CMAAO
CORONA FACTS and MYTH BUSTER 86
Dr K K Aggarwal
President Confederation
of Medical Associations of Asia and Oceania, HCFI, Past National President IMA,
Chief Editor Medtalks
With inputs from Dr Monica Vasudeva
801: Monoclonal
Antibodies
The use of mAbs
directed against infectious pathogens is an area of investigation. The
mechanism is not completely defined. Potential uses include preventing or
treating specific infections.
Most mAbs target
proteins on the surface of a virus, thus neutralizing the virus from entering
cells. Palivizumab is an antibody against the respiratory syncytial virus (RSV)
fusion (F) glycoprotein; it inhibits viral entry into host cells. This therapy was
approved by the US Food and Drug Administration (FDA) for the prevention of RSV
infection. ('Immunoprophylaxis'.)
Other
investigational preventive antiviral mAbs include those targeting the conserved
hemagglutinin A stem of Haemophilus influenzae. This therapy may be helpful in
cases in which vaccination offers ineffective humoral immunity.
Investigational
mAbs against HIV can improve immunity during active infection, with promising results
in animal models using broadly neutralizing antibodies
Some mAbs against
bacteria can function both prophylactically and therapeutically (eg, by
targeting the protective antigen domain of Bacillus anthracis or one of the
Clostridioides [formerly Clostridium] difficile toxins).
As stated in a 2018
editorial, mAbs directed against pathogens are unlikely to be used routinely
due to their high cost and requirement for parenteral administration; however,
they may be especially useful for certain emerging infectious diseases.
Treatment of active
disease and/or targeted prophylaxis might be especially important in
individuals who have not been vaccinated against a pathogen but require
immediate protection ( individuals infected with Ebola virus, pregnant women
residing in Zika virus-endemic areas and COVID 19).
802: Can COVID 19 be treated in OPD
OPD management is appropriate for most patients with
suspected or confirmed COVID-19. Follow a coordinated care management program
that includes initial risk stratification, clinician telehealth visits
(telephone call or video platform-based), a dedicated outpatient respiratory
clinic, and a close relationship with a local emergency department (ED).
Patients who live in regions with widespread community
transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
and have compatible symptoms are generally managed presumptively as having
COVID-19, even if they have not been tested or have an initial negative test
result
On initial evaluation, assess risk factors for severe
disease, dyspnea severity and duration (and oxygenation status of those with
dyspnea), overall level of acuity, and the patient’s home setting to determine
who warrants an in-person evaluation at an outpatient clinic or in the ED.
803: Refer to hospital
patients with one or more of the following features to
the ED for further management
Severe dyspnea (dyspnea at rest, and interfering with
the inability to speak in complete sentences)
Oxygen saturation on room air of ≤90 percent,
regardless of severity of dyspnea
Concerning alterations in mentation (eg, confusion,
change in behavior, difficulty in rousing) or other signs and symptoms of
hypoperfusion or hypoxia (eg, falls, hypotension, cyanosis, anuria, chest pain
suggestive of acute coronary syndrome)
804:
Refer to OPD CLINIK
Mild dyspnea in a patient with an oxygen saturation on
room air between 91 to 94 percent
Mild dyspnea in a patient at high risk for severe
disease
Moderate dyspnea in any patient
Symptoms concerning enough to warrant in-person
evaluation (eg, mild orthostasis) but not severe enough to require ED referral
805:
Stay at home
Other patients can generally remain at home for
management without in-person evaluation if they can reliably report worsened
symptoms and can self-isolate for the anticipated duration of illness. Whether
such patients warrant telehealth follow-up depends upon their risk for severe
disease and the extent of dyspnea.
806:
Differential diagnosis
Symptoms of COVID-19 can overlap with those of many
common conditions, so it is important to consider other possible etiologies of
symptoms including other respiratory infections, congestive heart failure,
asthma or chronic obstructive pulmonary disease (COPD) exacerbations, and even
anxiety. For conditions that can be treated remotely, we will often treat
without an in-person evaluation but with scheduled daily follow-up telehealth
visits.
807: Surgical practice opened in US
TO: ASC
Physicians, APC’s and Team Members (cc
ASMMC Leadership Team)
FROM: Rommel
Bote, MD, CMO
Douglas A. Fehrman, MD, ASC President
Good Morning Team
-
We have received approval for starting all
surgical elective surgeries on a soft opening starting May 11, 2020. As of 05/05/20, please see the attached
guidelines and required testing. We are a full go for all surgical specialties
May 18, 2020.
Steps to consider:
Surgical providers will have to run a list with their
nursing staff and triage patients who have been canceled, and will need to
determine what patients meet the criteria to get patients scheduled for surgery
Pre-ops, H&P’s, MRSA swabbing and COVID19 testing
(within the 48-72 window) will need to be reviewed and scheduled if outside of
recommendation
i. Please
see testing guidelines if less or greater than 24 hours pending if urgent case
or elective
Surgical provider has to order the COVID19
test, clinic team (ordering physician’s office) will contact
patient with results only (both positive and negative)
PSE team will contact patient to schedule COVID19
testing 4 days prior to surgery, will review test results once received and if
positive will contact surgical office to determine if surgery will be canceled
per algorithm attached
A new case request will need to be submitted if the
prior authorization has expired
May 12th will be the opening of the drive-thru testing
at the clinic, until then all COVID19 testing will be conducted at the ED
We are hoping to schedule the patients who are within
the allotted timeframes, authorizations are on file, no cardiac clearing is
needed and can be placed on the surgery list to be scheduled who have been
placed on the cancellation list prior to new case requests.
Surgeons - please ensure you work closely with your
nursing team on completing the surgical prioritization (SWAPS process tool)
which should have been communicated from your service line leader for
instructions on how to complete to prioritize the urgency and approval for the
procedure based on the scoring. Please let your clinic manager know if you have
not received it.
We are currently working with the primary care team to
determine the best workflow to accommodate the influx of pre-op appointment
requests that will be submitted, so please note with the social distancing
guidelines there will be some delay in getting patients in right away for their
appointment.
Please include your clinic manager and supervisor for
patient list so we can keep track of procedure counts.
Check the COVID weblink daily as guidelines and
reactivation guidelines can change daily.
https://www.advocatehealth.com/covid-19-info/
COVID19 Pre-Surgical testing tip sheet for EPIC:
https://www.advocatehealth.com/covid-19-info/_assets/documents/testing/covid-19-pre-surgical-testing-tip-sheet-epic-hospitals.pdf
Essential Surgery and Procedure Criteria by Surgical
Specialty:
https://www.advocatehealth.com/covid-19-info/_assets/documents/emergency-department-hospital/aah-covid-urgent-surgery-guidelines-vi-04-23.pdf
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