Two cases canceled today because our ICU’s are filled to capacity and overflowing. Last night another VV Covid ECMO– so patients are now being paired up in rooms in order to reduce the possibility of cross contamination from patient to staff to other staff to other patients to visitors and so on and so forth. Taking a walk though all the 5 or so ICU’s here at this Level I Trauma Ctr., its like walking through a hallway where each ICU room is an aquarium where you see so many large fish in various stages of respiratory decomposition. All on ventilators, all behind glass, all doors shut, and no staff in any of the rooms- because it has become a breeding ground for contagion and a holding pattern to land these patients to the other side of what our original intention was- Heavens Gate.
This is a teaching facility, so the approach remains Socratic, and all the plebes gather to do rounds in congested areas where we are crowded in like sardines in a humidor- hot, sweaty. damp, and all voices muffled from two layers of masks- an N-95 (for close encounters) with another standard surgical mask- “just to be sure”. An incubation area ripe for infection- just like the killing fields of the Velociraptors in Jurassic Park. But, the dedication here is to medicine- and the risk for potential contamination and sacrifice are muted not by herd immunity- but by a safety in numbers/we are in medicine thing. There remains a remnant of sophomoric expression of bombastic posturing from residents or un-nurtured egos that struggle to inflect whatever it is they feel they need to do in order to assert themselves as they express mantras that demonstrate their total cluelessness to the situation(s) at hand- these are the warts that can never be confined and ultimately end up being the assholes in medicine that we are forced to tolerate because of two letters- “M.D.”.
I saw one of them this morning. Petulant- wanting to talk about oxygenator function in the middle of a cytokine storm. He was clueless and posturing- barely worth talking to. He is staring at two patients that are dying right in front of him- and just feels that need to somehow tell somebody to do something- anything at all- as long as it is a response to whatever misguided clinical assertion or agenda he feels he can inject and win a minor skirmish in larger battle that already has a foregone conclusion.
I’m impressed with the clinical skill set and dedication to our RT’s managing the two ECMO’s we are running and have an amazing amount of respect for their courage and steadiness. That would be you AMY, and Stephanie- and the muscular ex-Army dude.
Amy texted me and sent me some literature that supported the use of MMR vaccines to help mitigate the symptoms of COVID should anyone become infected-
It is definitely worth looking at- and free vaccines were available so I took one.
Today’s Reality in Pictures
Just Amazing- She did this on her lunch break
More of SAME 🙂
It is this sort of EFFORT that sustains life 🙂
On the way in this morning…
Social distancing and having lunch-
There are so many people that seem like they don’t have homes- or are always waiting for a ride- and it’s really HOT and humid outside- I worry for them-
It’s a skylight- we just gotta get some hope and sunshine going on 🙂
We propose the concept that administration of an unrelated live attenuated
vaccine, such as MMR (measles, mumps, rubella), could serve as a preventive
measure against the worst sequelae of coronavirus disease 2019 (COVID-19). There is
mounting evidence that live attenuated vaccines provide nonspecific protection
against lethal infections unrelated to the target pathogen of the vaccine by inducing
“trained” nonspecific innate immune cells for improved host responses against subsequent
infections. Mortality in COVID-19 cases is strongly associated with progressive
lung inflammation and eventual sepsis. Vaccination with MMR in immunocompetent
individuals has no contraindications and may be especially effective for
health care workers who can easily be exposed to COVID-19. Following the lead of
other countries conducting clinical trials with the live attenuated Mycobacterium bovis
BCG (BCG) vaccine under a similar concept, a clinical trial with MMR in high-risk
populations may provide a “low-risk– high-reward” preventive measure in saving
lives during this unprecedented COVID-19 pandemic.
There is mounting evidence that the use of live attenuated vaccines commonly
administered during childhood also provides beneficial nonspecific effects (NSE),
including reduced mortality and hospitalization due to unrelated infections (1, 2). In this
Commentary, we outline a rationale to support the use of live attenuated vaccines, such
as MMR (measles, mumps, rubella), as a preventive measure against the pathological
inflammation and sepsis associated with coronavirus disease 2019 (COVID-19) infection.
We emphasize this is strictly a preventive measure against the worst inflammatory
sequelae of COVID-19 for those exposed/infected and does not represent an antiviral
therapy or vaccine against COVID-19 in any manner. It has been proposed that live
attenuated vaccines induce nonspecific effects representing “trained innate immunity”
by “training” leukocyte precursors in the bone marrow to function more effectively
against broader infectious insults. In support of this, work from our laboratory
demonstrated that vaccination with a live attenuated fungal strain induces trained
innate protection against lethal polymicrobial sepsis . The protection is
mediated by long-lived myeloid-derived suppressor cells (MDSCs) previously reported
to inhibit septic inflammation and mortality in several experimental models.
The general concept that the trained innate immunity induced by live attenuated
vaccines can limit pathological inflammation is novel but not without precedent. At least 6
clinical trials have been initiated in Europe, Australia, and the United States to test
vaccination with Mycobacterium bovis BCG (live attenuated tuberculosis [TB] vaccine) or
placebo in high-risk health care workers to determine whether beneficial trained innate
responses against COVID-19 can be elicited:
In these trials, the proposed trained innate response is one of immune enhancement
that could possibly reduce viral levels and/or sequelae associated with COVID-19,
similar to what has been reported for other viral infections (2). In contrast, we propose
that the trained innate response includes induction of the MDSCs that can inhibit/
reduce the severe lung inflammation/sepsis associated with COVID-19.
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