https://steelkiwi.com/blog/medicine-delivery-app-development/

having to take a "poison" so one can heal.

The takeaway: COVID-19 survivors are at a higher risk for mental illness.

The claim: COVID-19 survivors are at a higher risk for mental illness.

The evidence: Infection by SARS-CoV-2 was associated with an increase in anxiety disorders, insomnia, and dementia (1). Prior mental illness was also associated with an increased risk of SARS-CoV-2 infection (1). Approximately 1/3 of COVID patients were reported to have central nervous symptom issues in a study of 214 hospitalized Chinese patients (2). SARS-CoV-2 has been found in the brain and cerebral spinal fluid (3). Social isolation, pathology of SARS-CoV-2, and sedation are a few of the reasons why ICU patients experience delirium and the subsequent mental health risks (4).

All of these factors support the statement that COVID-19 survivors are at a higher risk of mental illness.

As a reminder, there is help for suicide. National Suicide Prevention Lifeline is a toll-free number for those in a suicidal crisis or emotional distress. The number is: 1-800-273-8255

Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

Sources:

1) https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30462-4/fulltext

2) https://pubmed.ncbi.nlm.nih.gov/32399719/

3) https://pubmed.ncbi.nlm.nih.gov/32240762/

4) https://www.termedia.pl/COVID-19-What-do-we-need-to-know-about-ICU-delirium-during-the-SARS-CoV-2-pandemic-,118,40590,1,1.html

The takeaway: Current data for three separate COVID-19 vaccines suggests that the vaccine prevents COVID-19 or lessens the disease severity. No data from top three COVID-19 vaccine candidates indicates that the vaccine makes the disease worse. Phase III clinical trials to conclusively prove the effect of the vaccine will be completed before administration of the vaccine to the general public.

The claim: The vaccine may make COVID-19 much, much worse in many people.

The evidence: A number of protein sequences encoded by SARS-CoV-2 genome are similar to human proteins (1). This similarity led to the hypothesis that a SARS-CoV-2 vaccine could result in more severe disease when exposure occurs after vaccination (1). For previous SARS and MERS, this severe reaction was observed during the animal studies and therefore the vaccines were not pursued. The hypothesis was proposed before SARS-CoV-2 animal study vaccines were published as stated in (1).

Three vaccines are currently in phase III clinical development in the USA, funded by Operation Warp Speed (2). Vaccine approval process involves four stages (3). Phase I is a small scale study in healthy people to make sure the vaccine does no harm. Phase II is a study with more people to test whether the vaccine does what it is supposed to do. Phase III study occurs in 300-3000 people to ensure that the vaccine works as intended in a larger group of people. Phase IV is post-approval monitoring of the vaccine for an adverse events that may happen after the drug is approved. Human study in Phase I clinical trials only occurs after the vaccine has been proven safe in animals first.

Moderna’s mRNA-1273 prevented COVID-19 disease in monkeys (4). Control monkeys' lungs showed signs of pneumonia from COVID-19. Lungs in vaccinated monkeys were normal after exposure to COVID. The virus was not detectable in the monkey's nose after two days for animals vaccinated with 100 ug dose. Phase I clinical trial data from humans is published and included older adults (5).

University of Oxford and AstraZeneca’s AZD1222 (ChAdOx1 nCoV-19) prevented pneumonia in monkeys and did not cause disease enhancement (6). AZD1222 reduced the number of SARS-CoV-2 (virus) in the lung of the monkeys but did not stop the virus from leaving the nose of the monkeys. Early results from the phase I/II clinical trials demonstrate the safety of the vaccine (7). Further research is ongoing to establish safety and efficacy. This includes phase III clinical trials with more participants and one year monitoring of Phase II participants.

Pfizer and BioNTech's BNT162 is several different vaccine candidates which were tested simultaneously to determine the vaccine with the best protection and least number of reactions such as pain at the injection site, fever, etc (8). In phase I/II clinical trails, the reactions to BNT162b1 were mild to moderate and did not last long (9). Animal studies are presented as a pre-print (10). From the pre-print, it is unclear whether the vaccine prevented lung damage because both vaccine and control group had no lung damage. In other rhesus macaque COVID infections with no vaccine, lung damage was observed (4, 6). BNT162b2 COVID vaccine resulted in no detectable COVID virus after the first day of challenge in monkeys (10).

Sources:

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142689/

2) https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker

3) https://www.fda.gov/patients/drug-development-process/step-3-clinical-research

4) https://pubmed.ncbi.nlm.nih.gov/32722908/

5) https://www.nejm.org/doi/full/10.1056/NEJMoa2028436?query=featured_home

6) https://pubmed.ncbi.nlm.nih.gov/32731258/

7) https://pubmed.ncbi.nlm.nih.gov/32702298/

8) https://www.nejm.org/doi/full/10.1056/NEJMoa2027906?query=featured_home#

9) https://pubmed.ncbi.nlm.nih.gov/32785213/

10) https://www.biorxiv.org/content/10.1101/2020.09.08.280818v1.full.pdf

Learn more at https://www.foundersfamilymedicine.com/castle-rock-family-physicians/

These highlight cases where you can treat patients without their consent.

1. Irresponsible people with communicable diseases (e.g. Tuberculosis)

2. Psychiatry patients that pose an immediate threat to themselves and/or those around them.

David Spiegelhalter and False Positives. (2020, October 14). https://www.youtube.com/watch?v=XmiEzi54lBI&feature=youtu.be

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Long-term effects of Covid include damage to heart, liver, kidneys. (2020, September 29). ITV News. https://www.itv.com/news/2020-09-29/long-covid-long-term-effects-of-coronavirus-include-damage-to-heart-liver-kidneys-oxford-study-reveals

Wilkinson, Jack, Kellyn F. Arnold, Eleanor J. Murray, Maarten van Smeden, Kareem Carr, Rachel Sippy, Marc de Kamps, et al. ‘Time to Reality Check the Promises of Machine Learning-Powered Precision Medicine’. The Lancet Digital Health 0, no. 0 (16 September 2020). https://doi.org/10.1016/S2589-7500(20)30200-4.

Thacker, P. D. (2020). A few tiny steps towards transparency: How the Sunshine Act shone light on industry’s influence in medicine. BMJ, 370. https://doi.org/10.1136/bmj.m3229

Take away: Though chloroquine and hydroxychloroquine showed some effects against SARS-CoV-2 in vitro for vero cells, the FDA removed emergency use authorization for COVID-19 patients due to increased heart problems. No in vitro effect was seen when using human lung cells instead of monkey cells. Many clinical trials are ongoing.

The claim: Hydroxychloroquine is a relatively cheap and available medication with positive results in patients who have taken the drug.

The evidence: Chloroquine and hydroxychloroquine inhibited infection of vero E6 cells (African green monkey kidney cell line) by SARS-CoV-2 (1, 2). These drugs did not inhibit SARS-CoV-2 infection in Calu-3 cells (human lung cell line, 3). Several clinical trials have reported positive outcomes with the use of hydroxychloroquine/chloroquine (4, 5). Current evidence is reviewed in (6). Known side effects including cardiovascular, neuropsychiatric, and gastrointestinal exist based on use of hydroxychloroquine and chloroquine in treating malaria and autoimmune conditions (7). These side effects may more severely affect COVID-19 patients due to the average age and comorbidities often present in severe COVID-19 cases and similarity to COVID-19 symptoms. A randomized, double blind placebo-controlled trial did not observe a significant difference between treatment and control groups when hydroxychloroquine was used prophylactically (8). Increased cardiovascular mortality, chest pain/angina, and heart failure occurred when hydroxychloroquine was combined with azithromycin (9). The FDA removed emergency use authorization in June (10). Many clinical trials are currently ongoing (11).

Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

Sources:

1 https://www.nature.com/articles/s41422-020-0282-0

2 https://academic.oup.com/cid/article/71/15/732/5801998

3 https://www.nature.com/articles/s41586-020-2575-3

4 https://www.jstage.jst.go.jp/article/bst/14/1/14_2020.01047/_pdf/-char/en

5 https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

6 https://pmj.bmj.com/content/96/1139/550.long

7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228887/

8 https://pubmed.ncbi.nlm.nih.gov/32492293/

9 https://www.medrxiv.org/content/medrxiv/early/2020/05/31/2020.04.08.20054551.full.pdf

10 https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or

11 https://clinicaltrials.gov/ct2/results?cond=Covid19&term=hydroxychloroquine&cntry=&state=&city=&dist=

Take Away: SARS-CoV-2 infection has been clearly linked to heart muscle injury in those with severe COVID-19 illness. However, at present, there is insufficient data to determine the impact of mild or asymptomatic COVID-19 on the hearts of previously healthy individuals.

The Claim: COVID-19 can wreck your heart, even if you haven’t had any symptoms.

The Evidence: Several articles, including this August 31st piece (1), have raised the alarm about dangerous effects of mild or even asymptomatic cases of COVID-19 on the heart of infected individuals.

In support of this argument, there have been numerous reports, some of which are cited in the article above, documenting severe heart inflammation (myocarditis) and injury (e.g. cardiomyopathy and/or heart failure) in patients with COVID-19. However, most of these documented cases were in individuals with severe cases of COVID-19. At present, the evidence for clinically significant heart injury (requiring treatment or special precautions) from mild or asymptomatic COVID-19, is much less clear, especially in those with no prior evidence of heart disease.

One recent study reported that 78% of patients from an unselected cohort (including patients with asymptomatic, mild, and severe cases) had evidence of myocarditis (via MRI or blood testing) following COVID-19 infection (2). This study clearly demonstrated the link between COVID-19 and myocarditis by examining tissue from biopsies of the heart (the gold standard definitive diagnosis of myocarditis) of patients with the most severe cases. The study went on to show that, on average, patients who were treated for COVID-19 at the hospital (presumably more severe cases) and patients who were treated at home (presumably asymptomatic to moderate cases) both had blood test levels or MRI findings suggesting elevated myocarditis compared to non-COVID-19 infected patients with similar health profiles.

A key limitation here is “average”. The study was not designed or powered to look for the rate of myocarditis in only previously healthy patients with mild or asymptomatic COVID-19. This study included asymptomatic patients in the analysis, but without knowing their prior health or comparing their findings to other healthy non-COVID patients, it is not possible to infer the risk of myocarditis to this population. To their credit, the authors of the study discuss this limitation in their conclusions.

Despite this, the study was widely covered as evidence that ”COVID-19 can wreck your heart, even if you haven’t had any symptoms.“ In order to answer that question, we need research looking selectively healthy patients with mild or asymptomatic COVID-19 as outlined above.

Until that research is conducted, we might look at COVID within the same context as a number of other well studied viruses, many of which generally cause mild illness, that have also been shown to lead to heart injury and inflammation (3).

Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

Sources:

1. https://www.scientificamerican.com/article/covid-19-can-wreck-your-heart-even-if-you-havent-had-any-symptoms/
2. https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
3. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.108.766022

Take away: People are infectious for only part of the time they test positive. The tests for COVID-19 were granted emergency status by the FDA so some debate concerning the most ideal number of cycles is to be expected. It is worth noting that the FDA has the disclaimer "Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information (2)."

The claim: Up to 90 percent of people diagnosed with coronavirus may not be carrying enough of it to infect anyone else

The evidence: Per Walsh et al. (1), SARS-CoV-2 virus (COVID-19) is most likely infectious if the number of PCR cycles is <24 and the symptom onset to test is <8 days. RT-PCR detects the RNA, not the infectious virus. Therefore, setting the cycle threshold at 37-40 cycles will most likely result in detecting some samples with virus which is not infectious. As the PCR tests were granted emergency use by the FDA (samples include 2-9), it is not surprising that some debate exists currently about where the cycle threshold should be. Thresholds need to be set and validated for dozens of PCR tests currently in use. If identifying only infectious individuals is the goal, a lower cycle number may be justified. If detection of as many cases as possible to get closer to the most accurate death rate is the goal, setting the cycle threshold at 37-40 makes sense. A lower threshold will result in fewer COVID-19 positive samples being identified. It is worth noting that the emergency use approval granted by the FDA includes the disclaimer that a negative test does not guarantee that a person is not infected with COVID-19. RNA degrades easily. If samples are not kept cold or properly processed, the virus can degrade and result in a false negative result.

Source: 1 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

2 https://www.fda.gov/media/134922/download

3 https://www.fda.gov/media/138150/download

4 https://www.fda.gov/media/137120/download

5 https://www.fda.gov/media/136231/download

6 https://www.fda.gov/media/136472/download

7 https://www.fda.gov/media/139279/download

8 https://www.fda.gov/media/136314/download

9 https://www.fda.gov/media/140776/download

What can be learned from this case?

• Carefully plan follow up plans with patients (general suggestion about follow up can be enough)
• Ask patient for family information to help them get involved in the follow up process and help increase compliance.

Consider:

• Giving the specific name of a provider to follow up with
• How to contact the facility,
• See if who you provided/recommended is avaliable to take the patient
• Help patient make the appointment or make it on their behalf (with permission)

The test for proximate cause "is whether it was reasonably foreseeable at the time that the negligent act occurred that would result in the consequent harms"

In this case, Dr. Liptzin, having seen Williamson having no history of violence or anything else, could not reasonably foresee that Williamson was going to do something illegal.

Crosby, S. S. (2020). My COVID-19. Annals of Internal Medicine. https://doi.org/10.7326/M20-5126

Welcome | Summer COVID-19 Education Series—ACC Virtual Education. (n.d.). Virtualacc. Retrieved August 5, 2020, from https://virtual.acc.org/cvcovid/welcome

Understanding Risk with Professor Sir David Spiegelhalter | Pager Podcast. (2020, March 24). https://www.youtube.com/watch?v=nLl9HEz5vng&feature=youtu.be

COVID-19 Social Science Tracker - Google Sheets

Risky Business. (2020, June 2). Lessons from COVID-19 - A free virtual conference. https://www.riskybusiness.events/lessons-from-covid-19-zoom-conference

Bae, J.-M. (2014). The clinical decision analysis using decision tree. Epidemiology and Health, 36. https://doi.org/10.4178/epih/e2014025

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Machado, D. F. T., de Siqueira, A. F., & Gitahy, L. (2020). Natural stings: Alternative health services selling distrust about vaccines on YouTube [Preprint]. SocArXiv. https://doi.org/10.31235/osf.io/vtf5r

Fuhrer, J., & Cova, F. (2020). “Quick and dirty”: Intuitive cognitive style predicts trust in Didier Raoult and his hydroxychloroquine-based treatment against COVID-19. https://doi.org/10.31234/osf.io/ju62p

Spiegelhalter, D. (2016). How old are you, really? Communicating chronic risk through ‘effective age’ of your body and organs. BMC Medical Informatics and Decision Making, 16(1), 104. https://doi.org/10.1186/s12911-016-0342-z

Welcome! You are invited to join a webinar: COVID-19 Series: Medical journals - Episode 24. After registering, you will receive a confirmation email about joining the webinar. (n.d.). Zoom Video. Retrieved June 20, 2020, from https://zoom.us/webinar/register/WN_4_dGVRvDQEWi_d7ll7kMtQ

RSM COVID-19 Series | Episode 24: Medical Journals. (2020, June 24). YouTube. https://www.youtube.com/watch?v=et-kl5ypx8Q

Horbach, S. P. J. M. (2020). Pandemic Publishing: Medical journals drastically speed up their publication process for Covid-19. BioRxiv, 2020.04.18.045963. https://doi.org/10.1101/2020.04.18.045963

MacFarlane, D., Hurlstone, M. J., & Ecker, U. K. H. (2020, April 17). Countering Demand for Ineffective Health Remedies: Do Consumers Respond to Risks, Lack of Benefits, or Both?. https://doi.org/10.31234/osf.io/xqckm

Dean, N. E. (2020, June 15). Asymptomatic Transmission? We Just Don’t Know. Medscape. Retrieved June 16, 2020, from http://www.medscape.com/viewarticle/932246

Wallace-Wells, B. (2020, June 12). Can Coronavirus Contact Tracing Survive Reopening? The New Yorker. https://www.newyorker.com/news/us-journal/can-coronavirus-contact-tracing-survive-reopening

Fung, D. J. (2018, April 10). The Corruption of Evidence Based Medicine—Killing for Profit. Medium. https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

Ouyang, H. (2020, April 14). I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. The New York Times. https://www.nytimes.com/2020/04/14/magazine/coronavirus-er-doctor-diary-new-york-city.html

Senior, J. (2020, May 3). Opinion | What One Doctor’s Suicide Taught Us. The New York Times. https://www.nytimes.com/2020/05/03/opinion/coronavirus-doctors-mental-health.html

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Stephenson, J. (2020). European Medicines Agency Tackles Potential Shortages of Drugs for Treating COVID-19. JAMA Health Forum, 1(4), e200485–e200485. https://doi.org/10.1001/jamahealthforum.2020.0485

Casas, R. S., Cooper, J. L., & Hempel, E. V. (2020). COVID‐19 risk triage: Engaging residents in telephonic screening. Medical Education, medu.14211. https://doi.org/10.1111/medu.14211

Nundy, S., & Patel, K. K. (2020). Hospital-at-Home to Support COVID-19 Surge—Time to Bring Down the Walls? JAMA Health Forum, 1(5), e200504–e200504. https://doi.org/10.1001/jamahealthforum.2020.0504

Zagury-Orly, I., & Schwartzstein, R. M. (2020). Covid-19—A Reminder to Reason. New England Journal of Medicine, NEJMp2009405. https://doi.org/10.1056/NEJMp2009405

Lipsitch, M., Perlman, S., & Waldor, M. K. (2020). Testing COVID-19 therapies to prevent progression of mild disease. The Lancet Infectious Diseases, 0(0). https://doi.org/10.1016/S1473-3099(20)30372-8

Fenton, N., Hitman, G. A., Neil, M., Osman, M., & McLachlan, S. (2020). Causal explanations, error rates, and human judgment biases missing from the COVID-19 narrative and statistics [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/p39a4

Olthof, M., Hasselman, F., & Lichtwarck-Aschoff, A. (2020, May 1). Complexity In Psychological Self-Ratings: Implications for research and practice. Retrieved from psyarxiv.com/fbta8

Newton, P. N., Bond, K. C., Adeyeye, M., Antignac, M., Ashenef, A., Awab, G. R., Babar, Z.-U.-D., Bannenberg, W. J., Bond, K. C., Bower, J., Breman, J., Brock, A., Caillet, C., Coyne, P., Day, N., Deats, M., Douidy, K., Doyle, K., Dujardin, C., … Zaman, M. (2020). COVID-19 and risks to the supply and quality of tests, drugs, and vaccines. The Lancet Global Health, S2214109X20301364. https://doi.org/10.1016/S2214-109X(20)30136-4

Sailer, M., Stadler, M., Botes, E., Fischer, F., & Greiff, S. (2020, April 9). Science knowledge and trust in medicine affect individuals’ behavior in pandemic crises. https://doi.org/10.31234/osf.io/tmu8f

Abdulla, A., Wang, B., Qian, F., Kee, T., Blasiak, A., Ong, Y. H., Hooi, L., Parekh, F., Soriano, R., Olinger, G. G., Keppo, J., Hardesty, C. L., Chow, E. K., Ho, D., & Ding, X. (n.d.). Project IDentif.AI: Harnessing Artificial Intelligence to Rapidly Optimize Combination Therapy Development for Infectious Disease Intervention. Advanced Therapeutics, n/a(n/a), 2000034. https://doi.org/10.1002/adtp.202000034

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PMID: 32219356 DOI: 10.1001/jamacardio.2020.1017

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unidad_COVID2019 Investigaciones revisadas por pares de la fuente más confiable del mundo Página de acceso libre sin fines de lucro. Herramienta impulsada por la inteligencia artificial.

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46: Lean not on your own understanding.

The early modern English physician William Harvey (1578-1627) made several valuable contributions to the medical sciences, including the circulation of blood in the human body. In De Motu Cordis (1628), Harvey sets down his landmark experiments; in these, Harvey used ligatures to stem blood flow to better understand how the heart works to pump blood throughout the human body. This knowledge will be critical for Victor's creation of the Creature.

By 1818 physiology had become a controversial branch of medicine at the center of the dispute between vitalism, the idea that a divine spark energized animal life, and materialism, the argument that chemical processes alone give rise to life. Mary Shelley was well aware of the dispute since the Shelleys' family doctor, William Lawrence, was vigorously taking up the materialist argument in works like An Introduction to Comparative Anatomy and Physiology (1816). For a full view of this controversy as it relates to the novel, see Marilyn Butler, "Frankenstein and Radical Science" [1993] reprinted in J. Paul Hunter, Frankenstein, Norton Critical Edition, second ed. (New York: Norton, 2012): 404-416.

Scarlet fever is a disease caused by a streptococcus infection, most common among children and young adults. Until the discovery of penicillin in the early 20th Century, it was frequently fatal. Also compare the 1831 edition, in which Elizabeth's condition is more "severe."

My imagination is running wild, but not in a good way. 😞