Friday, April 3, 2020



Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania

298: Only testing can decide that I have recovered

Myth: No. Re-testing method: The CDC advised that all confirmed and suspected coronavirus patients should be symptom-free and test negative for the virus twice within at least 24 hours to be considered recovered.

Non-testing method: The updated CDC guidance offered a second method to determine coronavirus recovery without a test.
If a confirmed or suspected COVID-19 patient is fever-free "without the help of fever-reducing medication" for at least three days, if it has been "at least seven days" since the coronavirus symptoms first appeared, that person can be considered recovered.
Respiratory symptoms of the virus must also be improving during that time, but don't have to disappear entirely by seven days for the patient to be considered recovered, the CDC said.
"That's the clinical way, and that's the way the vast majority of people are going to meet the term of having recovered," Houston Health Department's Dr. David Persse said. "Part of the reason is that testing remains a very precious resource."
299. Non testing method is ok for admitted patients

Myth: No. Some coronavirus patients “may be contagious for longer than others. The testing method "is preferred" for patients "who are hospitalized, or severely immunocompromised, or being transferred to long-term care of assisted living facility," according to the CDC.
The non-test-based strategy "will prevent most, but may not prevent all instances of secondary spread" of the virus, the CDC website added in a footnote.
300. Doctors can join once recovered after one week
Myth: Not without precautions: The CDC also provided new guidance for healthcare workers, who have tested positive for the virus, or who think they had it, and are now considered recovered without a test.
"Wear a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer," the CDC site stated. "Be restricted from contact with severely immunocompromised patients until 14 days after illness onset."

301.  You can not transmit the disease before the symptoms
Myth: Reuters excerpts: People infected with the novel coronavirus can transmit the infection one-to-three days before symptoms start to appear, according to a study published by the U.S. Centers for Disease Control and Prevention (CDC).
The study, which underscored the importance of social distancing to fight the coronavirus outbreak, looked at 243 cases of COVID-19, the illness caused by the coronavirus, reported in Singapore between January 23 and March 16.
It identified seven “clusters” where pre-symptomatic transmission was likely, and in four such groups, where the date of exposure could be determined, pre-symptomatic transmission occurred one-to-three days before symptoms appeared in the source patient.
Of the cases in Singapore, 157 were locally acquired and 10 of these were likely transmitted before symptoms started to show.
The findings suggest that it might not be enough for people showing symptoms to limit their contact to control the pandemic, the researchers wrote in the CDC’s Morbidity and Mortality Weekly Report, published online on Wednesday.
The study authors suggested that public health officials conducting contact tracing should strongly consider including a period before symptom onset to account for the possibility of this type of transmission.
Transmissions might take place through respiratory droplets or even speech and other vocal activities such as singing, with the rate of emission corresponding to voice loudness.

302. You can not die if your age is less than one
Myth: 2nd April: First Baby in Connecticut Dies From COVID-19. An infant who died in Connecticut tested positive for the coronavirus. The 7-week-old girl was from Hartford, according to the Connecticut NBC affiliate. The first infant death in the United States from COVID-19 happened in Chicago, the Illinois Department of Public Health reported on March 28. The infant was less than a year old.
Children account for a small number of coronavirus-related cases. A study published in the New England Journal of Medicine in mid-March reported that children made up less than 1% of COVID-19 cases in China. As of March 8, the study says, there was one death -- a 10-month-old. The child had bowel blockage and multi-organ failure and died 4 weeks after admission to the hospital.

303. NYC Ambulances Won't Take Cardiac Arrest Patients to Hospitals
Fact: April 2, 10:55 a.m.  Medical first responders in New York City have been ordered not to take patients in cardiac arrest to a hospital if they are unable to restart the patient's heart in the field, according to the New York Post.  

303.   Differentiate the population into five groups and treat accordingly.
Fact: NEJM
1.     We first need to know who is infected
2.     Who is presumed to be infected (i.e., persons with signs and symptoms consistent with infection who initially test negative)
3.     Who has been exposed
4.     Who is not known to have been exposed or infected
5.     Who has recovered from infection and is adequately immune.
We should act on the basis of symptoms, examinations, tests (currently, polymerase-chain-reaction assays to detect viral RNA), and exposures to identify those who belong in each of the first four groups.
Hospitalize those with severe disease or at high risk. Establish infirmaries by utilizing empty convention centers, for example, to care for those with mild or moderate disease and at low risk; an isolation infirmary for all patients will decrease transmission to family members.
Convert now-empty hotels into quarantine centers to house those who have been exposed, and separate them from the general population for 2 weeks; this kind of quarantine will remain practical until and unless the epidemic has exploded in a particular city or region. Being able to identify the fifth group — those who were previously infected, have recovered, and are adequately immune — requires development, validation, and deployment of antibody-based tests.

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