Tuesday, May 19, 2020




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


Chronic lung disease

Cancer (in particular hematologic malignancies, lung cancer, and metastatic disease)

Chronic kidney disease



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


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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