Monday, March 30, 2020



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.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.

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