CMAAO CORONA FACTS
and MYTH BUSTER 98 CORONA SERIOUSNESS
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 Vasudev
869: Even serious can recover: A WUHAN study found
that survivors recovered after a host of complications: 42% had sepsis, 36% had
respiratory failure, 12% had heart failure, and 7% had blood clotting problems.
870: Which doctors are at risk: A survey data show
that of all resident physicians who worked within the greater New York City
area between March and April, anesthesiology, emergency medicine, and
ophthalmology residents were at greatest risk of contracting COVID-19.
871: Children
recover more from serious illnesses: North American case series of children with
COVID-19 suggests the clinical course is typically less severe and the hospital
outcomes better in critically ill children than in adults. Overall ICU
mortality at the end of our follow-up period of less than 5% compared with
published mortalities of 50% to 62% in adults admitted to the ICU," Dr.
Lara Shekerdemian of Texas Children's Hospital, in Houston, and colleagues
write in JAMA Pediatrics.
872: Preventing sudden deaths in athletes: prevent
cardiac injury, athletes should rest for at least 2 weeks after symptoms
resolve, then undergo cardiac testing before returning high-level competitive
sports, reported lead author Dermot Phelan, MD, PhD, of Atrium Health in
Charlotte, N.C., and colleagues in JAMA Cardiology
873: Time of serious illness: Severe illness usually
begins approximately 1 week after the onset of symptoms. Dyspnea is the most
common symptom of severe disease and is often accompanied by hypoxemia.
874: A striking feature of Covid-19 is the rapid
progression of respiratory failure soon after the onset of dyspnea and
hypoxemia. Patients with severe Covid-19 commonly meet the criteria for the
acute respiratory distress syndrome (ARDS), which is defined as the acute onset
of bilateral infiltrates, severe hypoxemia, and lung edema that is not fully
explained by cardiac failure or fluid overload.
875: Blood markers: The majority of patients with
severe Covid-19 have lymphopenia,5 and some have disorders of the central or
peripheral nervous system.
876: Severe Covid-19 may also lead to acute cardiac, kidney,
and liver injury, in addition to cardiac arrhythmias, rhabdomyolysis,
coagulopathy, and shock. These organ failures may be associated with a cytokine
release syndrome characterized by high fevers, thrombocytopenia,
hyperferritinemia, and elevation of other inflammatory markers.
877: Preliminary data from a randomized, placebo-controlled
trial involving patients with severe Covid-19 suggest that the investigational
antiviral remdesivir shortens time to recovery.
878: Definition: Severe Covid-19 in adults is defined
as dyspnea, a respiratory rate of 30 or more breaths per minute, a blood oxygen
saturation of 93% or less, a ratio of the partial pressure of arterial oxygen
to the fraction of inspired oxygen (PaO2:FIO2) of less than 300 mm Hg, or infiltrates
in more than 50% of the lung field within 24 to 48 hours from the onset of
symptoms.
878: Occurrence: In a large cohort of patients with
Covid-19, 81% had mild disease, 14% had severe disease, and 5% became
critically ill with organ failure; the mortality in the critically ill group
was 49%. The majority of critically ill patients with Covid-19 receive
prolonged mechanical ventilation.
880: Who suffers more: People with chronic health
conditions such as cardiovascular disease, diabetes mellitus, and obesity are
more likely to become critically ill from Covid-19. The incidence of critical
illness is also higher among men than among women and higher among persons
older than 65 years of age than among younger persons
881: hall mark: A
hallmark of the Covid-19 pandemic is the sudden appearance of an unprecedented
number of critically ill patients in a small geographic area.
882: Consent: At the earliest opportunity, clinicians
should partner with patients by reviewing advanced directives, identifying
surrogate medical decision makers, and establishing appropriate goals of care.
Because infection-control measures during the pandemic may prevent families
from visiting seriously ill patients, care teams should develop plans to
communicate with patients’ families and surrogate decision makers.
883: Risk factors for severe illness — Severe illness
can occur in otherwise healthy individuals of any age, but it predominantly
occurs in adults with advanced age or underlying medical comorbidities.
Comorbidities and other conditions that have been associated
with severe illness and mortality
Cardiovascular disease
Diabetes mellitus
Hypertension
Chronic lung disease
Cancer (in particular hematologic malignancies, lung cancer,
and metastatic disease)
Chronic kidney disease
Obesity
Smoking
The United States Centers for Disease Control and Prevention
(CDC) also includes immunocompromising conditions and liver disease as
potential risk factors for severe illness.
884: In a subset of 355 patients who died with
COVID-19 in Italy, the mean number of pre-existing comorbidities was 2.7, and
only 3 patients had no underlying condition.
885: Age: Among patients with advanced age and
medical comorbidities, COVID-19 is frequently severe. For example, in a
SARS-CoV-2 outbreak across several long-term care facilities in Washington
State, the median age of the 101 facility residents affected was 83 years, and
94 percent had a chronic underlying condition; the hospitalization and
preliminary case fatality rates were 55 and 34 percent, respectively.
885: Males have comprised a disproportionately high
number of deaths in cohorts from China, Italy, and the United States.
886: Particular laboratory features have also been
associated with worse outcomes
Lymphopenia
Elevated liver enzymes
Elevated lactate dehydrogenase (LDH)
Elevated inflammatory markers (eg, C-reactive protein [CRP],
ferritin)
Elevated D-dimer (>1 mcg/mL)
Elevated prothrombin time (PT)
Elevated troponin
Elevated creatine phosphokinase (CPK)
Acute kidney injury
Progressive decline in the lymphocyte count and rise in the
D-dimer over time were observed in nonsurvivors compared with more stable
levels in survivors
887: Viral load: Patients
with severe disease have also been reported to have higher viral RNA levels in
respiratory specimens than those with milder disease
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