Wednesday, March 25, 2020


Last in  the series
From now onwards we will start fact series


Dr K K Aggarwal
President CMAAO, HCFI and Past National President CMAAO

CT chest is the test of choice

No, as CT can be normal in early illness, and after each potentially infected patient is scanned, the machine must be completely disinfected. Therefore, CT isn't recommended to screen for COVID-19.

Should doctors maintain physical distance with their colleague in the healthcare setting?
Yes. 10% of the health care workers get  covid 19 and one of the main mode of transmission is cross infection amongst each other.

Anosmia is as common as in flu
A growing body of data from COVID-19 patients in several countries strongly suggests that "significant numbers" of those patients experienced anosmia as one of the disease's symptoms, according to the ENT UK statement. 

Anecdotal evidence further describes the loss of smell and the loss of taste — known as dysgeusia — in people who had no other symptoms but who tested positive for COVID-19, representatives of the American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) in Alexandria, Virginia, said in a March 22 statement.

Is COVID 19 a occupational hazard amongst health care workers
As per WHO, Yes.

Should we nebulize a person with COVID ARI

No, use spacer and not nebulizer. It can produce aerosol and be infective to others.

Should we use high flow  oxygen to a person with COVID ARI

No, use low flow. It can produce aerosol and be infective to others.

Should we non invasive ventilation to  a person with COVID ARI

No, use invasive ventilation. NIV can produce aerosols and be infective to others. But if invasive ventilators are not available use them.

One ventilator two pateiunts, let one die

No. necessity is the mother of invention. Share one ventilator for more than one patient. Detroit, Michigan demonstrates in a YouTube video. She responded that a filter is placed before the expiration port connection with the T-piece and it's a 1-way circuit. She noted that the tubing is 5 feet from the endotracheal tube.

CPR should not be done kin dying COVID patients

The AHA advises
  • Aerosol-generating procedures such as CPR and endotracheal intubation expose providers to a greater risk of disease transmission and should be performed in airborne infection isolation rooms (AIIRs); personnel should use respiratory protection.
  • Only providers essential for patient care and procedural support should be present during the procedure and the room should be cleaned and disinfected following the procedure.
  • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed and AIIRs should be reserved for patients undergoing aerosol-generating procedures.
  • N95 respirators or respirators that offer a higher level of protection should be used instead of a face mask during aerosol-generating procedures.
  • Providers should put on a respirator or facemask (if a respirator is not available) before entering a patient's room or care area. Facilities should return to use of respirators for patients with known or suspected COVID-19 once the supply chain is restored.
  • Wear eye protection, gloves, and gowns.
  • When gowns are in short supply, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of providers.
  • If intubation is needed, consider using rapid sequence intubation with appropriate personal protective equipment (PPE).
  • If possible, avoid procedures which generate aerosols, such as bag-valve mask, nebulizers and non-invasive positive pressure ventilation.
  • Consider proceeding directly to endotracheal intubation in patients with acute respiratory failure. Avoid the use of high-flow nasal oxygenation and mask CPAP or bilevel CPAP due to greater risk of aerosol generation.

Liver involvement is mild

No. Individuals at high risk for severe COVID-19 are typically of older age and/or present with comorbid conditions such as diabetes, cardiovascular disease, and hypertension. This is also the same profile for those at increased risk for unrecognized underlying liver disease, especially nonalcoholic fatty liver disease. This could make them more susceptible to liver injury from the virus, medications used in supportive management, or hypoxia.

According to a report published in 2014 up to 60% of patients with SARS had liver impairment, with liver biopsy specimens demonstrating viral nucleic acids and injury.

This may have been the result of drug-induced liver injury, given that most of these patients were treated with high doses of potentially hepatotoxic antivirals, antibiotics, and steroids.

Peripheral ground-glass opacities are not specific for COVID 19 on CT chest

Although they are sensitive but not specific for coronavirus as it can also occur in Pneumocystis jirovecii pneumonia, cryptogenic organizing pneumonia, and acute lung injury from drug toxicity, hypersensitivity, and autoimmune diseases. But these causes are uncommon. In todays , COVID era this picture can be taken as diagnostic.

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