(With regular inputs from Dr Monica Vasudev)

Is alcohol safe during pandemic

As per WHO, an increase of alcohol consumption can lead to health vulnerability, risk-taking behaviors, mental health issues and violence. Alcohol tends to compromise the immune system and heightens the risk of adverse health outcomes.

A myth that claims consuming high-strength alcohol can kill the virus is false and can lead to fatal health consequences.

Unhealthy drinking increases the risk for infection. However, consuming alcohol within the recommended limits, i.e., one per day for women, two per day for men, may be fine. With moderate drinking, while some changes do happen in the immune system, they’re rather transient and go away quickly.

Echocardiography guidelines by ASE

Perform transthoracic echocardiograms (TTE), stress echocardiograms, and transoesophageal echocardiograms (TEE) only if they are expected to provide clinical benefit.

Determine studies that are "elective" and reschedule them.

Identify "nonelective" (urgent/emergent) indications and defer all others.

Determine the clinical benefit of echocardiography for symptomatic patients with unknown SARS-CoV-2 status.

Consider with caution, the benefit of a TEE examination weighed against the risk for exposure of healthcare personnel to aerosolization in a patient with suspected or confirmed COVID-19.

Postpone or cancel TEEs if an alternative imaging modality can yield the necessary information.

Treadmill or bicycle stress echo tests in patients with COVID-19 may lead to exposure due to deep breathing and/or coughing during exercise. These tests should be deferred or converted to a pharmacologic stress echo.

The ASE statement also advises on safe imaging protocol and adequate personal protection measures.

Limit the exposure of staff who may be particularly susceptible to severe complications of COVID-19.

Staff older than 60 years, those who have chronic conditions, are immunocompromised or are pregnant may want to avoid contact with patients suspected or confirmed with COVID-19.

Non pulmonary manifestations

1. Theres a case of a 37-year-old man with stomach pain, vomiting, and diarrhea, but no respiratory symptoms and a positive COVID test. A chest CT incidental to his abdominal scan demonstrated significant bilateral lung involvement.
2. A 69-year-old woman with a history of laparotomy and new onset intestinal subocclusion had only adhesions on a subsequent exploratory laparotomy and was doing okay. She suddenly developed respiratory failure with progressive bradycardia and died 3 days later. Aspiration pneumonia, pulmonary embolism, and MI had been ruled out. The pattern of cardiovascular failure pointed to myocarditis.
3. There has been a report of raised cardiac enzymes without coronary artery obstruction in a positive patient who went into shock, with an ejection fraction of 40% and markedly increased heart wall thickness, but no lung involvement.
4. There are two cases of idiopathic thrombocytopenia without fever of hypoxia.
5. Most patients become nauseated, and the taste of any food is unbearable. When you find these symptoms by history, the patient is 100% COVID-positive.
6. The ACE2 receptor that the virus uses to enter cells is common in many organs, and there have been extrapulmonary manifestations
7. Encephalopathy
8. Liver impairment
9. Kidney impairment
10. Multiorgan dysfunction

Reuse of N95 respirators

1. Can be safely decontaminated without impairing the functional integrity only two or three times
2. Ultraviolet light and vaporized hydrogen peroxide fulfilled the criteria for killing the virus without affecting fit testing for two rounds of wear and decontamination compared with control respirators.
3. Filtration was acceptable after a third round for those two methods.
4. Vaporized hydrogen peroxide (VHP, approximately 1,000 ppm) seemed to be the faster of the two methods. VHP eliminated viral growth in media exposed to the mask after decontamination to zero in about 10 minutes, while ultraviolet light (260-285 nm) took about an hour to drop it to below the acceptable level.
5. The CDC has not approved any method for decontaminating masks; however, the agency has stated that it does not intend to object to the distribution and use of sterilizers, disinfectant devices, and air purifiers that are intended to be effective at killing SARS-CoV-2.
6. According to the FDA, such devices will not create such an undue risk, when performance and labeling criteria are met.
7. 70% ethanol solution sprayed to saturation and heat treatment in a 70°C (158°F) oven for 10 minutes were also evaluated.Ethanol quickly decontaminated the respirators but didnt pass the test for respirator function on the second round of decontamination.

8. Dry heat was slow, taking about an hour to hit the viral kill threshold, but kept proper function for two rounds of decontamination.
9. A group studying N95 respirator decontamination has warned that soapy water, alcohol, bleach immersion, and overnight storage are inadequate.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA