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  1. #1
    splendid and tremendous
    somtamslap's Avatar
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    False negative: a tale of Covid and fear and hope...

    It all started, as it often does, on a grey and drizzly evening in suburbia.

    I'd just congratulated myself on negotiating another day with nary a sniffle or a dry cough or a life-threatening shortness of breath to speak of. Indeed, while the rest of the country brought out their dead, I was nestled in a comfortable corner of my living room watching Mike Tyson's greatest knockouts on YouTube and feeling as fit and healthy as the man himself in his pomp. It was an interesting clip. I especially liked the part when Mike threatened to eat his opponent's children - and he didn't even need a nice Chianti or some fava beans on the side. Oh no, Mike obviously took his nutrition very seriously and saw this not only as an opportunity to upset his rival by comsuming their offspring, but also to take some premium protein onboard in the process. A genuis move, Michael. A little barbaric, but well thought out.

    Then my wife entered the house. She had a sniffle, a dry cough, and a life-threatening shortness of breath. Well, perhaps not the latter, but her symptoms were such that anyone who hasn't been living in a Belarussian cave for the past three months would immediately conclude she'd picked up a dose of corona. And so she went to bed. And there she stayed, with a persistent fever and perpetual aches and pains for the next seven days. In accordance with government guidelines we were officially under quarantine. It was a particulary unpleasant experience. A cocktail of boredom and tedium topped up with a finger or two of fear. The situation begged several questions: when would my wife get better?; when would I get ill?; would the children be affected?; how long before I'm found wanking in a puddle of my own piss in the loft?

    As my wife is a key worker, a week after she fell ill we went to Chessington World of Adventures. Hooray! A day out at one of the country's foremost theme parks. Not a little ironic, then, that it is currently being used as a Covid test centre. Two swabs later, one throat, one nostril, and we got back in the car and headed home where my wife immediately returned to the solace of bed, shivering under the barrage of a 39-degree fever.

    Thirty hours later (six hours sooner than promised on the test registration card) I received a text message: "Your test result for Covid-19 has come back NEGATIVE".

    After reading this my first thoughts were that the good people at the NHS had spelt POSITIVE incorrectly, then, reading further we were instructed to contact my wife's employers and make arrangements to return to work. Return to work?! The women can barely stand up for 30 seconds, let alone assist 20-stone octogenarians with their ablutions.

    So I gave her the good news. "You haven't got coronavirus, love. The test came back negative."

    I celebrated that evening by banging back half a box of Malbec I'd bought especially for isolation purposes and a couple of cans of Heineken, eventually hitting the hay feeling not quite as toxic as I previously had.

    The following day dawned, which was a relief, but my wife was no better. This was now day 10 of whatever ailment it was, and it appeared to be a stubborn little fucker. I decided that the next day, if things hadn't improved that we'd have to brave the outside world again and go to the doctor's surgery.

    And sure enough the following day, the temperature was still present. And now it had company, in the form of a decided shortness of breath. I phoned the doctor who urged us to come along to the surgery - and we gladly obliged.

    An oxygen saturation test later and I was advised to take my wife to hospital - "And don't hang around"

    I gunned it down the A3 as fast as my piece of shit VW Sharan would allow, and swung up outside the Covid Pod at our nearest hospital. I looked at my wife as they led her in through the plastic awning. She was shellshocked, shaking her head in disbelief. So was I...

    I was told in no unceratin terms to get the fuck out of there... I probably had the virus, albeit asymptamatically, and they wanted me gone.

    I went.

    I returned home and the children asked me where mummy was. I told them she had to see another doctor who would be making her better. They started happily playing again.

    My brain turned to mush and I felt physically sick. I went to my shed and did an anaerobic endurance workout on the turbo trainer. That levelled things off.

    I called her. No answer.

    Again. No answer.

    Finally... "I'll call you when the doctor has seen me." The words were labooured.

    At ungodly o' clock the follwing morning I called here again. They wanted to keep her in... her oxygen levels were still low.

    This virus remains a complete unknown, even to medical experts who have spent the past three months dedictating their lives to understanding it. Why is the spectrum of reactions so broad? From asymptomatic to death. Time will tell, and a vaccine can't be concocted quickly enough.

    Two days after she'd been admitted, my wife was released from hospital with safe oxygen levels.

    We have been lucky.

    And I hope you and yours are too.

    Staying home is the idiot proof way of ensuring this.

    Stay safe.

  2. #2
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    NamPikToot's Avatar
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    A telling tale on the state of testing accuracy which is a real global issue. Glad she's pulling through.

  3. #3
    splendid and tremendous
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    Test is at its most accurate in the first week apparently. Still leaves you with little confidence.

  4. #4
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    WOW, glad she is better now and all can breathe better now, Slap. Stay safe!

  5. #5
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    Great to hear your wife is improving mate.

    And my wishes to everyone to keep fit and well.

  6. #6
    disturbance in the Turnip baldrick's Avatar
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  7. #7
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    ^
    excellent article, cut and pasted here.


    The Infection That’s Silently Killing Coronavirus Patients

    This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.

    By Richard Levitan
    Dr. Levitan is an emergency doctor.

    April 20, 2020

    1527


    I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.

    So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.

    On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”

    He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

    During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.



    Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.

    And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

    We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

    Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

    To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

    In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

    A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

    We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

    Share Your Stories From the Front Lines We want to hear from doctors, nurses and health care workers around the world.

    Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

    By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

    Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

    A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.

    Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.

    There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

    Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

    Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.

    Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.

    People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

    All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.

    More about this author.
    The Doctor Came to Save Lives. The Co-op Board Told Him to Get Lost.April 3, 2020

    What Doctors on the Front Lines Wish They’d Known a Month AgoApril 14, 2020

    There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) open up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.

    To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.

    But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.

    It’s time to get ahead of this virus instead of chasing it.

    Richard Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.

    The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.

    Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

    READ 1527 COMMENTS

  8. #8
    Thailand Expat TheRealKW's Avatar
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    A welcome post from the Slap; glad your missus is okenjoy readinng your posts

  9. #9
    Thailand Expat
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    Double thumbs up to Slap.

  10. #10
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    Quote Originally Posted by somtamslap View Post
    Why is the spectrum of reactions so broad? From asymptomatic to death.
    Blood types, age, genetics, health.

    Nice to see the wife is on the mend. Did they ask who she had been in contact with over the last couple of weeks?

  11. #11
    Thailand Expat lom's Avatar
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    Quote Originally Posted by Dillinger View Post
    Did they ask who she had been in contact with over the last couple of weeks?
    He mentioned that she is a key worker so I guess she meets a lot of patients while Slap is home watching porn:

    Quote Originally Posted by somtamslap View Post
    I was nestled in a comfortable corner of my living room watching Mike Tyson's greatest knockouts

  12. #12
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    nurses and the medical profession are the first casualties in that war, a lot have died from multiple exposure to the virus

  13. #13
    splendid and tremendous
    somtamslap's Avatar
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    Thanks all, I can safely say I've never been so worried. It escalated very quickly. Our local GP said that ethnic minorities, namely Southeast Asian and Africans seems to be more prone to developing difficulties with the virus, and that rather than sweeping the nation it is arising in a series of pockets. I'm absolutely stunned looking at the Thai statistics - I really hope they remain as they are.

    Bollski - she works in a care home and caught it from one of three colleagues who had the virus and quickly recovered.

  14. #14
    I'm in Jail

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    So surely you've had it now yourself Slap? Is there a way to find that out?

    And surely you yourself and family should be allowed out and about now and free roam of empty golf courses, beaches and countryside

  15. #15
    splendid and tremendous
    somtamslap's Avatar
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    I can only imagine that myself and the kids have had it, we live in a mid-terrace so domestic distancing was never going to happen. But alas, no antibody test yet so we can't be sure. I am allowed to go to Sainsbury's now though. Cosmic.

  16. #16
    Thailand Expat klong toey's Avatar
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    Best wishes to you and your family Mr Slap stay safe.
    What i find strange is in Blighty and other places South East Asians are high risk but in Thailand things appear to be different ,not that i believe to much that the Thai press releases in the news.

  17. #17
    splendid and tremendous
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    Quote Originally Posted by klong toey View Post
    not that i believe to much that the Thai press releases in the news
    Even for Thai officials, it would be a serious book cooking job to keep the figures that low. I sincerely hope the heat is getting the better of it.

  18. #18
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    @slap - good to hear that your wife is on the mend

    Accdg to the S. Korean doctor (epidemiology), the Covid swab test could turn negative if the virus doesn't have enough copies to be detected by the PCR (polymerase chain reaction) test. It's also the reason why some ppl test positive, get hospitalised and get better, test becomes negative (only minute amounts of the virus, not detectable by the test). The person is released from hospital, then the little remaining amounts of virus start to replicate and the person shows symptoms again & tests positive again.

    As I've mentioned in the covid thread, there was a young doctor here in PI (early 30s) who had symptoms yet tested negative. A few days later and more symptoms, he tested positive. In the initial test - the viral load/ number may not have been high enough to be detected by the test.

    IMO, the numbers in developing countries like PI, TH, India, Indonesia etc are severely underestimated since they're not doing enough testing. The worldometers site gives a good picture of number of tests per million of population.

    I've posted these in the covid thread, but will post again here, in case it got buried in the great thread.

    2nd interview with Dr. Kim, released April 15. Talks about updates, medications, cytokine storm, etc.



    First interview with Dr Kim, released 28 March. Talks of Korea's response to covid, mask-wearing, etc. A few days after this interview, the US surgeon general & Melania Trump advised the public to wear mask or face covering.



    Sorry for the long post. But I think there are still many ppl on this forum who don't believe in wearing the face masks. A person may be positive yet asymptomatic, so a mask prevents your droplets from potentially spreading it to others.

    Stay safe & take care!
    Last edited by katie23; 23-04-2020 at 02:49 PM. Reason: Added info

  19. #19
    ความรู้ลึกลับ HuangLao's Avatar
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    Nice one, Slap.
    Hope all is well.

    Don't be a stranger.

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