Saturday, April 4, 2020



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

304. Sputum the most toxic

Fact: JAMA March 11: There were 1070 specimens collected from 205 patients with COVID-19 who were a mean age of 44 years (range, 5-67 years) and 68% male. Most of the patients presented with fever, dry cough, and fatigue; 19% of patients had severe illness.

Bronchoalveolar lavage fluid specimens showed the highest positive rates (14 of 15; 93%), followed by sputum (72 of 104; 72%), nasal swabs (5 of 8; 63%), fibro-bronchoscope brush biopsy (6 of 13; 46%), pharyngeal swabs (126 of 398; 32%), faeces (44 of 153; 29%), and blood (3 of 307; 1%). None of the 72 urine specimens tested positive.
In addition, testing of specimens from multiple sites may improve the sensitivity and reduce false-negative test results.

305: Coronavirus on Fabric: Should worry about COVID-19 transmission from your own clothing, towels, and other textiles?

Fact: While researchers found that the virus can remain on some surfaces for up to 72 hours, the study didn’t include fabric. So far, evidence suggests that it’s harder to catch the virus from a soft surface (such as fabric) than it is from frequently touched hard surfaces like elevator buttons or door handles.

But if you suspect you got too close for too long, or someone coughed on you, there’s no harm in changing your clothing and washing it right away, especially if there are hard surfaces like buttons and zippers where the virus might linger.

Wash your hands again after you put everything into the machine. Dry everything on high, since the virus dies at temperatures above 133 F. File these steps under “abundance of caution”: They’re not necessary, but if it gives you peace of mind, it may be worth it.
Got your own washer and dryer? You can just do your laundry. But for those who share a communal laundry room or visit the laundromat, some extra precautions make sense:
Consider social distancing. Is your building’s laundry room so small that you can’t stand 6 feet away from anyone else? Don’t enter if someone’s already in there.

Sort your laundry before you go, and fold clean laundry at home, to lessen the amount of time you spend there and the number of surfaces you touch.

Bring sanitizing wipes or hand sanitizer with you to wipe down the machines’ handles and buttons before you use them. Or, since most laundry spaces have a sink, wash your hands with soap right after loading the machines.

If you have your own cart, use it. A communal cart shouldn’t infect your clothes, but touching it with your hands may transfer the virus to you.

Don’t touch your face while doing laundry.

Don’t hang out in the laundry room or laundromat while your clothes are in the machines. 
The less time you spend close to others, the better. Step outside, go back to your apartment, or wait in your car.

Fact from WHO: People living with HIV with advanced disease, those with low CD4 and high viral load and those who are not taking antiretroviral treatment have an increased risk of infections and related complications in general.  It is unknown if the immunosuppression of HIV will put a person at greater risk for COVID-19, thus, until more is known, additional precautions for all people with advanced HIV or poorly controlled HIV, should be employed.
At present there is no evidence that the risk of infection or complications of COVID-19 is different among people living with HIV who are clinically and immunologically stable on antiretroviral treatment when compared with the general population.  Some people living with HIV may have known risk factors for COVID-19 complications, such as diabetes, hypertension and other noncommunicable diseases and as such may have increased risk of COVID-19 unrelated to HIV.  We know that during the SARS and MERS outbreaks there were only a few case reports of mild disease among people living with HIV. 

307: has any one with HIV got COVID 19 till today

WHO Fact: To date, there is only one case report of a person living with HIV who had COVID-19 and recovered and a small study on risk factors and antiretrovirals used among people living with HIV with COVID-19 from China.  This study reported similar rates of COVID-19 disease as compared to the entire population and increased risk with older age, but not with low CD4, high viral load level or antiretroviral regimen.
Current clinical data suggest the main mortality risk factors are linked to older age and other comorbidities including cardiovascular disease, diabetes, chronic respiratory disease, and hypertension. Some very healthy people have also developed severe disease from the coronavirus infection.

308: PLHIV are advised to take the same precautions as the general population
Fact Yes.
  • wash hands often
  • cough etiquette
  • physical distancing
  • seek medical care if symptomatic
  • self-isolation if in contact with someone with COVID-19 and
  • other actions per the government response   
309: People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply

Fact Yes. It’s a fact. People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply of medicines and ensure that their vaccinations are up to date (influenza and pneumococcal vaccines). Adequate supplies of medicines to treat co-infections and comorbidities and addiction should also be ensured.

Fact: WHO has urged all countries to ensure an appropriate balance between protecting health, preventing economic and social disruption, and respecting human rights.

311: How to mitigate potential prison outbreaks of COVID19 and reduce morbidity and mortality among people in prisons and other closed settings

Fact: It is crucial that prisons and immigration detention centres are embedded within the broader public health response. This requires close collaboration between health and justice ministries and includes protocols for entry screening, personal protection measures, physical distancing, environmental cleaning and disinfection, and restriction of movement, including limitation of transfers and access for non-essential staff and visitors.  In the current context it is of critical importance that countries work toward developing non-custodial strategies to prevent overcrowding in closed settings.
Governance of prison health by a ministry of health, rather than a ministry of justice or similar, is likely to facilitate this.

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