proponents sound like.

I'm not a "covid denier" by any means but why would you mention an "alleged" survival rate? The best available data from the CDC shows a 99.4% survival rate.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

The rate of recovery after first dose, directly correlated with it was plain and clear. If you take a drug and experience significant effects within hours of taking it, you don't question if you randomly would've felt that way anyways, you know exactly whats causing it. This person was getting nearer and nearer to hospitalization possibly, when someone in that situation has a 180 in condition just hours after a dose of treatment, you don't question "oh maybe the treatment did nothing at all".

I understand of course questioning causation/correlation, except when something is so absolute and its life and death, its criminal and morally devoid to deny access to treatment.

It works. Look deeper into it if you really care, or stop saying anything against it. If you don't know someone with covid who's been treated with it, how can you take your own opinion seriously? You can question about the reality of how effective it is of course, but its wrong to argue against something that is harmless and may be life saving.

The in vivo response has been studied. This site has a fairly complete index to studies so far.

https://c19ivermectin.com/

I recommend ignoring the editorial content on that site and just read the original studies directly. None are really conclusive one way or the other due to small subject groups or other limitations. At least one study has been retracted. So more research is still needed.

72% improvement in 27 early treatment trials and 86% improvement in 14 prophylaxis trials https://ivmmeta.com/ is a bit easier to digest

Sure more research is still needed but with these sorts of results so far, if someone wants ivermectin, they should be able to get it, easily, cheaply. There is no excuse for it to be banned or doctors only allowed to prescribe it later into treatment (or not at all in some cases), its criminal, and when you've seen someone saved by it, you've heard the difference in their voice hours after first dosage, its absolutely infuriating that anyone would take a single action against easy access to ivermectin and information about it. It has been researched for use as malaria treatment for decades, so it being safe for people to take isn't even in question whatsoever. If it in some way made the infection worse, that would already be clear in the studies that have been done. It should be available to anyone who wants it.

No, but most of these would be prevented if people would just get vaccinated.

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