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Chapter 1

Bonus Short - COVID-19 Update

Neda Frayha, MD and Devang Patel, MD

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In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel and our own Dr. Neda Frayha discuss the latest, clinician-focused updates on the COVID-19 coronavirus outbreak.

  1. Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. Accessed 2 Mar 2020
  2. 2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. Accessed 2 Mar 2020.
  3. Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. Accessed 2 Mar 2020.
  4. del Rio C, Malani PN. COVID-19—New Insights on a Rapidly Changing Epidemic. JAMA. Published online February 28, 2020. doi:10.1001/jama.2020.3072
  5. Fauci AS, Lane HC, Redfield RR. Covid-19 - Navigating the Uncharted. N Engl J Med. Feb 28, 2020; DOI: 10.1056/NEJMe2002387
  6. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648
  7. Bai  Y, Yao  L, Wei T,  et al. Presumed asymptomatic carrier transmission of COVID-19.  JAMA. Published online February 21, 2020. doi:10.1001/jama.2020.2565
  8. Zhang W, Du RH, Li B,  et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes.  Emerg Microbes Infect. 2020; 9(1):386-389.
  9. Wang D, Hu B, Hu C,  et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585
  10. Yee J, Unger L, Zadravecz F, et al.  Novel coronavirus 2019 (COVID‐19): Emergence and implications for emergency care. Ann. Emerg. Med 2020; 1– 7.
  11. Li Q, Guan X, et al. Early transmission dynamics in Wuhan, China of novel coronavirus-infected pneumonia. N Engl J Med January 29, 2020. DOI: 10.1056/NEJMoa2001316
  12. MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection in healthcare and community settings  BMJ 2015; 350 :h694.
  13. 13. Rezaie S. “COVID-19: The Novel Coronavirus 2019.” REBEL EM Blog, March 1, 2020. Available at:

tsupshaw -

What is the sensitivity and specificity of the numerous tests used to diagnosis Covid-19? What about the use of CT scan of the chest to make the diagnosis?

Rob O., MD -

Hey! Looking through what's out there on lab tests, CT, and the like, I don't think there is a hard number we can land on. Here is a bit of the mish mash of evidence.

The sensitivity of RT-PCR is reported to be 60-70%

With a positive RT-PCR as reference, chest CT imaging sensitivity was 97% in one study.
(Ai T et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020. PMID: 32101510)
These authors, to your point, suggest that CT can be used as a screening tool in epidemic areas.

Another study showed RT-PCR sensitivity of 71% and for CT, 98%.

Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, Ji W. Sensitivity of Chest CT
for COVID-19: Comparison to RT-PCR. Radiology. 2020 Feb 19:PMID: 32073353.

Stephen W. -

Hi all. Great update! In regard to donning and doffing, I started what I call the "glove wipe" when we were training for Ebola and carried it through the flu season (which now seems year-round). Before doffing, I would wipe down my gloves with a Bleach Wipe or other disinfecting wipe OR wash my gloved hands with an alcohol-based gel. While I don't have any data on this, it seems to make sense to clean the gloves before reaching towards the face to take off a mask and/or gloves. I get a little teasing but why not wipe down the gloves before doffing! Thanks again and keep up the good work!

Rob O., MD -

Hey! I love this. We OCD cleaners always get a strange look when taking the extra step but it's usually those tiny cracks in the mortar where we get burned, not the obvious stuff. Thanks so much for sharing.

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