Sunday, April 19, 2020


Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania, HCFI and Past National President IMA

With regular inputs from Dr Monica Vasudev

Alcohol COVID link

708: Is alcohol safe during pandemic

As per WHO an increase of alcohol consumption can lead to "health vulnerability, risk-taking behaviours, mental health issues and violence." Alcohol compromises the body’s immune system and increases the risk of adverse health outcomes.

A pandemic myth that claims consuming high-strength alcohol can kill the virus is false and can lead to fatal health consequences.

While unhealthy drinking increases the risk for infection, consumption within the recommended limits — one per day for women, two per day for men — may be fine. With moderate drinking, “while we do see some changes that happen in our immune system, they’re transient and they go away rather quickly.
709: Echocardiography guidelines by ASE
Only perform transthoracic echocardiograms (TTE), stress echocardiograms, and transoesophageal echocardiograms (TEE) if they are expected to provide clinical benefit.

Determine which studies are "elective" and reschedule them.

Identify "nonelective" (urgent/emergent) indications and defer all others.

Determine the clinical benefit of echocardiography for symptomatic patients whose SARS-CoV-2 status is unknown.

Cautiously consider the benefit of a TEE examination weighed against the risk for exposure of healthcare personnel to aerosolization in a patient with suspected or confirmed COVID-19.

Postpone or cancel TEEs if an alternative imaging modality can provide the necessary information.

Note that treadmill or bicycle stress echo tests in patients with COVID-19 may lead to exposure because of deep breathing and/or coughing during exercise. These tests should generally be deferred or converted to a pharmacologic stress echo.

The ASE statement also provides advice on safe imaging protocol and adequate personal protection measures.

Limit the exposure of staff who may be particularly susceptible to severe complications of COVID-19

Staff who are older than 60 years, who have chronic conditions, are immunocompromised or are pregnant may wish to avoid contact with patients suspected or confirmed to have COVID-19.

710: Non pulmonary manifestations
1.    There's a case on Consult of a 37-year-old man with stomach pain, vomiting, and diarrhoea, but no respiratory symptoms and a positive COVID test. A chest CT incidental to his abdominal scan revealed significant bilateral lung involvement.
2.     A 69-year-old woman with a history of laparotomy and new onset intestinal sub occlusion had only adhesions on a subsequent exploratory laparotomy and was doing okay otherwise. She suddenly went into respiratory failure with progressive bradycardia and died 3 days later. Aspiration pneumonia, pulmonary embolism, and MI had been ruled out. The pattern of cardiovascular failure was in favour of myocarditis.
3.     Elevated cardiac enzymes without coronary artery obstruction in a positive patient who went into shock, with an ejection fraction of 40% and markedly increased heart wall thickness, but no lung involvement.
4.     There are two cases of idiopathic thrombocytopenia without fever of hypoxia.
5.     Most patients become nauseated, [and] the taste of any food is unbearable. When you find these symptoms by history, the patient is COVID positive 100%.
6.     The ACE2 receptor the virus uses to enter cells is common in many organs, plus there were extrapulmonary manifestations
7.    Encephalopathy
8.    Liver impairment
9.    Kidney impairment
10.                     Multiorgan dysfunction

711: Re use of N95 respirators
1.    Can be safely decontaminated without undermining functional integrity only two or three times
2.     Both ultraviolet light and vaporized hydrogen peroxide met the bar for killing the virus without impacting fit testing for two rounds of wear and decontamination compared with control respirators.
3.    Filtration remained "acceptable" after a third round for those two methods as well.
4.     Vaporized hydrogen peroxide (VHP, approximately 1,000 ppm) was the faster of the two. VHP eliminated viral growth in media exposed to the mask after decontamination to zero in about 10 minutes, whereas ultraviolet light (260-285 nm) dropped it to below the acceptable level in about an hour.
5.     The CDC has not approved any method for decontaminating masks, but it has said it "does not intend to object to the distribution and use of sterilizers, disinfectant devices, and air purifiers that are intended to be effective at killing SARS-CoV-2 .
6.    FDA believes such devices will not create such an undue risk, when performance and labelling criteria are met.
7.    The study also looked at a 70% ethanol solution sprayed to saturation and heat treatment in a 70°C (158°F) oven for 10 minutes.
Ethanol was quick to decontaminate the respirators but didn't pass the test for respirator function on the second round of decontamination.
8.    Dry heat was slow, taking about an hour to hit the viral kill threshold, but kept proper function for two rounds of decontamination.
9.     A separate group studying N95 respirator decontamination has cautioned that soapy water, alcohol, bleach immersion, and overnight storage are unsuitable.

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