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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