Last in
the series
From now onwards we will start fact series
CMAAO IMA HCFI CORONA MYTH BUSTER 15
Dr K K Aggarwal
President CMAAO, HCFI and Past National
President CMAAO
CT chest is the test of choice
No, as CT can be normal in early
illness, and after each potentially infected patient is scanned, the machine
must be completely disinfected. Therefore, CT
isn't recommended to screen for COVID-19.
Should doctors maintain physical distance with their
colleague in the healthcare setting?
Yes. 10% of the health
care workers get covid 19 and one of the
main mode of transmission is cross infection amongst each other.
Anosmia is as common as in flu
A growing body of data
from COVID-19 patients in several countries strongly suggests that
"significant numbers" of those patients experienced anosmia as one of the disease's symptoms, according to the ENT UK
statement.
Anecdotal evidence further describes the loss of smell and the
loss of taste — known as dysgeusia — in people who had no other symptoms but
who tested positive for COVID-19, representatives of the American Academy of
Otolaryngology–Head and Neck Surgery (AAO–HNS) in Alexandria, Virginia, said in a March 22 statement.
Is COVID 19 a occupational hazard
amongst health care workers
As per WHO,
Yes.
Should we nebulize a person with COVID ARI
No, use spacer and not nebulizer. It can produce aerosol and be infective
to others.
Should we use high flow oxygen to a person with COVID ARI
No, use low flow. It can produce aerosol and be infective to others.
Should we non invasive ventilation to a person with COVID ARI
No, use invasive ventilation. NIV can produce aerosols and be infective
to others. But if invasive ventilators are not available use them.
One ventilator two pateiunts, let one die
No. necessity is the mother of invention. Share one ventilator for more
than one patient. Detroit, Michigan demonstrates in a YouTube
video. She responded that a filter is placed before the expiration
port connection with the T-piece and it's a 1-way circuit. She noted that the
tubing is 5 feet from the endotracheal tube.
CPR should not be done kin dying COVID patients
The AHA advises
- Aerosol-generating
procedures such as CPR and endotracheal intubation expose providers to a
greater risk of disease transmission and should be performed in airborne
infection isolation rooms (AIIRs); personnel should use respiratory
protection.
- Only providers essential for
patient care and procedural support should be present during the procedure
and the room should be cleaned and disinfected following the procedure.
- Patients with known or
suspected COVID-19 should be cared for in a single-person room with the
door closed and AIIRs should be reserved for patients undergoing
aerosol-generating procedures.
- N95 respirators or
respirators that offer a higher level of protection should be used instead
of a face mask during aerosol-generating procedures.
- Providers should put on a
respirator or facemask (if a respirator is not available) before entering
a patient's room or care area. Facilities should return to use of
respirators for patients with known or suspected COVID-19 once the supply
chain is restored.
- Wear eye protection, gloves,
and gowns.
- When gowns are in short supply,
they should be prioritized for aerosol-generating procedures, care
activities where splashes and sprays are anticipated, and high-contact
patient care activities that provide opportunities for transfer of
pathogens to the hands and clothing of providers.
- If intubation is needed,
consider using rapid sequence intubation with appropriate personal
protective equipment (PPE).
- If possible, avoid
procedures which generate aerosols, such as bag-valve mask, nebulizers and
non-invasive positive pressure ventilation.
- Consider proceeding directly
to endotracheal intubation in patients with acute respiratory failure.
Avoid the use of high-flow nasal oxygenation and mask CPAP or bilevel CPAP
due to greater risk of aerosol generation.
Liver involvement is mild
No. Individuals at high risk for severe
COVID-19 are typically of older age and/or present with comorbid conditions
such as diabetes, cardiovascular disease, and hypertension. This is also the same profile for those at increased
risk for unrecognized underlying liver disease, especially nonalcoholic fatty
liver disease. This could make them more
susceptible to liver injury from the virus, medications used in supportive
management, or hypoxia.
According to a
report published in 2014 up to 60% of patients with
SARS had liver impairment, with liver biopsy specimens demonstrating viral
nucleic acids and injury.
This may have been the result of
drug-induced liver injury, given that most of these patients were treated with
high doses of potentially hepatotoxic antivirals, antibiotics, and steroids.
Peripheral ground-glass opacities are not specific for COVID 19
on CT chest
Although they are sensitive but not
specific for coronavirus as it can also occur in Pneumocystis jirovecii pneumonia,
cryptogenic organizing pneumonia, and acute lung injury from drug toxicity,
hypersensitivity, and autoimmune diseases. But these causes are uncommon. In
todays , COVID era this picture can be taken as diagnostic.
