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NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

  • 1.  NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 12:53
    This may be in the weeds but of interest:

    Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection
    https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smell-taste.html?referringSource=articleShare


    Sent from my iPhone

    David
    David L Meyers, MD FACEP
    410-952-8782


  • 2.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 14:53
    Anosmia is an early sign of Parkinson's Disease and Alzheimer's.  Does COVID-19 hit the brain?? Or could it be that elderly were selectively sampled and had another reason for this?
    Ed
    Edward P Hoffer MD, FACP, FACC





  • 3.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 14:57
    Curious if the older patients in Italy might include a good number who were somewhat cognitively impaired, and thereby were not as aware of their declining health.  Were they already impaired and/or more susceptible than patients of a similar age for whom there was no earlier evidence of cognitive decline. There might be a chance to get some anecdotal reports at this time from the affected families. 

    Since the doctors and nurses are clearly overwhelmed, it may only be that the families and caregivers would be able to respond to this issue at this time.  

    Peggy Zuckerman

    ------------------------------
    Peggy Zuckerman
    ------------------------------



  • 4.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 16:03

    The primary reason that Italy has had so many deaths is NOT because of an older population.

     

    The primary reason for the high mortality rate is that the healthcare system is overwhelmed and so patients die who would have lived but there is no ventilator available or no ICU bed.

    With a functioning healthcare system mortality rate is likely 1%, but without it more like 4%.

     

    https://nyti.ms/2wtYUqA via'Brace Yourself': How Doctors in Italy Responded to Coronavirus @nytvideo

     

    As of today this is VERY likely to occur in the US (at least in some states) because of federal incompetence in making testing widely available so that case contact tracking and testing can occur (and in mandating significant social distancing efforts).

    In most parts of the country we are not even testing all symptomatic patients unless they are hospitalized. Current wait times for results from one of the largest labs doing the testing is 8-9 days in Southern California (Quest) although nationally they say turnaround time is 5 days (this for a test that takes 3 ½ hours to run on the lab machine).

     

    Check out this piece in Medium.

    I don't agree with all the numbers but it is directionally correct and very well supported scientifically.

     

    And it makes me want to apologize the entire public health community. This problem started with inadequate follow up after SARS in the late 2000s and was exacerbated by dismantling by the current administration of the office most intimately knowledgeable about pandemic response (there has been a LOT of planning for pandemic flu, which is very much like the current crisis).

     

    https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

     

    There's a petition at the end to get the government to act in a way that will intelligently control this virus – difficult, painful, but the experiences in China, South Korea, Singapore show that it can be done and the initial difficult phase can be done in a few weeks (not months).

    And we must get to a position where we can do widespread testing or we'll have to be in this economic shutdown catastrophe for months to have any hope of preventing millions of deaths in this country.

     

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  • 5.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 16:27
    I was curious about the general issues in Italy, so did a bit of research.  The general population is older than that of the US, with our median age near 38 years, while Italy's is about 47 years, with several other European countries about 44years.  In addition, they have a relatively low number of ICU beds than many countries in Europe, and with the US having about 34 per 100,000, and Italy 12.5/100,00.  Germany is 29/100,000, Japan is 7.3/100,000.  


    However there is always a wide variation as to HOW these numbers are gathered and described, so that is not a complete story.  In addition, other stats would indicate that there are far fewer hospital beds per capita in the US, so we may be officially top-heavy as to ICU beds---or describe our hospital beds in a different manner.


    Peggy Zuckerman
    www.peggyRCC.comer





  • 6.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 18:11

    Here is a link to a paper published in JAMA today about the high case fatality rate in Italy.


    https://jamanetwork.com/journals/jama/fullarticle/2763667?guestAccessKey=77e714dd-0ad2-49cc-a649-bfdc1bec1737&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=032320

    jamanetwork.com
    This Viewpoint from physicians with the Italian National Institute of Health confirms a higher case-fatality rate from coronavirus disease 2019 (COVID-19) in Italy compared with China and explains possible reasons, including age, cause of death definitions, and testing strategy.







  • 7.  RE: NYTimes: Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

    Posted 03-23-2020 14:58

    Hi Ed, Hi everybody,


    Nasal congestion is an early symptom in many cases.  The anosmia could be as simple as that.  I've attached a few papers that may be helpful to the clinicians on this list, with regard to the reported symptom cluster, treatment approaches and diagnostic criteria. 


    Also have attached an "Action Paper" from the MIT/MITRE group, which was commissioned by DoD and is based on data as current as last Thursday.


    All the best,


    Mike



    Michael A. Bruno, M.D., M.S., F.A.C.R.   
    Professor of Radiology & Medicine

    Vice Chair for Quality & Patient Safety

    Chief, Division of Emergency Radiology

    Penn State Milton S. Hershey Medical Center
    ( (717) 531-8703  |  6 (717) 531-5737

    * mbruno@pennstatehealth.psu.edu  

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