What is the meaning of cleaning and disinfecting

• Cleaningis the removal of germs, dirt, and impurities from surfaces. The germs are not killed, but by removing them, cleaning lowers their numbers and the risk of spreading infection.
• Disinfectingrefers to using chemicals, such as EPA-registered disinfectants, to kill germs on surfaces. This process may not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can diminish the risk of spreading infection.

Can the virus go up to 8 meters

Fact: Many people believe that the novel coronavirus can be transmitted only till short distances in respiratory droplets if someone sneezes or coughs. However, a National Academy of Sciences letter and papers published in The New England Journal of Medicine and JAMA suggest it is possible that the novel coronavirus can hang in the air for hours and remain infectious. Hence, people could spread the virus by breathing normally, and the virus could even be propelled as far as 8 meters by a sneeze. Some skeptics still remain unconvinced that the respiratory particles can transmit infection. [Science 10 Apr 2020]

When should hydroxychloroquine and azithromycin combination not be given

Withhold the drugs in patients with baseline QT prolongation (for instance, QTc of at least 500 msec) or in those with known congenital long QT syndrome. It is recommended to monitor cardiac rhythm and QT interval and withdraw hydroxychloroquine and azithromycin if QTc exceeds 500 msec. Correct hypokalemia to levels greater than 4 mEq/L and hypomagnesemia to more than 2 mg/dL, and avoid other QTc-prolonging agents when possible. [Medscape]

Can you have unilateral pneumonia in COVID-19

No. Asymmetrical lung involvement is common, but it is rare for only one lung to be affected.

What are the two patterns of oxygen requirement

1)   Patients with mild-to-moderate hypoxia, who improve slowly over time

2)    Patients with rapidly increasing oxygen needs, who proceed quickly to intubation.

How do we know the status of asymptomatic infections

A new study has started recruiting at the National Institutes of Health in Bethesda, Maryland, to assess how many adults in the United States without a confirmed history of infection with SARS-CoV-2, have antibodies to the virus.

The presence of antibodies in the blood points to prior infection. This serosurvey will involve collection and analysis of blood samples from nearly 10,000 volunteers to provide critical data for epidemiological models. The results will help determine the extent to which the novel coronavirus has spread undetected in the United States and will go on to provide insights into which communities and populations have been most affected. [NIH]

What is blood purification device to treat COVID-19

The US FDA has issued an emergency use authorization (EUA) for a blood purification system for the treatment of patients 18 years of age or older with confirmed COVID-19 admitted to the intensive care unit (ICU) with confirmed or imminent respiratory failure.

The authorized product reduces the amount of cytokines and other inflammatory mediators, i.e. small active proteins in the bloodstream that control a cell’s immune response by filtering the blood and returning the filtered blood to the patient. The proteins that are removed are typically elevated during infections and can be associated with a "cytokine storm" that is seen in some COVID-19 patients. This results in severe inflammation, rapidly progressive shock, respiratory failure, organ failure and death. [FDA]

Has ICMR approved the use of diagnostic machine used for drug-resistant TB for COVID-19

Yes: ICMR has approved the use of diagnostic machines used for testing drug-resistant tuberculosis for conducting coronavirus tests.

The ICMR has approved ‘TruenatTM beta CoV test on TruelabTM workstation’ and has recommended it as a screening test.

Throat/nasal swabs can be collected in the viral transport medium (VTM) with virus lysis buffer provided along with the kit. Truenat beta CoV test should only be performed with all biosafety precautions in BSL-2 or BSL-3 setups at laboratories. [The Economic Times]

After lungs, which is the main organ involved

Kidney is one of the other major organs involved.

Can there be a role of colchicine

Nephrologists in Italy and US have used colchicine in the successful treatment of kidney transplant patients with COVID-19. The key is starting treatment before patients become too sick. [American Journal of Transplantation]

Is CKD a risk factor

Yichun Cheng, MD, Department of Nephrology, Huazhong University of Science and Technology, Wuhan, China has stated that findings have indicated that the prevalence of kidney disease on admission, and the development of acute kidney disease during hospitalization, is high and is associated with in-hospital mortality.

In a meta-analysis of 30 studies involving 53,000 patients in China, although a preprint that has not been peer-reviewed, chronic kidney disease was associated with a six-fold higher risk of severe COVID-19 (odds ratio, 6.0). This compared with an OR of 5.3 for COPD and 3.2 for cerebrovascular disease. [Medscape]

CDC new guidelines on resuming work for critical workers following exposure to COVID-19

A potential exposure means being a household contact or having close contact within 6 feet of an individual with confirmed or suspected COVID-19. The timeframe for having contact with an individual includes the period of time of 48 hours before the individual became symptomatic.

Critical infrastructure workers who have had exposure but remain asymptomatic should abide by the following prior to and during their work shift:

• Pre-Screen: Employers should measure the employee’s temperature and assess symptoms before they start work. Ideally, temperature checks should happen before the individual enters the facility.
• Regular Monitoring: As long as the employee doesn’t have a temperature or symptoms, they should self-monitor under the supervision of their employer’s occupational health program.
• Wear a Mask: The employee should wear a face mask at all times while in the workplace for 14 days after last exposure. Employers can issue facemasks or can approve employees’ supplied cloth face coverings if there is shortage.
• Social Distance:The employee should maintain a distance of 6 feet and practice social distancing as work duties permit in the workplace.
• Disinfect and Clean work spaces:Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely.

If the employee becomes sick during the day, he/she should be sent home immediately. Surfaces in the workspace should be cleaned and disinfected. Information on persons who had contact with the ill employee during the time the employee had symptoms and 2 days prior to symptoms should be compiled. Others at the facility with close contact within 6 feet of the employee during this time are to be considered exposed.

(Source: Implementing safety practices for critical infrastructure workers who may have had exposure to a person with suspected or confirmed COVID-19. Interim Guidance)

A Negative Ultrasound Is the Most Useful

There are situations where lung ultrasound can be considered definitive.

If we see a patient with mild signs of the disease, just fever, and lung ultrasound shows nothing, lung ultrasound rules out pneumonia.

This patient may have COVID-19, but does not have pneumonia, and can be treated at home, awaiting the result of the swab test. This can reduce the burden in the emergency department.

On the other hand, there are patients with acute respiratory failure in respiratory distress. If the lung ultrasound is normal, you can rule out COVID-19 and you need to use other diagnostic procedures to understand the problem.

How many segments are seen in ultrasound

14 for 10 seconds each

What are lung ultrasound scores

A score of 0 is given when the pleural line is continuous and regular, with the presence of A-lines, indicating that the lungs are unaffected.

A score of 3 is given when the scan shows dense and largely extended white lung tissue, with or without consolidations, indicating severe disease.

Intermediate cases: On the Butterfly algorithm, look for B-lines, caused by fluid and cellular infiltration into the interstitium, and weigh that against the need for supplementary oxygen.

An Italian team, in contrast, says a score of 1 is given when the pleural line is indented, with vertical areas of white visible below.

A score of 2 is given when the pleural line is broken, with small to large areas of consolidation and associated areas of white below. [MDEdge]

What is the SARS case of Amoy Gardens apartment complex in Hong Kong

The complex witnessed a large community outbreak of SARS during the 2003 epidemic. With the help of airflow dynamics studies, investigators could retrospectively track the spread of the virus from one individual patient, the index case, to other residents of the complex.

Patients toilet exhaust fan, which created a negative pressure effect, vented into the apartments above and also to the outside. This was linked to 187 cases in the complex with available data. The analysis thus suggested that the SARS virus could be transmitted by microdroplets through inhalation, touch, and potentially fecal-oral routes. [Medscape]

Can COVID-19 cause GBS

Physicians in China have reported possibly the first case of COVID-19 initially presenting as acute Guillain-Barré syndrome (GBS). The patient was a 61-year-old woman returning home from Wuhan during the pandemic.

GBS is an autoimmune neuropathy, which could be triggered by various infections. It may be an association and not a causal relationship. The case study was published online April 1 in Lancet Neurology.

Who was Urologist Dr Abdul Mabud Chowdhury 

He was a 53-year-old doctor who warned the UK Prime Minister about PPE shortages and died after testing positive for the virus. His message to Boris Johnson urged him to urgently ensure that personal protective equipment was available for each and every NHS worker in the UK. He worked at Homerton Hospital in East London and died at Queens Hospital in Romford. [Medscape]

Can COVID-19 present as acute hepatitis

A woman presented to the emergency department with high liver enzyme levels and dark urine. She developed fever on day 2 of care, and then tested positive for the new coronavirus, researchers at Northwell Health, in Hempstead, New York, have reported.

The case, published online in the American Journal of Gastroenterology, is the first documented case of a patient with COVID-19 presenting with acute hepatitis as the primary symptom prior to developing respiratory symptoms. [Medscape]

What are the guidelines for abortion care in COVID era

Access to safe abortion care is time-sensitive and vitally important. The American College of Obstetricians and Gynecologists (ACOG) and other reproductive health professional organizations have thus issued a statement on March 18, 2020, that they “do not support COVID-19 responses that cancel or delay abortion procedures.”

Despite ACOG’s position, governors in several states have asked for putting a halt to abortion care throughout the COVID-19 epidemic. Governors in Texas, Louisiana, Mississippi, Alabama, and Oklahoma have ordered or supported the cessation of both medication and surgical abortion, while governors in other states have directed that surgical abortion must stop. 

Politicians in other states have announced their intentions to issue similar orders. [NEJM]

What is treatment with compassionate-use remdesivir

NEJM: In the cohort of patients hospitalized for severe COVID-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)

Dr KK Aggarwal

President CMAAO