I have been posting about covid on my other blog. part of the reason is that it is mixed with political or local news here in the Philippines.
Hydoxychloroquin might or might not work (depending on the study) but now it is PC to say it doesn't work.
but the next big thing is dog dewormer medicine:
Saturday, December 12, 2020
Saturday, August 29, 2020
polio
one of the problems of oral polio vaccine is that it is an attenuated "live" vaccine: a weakened form of the infection. Alas, in one out of a million cases, it will mutate back to the severe form.
this is not a major problem because with universal vaccination, the mutated virus does not spread, because every one is immune.
But that's not what happens where vaccination rates are low
that is what happened here.
But note: the numbers are low:
In 2019, 358 cVDPV2 cases were reported, representing a fourfold increase over the 71 cases reported in 2018 and more than tripling the number of countries with outbreaks, from five (2) to 16. As of August 2, a total of 236 cVDPV2 cases in 17 countries have been reported in 2020. Among 33 cVDPV outbreaks reported during July 2018–February 2020, 31 (94%) were caused by cVDPV2 (1).
this is not a major problem because with universal vaccination, the mutated virus does not spread, because every one is immune.
But that's not what happens where vaccination rates are low
that is what happened here.
But note: the numbers are low:
In 2019, 358 cVDPV2 cases were reported, representing a fourfold increase over the 71 cases reported in 2018 and more than tripling the number of countries with outbreaks, from five (2) to 16. As of August 2, a total of 236 cVDPV2 cases in 17 countries have been reported in 2020. Among 33 cVDPV outbreaks reported during July 2018–February 2020, 31 (94%) were caused by cVDPV2 (1).
Monday, March 23, 2020
infectious disease update
I am posting about the Corona virus on my main blog LINK
and have been too lazy to cross post here, since I'd have to remove the political stuff and that would take time.
however, if you are interested in infectious disease, check out the Teaching company videos that they posted on youtube: A course in infectious disease:
and have been too lazy to cross post here, since I'd have to remove the political stuff and that would take time.
however, if you are interested in infectious disease, check out the Teaching company videos that they posted on youtube: A course in infectious disease:
Saturday, March 21, 2020
Pre eclampsia: Pregnancy can be dangerous
A woman in our neighborhood just died in childbirth of eclampsia... they did a CSection but the baby died too. Sigh.
There was a delay sending her to the hospital in the next town due to the blockades and discouragement of going outside.
Sigh. This is the third death in the last ten years in our neighborhood: two in older ladies who had a history of high blood pressure (one also with twins) and one a teenager who was too ashamed to see a physician or midwife for prenatal care. In both cases, the babies were saved.
Article on the problem LINK
one of the problems here in the Philippines is the lack of prenatal care for the poor: Many deliver with midwives, and many more just don't go for prenatal care because they don't realize why then need to get care. But even with prenatal care, this problem can appear suddenly or be missed.
When a person develops signs of pre eclampsia (swelling, headache, etc) the treatment is bedrest, anti seizure and anti high blood pressure medicine, and deliver the baby as soon as possible.
Here, this means going to the referral hospital in the next town for most people, although Dr. Angi can do this in the local private hospital (but no ICU for the baby).
The next town is only 10 miles away, and the roads are paved, but still it may take 30 to 69 minutes for transfer, or more if you live in the rural areas. When one of our farmer's wives developed edema/tremors, it took 3 hours to arrange an ambulance and get it to her house, and another hour to transfer her to the hospital, and she too died on the operating table.
Dr. Angi said frustratedly: Why didn't you just put her in a car and send her to me? But of course, that assumes she wouldn't have gone into convulsions in the car, and the transfer would still have taken time.
Few American doctors have cared for a complicated case of eclampsia: We did see it in the IHS, but a prompt C section usually prevented the mom from going into the seizures that are often fatal.
Ironically, in Africa, the women did not develop the typical signs of edema/swollen legs and high blood pressure: I'm not sure why: Maybe due to the low salt diet in the area where I worked.
They would come in without problems and then suddenly start having brisk reflexes, then tremor, and then would have a seizure. Sometimes the seizures happened after the delivery (one third of cases).
The argument about a C section vs waiting a short time to let her deliver normally was a sub plot in Downton Abbey... Back then, in the days before antibiotics and blood transfusions, there was a high death rate from the surgery, and if it had been done, the mother might have died anyway.
There was a delay sending her to the hospital in the next town due to the blockades and discouragement of going outside.
Sigh. This is the third death in the last ten years in our neighborhood: two in older ladies who had a history of high blood pressure (one also with twins) and one a teenager who was too ashamed to see a physician or midwife for prenatal care. In both cases, the babies were saved.
Article on the problem LINK
one of the problems here in the Philippines is the lack of prenatal care for the poor: Many deliver with midwives, and many more just don't go for prenatal care because they don't realize why then need to get care. But even with prenatal care, this problem can appear suddenly or be missed.
When a person develops signs of pre eclampsia (swelling, headache, etc) the treatment is bedrest, anti seizure and anti high blood pressure medicine, and deliver the baby as soon as possible.
Here, this means going to the referral hospital in the next town for most people, although Dr. Angi can do this in the local private hospital (but no ICU for the baby).
The next town is only 10 miles away, and the roads are paved, but still it may take 30 to 69 minutes for transfer, or more if you live in the rural areas. When one of our farmer's wives developed edema/tremors, it took 3 hours to arrange an ambulance and get it to her house, and another hour to transfer her to the hospital, and she too died on the operating table.
Dr. Angi said frustratedly: Why didn't you just put her in a car and send her to me? But of course, that assumes she wouldn't have gone into convulsions in the car, and the transfer would still have taken time.
Few American doctors have cared for a complicated case of eclampsia: We did see it in the IHS, but a prompt C section usually prevented the mom from going into the seizures that are often fatal.
Ironically, in Africa, the women did not develop the typical signs of edema/swollen legs and high blood pressure: I'm not sure why: Maybe due to the low salt diet in the area where I worked.
They would come in without problems and then suddenly start having brisk reflexes, then tremor, and then would have a seizure. Sometimes the seizures happened after the delivery (one third of cases).
The argument about a C section vs waiting a short time to let her deliver normally was a sub plot in Downton Abbey... Back then, in the days before antibiotics and blood transfusions, there was a high death rate from the surgery, and if it had been done, the mother might have died anyway.
Thursday, January 23, 2020
Wuhan flu
cross posted from my regular blog.
I remember SARS: the Chinese kept it secret how bad it was, and it spread to Hong Kong and then to Toronto. Luckily it stopped, mainly due to old fashioned quarantine (and screening airline passengers for fever) but that was scary, because it seemed to have a high mortality.
Mortality is hard evidence of a disease, but doesn't always give a clue to how many cases are actually around, since many mild cases never see a physician. (e.g. Dengue is probably under diagnosed since ordinary folks don't see doctors unless they are very sick because they can't afford it. )
So now, on top of ordinary flu, we have Wuhan flu. As suspected, the Chinese underestimated the cases and now there are cases all over Asia and perhaps in the USA: we have a few cases here in the Philippines.
Apparently it has a long "incubation period" which means you aren't sick right away so don't get sick until days later. (CDC says to check for it if your patient has been in Wuhan or in contact with another peson with the disease in the last 14 days, meaning the infected people could travel quite a distance before they got sick).
China finally has decided to stop flights from Wuhan to stop people from leaving the area, to stop more cases from leaving, but it is a bit late.
And the bad news: Some of the nurses etc. have caught it, meaning it spread person to person in close contact.
the treatment (like SARS) is "supportive", meaning oxygen, nutrition, isolation, antibiotics if a secondary infection occurs, and maybe put on a respirator if it gets bad.
the patient needs to be put in a private room, preferably one with respiratory protection (we use this in TB patients so the air with the germ doesn't get blown out to infect other patients: In SARS it spread via air ducts, but it's not known if this will also). Docs and nurses should wear special masks and even eye shields.
Luckily, the death rate isn't high, (China only reported 9 deaths so far, but of course, the bad news is that they lie and there could be more cases they are covering up).
But it does kill people, and with Chinese New Year coming up this weekend, it means everyone will be visiting family, (meaning traveling in crowded trains, buses and airplanes where viruses can spread easily) and so there is a big worry it will spread all over the world quickly.
Sigh.
The news changes from day to day, and there is a big meeting coming up to discuss the problem. However, China, as usual, has it's priorities intact: they pressured the World Health Organization to keep out scientists from Taiwan, because China hates Taiwan and thinks it should be part of China, whereas the Taiwanese don't, and politics is more important than people dying.
Here is John Bachelor's show discussion of the disease.
of course, the news is changing fast so it might already be out of date.
the latest CDC report is here.
This article worries that the Wuhan flu could be more bad news for China's economy, which is already hit by Trumpieboy's trade negotiations.
We have cases in the Philippines, but none in our district yet. Chinese new year is big in Manila, but not so much here in the rural provinces, and our fiesta season is pretty well over. But we are close enough to Manila that it could spread here quickly.
In Asia, they wear masks in flu season: The bad news? The heavy masks are already out of stock since people used them to breath after the volcano Taal put ash in the air (the gov't said a wet cloth would work better than the wimpy masks). I have a wimpy surgical mask here, just in case, but my personally fitted HEPA mask (which was used when we went into rooms with folks with TB etc) was left at home.
Sigh.
----------------------
update: Did you know Wuhan has a lab that studies "dangerous pathogens" (aka germs)?
From Nature (Feb 2017):
again italics mine.
headsup Bigleaguepolitics via FR
Yes these two sites are fake news/conspiracy type sites, but hey, when Nature Magazine (which is one of the top scientific journals) has an article about the Wuhan facility, why hasn't this been in the news?
Yes, I know: given the lack of hygiene in low end markets, it's probably started from animal contact, but still, when possible sources of a disease like this aren't mentioned in the MSM, it leads to people believing in conspiracy theories....
luckily, after the SARS and MERS outbreaks, the Infectious disease folks at Johns Hopkins did hold a "war game" (i.e. simulation) of such an outbreak a few years ago. LINK. the simulation was called Event 201 and they do have a website.
This is not pushing a conspiracy theory: these are practice simulations to plan how to repond and they make recommendations.
Right before 911, a really scary simulation was about a bioweapon attack with smallpox release called Dark Winter. And the site has held other simulations: CladeX about a pandemic of an influenza type disease (I suspect they were inspired by birdflu cases that jumped the species barrier about that time), and Atlantic storm that posited a bioweapons attack causing an outbreak.
Hospitals and emergency services organizations hold similar simulations all the time to prepare for mass casualty situations. so forget the conspiracy theory.
Indeed, the lessons from Dark Winter were used to plan for a possible bioweapons attack with smallpox after 911 (I had to review our clinic's protocol, which thank the Lord was never u
I remember SARS: the Chinese kept it secret how bad it was, and it spread to Hong Kong and then to Toronto. Luckily it stopped, mainly due to old fashioned quarantine (and screening airline passengers for fever) but that was scary, because it seemed to have a high mortality.
Mortality is hard evidence of a disease, but doesn't always give a clue to how many cases are actually around, since many mild cases never see a physician. (e.g. Dengue is probably under diagnosed since ordinary folks don't see doctors unless they are very sick because they can't afford it. )
So now, on top of ordinary flu, we have Wuhan flu. As suspected, the Chinese underestimated the cases and now there are cases all over Asia and perhaps in the USA: we have a few cases here in the Philippines.
Apparently it has a long "incubation period" which means you aren't sick right away so don't get sick until days later. (CDC says to check for it if your patient has been in Wuhan or in contact with another peson with the disease in the last 14 days, meaning the infected people could travel quite a distance before they got sick).
China finally has decided to stop flights from Wuhan to stop people from leaving the area, to stop more cases from leaving, but it is a bit late.
And the bad news: Some of the nurses etc. have caught it, meaning it spread person to person in close contact.
the treatment (like SARS) is "supportive", meaning oxygen, nutrition, isolation, antibiotics if a secondary infection occurs, and maybe put on a respirator if it gets bad.
the patient needs to be put in a private room, preferably one with respiratory protection (we use this in TB patients so the air with the germ doesn't get blown out to infect other patients: In SARS it spread via air ducts, but it's not known if this will also). Docs and nurses should wear special masks and even eye shields.
Luckily, the death rate isn't high, (China only reported 9 deaths so far, but of course, the bad news is that they lie and there could be more cases they are covering up).
But it does kill people, and with Chinese New Year coming up this weekend, it means everyone will be visiting family, (meaning traveling in crowded trains, buses and airplanes where viruses can spread easily) and so there is a big worry it will spread all over the world quickly.
Sigh.
The news changes from day to day, and there is a big meeting coming up to discuss the problem. However, China, as usual, has it's priorities intact: they pressured the World Health Organization to keep out scientists from Taiwan, because China hates Taiwan and thinks it should be part of China, whereas the Taiwanese don't, and politics is more important than people dying.
Here is John Bachelor's show discussion of the disease.
of course, the news is changing fast so it might already be out of date.
the latest CDC report is here.
This article worries that the Wuhan flu could be more bad news for China's economy, which is already hit by Trumpieboy's trade negotiations.
We have cases in the Philippines, but none in our district yet. Chinese new year is big in Manila, but not so much here in the rural provinces, and our fiesta season is pretty well over. But we are close enough to Manila that it could spread here quickly.
In Asia, they wear masks in flu season: The bad news? The heavy masks are already out of stock since people used them to breath after the volcano Taal put ash in the air (the gov't said a wet cloth would work better than the wimpy masks). I have a wimpy surgical mask here, just in case, but my personally fitted HEPA mask (which was used when we went into rooms with folks with TB etc) was left at home.
Sigh.
----------------------
update: Did you know Wuhan has a lab that studies "dangerous pathogens" (aka germs)?
From Nature (Feb 2017):
Inside the Chinese lab poised to study world's most dangerous pathogens
Maximum-security biolab is part of plan to build network of BSL-4 facilities across China...
Some scientists outside China worry about pathogens escaping, and the addition of a biological dimension to geopolitical tensions between China and other nations.italics mine
But Chinese microbiologists are celebrating their entrance to the elite cadre empowered to wrestle with the world’s greatest biological threats....and later in the article is this:
But worries surround the Chinese lab, too. The SARS virus has escaped from high-level containment facilities in Beijing multiple times, notes Richard Ebright, a molecular biologist at Rutgers University in Piscataway, New Jersey. Tim Trevan, founder of CHROME Biosafety and Biosecurity Consulting in Damascus, Maryland, says that an open culture is important to keeping BSL-4 labs safe, and he questions how easy this will be in China, where society emphasizes hierarchy. “Diversity of viewpoint, flat structures where everyone feels free to speak up and openness of information are important,” he says..
again italics mine.
headsup Bigleaguepolitics via FR
Yes these two sites are fake news/conspiracy type sites, but hey, when Nature Magazine (which is one of the top scientific journals) has an article about the Wuhan facility, why hasn't this been in the news?
Yes, I know: given the lack of hygiene in low end markets, it's probably started from animal contact, but still, when possible sources of a disease like this aren't mentioned in the MSM, it leads to people believing in conspiracy theories....
luckily, after the SARS and MERS outbreaks, the Infectious disease folks at Johns Hopkins did hold a "war game" (i.e. simulation) of such an outbreak a few years ago. LINK. the simulation was called Event 201 and they do have a website.
This is not pushing a conspiracy theory: these are practice simulations to plan how to repond and they make recommendations.
Right before 911, a really scary simulation was about a bioweapon attack with smallpox release called Dark Winter. And the site has held other simulations: CladeX about a pandemic of an influenza type disease (I suspect they were inspired by birdflu cases that jumped the species barrier about that time), and Atlantic storm that posited a bioweapons attack causing an outbreak.
Hospitals and emergency services organizations hold similar simulations all the time to prepare for mass casualty situations. so forget the conspiracy theory.
Indeed, the lessons from Dark Winter were used to plan for a possible bioweapons attack with smallpox after 911 (I had to review our clinic's protocol, which thank the Lord was never u
Tuesday, January 7, 2020
Killer Flu?
Lots of hysteria about Ebola, a really nasty disease that medical personnel from many countries are fighting in central Africa.
This doesn't worry me too much, however: it is spread via direct contact, so cases and their contacts can be isolated, and there is a new vaccine to stop the spread.
But not much hysteria or headlines about Dengue fever, which is spread via mosquitoes: part of the new normal, I guess, since it rarely kills but just makes you sick as a dog (alternative name: BreakBone fever because of the pain associated with it).
But 100 years after the Great Influenza epidemic of 1918-1919, a new disease with influenza type sickness has popped up in China, and this worries me.
From the BBC:
This isn't the first influenza type illness that has popped up in recent years, but luckily most of them have not been very infectious (e.g. MERS and bird flu, at least so far) or prompt public health intervention has stopped the spread via isolating suspected cases (e.g. SARS)
most cases seem to be from animal contact at a meat and seafood market, and not spread person to person.
this is good news, since it means that isolation and finding the source could stop it's spread.
People to people transmission is especially worrisome, since Chinese new year coming next month, people will be traveling home and could spread the disease all over.
I remember a few years ago when a nasty influenza hit Mexico, and it arrived with visitors coming to celebrate the May fiestas. Even our small town hospital acquired hazmat suits just in case. Ditto for MERS: one case arrived in the Philippines in a nurse who worked in Saudi.
And of course, there were a few cases of Yellow fever brought to China with returning workers a couple years back: Luckily mosquito control and prompt hospitalization stopped that disease from spreading.
Person to person contact is more worrisome: If it is spread via direct contact it is easier to control; Spread via mosquitoes is harder (which is why Dengue is such a problem here). But airborne viruses can spread quickly from a cough or sneeze or with minimal contact.
an example is influenza, which goes around every year.
Right now, Asia is having a terrible epidemic of African swine flu, There have been cases in our area, and the gov't ordered pigs in contact with sick pigs to be killed to stop the spread. One result was a ham shortage at Christmas, where ham is a traditional part of Noche Buena (Christmas eve) dinner, and Lechon (barbecued suckling pig) is served at most larger parties...
Here's a Youtube report from China. Notice people wearing masks? This is quite common here in Asia during flu season.
and here is the history Guy discussing the 1858 quarantine war.
----------------
update;
reminds me of when we had an outbreak of Hanta virus on the Navajo reservation, caused by dust from rat droppings. or like MERS, which is caught from camels in the Middle East, but also spread to a few nurses from the Philippines (and one came back here with it) but was only infectious to very close contact (e.g. suctioning).
The only “ good” news about this outbreak in China is that so far it is not spreading person to person, meaning a large spread like in SARS is unlikely. of course, with SARS, the Chinese lied about that outbreak, and covered it up. But here the World Health Organization is involved, so coverup of what's going on would be limited.
-------------
This doesn't worry me too much, however: it is spread via direct contact, so cases and their contacts can be isolated, and there is a new vaccine to stop the spread.
But not much hysteria or headlines about Dengue fever, which is spread via mosquitoes: part of the new normal, I guess, since it rarely kills but just makes you sick as a dog (alternative name: BreakBone fever because of the pain associated with it).
But 100 years after the Great Influenza epidemic of 1918-1919, a new disease with influenza type sickness has popped up in China, and this worries me.
From the BBC:
A mysterious viral pneumonia that has infected dozens in central China is not Severe Acute Respiratory Syndrome (Sars), health chiefs have said. They also discounted bird flu and Middle East Respiratory Syndrome, and said investigations were continuing.
A total of 59 cases have been reported in the city of Wuhan, seven of which are considered critical. The outbreak prompted Singapore and Hong Kong to bring in screening processes for travellers from the city.in airports this probably means they take your temperature by scanning you, as was done in previous epidemics.
This isn't the first influenza type illness that has popped up in recent years, but luckily most of them have not been very infectious (e.g. MERS and bird flu, at least so far) or prompt public health intervention has stopped the spread via isolating suspected cases (e.g. SARS)
An epidemic of the potentially deadly, flu-like Sars virus killed more than 700 people around the world in 2002-03, after originating in China.
most cases seem to be from animal contact at a meat and seafood market, and not spread person to person.
this is good news, since it means that isolation and finding the source could stop it's spread.
People to people transmission is especially worrisome, since Chinese new year coming next month, people will be traveling home and could spread the disease all over.
I remember a few years ago when a nasty influenza hit Mexico, and it arrived with visitors coming to celebrate the May fiestas. Even our small town hospital acquired hazmat suits just in case. Ditto for MERS: one case arrived in the Philippines in a nurse who worked in Saudi.
And of course, there were a few cases of Yellow fever brought to China with returning workers a couple years back: Luckily mosquito control and prompt hospitalization stopped that disease from spreading.
Person to person contact is more worrisome: If it is spread via direct contact it is easier to control; Spread via mosquitoes is harder (which is why Dengue is such a problem here). But airborne viruses can spread quickly from a cough or sneeze or with minimal contact.
an example is influenza, which goes around every year.
Right now, Asia is having a terrible epidemic of African swine flu, There have been cases in our area, and the gov't ordered pigs in contact with sick pigs to be killed to stop the spread. One result was a ham shortage at Christmas, where ham is a traditional part of Noche Buena (Christmas eve) dinner, and Lechon (barbecued suckling pig) is served at most larger parties...
Here's a Youtube report from China. Notice people wearing masks? This is quite common here in Asia during flu season.
and here is the history Guy discussing the 1858 quarantine war.
----------------
update;
reminds me of when we had an outbreak of Hanta virus on the Navajo reservation, caused by dust from rat droppings. or like MERS, which is caught from camels in the Middle East, but also spread to a few nurses from the Philippines (and one came back here with it) but was only infectious to very close contact (e.g. suctioning).
The only “ good” news about this outbreak in China is that so far it is not spreading person to person, meaning a large spread like in SARS is unlikely. of course, with SARS, the Chinese lied about that outbreak, and covered it up. But here the World Health Organization is involved, so coverup of what's going on would be limited.
-------------
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