Thursday, March 19, 2020

CMAAO IMA HCFI Corona Myth Busters 19 March

CMAAO IMA HCFI Corona Myth Busters 19  March

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

1.            Lopinavir–Ritonavir are the drug of choice in COVID 19

No but still be continued and given in hospitalised patients.

NEJM:  In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit.

We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir–ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first.

RESULTS: A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir–ritonavir group, and 100 to the standard-care group. Treatment with lopinavir–ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.24; 95% confidence interval [CI], 0.90 to 1.72). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir–ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir–ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events.

2.            The most important prevention is “Wash your hands”.
Hand-washing -- with soap and water -- is a far more powerful weapon against germs than many of us realize. The soap will actually be busting open that agent, breaking it apart.”
Coronaviruses, are encased in a lipid envelope -- basically, a layer of fat. Soap can break that fat apart and make the virus unable to infect you. The second thing soap does is mechanical. It makes skin slippery so that with enough rubbing, we can pry germs off and rinse them away.

3.            Most people splash and dash?

Yes. A 2013 study had trained observers discreetly watch more than 3,700 people wash their hands. It found that only about 5% of them followed all the rules. About one in four people just wet their hands without using soap -- “splash and dash.” About one in 10 didn’t wash at all after a trip to the restroom. The most common shortcoming for most people was time. Only 5% spent more than 15 seconds washing, rubbing, and rinsing their hands.

4.            It’s a must to use hot water to wash hands?
No. It doesn’t matter if it’s hot or cold. Water temperature doesn’t really matter in terms of effectiveness.

5.            If you’re in a public bathroom, and there’s no soap, just rubbing your hands together under the water does do some good.
Yes.  A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. Washing with soap and water brought bacterial counts down to about 8% of where they were before washing. The bottom line is work with what you have. Something is better than nothing.

6.            How long should you scrub your hands?
At least 20 seconds, according to the CDC. As you’ve probably heard, that’s the same amount of time it takes to sing “Happy Birthday to You” twice. Studies where people smother their hands with Glo Germ -- a product used to teach proper hand-washing that glows under a black light -- before they wash reveal the areas people tend to miss.

7.            Paper towels actually have a beneficial effect beyond simply washing
Yes. Rubbing your hands with a paper towel removes even more germs than just washing alone. Dry hands are also less likely to spread contamination than wet hands.

8.            I can use vodka as hand sanitiser?

No. Lipid membrane viruses like coronaviruses are killed by > 60% alcohol-based hand sanitizer.  Vodka has only 40% alcohol.

9.            Use a clean paper towel to open bathroom doors.

10.         Disinfect dirty surfaces that you use every day, like the touchscreen on your phone and your computer keyboard.

11.         Hospitals are safe and can not transmit infections?
No. 41% of the Covid-19 cases in Wuhan resulted from hospital-related transmission.
Health care providers are at increased risk for developing the condition and spreading it.
Work stress is believed to weaken their immune systems, and close, intimate care of patients can lead to exposure to a higher viral load.

[ Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 February 24 ; Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020;8(3):e13-e13].

12.         The virus can remain alive on plastic and steel

NEJM: longest viability of viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic.

13.         The ventilator patient needs 14 days to recover.

No. NEJM “The triage algorithm should also be reviewed regularly as knowledge about the disease evolves. If we decided not to intubate patients with Covid-19 for longer than 10 days, for example, but then learned that these patients need 15 days to recover, we would need to change our algorithms.”

14.         Quarantine and isolation are same

In public health practice, “quarantine” refers to the separation of persons (or communities) who have been exposed to an infectious disease. “Isolation,” in contrast, applies to the separation of persons who are known to be infected. In U.S. law, however, “quarantine” often refers to both types of interventions, as well as to limits on travel. Isolation and quarantine can be voluntary or imposed by law.

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