Found this info very helpful about #COVID19. Not my own; paraphrasing from Physician Moms in Massachusetts Group via Martha Blum, MD PhD, & Women in Critical Care Medicine groups. Would be helpful for PCP’s, ER docs, & Critical Care/intensivists.
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“Most common presentation is 1wk prodrome myalgia, malaise, cough, low grade fevers leading to more severe trouble breathing in the second week of illness. Avg 8d. to dev. of dyspnea and avg 9d. to onset of PNA/pneumonitis. (not like Influenza with classic sudden onset)
Fever was not very prominent in several cases.Most consistent lab finding was lymphopenia (with either leukocytosis or leukopenia). Most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that,other markers (CRP, PCT)were inconsistent
Co-infection rate with other resp. viruses (Influenza,RSV) is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.
So far,very few concurrent or subsequent bacterial infxns, unlike Influenza where secondary bacterial infections are common and a large source of additional morb/mortality.
Pts w/underlying cardiopulm dz seem to progress to ARDS and acute resp failure requiring BiPAP then intub. There may be a component of cardiomyopathy from direct viral infection as well. Intub is considered “source control” equal to pt wearing mask & greatly ⬇️ transmission risk
BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs. To date, pts with severe dz are most all (except when fam didn’t sign consent) getting Remdesivir from Gilead through compassionate use.
However,expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5v10d of Remdesivir) or NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, not much benefit.
Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort. Pts can shed RNA from 1-4wks after sympt resolution, but unknown if presence of RNA equals presence of infectious virus.
For now, pts “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart. All suggested ramping up alternatives to face-to-face visits, telemedicine, “car visits”, telephone consultation hotlines.
Health Depts (CDPH and OCHD) state the Airborne Infection Isolation Room is the least impt of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective.”
Found some ICU’s also avoiding routine bronch (only severe mucous plugs), intubating early (avoiding all non-invasive vent.), & liberally using glidescope (to limit intubator’s face near pt’s airway). Also using scrub techs as “PPE monitors” for extra safety.
