Corona has general flu like symptoms with no clinical clues

THINK of Corona: Patient says he or she has sudden loss of sense of smell (American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS), Sudden loss of taste, TLC shows low lymphocytes count. Viral fever must have high lymphocyte count. Cough with exertional fall of SPO₂ by > 4%, Sudden onset of fever and cough 

Italy has 9% mortality because of elderly population

This is not the only factor. Italy has world-leading fatality rate of more than 9%. In contrast, China has a mortality rate of 3.8%. Germany, with more than 24,000 cases and 94 deaths, has a 0.3% mortality rate. South Korea has a rate of 0.6%.

In Italy, 85.6% of those who have died were over 70, reported the National Institute of Health (ISS).

Nearly 23% of Italians are over 65 years old. It has the second-oldest population in the world after Japan and not the first. However, Japan has done fairly in this pandemic.

Italys healthcare system provides universal coverage and is largely free of charge.

Italys "social contact matrix" could be another possible reason. While most elderly Italians live by themselves, they are not isolated, and their life is characterized by a much more intense interaction with their children and younger population in comparison with other countries, states Linda Laura Sabbadini, central director of the Italian National Institute of Statistics. [AlJazeera]

Every government with universal health care restricts access in one way or another to control costs.

WUHAN lock down has been lifted

No. Hubei Province, where the coronavirus is believed to have originated, is set to allow most of its 60 million residents to leave by ending the end of a nearly two-month lockdown.

However, it raises concerns among epidemiologists about the possibility of a second wave of the outbreak in the country.

Wuhan has been hardest hit by the virus, and will remain locked down until April 8, though public transit will start. Schools across the province will remain closed.

D Dimer cannot guide treatment

Endothelial damage and the ensuing clotting is common in severe and critical cases of COVID-19 coronavirus, which may have significance for treatment.

Clots in the small vessels, not only in the lungs but also in the heart, the liver, and the kidney, have been described by Bin Cao, MD, of the National Clinical Research Center for Respiratory Diseases in Beijing, who was involved in developing treatment strategies from the beginning of the epidemic.

The team reported March 11 in The Lancet that D-dimer levels over 1 μg/L at admission predicted an 18-fold increased risk of dying before discharge in 191 COVID-19 patients at two hospitals in Wuhan, China.

D-dimer is a fibrin degradation product that indicates thrombosis. It can exceed 70 or 80 μg/L.

Anticoagulation therapy must be started in severe COVID-19 patients unless otherwise contraindicated. If there is a high D-dimer level, anticoagulation must be administered, regardless of the underlying mechanism. [Medpage Today]

BCG has no role in Corona

A team in the Netherlands will soon start a trial. Overall, 1000 healthcare workers in eight Dutch hospitals will be enrolled who will either receive the BCG vaccine or a placebo.

BCG contains a live, weakened strain of Mycobacterium bovis. Studies published over the years suggest that BCG may enhance the ability of the immune system to fight pathogens other than the TB bacterium.

The vaccine can potentially prevent nearly 30% infections with any particular pathogen, including viruses, in the first year after it’s given. BCG is also used in bladder tumor.

Lung ultrasound cannot diagnose COVID-19

No, it can help in triage. At University Hospital San Luigi Gonzaga, in Turin, Italy, nurses are classifying patients on the basis of whether they have fever, cough, or labored breathing. Only one of these symptoms is enough to prompt suspicion and the patient is moved into isolation.

After examination, the first thing that is being done is lung ultrasound.

Several patients presented with a negative chest X-ray but the lung ultrasound was positive for interstitial pneumonia.

Pneumonia can also be present even in patients with mild or almost no symptoms, just a little bit of fever.

If an ultrasound is negative and emergency department staff continue their diagnostics, they swab nasal passages for testing with RT-polymerase chain reaction (rRT-PCR), and send the patient home to wait for test results in isolation. [Medscape]

Viral load is maximum before symptoms

According to a study published in The Lancet Infectious Diseases, salivary viral load of SARS-CoV-2 was found to be the highest in patients during the first week after symptom onset and declined with time.

New York trends is same as in other parts of US

No. New York City has now become the center of the coronavirus outbreak in the U.S., and the number of cases in the state is doubling every three days.

One factor is the density of the city. About twenty-eight thousand people occupy every square mile of New York. Another factor is that New York has been testing a lot of people.

It is true that New York has conducted more tests than any other state. However, the number of cases in New York is still much higher.

On comparing the percentage of tests that are positive, it’s about 25% in New York, and in California it’s about 5%. This suggests that the virus is more widespread in New York than in California.

It is possible that the virus was circulating in the city for much longer and it spread before social-distancing measures were put into place.

Only 2% of admitted patients require ventilators

No.  Experience in Italy has shown that about 10 to 25% of hospitalized patients will require ventilation, in some cases for several weeks.

  [Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva [SIAARTI]). Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA