Thread by @mirvatalasnag

#HCW
We r trained 2 care @ any cost
We r trained 2 put patient 1st

I didn’t cover #COVID19 unit
I covered cardiology
Our objective was 2 keep CCU “sterile” zone

PUI went into shock & required brief CPR (recovered)
CT abd w a few cuts of thorax showed lung infiltrates 1/2

Process:
Trace & isolate all HCW contacts from CCU, cath, CT (significant exposure)

Swab patient & wait

Result -ve for COVID19

Now what?
1 Ignore PCR result & Isolate ~ 20 people for 2 weeks
2 Swab HCW & isolate only +ve
3 Repeat swab for patient
2/2

How would you proceed?
@saraceciliamtz @mmamas1973 @DrMarthaGulati @biljana_parapid @AChoiHeart @VietHeartPA @JJheart_doc @IAmDrIbrahim @aayshacader @GilbertTangMD @ajaykirtane @JelaniAini @SSamargandy @SukhNijjer @Allison_Dupont @fischman_david @DocSavageTJU

🧵 cont. 3
What I learned:
🔑Pathways ≠ individualized care
🔑Pre-COVID19 era practices still valid
🔑Treat all as suspected

So:
1 ▶️HCW screened 4 symptoms & isolated (fortunately none did)

cdc.gov/coronavirus/20…

🧵 4

2▶️CT reviewed w radiologist & likely aspiration pneumonia (not COVID19)

Contrarian view
annals.org/aim/fullarticl…

Wuhan study
59% (n = 601) had +PCR
88% (n = 888) had + chest CT
75% (n = 308)-PCR w + chest CT

Serial PCR & CT scan
mean 5.1 days -➡️+
mean 6.9 days +➡️-

🧵3

3▶️ Sputum vs swab

1070 specimens from 205 confirmed COVID

-Bronchoalveolar lavage 93%
-Sputum 72%
-Nasal swabs 63%
-Fibrobronchoscope bx 46%
-Pharyngeal swabs 32%
-Feces 29%
-Blood 1%
? Sample multiple sites ? improve sensitivity &⬇️ reduce false-
jamanetwork.com/journals/jama/…