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Bonus Short - COVID-19 Update

Neda Frayha, MD and Devang Patel, MD
00:00
23:04

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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. 

References:
  1. Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. https://www.idsociety.org/public-health/wuhan-coronavirus/. Accessed 2 Mar 2020
  2. 2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/summary.html. 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. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. 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. https://doi.org/10.1002/emp2.12034
  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: https://rebelem.com/covid-19-the-novel-coronavirus-2019/.

Ian L., Dr -

Doctors who are mildly ill and decide to self isolate can be involved in phone consultations Telehealth and providing prescriptions if only repeats . Self testing with nasal swabs for a runny nose for viral panel and Covid-19 by a doctor is being done- the challenge is getting the result in 24 hours by an express system -the RT -PCR for viral panel is six hours or less . -The vulnerable populations will it seems have a upper respiratory tract symptom phase before the worsening into a pneumonia it seems -giving a time of opportunity to prepare .

Mike W., MD -

Yes, thx for the comments Ian. Good points!
M

Riccara E. -

What would be the financial burden of a respiratory panel? I have been told it costs about $700 in my city.

Mike W., MD -

This is from Neda:
Thanks for your question, Riccara. Typically the full respiratory viral panel (which tests for around 12 pathogens) costs approximately $100-120. Insurance plans may decide to charge different amounts, however.

Karen E. -

What about the cost of all of this. A respiratory viral panel can cost $1500-$2000.

Krista B., MD -

What do we advise low risk people with mild ILI who are not able to obtain testing right now as far as isolating themselves - do you recommend they do so and if so for how long?

What do we know about how long people remain contagious especially in the milder 80%

Mizuho M., DO -

they go home for self quarantine for remainder of 14 days since symptom onset. For more info you can go to hippoed.com/covid

Jamieson P. -

I am finding myself at a major point of frustration...wondering if anyone is feeling the same way? Reading & listening to constant inflow of information about COVID19 and trying my best to keep up with it all. I work at a small walk-in/urgent care clinic in the southeastern US. My clinic is within the same building for OB/GYN, orthopedics & primary care practice. We are part of a larger health system however are getting almost no support in terms of PPE and practical guidance on infection control in the office. I have submitted recommendations to hospital infection control liaison with almost no feedback. It feels like no one around here is concerned beyond forwarding me emails from the CDC :(

Mike W., MD -

New recording to address these questions is scheduled for tomorrow 3/13/20 - will be released as a HIPPO 'short' asap!!
M

Mizuho M., DO -

Agree with you Jamieson! We are doing our best to help bring valuable information to you all. We have a new COVID information website up for clinicians that is FREE OPEN ACCESS to all. On it you will find LISTEN/READ/WATCH links with valuable information for UC providers. We are frantically adding to this as more and more information becomes available. Please go to https://covid.hippoed.com/
hope this helps!

Mike W., MD -

Listener question:
Hi all! NP at a busy urgent care system in Central IL and trying to look for sources regarding treatments of COVID at risk URI patients (we are not testing yet--only high risk, international travel which is frustrating because we feel we are seeing it!) I've seen info that steroids possibly increase mortality and increase length of viral shedding and should be avoided. In the case of the wheezer who is not tested and stable to discharge home, steroids or no steroids? Also in the wheezer, wouldn't a neb aerolize the virus and put staff at greater risk of exposure? And if you agree, what would you advise for alternative treatments?
Weinstock here. A few thoughts:
1. Use MDI instead of aerosol as they are equally efficacious
2. Like everything, we need to balance risks and benefits - if it is asthma in a known asthmatic w wheezing, steroids should balance on the benefit side

Thx for the comments and for listening!
M

Mike W., MD -

From: Chanda M, ARNP
Read this article and was wondering thoughts from the experts from urgent care rap (Best educational podcast for urgent care providers).
BMJ journal
BMJ 2020 368 doi https:doi.org/10.1136/bmj.m1086 (published 17march2020)
Discusses how NSAIDS/motrin should not be used for COVID patients, or for fevers in general.
Thoughts? This is the first I have heard of this.

Mike W., MD -

Thanks Chanda,
While this is a little preliminary, might be safest to use acetaminophen for now. I am sure we will get CDC guidance soon! Thx for listening and for the question!!
Michael

Mizuho M., DO -

**** Hi UC Listeners - We are doing our best to help bring valuable information to you all. We have a new COVID information website up for clinicians that is FREE OPEN ACCESS to all. On it you will find LISTEN/READ/WATCH links with valuable information for UC providers. We are frantically adding to this as more and more information becomes available. Please go to https://covid.hippoed.com/
hope this helps! *** Stay well! ~Miz & team

kate h. -

Is there any information about patients doing "self swabs" for Covid19, flu, rapid strep? I loved the show you did discussing self swabs for wet mount/gonorrhea/chlamydia. It changed our practice here at the UC.

Mike W., MD -

check out: covid.hippoed.com
Thx!!
M

Mike W., MD -

And yes, self swabs are certainly an option. I am guessing an observed self swab from across the room will ensure a good sample!
M

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