CMAAO
IMA HCFI CORONA MYTH BUSTER 24
Dr K K Aggarwal
President CMAAO, HCFI and Past National President
CMAAO
You
can drink sanitiser alcohol
Isopropyl alcohol is commonly ingested intentionally (either as
an ethanol substitute or for self-harm) or in accidental exposures. It is
commonly used as a disinfectant, antifreeze, and solvent, and typically
comprises 70 percent of "rubbing alcohol." When ingested, isopropyl
alcohol functions primarily as a central nervous system (CNS) inebriant and
depressant, and its toxicity and treatment resemble that of ethanol. A summary
table to facilitate emergent management is provided
The hallmark of isopropyl alcohol
metabolism is a marked ketonemia and ketonuria in the absence of
metabolic acidosis.
Isopropyl alcohol is rapidly and
completely absorbed following oral ingestion.
200 ml can be the toxic dose and less if
the patient is on anti-depressants
COVID 19 cannot be air borne
WHO: In the context of COVID-19, airborne transmission may be possible
in specific circumstances and settings in which procedures that generate
aerosols are performed (i.e. endotracheal intubation, bronchoscopy, open
suctioning, administration of nebulized treatment, manual ventilation before
intubation, turning the patient to the prone position, disconnecting the
patient from the ventilator, non-invasive positive-pressure ventilation,
tracheostomy, and cardiopulmonary resuscitation). In analysis of 75,465 COVID-19
cases in China, airborne transmission was not reported.6
Like SARS COVID 19 can
travel through feco-oral root
WHO: NO.? There is some evidence that COVID-19 infection may lead to
intestinal infection and be present in faeces. However, to date only one study
has cultured the COVID-19 virus from a single stool specimen.8 There
have been no reports of faecal−oral transmission of the COVID-19 virus to date.
In hospitals virus can infect up to 3
hours
WHO: No, A recent
publication in the New England Journal of Medicine has
evaluated virus persistence of the COVID-19 virus.9 In this
experimental study, aerosols were generated using a three-jet Collison
nebulizer and fed into a Goldberg drum under controlled laboratory conditions.
This is a high-powered machine that does not reflect normal human cough
conditions. Further, the finding of COVID-19 virus in aerosol particles up to 3
hours does not reflect a clinical setting in which aerosol-generating
procedures are performed—that is, this was an experimentally induced
aerosol-generating procedure.
WHO has no final recommendation
WHO continues to emphasize the utmost
importance of frequent hand hygiene, respiratory etiquette, and environmental
cleaning and disinfection, as well as the importance of maintaining physical
distances and avoidance of close, unprotected contact with people with fever or
respiratory symptoms.
The R0 is an intrinsic feature of the virus.
The pandemic appears to be largely
driven by direct, human-to-human transmission. That is why public health
officials have told people to engage in social distancing, a simple but
effective way to drive down virus’s reproductive number — known as R0,
pronounced “R naught.” That is the average number of new infections generated by
each infected person.
The R0 is not an intrinsic feature of
the virus. It can be lowered through containment, mitigation and ultimately
“herd immunity,”
For the epidemic to begin to end, the
reproduction rate has to drop below 1.
In the early days in China, before the
government imposed extreme travel restrictions in Wuhan and nearby areas, and
before everyone realized exactly how bad the epidemic might be, the R0 was
2.38, according to a study published in the journal Science.
That is a highly contagious disease.
But on Jan. 23, China imposed extreme
travel restrictions and soon put hundreds of millions of people into some form
of lockdown as authorities aggressively limited social contact. The R0
plummeted below 1, and the epidemic has been throttled in China, at least for
now.
The virus does have an innate
infectivity, based on how it binds to receptors in cells in the respiratory
tract and then takes over the machinery of those cells to make copies of
itself. But its ability to spread depends also on the vulnerability of the
human population, including the density of the community.
If you have a seriously infectious virus
and you’re sitting by yourself in a room, the R naught is zero. You can’t give
it to anybody. This is also the basis of lock down.
Aerial spraying should work
There is no way to combat the virus
through aerial spraying, dousing the public drinking water with a potion or
simply hoping that it will magically go away.
We
have not been able to trace patient zero
A shrimp seller at the wet market in the Chinese city of Wuhan believed
to be the centre of the coronavirus pandemic, may be the first person to have
tested positive for the disease.
The report by the London-based Metro newspaper said that 57-year-old
woman, named by the Wall Street Journal as Wei Guixian, was selling shrimp at
the Huanan Seafood Market when she developed what she thought was a cold last December.
Chinese digital news outlet, The Paper has said that she may be 'patient
zero'.
Knowing viral load
has no significance
In The Lancet Infectious Diseases
Although
the authors make a case for COVID-19 presenting as three distinct clinical
patterns, we believe a distinction based on such small numbers is highly
speculative. Nevertheless, based on the assumption that viral RNA load
correlates with high levels of viral replication, there are important
insights to be gained from this time-course analysis.
Currently,
our understanding of the relationship between viral RNA load kinetics and
disease severity in patients with COVID-19 remains fragmented. Zou and colleagues
reported that patients with COVID-19 with more severe disease requiring
intensive care unit admission had high viral RNA loads at 10 days and beyond,
after symptom onset.
By
contrast, Lescure and colleagues report the viral RNA kinetics of two patients
who developed late respiratory deterioration despite the disappearance of
nasopharyngeal viral RNA. It would be interesting to know whether viral RNA
load in lung tissue, or a surrogate sample such as tracheal aspirate, mirrors
the decline in nasopharyngeal shedding. Nevertheless, this observation suggests
that these late, severe manifestations might be immunologically mediated and
has obvious implications for the potential to use immune-modulatory therapies
for this subset of patients. This finding is consistent with recent reports
that corticosteroids were beneficial for acute respiratory distress syndrome, and
possibly those with COVID-19.
Lescure and
colleagues wisely note the implications for transmission from patients with few
symptoms but high viral RNA load in the nasopharynx early in the course of
disease. Individuals within the community, policy makers, and frontline
health-care providers, especially general and emergency room practitioners,
should be alert and prepared to manage this risk. Equally worrying is the
persistently high nasopharyngeal viral RNA load, and the detection of viral RNA
in blood and pleural fluid, of the older patient (aged 80 years) with severe
multi-organ dysfunction.
Presence of viral RNA in specimens always correlate with viral
transmissibility
No, in a ferret model of
H1N1 infection, the loss of viral culture positivity but not the absence of
viral RNA coincided with the end of the infectious period. In fact, real-time
reverse transcriptase PCR results remained positive 6–8 days after the loss of
transmissibility.
In SARS live virus was detected for 4 weeks
No, For
SARS coronavirus, viral RNA is detectable in the respiratory secretions and
stools of some patients after onset of illness for more than 1 month, but live
virus could not be detected by culture after week 3. Lancet
Its easy to differentiate between infective and non-infective
virus
Lancet: The inability to differentiate between infective
and non-infective (dead or antibody-neutralised) viruses remains a major
limitation of nucleic acid detection. Despite this limitation, given the
difficulties in culturing live virus from clinical specimens during a pandemic,
using viral RNA load as a surrogate remains plausible for generating clinical
hypotheses.