CMAAO Corona Facts and Myth Buster 32

Only testing can decide that I have recovered

Myth: No. , Re-testing method: The CDC has advised that all confirmed and suspected patients should be symptom-free and test negative twice within at least 24 hours to be considered as having recovered.

Non-testing method: The updated CDC guidance suggests a second method to determine recovery from COVID-19 without a test. If a confirmed or suspected COVID-19 patient is free of fever without the use of fever-reducing medication for at least three days, if it has been at least seven days since the symptoms first appeared, the person can be considered recovered.

Respiratory symptoms must also be improving during that time, but dont necessarily have to disappear completely by seven days for the patient to be considered recovered.

Houston Health Departments Dr. David Persse has stated that this is the clinical way, and this is the way vast majority of people will meet the criteria of having recovered.

Non testing method is ok for admitted patients

Myth: No. Some patients infected with COVID-19 may be contagious for a longer period than others. Testing method is the preferred option for those who are hospitalized, or severely immunocompromised, or being transferred to long-term care of assisted living facility, suggests CDC.

Non-test-based strategy would prevent most, but may not be able to prevent all instances of secondary spread of contagion.

Doctors can join once recovered after one week

Myth: Not without precautions: The CDC has provided new guidance for healthcare workers, who have tested positive for coronavirus, or who think they had it, and are now considered recovered without a test.

It is required to wear a facemask at all times when in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer. Restrict from contact with severely immunocompromised patients until 14 days of illness onset.

You cannot transmit the disease before the symptoms

Myth: A study published by the U.S. CDC has stated that people infected with COVID-19 can transmit the infection one-to-three days before symptoms start appearing.

The study emphasized on the importance of social distancing to fight the COVID-19 pandemic. Overall, 243 cases of COVID-19 reported in Singapore from January 23 to March 16 were assessed. Seven clusters were identified where pre-symptomatic transmission was likely. In four such groups, where the date of exposure could be determined, pre-symptomatic transmission was found to occur one-to-three days before symptoms appeared in the source patient.

Of the cases in Singapore, 157 were locally acquired and 10 of these were likely transmitted before symptoms started appearing. The findings thus point that it might not be enough for people having symptoms to limit contact to control the pandemic, noted the investigators in the CDC’s Morbidity and Mortality Weekly Report.

Public health officials carrying out contact tracing need to consider including a period before symptom onset to account for the possibility of this type of transmission. Transmissions might take place through respiratory droplets or even speech and other vocal activities like singing. The rate of emission corresponds to voice loudness. (Excerpts from Reuters)

You cannot die if your age is less than one

Myth: A baby in Connecticut died from COVID-19. An infant who passed away in Connecticut tested positive for COVID-19. The 7-week-old girl hailed from Hartford. The first infant death in the United States from COVID-19 was in Chicago, the Illinois Department of Public Health reported on March 28. The infant was less than a year old.

Children constitute a small number of coronavirus-related cases. A study published in the New England Journal of Medicine had reported that children accounted for fewer than 1% of COVID-19 cases in China. As of March 8, there was one death, that of a 10-month-old baby. The child had bowel blockage and multi-organ failure and succumbed 4 weeks following hospital admission.

NYC Ambulances Wont Take Cardiac Arrest Patients to Hospitals

Fact: April 2:  Medical first responders in New York City have been told not to take patients in cardiac arrest to a hospital if they fail to restart the patients heart in the field, according to the New York Post.  

303.  Differentiate the population into five groups and treat accordingly.

Fact:

1. We need to know who is infected
2. Identify who is presumed to be infected, i.e., those with signs and symptoms consistent with infection who initially test negative
3. Who has been exposed
4. Who is not known to have been exposed or infected
5. Who has recovered from infection and has adequate immunity.

It is required to take action on the basis of symptoms, examinations, tests (polymerase-chain-reaction assays to detect viral RNA), and exposures to recognize those who belong to each of the first four groups.

Those with severe disease or at high risk must be hospitalized. Infirmaries need to be established making use of empty convention centers, to care for those with mild or moderate disease and at low risk; an isolation infirmary for all patients will decrease transmission to family members.

Convert hotels that are vacant now into quarantine centers to accomodate those who have had exposure to the novel coronavirus, and separate them from the general population for 2 weeks. This quarantine method will remain practical until and unless the epidemic has exploded in a particular city or region.

Being able to identify the fifth group of people requires development, validation, and deployment of antibody-based tests. [NEJM]

Dr KK Aggarwal

President CMAAO