Friday, April 17, 2020


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

656: Coranxiety the next Pandemic

In an article published online April 10 in JAMA Internal Medicine on the mental health consequences of COVID-19, the authors warn of a “pandemic” of behavioral problems and mental illness.

657: What can happen

The COVID-19 pandemic will likely result in “substantial” increases in anxiety and depression, substance use, loneliness, and domestic violence. In addition, with school closures, the possibility of an epidemic of child abuse is “very real,”

658: COVID era the Guidance states that, prior to and during the work shift for post positive workers, employers should:

·        Pre-screen and measure the employee’s temperature and assess symptoms prior to enters the facility;
·        Regularly Monitor the employee’s temperature and symptoms
·        Have the employee wear a face mask at all times while in the workplace for 14 days after the last exposure;
·        Have the employee social distance and maintain a 6 feet perimeter as work duties permit in the workplace;
·        Clean and disinfect all areas such as offices, bathrooms, common areas and shared electronic equipment routinely; and
·        Work with facility maintenance to increase air exchanges in the building.

659: How to minimise patient contact visits

UCSD Hospital Medicine drafted guidelines for the reduction of patient contacts.

Target one in-person MD visit per day for stable patients.

Attending reexaminations of patients seen by residents, nurse practitioners, physician assistants, and so on would not be done for billing or teaching purposes, only when clinically necessary.

Use phone or video conferencing for follow-up discussions unless direct patient contact is needed.

Consider skipping daily exams on patients who do not require them, such as patients awaiting placement or stably receiving long courses of antibiotics. Interview them remotely or from the door instead.

Conduct team rounds, patient discussions, and handoffs with all members 6 feet apart or by telephone or video. Avoid shared work rooms. Substitute video conferences for in-person meetings. Use EMR embedded messaging to reduce face-to-face discussions.

Check if a patient is ready for a visit before donning PPE to avoid waste.

Explain to patients that distancing is being conducted to protect them.

660: Hb in COVID 19

A meta-analysis of four applicable studies found that the hemoglobin value was significantly lower in COVID-19 patients with severe disease, compared with those with milder forms, according to a letter to the editor of Hematology Transfusion and Cell Therapy by Giuseppe Lippi, MD, of the University of Verona (Italy) and colleague.

Overall, the hemoglobin value was found to be significantly lower in COVID-19 patients with severe disease than in those with milder forms, yielding a weighted mean difference of −7.1 g/L, with a 95% confidence interval of −8.3 g/L to −5.9 g/L.

661: PPE side effects in skin

Almost 75% of doctors and nurses in and around Wuhan, China, where the outbreak first emerged, reported skin problems during a single week in early February 2020, in a survey of health care workers (HCW) caring for COVID-19 patients at five university and five regional hospitals. Hands, cheeks, and the nasal bridge were the most commonly affected areas, with skin dryness, maceration, papules, and erythema the most common problems, according to research published in the British Journal of Dermatology.

662:  FDA restricted blood donation guidelines

The FDA on April 2 issued three sets of revised recommendations aimed at getting more people eligible to donate blood. All of the revised recommendations will remain in effect after the COVID-19 health emergency is declared over.

The first revised recommendation makes changes to December 2015 guidance.
For male blood donors who would have been deferred for having sex with another male partner, the deferral period has been reduced from 12 months to 3 months. That deferral period change also applies to female donors who had sex with a man who had sex with another man as well as for those with recent tattoos and piercings.

The second recommendation revises guidance from August 2013 and relates to the risk of transfusion-transmitted malaria.

Under the new recommendations, for those who traveled to malaria-endemic areas (and are residents of malaria non-endemic countries), the FDA is lowering the recommended deferral period from 12 months to 3 months, and also provides notices of an alternate procedure that permits donations without a deferral period provided the blood components are pathogen-reduced using an FDA-approved pathogen reduction device.

The third recommendation finalizes draft guidance from January that eliminates the referral period for donors who spent time in certain European countries or were on military bases in Europe and were previously considered to have been exposed to a potential risk of transmission of Creutzfeldt-Jakob Disease or Variant Creutzfeldt-Jakob Disease.

663:  Can X ray be normal

Among cases of confirmed COVID-19, 58.3% of chest x-rays read as "normal," with 89% reading as either normal or "mild," reported Michael Weinstock, MD, of Wexner Medical Center at The Ohio State University in Columbus, and colleagues, in the Journal of Urgent Care Medicine.

664:  Self-collected throat washings

Throat washing is a promising candidate for 2019-nCoV screening due to its safety and reliability. Its utility and efficacy in 2019-nCoV detection have been well described in this study," Dr. Shi-Yue Li of The First Affiliated Hospital of Guangzhou Medical University in China and colleagues write.

The WHO recommends both NP swabs and oropharyngeal (OP) swabs. Dr. Li and colleagues note in Clinical Infectious diseases that while researchers found NP swabs were more effective than OP swabs for diagnosing infection, this approach still puts healthcare workers at risk of infection, samples are of inconsistent quality, and the test is uncomfortable for patients.

Dr. Li and colleagues report on the performance of throat washing in 11 patients with laboratory-conformed COVID-19. Subjects gargled with 20 ml of normal saline for 5 to 10 seconds, and then spit in a sterile container.

Twenty-four paired throat washings and NP swabs were obtained from the patients, including five from the five patients who had been discharged, and 19 from the six patients who remained hospitalized. Sample collection was done a median 53 days after symptoms began.

Fourteen of the pairs were negative for 2019-nCoV. Five pairs had inconsistent results, with the throat washing testing positive and the NP swab testing negative.

Using the Chi-squared test, they identified positive testing rate of throat washing was much higher than that of NP swabs (P=0.031).

665:  Contact lenses and COVID 19

Contact lenses are not likely to raise the risk of contracting COVID-19. And contrary to popular belief, glasses may offer little protection from the virus, according to the review article published in Contact Lens and Anterior Eye.

666:  Social distancing for how long

The United States may need to endure social distancing measures adopted during the coronavirus outbreak until 2022, according to researchers at the Harvard School of Public Health.

“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available”, the Harvard researchers said in findings published Tuesday in the journal Science.

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