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CMAAO IMA HCFI CORONA MYTH BUSTER 11 (For attention of Doctors) |
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CMAAO IMA HCFI CORONA MYTH BUSTER 11 (For attention of Doctors)

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One can consume alcohol during lock down

During lock down, it’s important to continue to look after your physical and mental health.

Here’s WHO’s advice for keeps

  • Eat healthy to boost your immunity.
  • Limit intake of alcohol and sugary drinks.
  • Don’t smoke. Smoking can aggravate COVID-19 symptoms and heighten the risk of getting seriously sick.
  • Adults should exercise for at least 30 minutes a day and kids for an hour a day.
  • You may go outside, go for a walk, run or bike ride while keeping a safe distance from others.
  • If you are unable to leave the house, dance, do yoga or walk up and down the stairs.
  • People working from home should avoid sitting for too long in the same position.
  • Take a 3-minute break every 30 minutes.
  • Get your mind off the crisis. Listen to music, read a book or play a game.
  • Obtain information from reliable sources once or twice a day.

All infected patients need to be admitted

Home management is suitable for patients with mild infection who can be isolated satisfactorily in the outpatient setting.

Management of these patients should be focused on prevention of transmission to others and monitoring for clinical worsening, which should prompt hospitalization.

Outpatients with COVID-19 should stay at home and separate themselves from other people and animals in the household. They should wear a facemask when in the same room (or vehicle) with other people and when visiting healthcare settings. Disinfection of frequently touched surfaces is important.

World Health Organization. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts. Updated February 4, 2020. 

https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts (Accessed on February 14, 2020).

 There is no definition of “How close is too close”

The US CDC recommends keeping a distance of six feet from other people in order to minimize the chances of infection. (Six feet is roughly twice the length of the average person’s extended arm.)

The WHO emphasizes three feet as the distance that is particularly risky when standing near a person who is coughing or sneezing.

Other public health experts state that at this crucial moment, when the world still has an opportunity to slow the transmission of the coronavirus, any number of feet is too close. By cutting out all except essential in-person interactions, the curve can be flattened, keeping the number of sick people to levels that medical providers can manage. (NY Times)

Prolonged contact is required with an infected person

Although it’s not yet clear, most experts agree that more time equates to more risk.

The virus cannot last on a bus pole, a touch screen

After several people who attended a Buddhist temple in Hong Kong fell ill, the city’s Center for Health Protection obtained samples from the site. Restroom faucets and the cloth covers over Buddhist texts tested positive for the coronavirus.

recent study  found that the virus could live for three days on plastic and steel. If ordering supplies online, it might come to you as a relief that the virus did poorly on cardboard — it disintegrated over the course of a day. It survived for about four hours on copper.

Dirty surfaces are more likely to keep the virus

No, whether a surface looks dirty or clean is immaterial. If an infected person sneezes and a droplet lands on a surface, a person who then touches that surface could pick it up. The amount required to infect a person is unclear.

As long as you wash your hands before touching your face, you should be fine, because viral droplets don’t pass through skin.

Buy a good brand soap

No, the brand or type of soap does not matter.

My coughing neighbor cannot cause infection in me

No. An infected neighbor might sneeze on a railing and if you touch it, you could get infected.

Virus particles can cross the glasses

No. There is no evidence to state that viral particles can pass through walls or glass, said Dr. Ashish K. Jha, director of the Harvard Global Health Institute. (NY Times)

AC is dangerous

We are more concerned about the dangers posed by common spaces than those posed by vents, given that there is good air circulation in a room.

Dog or cat cannot join me in quarantine

Professor Whittaker who has studied the spread of coronaviruses in animals and humans. He has stated that he found no evidence that people who have the virus could be a danger to their pets.

Sex is safe

Kissing could spread it. Coronaviruses are not typically sexually transmitted, but it’s too soon to know, states the WHO.

Virus can move freely

A naked virus can’t travel anywhere unless it is riding with a droplet of mucus or saliva, said Kin-on Kwok, a professor at the Jockey Club School of Public Health and Primary Care at the Chinese University of Hong Kong.

These mucus and saliva droplets are discharged from the mouth or the nose when someone coughs, sneezes, laughs, sings, breathes and talks. If they don’t hit something along the way, they land on the floor or the ground. When the virus becomes suspended in droplets smaller than five micrometres, also known as aerosols, it can stay suspended for about a half-hour. (NY Times)

Face to face eating is safe

No, to gain access to your cells, the viral droplets need to enter through the eyes, nose or mouth. Sneezing and coughing are most likely the primary forms of transmission. Talking loudly face-to-face or sharing a meal with someone could also pose a risk.

If you are able to smell what someone had for lunch, you are inhaling what they are breathing out, including any virus in their breath.

The virus is smart, it makes the nose loose the smell, so to experience the smell you inhale deeply.

There are no predictors of transmission

There are four factors that likely play a role: how close you get; how long you are near the person; whether that person projects viral droplets on you; and how much you touch your face.

COVID virus behaves like any other virus

No. Most viral illnesses have high lymphocyte counts but COVID-19 leads to low lymphocyte count.

Dengue taught us the value of platelet count interpreted along with hematocrit and COVID-19 is now teaching us the value of lymphocytes in blood test.

It has been a standard teaching that all viral fevers will have high lymphocyte counts. Low count will only occur with HIV, SARS-like illness, measles and hepatitis.

Now all studies have shown it to be an important marker of COVID-19.

In the latest study published on March 9, 2020, in the Lancet, the authors showed that baseline lymphocyte count was significantly higher in survivors than non-survivors; in survivors, lymphocyte count was lowest on day 7 after illness onset and improved during hospitalization, whereas severe lymphopenia was observed until death in non-survivors.

Clues for COVID-19 include leukopenia, evident in 30% to 45% of patients, and lymphocytopenia, in 85% of the patients in the case series from China.

Other associated lab findings are elevated alanine aminotransferase and aspartate aminotransferase levels (37%).

High D-dimer levels and more severe lymphopenia have been associated with mortality.

  1. Chen N, Zhou M, Dong X, Qu J, Gong F. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Jan 30. [Epub ahead of print]
  2. Li Q, Guan X, Wu P, Wang X, Zhou L, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Jan 29.
  3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395:507.

 

Most fevers cannot be differentiated clinically

No, here are the tips -

Fever with cough and cold - think of flu

Fever with retroorbital eye pain - think of dengue

Fever with joint pain which improves on bending - think of Chikungunya

Fever with lymphocytosis – Think of viral fever

Fever with lymphopenia - Think of COVID-19, acute hepatitis, HIV

Fever with jaundice: Rules out viral hepatitis

Fever subsides capillary leakage appears in dengue

Low grade evening rise fever - think of TB

Fever with chills and rigors - think of malaria, filaria, UTI, sepsis

Fever with cough and breathlessness - think of COVID-like illness

Fever with ESR >100 – think of painful thyroiditis, sepsis

Fever with SGOT > SGPT – think of dengue

Fever with angry looking throat with no cough - think of streptococcal sore throat

Fever with red eyes - think of Zika illness

Fever with eschar - think of scrub typhus

Fever with single chills - think of pneumonia

Fever with jaundice - Rule out leptospirosis

Fever with involvement of skin, joint and/or kidney - rule out autoimmune disease

Fever with TLC > 15000 is sepsis

Fever with positive thump sign - rule out liver abscess

 

It’s unethical for doctors to create awareness about COVID-19

 No, it’s as per MCI ethics regulations

MCI Ethics Regulation

  5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself. 

 7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press.  

Loss of sense of smell is hallmark of COVID-19

No. Post-viral anosmia is among the major causes of loss of sense of smell in adults, accounting for up to 40% cases of anosmia. Viruses causing the common cold are known to cause post-infectious loss, and over 200 different viruses are known to cause upper respiratory tract infections. Previously described coronaviruses are thought to account for 10-15% cases. It is therefore not surprising that the novel COVID-19 virus would also cause anosmia in infected patients.

Evidence from South Korea, China and Italy suggest that significant numbers of patients with proven COVID-19 infection have developed anosmia/hyposmia. In Germany, it is reported that more than 2 in 3 confirmed cases have anosmia. In South Korea, where testing has been more widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases. [entuk.org]

 

Lopinavir-ritonavir is the drug of choice

This combined protease inhibitor, which has primarily been used for HIV infection, has in vitro activity against the SARS-CoV and seems to have some activity against MERS-CoV in animal studies.

Although the use of this agent for treatment of COVID-19 has been described in case reports, there was no difference in time to clinical improvement or mortality at 28 days in a randomized trial of 199 patients with severe COVID-19 given lopinavir-ritonavir (400/100 mg) twice daily for 14 days in addition to standard care in comparison with those who received standard of care alone [ Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med 2020.]

 

Virus can be transmitted through breast milk

The only report of testing has found no virus in the maternal milk of six patients. However, droplet transmission is possible through close contact during breastfeeding. Thus, mothers with confirmed COVID-19 or symptomatic mothers with suspected COVID-19 should take precautions to prevent transmission to the infant during breastfeeding, including diligent hand hygiene and use of a facemask.

In order to minimize direct contact, the infant can be fed expressed breastmilk by another caregiver until the mother recovers, given that the other caregiver is healthy and follows hygiene precautions.

Women who choose not to breastfeed must take similar precautions to prevent transmission through close contact when formula is used. [Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395:809.]

 

There are no guidelines for discontinuation of home isolation

The US CDC has issued recommendations on discontinuation of home isolation; both test-based and non-test-based strategies are included in the recommendations.

The choice of strategy is guided by the patient population (eg, immunocompromised versus nonimmunocompromised), availability of testing supplies, and access to testing.

When a test-based strategy is used, patients may discontinue home isolation in the following circumstances:

  • Resolution of fever without the use of fever-reducing medications AND
  • Improvement in respiratory symptoms (eg, cough, shortness of breath) AND
  • Negative results of a US FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)

When a non-test-based strategy is used, patients may discontinue home isolation if the following criteria are fulfilled:

  • At least seven days have passed since symptoms first appeared AND
  • At least three days (72 hours) have passed since recovery of symptoms (resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms [eg, cough, shortness of breath])

In certain cases, patients may have had laboratory-confirmed COVID-19, but there were no symptoms when they were tested. In such patients, home isolation may be discontinued when at least seven days have passed since the date of their first positive COVID-19 test so long as there was no evidence of subsequent illness.

The use of non-test-based strategies that use time since illness onset and time since recovery as the criteria for discontinuing precautions is guided by findings that transmission is most likely to occur in the early stage of infection. However, data are limited, particularly in immunocompromised patients, and this strategy may not prevent all instances of secondary spread. [uptodate.com]

 

You require two tests to declare recovery?

Ideally it is 4. Factors include resolution of clinical signs and symptoms and negative results of reverse-transcription polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on two sequential paired nasopharyngeal and throat specimens (four specimens total, each handled separately), with each pair collected ≥24 hours apart [Centers for Disease Control and Prevention. Interim Considerations for Disposition of Hospitalized Patients with 2019-nCoV Infection. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html (Accessed on February 11, 2020).]

 

You cannot diagnose COVID-19 without tests

In certain cases, testing for COVID-19 may not be accessible, especially for individuals who have a compatible but mild illness that does not require hospitalization.

If the clinician has sufficient concern for possible COVID-19 (such as, there is community transmission), it is reasonable to advise the patient to self-isolate at home (if hospitalization is not warranted) and alert the clinician about worsening symptoms. The optimal duration of home isolation in such cases is uncertain.

 

Continuing steroids in COVID-19 patients will harm

For people with underlying conditions who require treatment with these agents and have no evidence of COVID-19, there is lack of evidence that routinely discontinuing treatment is beneficial. Discontinuing these medications may lead to loss of response when the agent is reintroduced. Statements from American and other dermatology, rheumatology, and gastroenterology societies support this approach.

Normally immunocompromised patients with COVID-19 are at increased risk for severe disease, and the decision to discontinue prednisolone, biologics, or other immunosuppressive drugs in the setting of infection must be determined on a case-by-case basis.

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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