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CMAAO Coronavirus Facts and Myth Buster 31

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Dr KK Aggarwal    02 April 2020

FACTS

Healthcare workers carrying out aerosol-generating procedures on COVID-19 patients in the ICU setting must use fitted respirator masks such as N95 respirators, FFP2, or equivalent, in comparison with surgical/medical masks, besides using other personal protective equipment (eg, gloves, gown, and eye protection such as a face shield or safety goggles).

Perform aerosol-generating procedures on COVID-19 patients in the ICU in a negative-pressure room.

Healthcare personnel involved in providing usual care for nonventilated patients with COVID-19 must use surgical/medical masks, as compared to respirator masks besides using other personal protective equipment.

Endotracheal intubation is recommended in patients with COVID-19, to be performed by healthcare workers with experience in airway management, in order to minimize the number of attempts and risk of transmission.

For intubated and mechanically ventilated adults suspected to have COVID-19, it is suggested to obtain endotracheal aspirates, over bronchial wash or bronchoalveolar lavage samples.

For adults with COVID-19 and acute hypoxemic respiratory failure, use high-flow nasal cannula [HFNC] over non-invasive positive pressure ventilation [NIPPV].

For adults with COVID-19 given NIPPV or HFNC, monitor closely for worsening of respiratory status and perform early intubation in a controlled setting if worsening occurs.

For mechanically ventilated adults with COVID-19 and moderate to severe acute respiratory distress syndrome [ARDS], go for prone ventilation for 12 to 16 hours over no prone ventilation.

For mechanically ventilated adults with COVID-19 and respiratory failure (without ARDS), dont use systemic corticosteroids on a routine basis.

Healthcare workers carrying out non-aerosol-generating procedures on mechanically ventilated (closed circuit) patients with COVID-19 should use surgical/medical masks, as compared to respirator masks, besides using other personal protective equipment.

Healthcare workers performing endotracheal intubation on patients with COVID-19 should use video guided laryngoscopy, over direct laryngoscopy, if available.

[Recommendations issued by the European Society of Intensive Care Medicine (ESICM), to be published in Intensive Care Medicine.]

CMAAO Coronavirus Myth Buster 30

Non shedders cannot happen

Non shedder: Both asymptomatic and symptomatic patients, but do not shed the virus

Shedder (normal spreader and silent spreaders): Both asymptomatic and symptomatic patients and shed the virus

Super spreader: Both asymptomatic and symptomatic patients and shed high volume and high distance of viruses in micro droplets

WBC account provides accurate information

No. White blood cell count can vary. It does not provide precise information about COVID-19.

[Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni. Yu Hu, W. Liang, C. Ou, J. He, L. Liu]

Lymphopenia is seen in 100% cases

Leukopenia, leucocytosis, and lymphopenia have been reported, with lymphopenia being more common, seen in more than 80% of patients.  

[Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni. Yu Hu, W. Liang, C. Ou, J. He, L. Liu]

Thrombocytopenia is seen in all cases

Mild thrombocytopenia is common. But thrombocytopenia is a poor prognostic sign.

[Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni, Yu Hu, W. Liang, C. Ou, J. He, L. Liu; Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni, Yu Hu,  W. Liang, C. Ou, J. He, L. Liu, H. Shan, C. Lei, D.S.C. Hui, B. Du, L. Li, G. Zeng, K.-Y. Yuen, R. Chen]

Serum Procalcitonin has no value

No, serum procalcitonin is often normal at the time of admission, but increases in patients who require ICU care.

D dimer is not linked to low lymphocytes counts

A study noted that high D-Dimer and lymphopenia are associated with poor prognosis.

[Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni. Yu Hu,

  1. Liang, C. Ou, J. He, L. Liu; Clinical Characteristics of Coronavirus Disease 2019 in China. W. Guan, Z. Ni, Yu Hu,  W. Liang, C. Ou, J. He, L. Liu, H. Shan, C. Lei, D.S.C. Hui, B. Du, L. Li, G. Zeng, K.-Y.  Yuen, R. Chen]

C-reactive protein shows non-significant rise

COVID-19 increases C-reactive protein (CRP). This seems to follow with disease severity and prognosis. In patients with severe respiratory failure with a normal CRP level, an alternative diagnosis should be sought.

[Source: INTERNATIONAL PULMONOLOGIST’S CONSENSUS ON COVID-19: Dr. Tinku Joseph (India), Dr. Mohammed Ashkan Moslehi (Iran)]

All viral infections raise CRP levels

No, CRP levels are not generally associated with viral infections. Acute bacterial infections raise CRP to levels of 150 to 350 mg/L, while acute viral infections are associated with lower levels. But uncomplicated infections caused by COVID-19, adenovirus, influenza, and cytomegalovirus can be associated with CRP levels of up to 100 mg/L.

[Non Covid: Jaye DL, Waites KB. Clinical applications of C-reactive protein in paediatrics. Pediatr Infect Dis J. 1997;16(8):735–746; quiz 746–747]

Handshake and hand kiss are equally dangerous

Hand kiss is more dangerous than handshake.

There is no link with duration of exposure

Dangers:

A person who has had face-to-face contact with a COVID-19 patient within 2 metres and > 15 minutes

A person who has been in a closed environment, such as s classroom, meeting room, hospital waiting room, etc., with a COVID-19 patient for >15 minutes and at a distance of <2 metres

[Source: Public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union, 25 February 2020]

Dr KK Aggarwal

President CMAAO

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