Emergence of a Deadly Coronavirus

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Yes already had a dizzy spell from this conundrum. But the herd immunity argument is going to be less potent anyway when the HIV characteristics of the COVID-19 virus become apparent and infected people discover their antibodies won't prevent reinfection.

Now you freaked me out, jimmy. I've had walking pneumonia for nearly three weeks. It's bacterial, as confirmed on xray and blood / sputum cultures. I've recently finished my antibiotics and steroid treatment but I still feel like I'm short of breath.

As a child I went on a respirator (not ventilator) weekly at hospital, to expand my lung capacity because I got pneumonia so often that my lungs didn't develop fully.

Now your article scared me. My doctor said I didn't need a covid test because I was bacterial, and it would put me at unnecessary risk to go to a test centre.

Thoughts?

A spring heat wave drove an uptick of people to California beaches, golf courses and trails, leading to the closure of one coastal park as authorities warned people not to swarm recreational areas for fear of igniting a deadly coronavirus surge.

Temperatures soared into the 80s and 90s in many areas from Sacramento to San Diego on Saturday. While most recreation remains shuttered under various stay-at-home orders, officials are wary that those still open could draw crowds that will ignore social distancing rules and seek sun and air after being mainly confined indoors for more than a month.

"We're seeing a summer day crowd," said Brian O'Rourke, a lifeguard battalion chief in Newport Beach in Orange County, which saw an estimated 40,000 people on Friday. A similar crowd was expected Saturday as the fog burns off.

Police in Pacific Grove said they had to close the picturesque Lovers Point Park and Beach at the southern end of Monterey Bay because of a lack of social distancing.

Los Angeles city and county beaches, trails and playgrounds were closed, and officers on horseback were patrolling those areas to enforce social distancing rules. The city also opened cooling centers for people "who might not be able to survive the heat wave at home," Mayor Eric Garcetti said.

California has more than 41,000 coronavirus cases and more than 1,670 deaths, half of them in the Los Angeles area, according to data compiled by Johns Hopkins University. However, the number of infections is thought to be far higher because many people have not been tested, and studies suggest people can be infected with the virus without feeling sick.

New York City Mayor Bill de Blasio says he hopes to have a roadmap by June 1 on how to rebuild the city after the coronavirus threat subsides.

He has invited city leaders to help plan the recovery. He said a full rebuild will take about 20 months.

"We don't just need a recovery, we need a transformation," de Blasio said. "We need to build a better and more just society than the one we left behind," de Blasio said.

He outlined the advisory councils will work on the recovery plan:
Large Business
Small Business
Public Health and Health care
Education and Vocational Training
Arts, Culture, Tourism
Labor
Nonprofits and Social Services
Faith-Based Community

The Mayor stressed that it is imperative that the city's approach to recovery must address the "structural racism," "painful inequalities" and disparities that have been "laid bare" during the coronavirus crisis.

He announced that city would also create a "Fair Recovery Task Force" to help New Yorkers recover from the coronavirus crisis, and a charter revision commission, to apply "structural changes to foster a fair recovery."

"Recovery means to me getting back not just to a point where life feels more normal but getting back to a point of strength, additionally addressing the underlying issues we still need to address in the city," de Blasio added.

The mayor said most key COVID-19 indicators remain on a downward trend, but that must continue for 10 to 14 days consistently.

"We restart when we have evidence," he said. "Anybody, any state, any city that doesn't pay attention to those factual health care indicators that evidence is endangering themselves and their people and the whole idea of having a restart to have an economy again, recover, it could all backfire because the disease reasserts.

De Blasio added getting people back to work is central to recovery and that there are a number of outstanding questions that his administration is working to address.

"How do you reopen a restaurant and still do it in a way that protects the customers and protects the people that work there? What kind of protection will people need? What kind of PPE's will people need to wear in different parts of the city, a lot of different work they do to make sure they are safe. When will they need more? When will they need less? We've got to start filling in those blanks," he said.

There’s a better chance your boyfriend will get severe symptoms, but not a 100% chance, and certainly not a 100% chance he will die.

My mother is 85 and immunocompromised. She had less severe symptoms than I had.

Thanks jimmy.
Oh, PS again: Are the UVC lights on my air purifier OK for my dog and cat? They don't stare at it or anything but is it a harmful wavelength?

Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room.

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.

Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the coronavirus. The median age for that type of severe stroke is 74.

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

Stroke surge
Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of the disease it causes. The numbers of those affected are small but nonetheless remarkable because they challenge how doctors understand the virus. Even as it has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.

Until recently, there was little hard data on strokes and covid-19.

There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes, with many being seriously ill and elderly. But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist and critical care doctor.

Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. There are only a few dozen cases per location, but they provide new insights into what the virus does to our bodies.

A stroke, which is a sudden interruption of the blood supply, is a complex problem with numerous causes and presentations. It can be caused by heart problems, clogged arteries due to cholesterol, even substance abuse. Mini-strokes often don’t cause permanent damage and can resolve on their own within 24 hours. But bigger ones can be catastrophic.

The analyses suggest coronavirus patients are mostly experiencing the deadliest type of stroke. Known as large vessel occlusions, or LVOs, they can obliterate large parts of the brain responsible for movement, speech and decision-making in one blow because they are in the main blood-supplying arteries.

Many researchers suspect strokes in covid-19 patients may be a direct consequence of blood problems that are producing clots all over some people’s bodies.

Clots that form on vessel walls fly upward. One that started in the calves might migrate to the lungs, causing a blockage called a pulmonary embolism that arrests breathing — a known cause of death in covid-19 patients. Clots in or near the heart might lead to a heart attack, another common cause of death. Anything above that would probably go to the brain, leading to a stroke.

Robert Stevens, a critical care doctor at Johns Hopkins Hospital in Baltimore, called strokes “one of the most dramatic manifestations” of the blood-clotting issues. “We’ve also taken care of patients in their 30s with stroke and covid, and this was extremely surprising,” he said.

Many doctors expressed worry that as the New York City Fire Department was picking up four times as many people who died at home as normal during the peak of infection that some of the dead had suffered sudden strokes. The truth may never be known because few autopsies were conducted.

Chou said one question is whether the clotting is because of a direct attack on the blood vessels, or a “friendly-fire problem” caused by the patient’s immune response.

“In your body’s attempt to fight off the virus, does the immune response end up hurting your brain?” she asked. Chou is hoping to answer such questions through a review of strokes and other neurological complications in thousands of covid-19 patients treated at 68 medical centers in 17 countries.

Thomas Jefferson University Hospitals, which operates 14 medical centers in Philadelphia, and NYU Langone Health in New York City, found that 12 of their patients treated for large blood blockages in their brains during a three-week period had the virus. Forty percent were under 50, and they had few or no risk factors. Their paper is under review by a medical journal, said Pascal Jabbour, a neurosurgeon at Thomas Jefferson.

In the vast majority of younger adults, covid-19 appears to result in mild illness with the risk of more severe consequences rising with every decade of age. According to Centers for Disease Control and Prevention data, 0.8 percent of U.S. deaths as of Apr. 18 were in people ages 25 to 34; 2 percent among those 35 to 44; and 5.4 percent among those 45 to 54.

Jabbour and his co-author Eytan Raz, an assistant professor of neuroradiology at NYU Langone, said that strokes in covid-19 patients challenge conventional thinking. “We are used to thinking of 60 as a young patient when it comes to large vessel occlusions,” Raz said of the deadliest strokes. “We have never seen so many in their 50s, 40s and late 30s.”

Raz wondered whether they are seeing more young patients because they are more resistant than the elderly to the respiratory distress caused by covid-19: “So they survive the lung side, and in time develop other issues.

Jabbour said many cases he has treated have unusual characteristics. Brain clots usually appear in the arteries, which carry blood away from the heart. But in covid-19 patients, he is also seeing them in the veins, which carry blood in the opposite direction and are trickier to treat. Some patients are also developing more than one large clot in their heads, which is highly unusual.

“We’ll be treating a blood vessel and it will go fine, but then the patient will have a major stroke” because of a clot in another part of the brain, he said.

The 33-year-old
At Mount Sinai, the largest medical system in New York City, physician-researcher J Mocco said the number of patients coming in with large blood blockages in their brains doubled during the three weeks of the covid-19 surge to more than 32, even as the number of other emergencies fell. More than half of were covid-19 positive.

It isn’t just the number of patients that was unusual. The first wave of the pandemic has hit the elderly and those with heart disease, diabetes, obesity or other preexisting conditions disproportionately. The covid-19 patients treated for stroke at Mount Sinai were younger and mostly without risk factors.

On average, the covid-19 stroke patients were 15 years younger than stroke patients without the virus.

“These are people among the least likely statistically to have a stroke,” Mocco said.

Mocco, who has spent his career studying strokes and how to treat them, said he was “completely shocked” by the analysis. He noted the link between covid-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”

“This is much too powerful of a signal to be chance or happenstance,” he said.

n a letter to be published in the New England Journal of Medicine next week, the Mount Sinai team details five case studies of young patients who had strokes at home from March 23 to April 7. They make for difficult reading: The victims’ ages are 33, 37, 39, 44 and 49, and they were all home when they began to experience sudden symptoms, including slurred speech, confusion, drooping on one side of the face and a dead feeling in one arm.

One died, two are still hospitalized, one was released to rehabilitation, and one was released home to the care of his brother. Only one of the five, a 33-year-old woman, is able to speak.

Oxley, the interventional neurologist, said one striking aspect of the cases is how long many waited before seeking emergency care.

The 33-year-old woman was previously healthy but had a cough and headache for about a week. Over the course of 28 hours, she noticed her speech was slurred and that she was going numb and weak on her left side but, the researchers wrote, “delayed seeking emergency care due to fear of the covid-19 outbreak.”

It turned out she was already infected.

By the time she arrived at the hospital, a CT scan showed she had two clots in her brain and patchy “ground glass” in her lungs — the opacity in CT scans that is a hallmark of covid-19 infection. She was given two different types of therapy to try to break up the clots and by Day 10, she was well enough to be discharged.

Oxley said the most important thing for people to understand is that large strokes are very treatable. Doctors are often able to reopen blocked blood vessels through techniques such as pulling out clots or inserting stents. But it has to be done quickly, ideally within six hours, but no longer than 24 hours: “The message we are trying to get out is if you have symptoms of stroke, you need to call the ambulance urgently. ”

As for the 44-year-old man Oxley was treating, doctors were able to remove the large clot that day in late March, but the patient is still struggling. As of this week, a little over a month after he arrived in the emergency room, he is still hospitalized.

Cripes. My father died at 59 from multiple heart attacks, his own father died of a heart attack at a similar age, my younger brother needed a quadruple heart bypass a few years ago, my mother died from COPD, I wonder what my own chances of survival would be if I were to catch this thing.

Not sure what to make of any of this. Just cross my fingers and hope for the best maybe?