CMAAO CORONA FACTS and MYTH BUSTER 45

CMAAO CORONA FACTS and MYTH BUSTER 45

Dr K K Aggarwal

President Confederation of Medical Associations of Asia and Oceania

451:  What sit meaning between cleaning and disinfecting

These guidelines are focused on household settings and are meant for the general public.

• Cleaning refers to the removal of germs, dirt, and impurities from surfaces. It does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.
• Disinfecting refers to using chemicals, for example, EPA-registered disinfectants, to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

452: Can the virus go upto 8 meters

Fact: Many people believe the novel coronavirus can be transmitted only short distances in respiratory droplets from a sneeze or cough. But a National Academy of Sciences letter and papers published in The New England Journal of Medicine and JAMA suggest it's possible that the novel coronavirus can hang in the air for hours and remain infectious. This means people could spread the virus just by breathing normally, and the virus could even be propelled as far as 8 meters by a sneeze. However, some skeptics remain unconvinced that the respiratory particles can transmit infection.

453:  when hydroxy chloroquine and azithromycin combination should not be given

Withhold the drugs in patients with baseline QT prolongation (e.g., QTc of at least 500 msec) or with known congenital long QT syndrome; monitoring cardiac rhythm and QT interval and withdrawing hydroxychloroquine and azithromycin if QTc exceeds 500 msec; correcting hypokalemia to levels greater than 4 mEq/L and hypomagnesemia to more than 2 mg/dL; and avoiding other QTc-prolonging agents when possible.

454: Can you have unilateral pneumonia in COVID 19

No.Asymmetrical lung involvement is common, but it is rare for only one lung to be affected.

455: what are two patterns of oxygen requirement

1)    those with mild-to-moderate hypoxia, who improve slowly over time

2)    those with rapidly escalating oxygen needs, who proceed quickly to intubation.

456: How do we know the status of asymptomatic  infections

A new study has begun recruiting at the National Institutes of Health in Bethesda, Maryland, to determine how many adults in the United States without a confirmed history of infection with SARS-CoV-2, have antibodies to the virus.

The presence of antibodies in the blood indicates a prior infection. In this “serosurvey,” researchers will collect and analyze blood samples from as many as 10,000 volunteers to provide critical data for epidemiological models. The results will help illuminate the extent to which the novel coronavirus has spread undetected in the United States and provide insights into which communities and populations are most affected.

457: what is blood purification device to treat COVID-19

The US FDA issued an emergency use authorization (EUA) for a blood purification system to treat patients 18 years of age or older with confirmed COVID-19 admitted to the intensive care unit (ICU) with confirmed or imminent respiratory failure.

The authorized product works by reducing the amount of cytokines and other inflammatory mediators, i.e. small active proteins in the bloodstream that control a cell’s immune response by filtering the blood and returning the filtered blood to the patient. The FDA added that the proteins that are removed are typically elevated during infections and can be associated with a "cytokine storm" that occurs in some COVID-19 patients. This leads to severe inflammation, rapidly progressive shock, respiratory failure, organ failure and death.

458:   Has ICMR approvesd use of diagnostic machine used for drug-resistant TB for COVID-19

Yes: ICMR has approved the use of diagnostic machines used for testing drug-resistant tuberculosis for conducting coronavirus tests.

The ICMR has validated ‘TruenatTM beta CoV test on TruelabTM workstation’ and has recommended it as a screening test, the apex health research body said on Friday.

Throat/nasal swabs will be collected in the viral transport medium (VTM) with virus lysis buffer provided along with the kit.

Truenat beta CoV test should only be performed with all biosafety precautions in BSL-2 or BSL-3 setups at laboratories.

459: after lungs which is the main organ involved

Kidney is one of the other major organs involved.

460: Can there be a role of colchicine

Nephrologists in Italy and US have used colchicine, in the successful treatment of kidney transplant patients with COVID-19 who both recovered. The key, is starting treatment before patients become too sick. [American Journal of Transplantation.]

461: Is CKD a risk factor

"Our findings show the prevalence of kidney disease on admission, and the development of acute kidney disease during hospitalization, is high and is associated with in-hospital mortality," say Yichun Cheng, MD, Department of Nephrology, Huazhong University of Science and Technology, Wuhan, China.

And in a meta-analysis of 30 studies involving 53,000 patients in China — albeit a preprint that has not been peer-reviewed — chronic kidney disease was associated with a sixfold increased risk of severe COVID-19 (odds ratio, 6.0).

This compared with an OR of 5.3 for COPD and 3.2 for cerebrovascular disease, Bruchfeld reported.

462:  CDC new guidelines on resuming work for critical workers following exposure to COVID-19

A potential exposure means being a household contact or having close contact within 6 feet of an individual with confirmed or suspected COVID-19. The timeframe for having contact with an individual includes the period of time of 48 hours before the individual became symptomatic.

Critical Infrastructure workers who have had an exposure but remain asymptomatic should adhere to the following practices prior to and during their work shift:

·         Pre-Screen: Employers should measure the employee’s temperature and assess symptoms prior to them starting work. Ideally, temperature checks should happen before the individual enters the facility.

·         Regular Monitoring: As long as the employee doesn’t have a temperature or symptoms, they should self-monitor under the supervision of their employer’s occupational health program.

·         Wear a Mask: The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings in the event of shortages.

·         Social Distance: The employee should maintain 6 feet and practice social distancing as work duties permit in the workplace.

·         Disinfect and Clean work spaces: Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely.

If the employee becomes sick during the day, they should be sent home immediately. Surfaces in their workspace should be cleaned and disinfected. Information on persons who had contact with the ill employee during the time the employee had symptoms and 2 days prior to symptoms should be compiled. Others at the facility with close contact within 6 feet of the employee during this time would be considered exposed.

(Source: Implementing safety practices for critical infrastructure workers who may have had exposure to a person with suspected or confirmed COVID-19. Interim Guidance)

463: A Negative Ultrasound Is the Most Useful

There are situations where lung ultrasound can be considered definitive.

For instance, if we see a patient with mild signs of the disease, just fever, and lung ultrasound shows nothing, lung ultrasound rules out pneumonia.

This patient may have COVID-19 of course, but they do not have pneumonia, and they can be treated at home, awaiting the result of the swab test. And this is useful because you can reduce the burden in the emergency department.

On the other hand, there are patients with acute respiratory failure in respiratory distress. If the lung ultrasound is normal, you can rule out COVID-19 and you need to use other diagnostic procedures to understand the problem.

464:  how many segments are seen kin ultrasound

14 for 10 seconds each

465: A score of 0 is given when the pleural line is continuous and regular, with the presence of A-lines, denoting that the lungs are unaffected.

An area is given a score of 3 when the scan shows dense and largely extended white lung tissue, with or without consolidations, indicating severe disease.

Intermediate cases: On the Butterfly algorithm, the suggestion is to look for B-lines, caused by fluid and cellular infiltration into the interstitium, and to weigh that against the need for supplementary oxygen.

The Italian team, in contrast, says a score of 1 is given when the pleural line is indented, with vertical areas of white visible below.

A score of 2 is given when the pleural line is broken, with small to large areas of consolidation and associated areas of white below.

465:What is the SARS  case of   Amoy Gardens apartment complex in Hong Kong

Experienced a large community outbreak of SARS during the 2003 epidemic. Using airflow dynamics studies, they were able to retrospectively track the spread of the virus from one individual patient—the index case—to other residents of the complex.

They reported that the patient's toilet exhaust fan, which created a negative pressure effect, vented into the apartments above and also to the outside. They linked this to 187 cases in the complex with available data. This analysis suggests that the SARS virus was able to be transmitted by microdroplets through inhalation, touch, and potentially fecal-oral routes.

466:  Can covid cause GBS

Physicians in China are reporting what they believe is the first case of COVID-19 initially presenting as acute Guillain-Barré syndrome (GBS). The patient was a 61-year-old woman returning home from Wuhan during the pandemic.

GBS is an autoimmune neuropathy, which could be triggered by various infections, corresponding author Sheng Chen, MD, PhD, Shanghai Jiao Tong University School of Medicine, China,

It may be an association ant not a causal relationship.

The case study was published online April 1 in Lancet Neurology.

467:  who was Urologist Dr Abdul Mabud Chowdhury 

A: He 53, was a doctor who warned the Prime Minister about PPE shortages and died after testing positive for the virus. His message to Boris Johnson 3 weeks ago urged him to "urgently" ensure personal protective equipment was available for "each and every NHS worker in the UK". He worked at Homerton Hospital in East London and died on Wednesday at Queen's Hospital in Romford.

468: Can COVID 19 present as acute hepatitis

A woman presented to the emergency department with high liver enzyme levels and dark urine. She developed fever on day 2 of care, and then tested positive for the new coronavirus, researchers at Northwell Health, in Hempstead, New York, report.

The authors say the case, published online in the American Journal of Gastroenterology, is the first documented instance of a patient with COVID-19 presenting with acute hepatitis as the primary symptom before developing respiratory symptoms.

469:  What are the guidelines for abortion care in COVID era

A: Because access to safe abortion care is time-sensitive and vitally important, the American College of Obstetricians and Gynecologists (ACOG) and other reproductive health professional organizations issued an unequivocal statement on March 18, 2020, that they “do not support Covid-19 responses that cancel or delay abortion procedures.”

Despite ACOG’s position, governors in a number of states have called for a halt to abortion care throughout the Covid-19 epidemic. Governors in Texas, Louisiana, Mississippi, Alabama, and Oklahoma have ordered or supported the cessation of both medication and surgical abortion, while governors in other states have directed that surgical abortion alone must stop. Politicians in additional states have announced their intentions to issue similar orders.

470:  What is treatment with compassionate-use remdesivir

NEJM: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)