[AGL] What's the death rate for us? Read on. Do the math.

Mon Mar 16 19:03:21 EDT 2020

Can we just get info in a nutshell, please

> On Mar 16, 2020, at 12:46 PM, J. David Moriaty <moriaty at sbcglobal.net> wrote:
> 
> 
>> 
>> Friend of mine is a medical professional, says this is one of his trusted sources—sort of a digest of actual medical journals.
> 
> 
>> 
>> This is your daily JournalFeed. 
>> View this email in your browser
>> 
>> COVID-19 | Spoon-Feed Version
>> Mar 16, 2020 01:00 am
>> Updated March 16, 2020
>> 
>> Written by Clay Smith
>> 
>> Spoon Feed
>> This post compiles the most authoritative answers to your questions about COVID-19 all in one place.
>> 
>> Why does this matter?
>> COVID-19 is considered a global pandemic. In the U.S. alone, there are 330 million people. Estimates are that 60-70% of the population will become infected. That’s between 160 million and 214 million infected in the U.S., of which an estimated 200,000 to 1.7 million may die. The U.S. has only 924,000 staffed beds. These numbers assume no mitigation strategies and may be better than expected. This is a very important topic.
>> 
>> COVID-19 - Authoritative Answers In One Place
>> We have previously written about COVID-19 in a broad overview and a deep dive on the clinical presentation. This post is a quick way to find the most reliable sources of information to answer your clinical questions about COVID-19. If you see something that should be added, please help me and leave a comment or use the website’s contact form to let me know.
>> 
>> Basic Science
>> Where can I learn about the coronavirus, SARS-CoV-2, that causes the disease COVID-19?
>> 
>> This article in Nature takes a deep dive into the basic science of coronaviruses. Free full text.
>> 
>> Mark Denison, MD, Vanderbilt Pediatric Infectious Disease, has been researching coronaviruses for almost 30 years. See this treasure trove of publications from the Denison Lab.
>> 
>> For more on taxonomy and where SARS-CoV-2 fits among other coronaviruses, see this from Nature Microbiology. Free full text.
>> 
>> Epidemiology
>> What is the incubation period?
>> 
>> It is 2-14 days (CDC); median 4-5 days.
>> 
>> How is COVID-19 spread?
>> 
>> Respiratory droplets (CDC)
>> 
>> SARS and MERS can live on surfaces for days. SARS-CoV-2 is likely to behave similarly.
>> 
>> Here is a list of EPA-approved disinfectants with activity against SARS-CoV-2.
>> 
>> If I am infected, can I get infected again?
>> 
>> We don’t know yet.
>> 
>> If other coronaviruses are any indication, immunity wains and reinfection is common.
>> 
>> What is the case fatality rate for COVID-19?
>> 
>> It depends on the age of the patient.
>> 
>> There was 0% mortality in children 0-9 years and 14.8% mortality over age 80. It was a little worse than seasonal influenza in those aged 10 - 39 years, with case fatality rate of 0.2%. But case fatality steadily rose with age over ≥40.
>> 
>> Case fatality among healthcare providers was 0.3%.
>> 
>> This came from the China CDC, which loads very slowly. Here is a PDF version you can rapidly download. Citation credit: The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
>> 
>> How do I protect myself as a healthcare provider?
>> 
>> See this guidance from the CDC. Wear a surgical mask, gown (if possible), eye protection, and gloves.
>> 
>> If intubating or doing a procedure that creates aerosols, an N-95 mask is recommended.
>> 
>> What are general ways to protect myself and my family?
>> 
>> The basics make a big difference (CDC).
>> 
>> Keys: Handwashing (or hand sanitizer with 60% alcohol); social distance (6 feet); don’t touch eyes, nose, or mouth; avoid close contact with sick people (obviously meant for a non-healthcare audience); stay home if sick; cover coughs and sneezes; wear a facemask if sick; disinfect high-touch surfaces like counters, doorknobs, etc.
>> 
>> Who is at higher risk from infection with COVID-19?
>> 
>> Older patients and those with comorbidities are at greatest risk.
>> 
>> Comorbidities may include diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease.
>> 
>> It is unknown if COVID-19 is more dangerous in pregnancy. The WHO stated, “pregnant women do not appear to be at higher risk of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.” The CDC has an entire section devoted to pregnancy and breastfeeding.
>> 
>> How widespread is the disease, COVID-19?
>> 
>> The best map is from Johns Hopkins.
>> 
>> The WHO map is here.
>> 
>> The New York Times has a frequently updated map as does the CDC.
>> 
>> What are the best sites to keep informed about this emerging pandemic?
>> 
>> CDC | WHO | NEJM | Lancet | BMJ | JAMA | UpToDate
>> 
>> Clinical Pearls
>> What is the clinical presentation?
>> 
>> Acute cough is common.
>> 
>> Fever on initial presentation was noted in 44% of patients and in almost 90% during hospitalization at some point. “Fever” was defined as an axillary temperature ≥ 37.5°C in this large Chinese case series.
>> 
>> Some patients had fatigue, headache, myalgia, sore throat, or shortness of breath. (NEJM).
>> 
>> GI symptoms were uncommon. Rhinorrhea, conjunctival injection, tonsil swelling, and rash were also uncommon.
>> 
>> Around 80% have mild disease. They may be treated at home.
>> 
>> Approximately 14% will develop severe disease requiring hospitalization, and 5% will need critical care (JAMA).
>> 
>> 83% of hospitalized patients with pneumonia had lymphocytopenia, <1,100. About one-third of these patients had leukopenia and thrombocytopenia.
>> 
>> Over half of early presenters (in the first 2 days) may have no CT changes. However, most hospitalized patients with pneumonia from COVID-19 develop bilateral consolidation and ground glass opacities. See these images (AJR). The American College of Radiology does not recommend CT be used to screen for COVID-19.
>> 
>> Which patients should be tested for possible COVID-19?
>> 
>> The CDC recommendations are found here. These are evolving over time.
>> 
>> Patients who have symptoms and are hospitalized, those with comorbidities, and healthcare workers should be prioritized.
>> 
>> How do I test for it?
>> 
>> This is what you need to know from the CDC. We use universal viral transport medium and FLOQSwabs in my facility.
>> 
>> If collecting a specimen, you need to watch this 41 second video on proper nasopharyngeal sampling technique.
>> 
>> What lab test is done to test for SARS-CoV-2?
>> 
>> It is a Real-Time RT-PCR test.
>> 
>> Here are all the details.
>> 
>> How is COVID-19 treated?
>> 
>> There are no drugs approved for use yet.
>> 
>> The CDC recommends avoiding corticosteroids if possible.
>> 
>> Trials of remdesivir are underway.
>> 
>> For now, it is supportive care.
>> 
>> How long do infected patients remain infectious?
>> 
>> According to the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), “ virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset and persist for 7-12 days in moderate cases and up to 2 weeks in severe cases.”
>> 
>> What should healthcare workers do if they are exposed to patients with confirmed COVID-19?
>> 
>> It depends on the risk of the exposure.
>> 
>> See this CDC guidance.
>> 
>> What should healthcare workers do if they develop symptoms?
>> 
>> You should be tested (CDC).
>> 
>> When should healthcare workers return to work if they test positive for COVID-19?
>> 
>> This must be determined by your employer on a case-by-case basis at this point.
>> 
>> How should EMS handle confirmed or potential cases of COVID-19?
>> 
>> Here are recommendations for EMS related to COVID-19.
>> 
>> Will there be a vaccine for COVID-19?
>> 
>> It will likely be a while.
>> 
>> But phase 1 trials may begin has early as April. 
>> 
>> 
>> What additional questions would you like to see answered here?
>> 
>> Please contact us. We would love to hear from you.
>> 
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