CMAAO
CORONA FACTS and MYTH BUSTER 45
Dr K K Aggarwal
President Confederation of Medical
Associations of Asia and Oceania
451:
What sit meaning between cleaning and
disinfecting
These guidelines are focused on household settings
and are meant for the general public.
- Cleaning refers
to the removal of germs, dirt, and impurities from surfaces. It does not
kill germs, but by removing them, it lowers their numbers and the risk of
spreading infection.
- Disinfecting refers
to using chemicals, for example, EPA-registered disinfectants, to kill
germs on surfaces. This process does not necessarily clean dirty surfaces
or remove germs, but by killing germs on a surface after cleaning,
it can further lower the risk of spreading infection.
452:
Can the virus go upto 8 meters
Fact: Many people believe the novel coronavirus can be transmitted
only short distances in respiratory droplets from a sneeze or cough. But a
National Academy of Sciences letter and papers published in The New England Journal of Medicine and JAMA suggest it's
possible that the novel coronavirus can hang in the air for hours and remain
infectious. This means people could spread the virus just by breathing
normally, and the virus could even be propelled as far as 8 meters by a sneeze.
However, some skeptics remain unconvinced that the respiratory particles can
transmit infection.
453:
when hydroxy chloroquine and
azithromycin combination should not be given
Withhold the
drugs in patients with baseline QT prolongation (e.g., QTc of at least 500
msec) or with known congenital long QT syndrome; monitoring cardiac rhythm and
QT interval and withdrawing hydroxychloroquine and azithromycin if QTc exceeds
500 msec; correcting hypokalemia to levels greater than 4 mEq/L and
hypomagnesemia to more than 2 mg/dL; and avoiding other QTc-prolonging agents
when possible.
454: Can you
have unilateral pneumonia in COVID 19
No.Asymmetrical
lung involvement is common, but it is rare for only one lung to be
affected.
455:
what are two patterns of oxygen requirement
1) those
with mild-to-moderate hypoxia, who improve slowly over time
2)
those with rapidly escalating oxygen
needs, who proceed quickly to intubation.
456: How do we know the status of asymptomatic
infections
A
new study has begun recruiting at the National Institutes of Health in
Bethesda, Maryland, to determine how many adults in the United States without a
confirmed history of infection with SARS-CoV-2, have antibodies to the virus.
The
presence of antibodies in the blood indicates a prior infection. In this
“serosurvey,” researchers will collect and analyze blood samples from as many
as 10,000 volunteers to provide critical data for epidemiological models. The
results will help illuminate the extent to which the novel coronavirus has
spread undetected in the United States and provide insights into which
communities and populations are most affected.
457: what is blood
purification device to treat COVID-19
The US FDA issued an emergency use
authorization (EUA) for a blood purification system to treat patients
18 years of age or older with confirmed COVID-19 admitted to the intensive care
unit (ICU) with confirmed or imminent respiratory failure.
The authorized product works by reducing the amount
of cytokines and other inflammatory mediators, i.e. small active proteins in
the bloodstream that control a cell’s immune response by filtering the blood
and returning the filtered blood to the patient. The FDA added that the
proteins that are removed are typically elevated during infections and can be
associated with a "cytokine storm" that occurs in some
COVID-19 patients. This leads to severe inflammation, rapidly progressive
shock, respiratory failure, organ failure and death.
458: Has ICMR approvesd use of diagnostic machine used for drug-resistant TB for
COVID-19
Yes: ICMR has approved the use of diagnostic
machines used for testing drug-resistant tuberculosis for
conducting coronavirus tests.
The ICMR has validated ‘TruenatTM beta CoV test on
TruelabTM workstation’ and has recommended it as a screening test, the apex health research body said on Friday.
Throat/nasal swabs will be collected in the viral
transport medium (VTM) with virus lysis buffer provided along with the kit.
Truenat beta CoV test should only be performed with
all biosafety precautions in BSL-2 or BSL-3 setups at laboratories.
459:
after lungs which is the main organ involved
Kidney is one of the other major organs involved.
460:
Can there be a role of colchicine
Nephrologists in Italy and US have used colchicine, in the successful treatment of kidney transplant patients
with COVID-19 who both recovered. The key, is starting treatment before
patients become too sick. [American Journal of Transplantation.]
461: Is CKD a risk factor
"Our
findings show the prevalence of kidney disease on admission, and the
development of acute kidney disease during hospitalization, is high and is
associated with in-hospital mortality," say Yichun Cheng, MD, Department
of Nephrology, Huazhong University of Science and Technology, Wuhan, China.
And in
a meta-analysis of 30 studies involving 53,000 patients in China —
albeit a preprint that has not been peer-reviewed — chronic kidney disease was
associated with a sixfold increased risk of severe COVID-19 (odds ratio, 6.0).
This
compared with an OR of 5.3 for COPD and 3.2 for cerebrovascular disease,
Bruchfeld reported.
462: CDC new guidelines on resuming work for critical
workers following exposure to COVID-19
A potential exposure means being a household
contact or having close contact within 6 feet of an individual with confirmed
or suspected COVID-19. The timeframe for having contact with an individual
includes the period of time of 48 hours before the individual became
symptomatic.
Critical Infrastructure workers who have had an
exposure but remain asymptomatic should adhere to the following practices prior
to and during their work shift:
· Pre-Screen: Employers
should measure the employee’s temperature and assess symptoms prior to them
starting work. Ideally, temperature checks should happen before the individual
enters the facility.
· Regular
Monitoring: As long as the employee doesn’t have a temperature or
symptoms, they should self-monitor under the supervision of their employer’s
occupational health program.
· Wear a Mask: The
employee should wear a face mask at all times while in the workplace for 14
days after last exposure. Employers can issue facemasks or can approve
employees’ supplied cloth face coverings in the event of shortages.
· Social
Distance: The employee should maintain 6 feet and practice social
distancing as work duties permit in the workplace.
· Disinfect and
Clean work spaces: Clean and disinfect all areas such as offices,
bathrooms, common areas, shared electronic equipment routinely.
If the employee becomes sick during the day, they
should be sent home immediately. Surfaces in their workspace should
be cleaned and disinfected. Information on persons who had contact with
the ill employee during the time the employee had symptoms and 2 days prior to
symptoms should be compiled. Others at the facility with close contact within 6
feet of the employee during this time would be considered exposed.
(Source: Implementing safety practices for critical
infrastructure workers who may have had exposure to a person with suspected or
confirmed COVID-19. Interim Guidance)
463: A Negative Ultrasound Is the Most Useful
There are situations where lung ultrasound
can be considered definitive.
For
instance, if we see a patient with mild signs of the disease, just fever, and lung
ultrasound shows nothing, lung ultrasound rules out pneumonia.
This patient may have COVID-19 of course,
but they do not have pneumonia, and they can be treated at home, awaiting the
result of the swab test. And this is useful because you can reduce the burden
in the emergency department.
On the other hand, there are patients with
acute respiratory failure in respiratory distress. If the lung ultrasound is
normal, you can rule out COVID-19 and you need to use other diagnostic
procedures to understand the problem.
464:
how many segments are seen kin ultrasound
14
for 10 seconds each
465:
A score of 0 is given when the pleural line is continuous and regular, with the
presence of A-lines, denoting that the lungs are unaffected.
An area
is given a score of 3 when the scan shows dense and largely extended white lung
tissue, with or without consolidations, indicating severe disease.
Intermediate
cases: On the Butterfly algorithm, the suggestion is to look for B-lines,
caused by fluid and cellular infiltration into the interstitium, and to weigh
that against the need for supplementary oxygen.
The
Italian team, in contrast, says a score of 1 is given when the pleural line is
indented, with vertical areas of white visible below.
A score
of 2 is given when the pleural line is broken, with small to large areas of
consolidation and associated areas of white below.
465:What
is the SARS case of Amoy
Gardens apartment complex in Hong Kong
Experienced a large community outbreak of SARS during
the 2003 epidemic. Using airflow dynamics studies, they were able to
retrospectively track the spread of the virus from one individual patient—the
index case—to other residents of the complex.
They reported that the patient's toilet exhaust fan,
which created a negative pressure effect, vented into the apartments above and
also to the outside. They linked this to 187 cases in the complex with
available data. This analysis suggests that the SARS virus was able to be
transmitted by microdroplets through inhalation, touch, and potentially
fecal-oral routes.
466: Can covid cause GBS
Physicians
in China are reporting what they believe is the first case of COVID-19
initially presenting as acute Guillain-Barré syndrome (GBS). The patient was a
61-year-old woman returning home from Wuhan during the pandemic.
GBS is an
autoimmune neuropathy, which could be triggered by various infections,
corresponding author Sheng Chen, MD, PhD, Shanghai Jiao Tong University School
of Medicine, China,
It may be
an association ant not a causal relationship.
The case
study was published online April 1 in Lancet Neurology.
467: who was Urologist Dr Abdul Mabud
Chowdhury
A: He 53,
was a doctor
who warned the Prime Minister about PPE shortages and died after testing
positive for the virus. His
message to Boris Johnson 3 weeks ago urged him to "urgently" ensure
personal protective equipment was available for "each and every NHS worker
in the UK". He worked at Homerton Hospital in East London and died on
Wednesday at Queen's Hospital in Romford.
468: Can COVID 19 present as acute hepatitis
A woman
presented to the emergency department with high liver enzyme levels and dark
urine. She developed fever on day 2 of care, and then tested positive for the
new coronavirus, researchers at Northwell Health, in Hempstead, New York,
report.
The
authors say the case, published online in the American
Journal of Gastroenterology, is the first documented instance of a patient
with COVID-19 presenting with acute hepatitis as the primary
symptom before developing respiratory symptoms.
469: What are the guidelines for abortion care in
COVID era
A: Because access to safe abortion care
is time-sensitive and vitally important, the American College of Obstetricians
and Gynecologists (ACOG) and other reproductive health professional
organizations issued an unequivocal statement on March 18, 2020, that they “do
not support Covid-19 responses that cancel or delay abortion procedures.”
Despite ACOG’s position, governors in a
number of states have called for a halt to abortion care throughout the
Covid-19 epidemic. Governors in Texas, Louisiana, Mississippi, Alabama, and
Oklahoma have ordered or supported the cessation of both medication and
surgical abortion, while governors in other states have directed that surgical
abortion alone must stop. Politicians in additional states have announced their
intentions to issue similar orders.
470: What is treatment
with compassionate-use remdesivir
NEJM: In this cohort of
patients hospitalized for severe Covid-19 who were treated with
compassionate-use remdesivir, clinical improvement was observed in 36 of 53
patients (68%). Measurement of efficacy will require ongoing randomized,
placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)
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