CMAAO IMA HCFI COVID Myths Busters 20th March 2020 |
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CMAAO IMA HCFI COVID Myths Busters 20th March 2020
Dr KK Aggarwal,  21 March 2020
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Ten seconds self-check for corona

Incorrect, a recent coronavirus "simple self-check test" has been going viral over social media is completely inaccurate as per medical experts.

This post, developed probably on iPhone notes app, falsely claims that people can find out whether they have coronavirus simply by holding their breath for more than 10 seconds. If they can hold their breath without coughing, the test claims they dont have the virus.

The post, which began circulating Twitter, Facebook, and emails last week, was falsely credited to a member of the "Stanford Hospital board." Stanford Health Care spokeswoman Lisa Kim told CNN that the "dangerous" post is not affiliated with Stanford Medicine and "contains inaccurate information."

All surfaces need equal disinfection in hospitals

Even though frequent cleaning is recommended in hospitals, they should give special attention to “high-touch surfaces” such as in-room phones, TV/nurse calls, light switches and cords, handles, drawer pulls, bed rails, tray tables and bathroom fixtures, as per American Hospital Association.

 Chloroquine is a must in corona infection

Questions have arisen whether the old-generic malaria drug hydroxychloroquine (Plaquenil, Sanofi-Aventis, among others), also used for the treatment of rheumatic disease, is an essential treatment for COVID-19?

Hypothesized by some researchers including  Professor Didier Raoult of the IHU Méditerranée Infection in Marseille, this suggestion was rejected by other eminent infectious disease experts and dismissed as fake news recently by the Ministry of Health.

However, in a YouTube presentation by Prof Raoult, it was suggested shown that positive results were seen in a in a non-randomised, unblinded trial of 24 patients.

These results were also followed by encouraging in vitro results obtained by a Chinese team led by Xueting Yao, from Peking University Third Hospital, Beijing, China, which were published online by the journal Clinical Infectious Diseases on March 9th. However, the data was considered insufficient by the infection community to recommend chloroquine as a treatment.

Additionally, chloroquine is not listed among the four treatments studied as part of the recently launched European clinical trial piloted by Inserm, which includes 3200 severe hospitalised patients, including 800 French patients.

Chloroquine was not considered as a treatment because of the risk of interactions with other medications for common comorbidities in infected patients, and because of possible adverse effects in patients undergoing resuscitation.

Antibacterial soap has an advantage

They have no added benefit.

Stock up on vitamin C

No.  Even in the cases of colds or flus, vitamin C hasn’t shown a consistent benefit.  There is no evidence that natural supplements like green tea and Echinacea are beneficial to prevent coronavirus.

Everyone should wear masks

No.  Currently, masks are not recommended for healthy, symptom-free members of the general public; masks are a must for hospital workers and those caring for infected patients.

Most of surgical masks are loose to be effective. They can prevent an infected person from transmitting the disease. They are important for patients, not the general public.

Wear gloves when touching common surfaces like elevator buttons and subway poles

May be. The downside of this is that wearing gloves may not be effective in preventing the spread of the virus, eventually, the gloves themselves become contaminated. Also most gloves have minute holes. The best practice is simple hand washing with soap and water is the most time-tested and the most effective intervention.

Flu shot is a must

Yes, but not for coronavirus infection.   Getting an influenza vaccine is important for maintaining general public health.

Tocilizumab, is a new corona drug

China is using a Roche Holding AG arthritis drug to treat some coronavirus patients in severe conditions.

Tocilizumab, sold by the Swiss pharma giant under the trade name Actemra, may be prescribed to coronavirus patients who experience serious lung damage and show increased concentration of Interleukin 6, which may be reflective of inflammation or immunological diseases, according to the National Health Commission treatment guidelines published online. Actemra can help contain inflammation related to Interleukin 6, according to Roche.

Is Home Quarantine a house arrest?

No. Recommendations for home quarantine are: 

  1. Stay in a well-ventilated single-room preferably with an attached/separate toilet. If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 meter between the two.

  2. Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.

  3. Restrict his/her movement within the house.

  4. Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.

Doctors cannot provide teleconsultation?

Prime Minister Narendra Modi has also suggested that home teleconsultation is the best solution for people with covid like flu illness.

Indians are immune to COVID 19 virus?

WHO has stressed on the significance of social distancing, testing suspected coronavirus cases and keeping sick patients isolated. WHO has warned against assuming any area or person is immune to the coronavirus and urged the public to prepare for the worst case scenario.

It’s also an unprecedented opportunity to come together as one against a common enemy — an enemy against humanity.

 Maximum number of people have died in China?

No, 3404 people have died in Italy as against 3248 in China.

Death rate in Wuhan was 3.4%

According to a new study the Death rates in Wuhan were lower than around 1.4 percent, instead of the previously reported 2 percent to 3.4 percent.

It’s my doctor’s job to guide me if I have COVID like illness?

No, first it’s your duty to self-isolate if you have symptoms such as sore throat, fatigue, chills, stuffy nose, poor appetite, muscle aches, vomiting and diarrhea, and most of all, fever and cough.

Stay home and self-quarantine for 14 days. Inform your state government officials that widespread, easily accessible testing is required. Follow the new guidance or restrictions as they come from the government, and follow them.

South Korea model was a failure?

No, In South Korea, where the outbreak was successfully contained, and deaths were minimized compared to other countries, they performed frequent and early testing. They quarantined all the affected individuals and were able to curb the spread. South Korea witnessed the death of less than 100 people. This is in contrast to Italy, which. tested far fewer people (similar to US) in the early stages of the outbreak and responded slowly in imposing quarantines and lockdowns. Just this week, Italy had 368 deaths from the virus in one 24-hour period, and 475 in another.

Rapid, frequent testing, which weve been lacking, has been shown to save lives.

Social distancing only plays a role once I have a confirmed diagnosis

Social distancing and self-quarantining are the two pillars of prevention. It is important, because any of us could contract the infection. Until we can test everyone, widely, we are not sure. In the current context, you may not be able to get tested, as we have very limited resources. Hence, the only way to curb the spread is to assume you may have it with covid illness like symptoms, and do your utmost best to limit your exposure to anyone else. Or, to wait in isolation until you can get tested and cleared.

It can also be quoted as China Virus or China Pneumonia?

  1. WHO announced that "COVID-19" is the official name of the disease caused by the new coronavirus from China. The new strain of the coronavirus that causes COVID-19 was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

"CO" stands for "corona", "VI" for "virus" and "D" for "disease", while "19" was for the year, as the outbreak was first identified on December 31, 2019.

The name was adapted to avoid references to a specific geographical location, animal species or group of people in line with international recommendations for naming aimed at preventing stigmatisation. The agency had earlier given the virus the temporary name of "2019-nCoV acute respiratory disease" and Chinas National Health Commission this week said it was temporarily calling it "novel coronavirus pneumonia" or NCP.

As per a set of guidelines issued in 2015, WHO advises against using place names such as Ebola and Zika - where those diseases were first identified and which are now inevitably linked to them in the public mind.

There is no joint research on the subject so far by different countries

No, WHO and its partners are organizing a study in many countries in which some of these untested treatments are compared with each other. Naming it SOLIDARITY trial, WHO said,  "it  is designed to generate the robust data we need, to show which treatments are the most effective." SOLIDARITY trial provides simplified procedures to enable even hospitals that have been overloaded to participate. 

Several countries have confirmed that they will join the SOLIDARITY trial, including Argentina, Bahrain, Canada, France, Iran, Norway, South Africa, Spain, Switzerland and Thailand.

The study has five arms. The first arm is the usual care that is provided to the patients in the country. The second arm is remdesivir; the third arm is lopinavir/ritonavir; the fourth arm is lopinavir/ritonavir with interferon beta and the fifth arm includes chloroquine.

The aim of the SOLIDARITY trial is to find out;

  • do any of these drugs reduce the mortality

  • do any of these drugs reduce the time the patient is in hospital, and

  • Whether or not the patients receiving any of the drugs needed ventilation or an intensive care unit.

I need to be worried for people over 65 only

No its not just adults 65 and older. According to CDC, Americans of all ages have faced serious health complications amid the new coronavirus outbreak.

New data show that among the roughly 12% of COVID-19 cases in the U.S. known to need hospitalizations, about 1 in 5 were among people ages 20 to 44. The CDC report released on 5th March tracked the health outcomes from February 12 to March 16 for the 2,449 COVID-19 patients in the U.S. whose ages were known.

According to the CDC, among 508 patients known to have been hospitalised, 9% were aged ≥85 years, 36% were between 65–84 years, 17% were aged 55–64 years, 18% were 45–54 years, and 20% were aged 20–44 years. Less than 1% of hospitalisations were among people aged ≤19 years.

Further, among 121 patients known to have been admitted to an ICU, 7% of cases were reported among adults ≥85 years, 46% among those aged 65–84 years, 36% among patients aged 45–64 years, and 12% were between 20–44 years. No ICU admissions were reported among persons aged ≤19 years.

At the time of the analysis, there were also 44 cases with known outcome, with 34% of deaths being reported among patients aged ≥85 years, 46% were among patients aged 65–84 years, and 20% were among those in the 20–64 age group. The CDC said, “case-fatality percentages rose with increasing age, from no deaths reported among people 19 years and younger, to the highest percentages ranging from 10%–27% among those aged ≥85 years. For people in the 65–84 age group, the mortality rate was 3% to 11%.”

Health Care Workers cannot get asymptomatic infections

In a study presented by Dr Prof Colosio and ICRH team from Italy, 4142 workers employed in two public hospitals in South Ovest Milan, both university hospitals. In San Paolo hospitals 537 swabs were tested and 19 were positive amongst workers. In San Carlo hospital 349 swabs were tested and 17 were positive.

This shows that 90 percent of those who tested positive were asymptomatic.

Mosquitos can also transmit coronavirus

To date there has been neither information nor evidence to suggest that the new coronavirus could be transmitted by mosquitoes. The new coronavirus is a respiratory virus which spreads primarily through droplets generated when an infected person coughs or sneezes, or through droplets of saliva or discharge from the nose.

Hand dryers can kill coronaviruses

No. Hand dryers are not effective in killing the COVID 19 virus. To protect yourself against the new coronavirus, you should frequently clean your hands with an alcohol-based hand rub or wash them with soap and water. Once your hands are cleaned, you should dry them thoroughly by using paper towels or a warm air dryer.

I shouldn’t use ultraviolet disinfection lamp to kill coronaviruses?

UV lamps should not be used to sterilize hands or other areas of skin as UV radiation can cause skin irritation.

COVID-19 virus can be transmitted in areas with hot and humid climates

Who has suggested that from the evidence available so far, the COVID-19 virus can be transmitted in ALL AREAS, including areas with hot and humid weather. Regardless of climate, adopt protective measures if you live in, or travel to an area reporting COVID-19.

Thermal scanners can detect Coronaviruses

No, Thermal scanners are only effective in detecting fever. Also, it takes between 2 and 10 days before people who are infected become sick and develop a fever.

 I must keep my nose clean and moist?

There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus but there is some limited evidence that regularly rinsing nose with saline can help people recover more quickly from the common cold. Also people with allergy with this may touch their nose on less occasions (nose hygiene)

 Taking a chlorine bath will help

No. Spraying or bathing with chlorine will not kill viruses that have already entered your body. Spraying such substances can be harmful to clothes or mucous membranes (eyes, mouth). Chlorine can be useful to disinfect surfaces, but they need to be used under appropriate recommendations.

I must take a hot bath daily

Taking a hot bath will not prevent you from catching COVID-19. Your normal body temperature remains around 36.5°C to 37°C, regardless of the temperature of your bath or shower. Actually, taking a hot bath with extremely hot water can be harmful, as it can burn you.

For Asian countries COVID 19 is very fatal

  • Measles 10-15% developing countries. More than one third of all measles deathsworldwide are among children in India.

  • MERS 34% (2012, killed 858 people out of the 2,494 infected)

  • SARS 10% (Nov. 2002 – Jul. 2003, originated from Beijing, spread to 41 countries, with 8,096 people infected and 774 deaths).

  • Ebola 50%

  • Smallpox 30-40%

  • Diphtheria 5-10%

  • Whooping cough 4% infants < 1yr, 1% children < 4 years

  • Swine flu < 0.1-4 %

  • Seasonal flu 0.01%

  • Number of flu deaths every year: 290,000 to 650,000 (795 to 1,781 deaths per day)

Numbers have no value in COVID 19

No, they help understanding its course.

  • 56% are males

  • Deaths rate males 2.8% females 1.7%

  • Causes mild illness in 82%, Severe illness in 15%, Critical illness in 3%, Death 3.4 % (March 3)

  • Deaths: 15% severe disease, 5% require ICU care, 2% require ventilators,

  • Deaths 71% with comorbidity

  • 71% deaths are in patients with comorbidity due to cytokine storm. [72,314Chinese cases, largest patient-based study, JAMA)

  • CAD patients most at risk [CAD 10.5%, Diabetes 7.3%, COPD 6.3%, HT 6%, Cancer 5.6%, no pre-existing disease (0.9%)

  • Health care provider infections China 3.8% 0.3% deaths. Singapore Nil

  • Deaths 10% in Iran (under reporting)

  • Deaths S Korea (1%)

  • Affects all sexes but predominately males 56%

  • Age; 87% (30-79), 10% (< 20), 3% (> 80)

  • Mean time to symptoms 5 days

  • Mean time to pneumonia 9 days

  • Mean time to death 14 days

  • Mean time to CT changes 4 days

  • 3-4 reproductive number R0 (flu 1.2, SARS 2)

  • Epidemic doubling time 7.5 days

  • Doubling time in Korea 1 day probably due to super spreader

  • Tripling time in Korea 3 days

  • Positivity rate% (UK 0.2, Italy 5, France 2.2, Austria 0.6, USA 3.1)

  • Incubation period days 2-14 days

  • Mean Incubation period: 5.2 days

  • Recover time Mild cases 2 weeks

  • Recovery time sever cases 4-6 weeks

  • Case fatality 80 + 14.8%; 70-79 = 8%; Case fatality 60-69 = 3.6%; Case Fatality 50-59 = 1.3%; Case fatality 40-49 – 0.4%; Case fatality 10-39: 0.2%; Case fatality < 9 years: nil

Corona can spread through semen after recovery

No, there is no evidence. But we do know that in patients infected with Ebola, the virus may persist for months in the testes or eyes even after recovery and can infect others and keep the epidemic going.

Environmental disinfection is not important

No. CDC states routine cleaning and disinfection procedures are appropriate for COVID-19 virus. Products approved by the Environmental Protection Agency for emerging viral pathogens should be used.

Viruses can stay on the surfaces. Human coronaviruses can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite" or bleach within one minute.

According to the CDC, the flu virus can live on some surfaces for as long as 48 hours and potentially infect someone if the surface has not been cleaned and disinfected.

People can get re-infected

There has been an instance where the Japanese government reported that a woman in Osaka had tested positive for the coronavirus for a second time, weeks after recovering from the infection and being discharged from a hospital. Similar reports were also obtained from China.  Reinfections are common among people who have recovered from coronaviruses that cause the common cold.

However, reinfection in a short time is unlikely. Even the mildest of infections should leave at least short-term immunity against the virus in the recovering patient. More likely, the “re-infected” patient still harbours low levels of the virus when they were discharged from the hospital, and testing failed to pick it up.

Even if there were occasional cases of reinfection, they have not raised alarm at this point in the pandemic. .

COVID 19 behaves the same way in every country

No. Japan and S Korea have slowed it, Hong Kong and Singapore have contained it. India and African countries are less impacted by the COVID 19. Most Western countries are on the same coronavirus trajectory.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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