Consolidated Reputable and Cited Info on COVID-19 that can help leaders make informed decision based on what we know (As of 18 MARCH 2020)
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SUMMARY: The SARS-COV2 virus has infected over 200,000 people of whom we are aware. The virus is thought to be “silent” in numerous individuals and cause mild symptoms in others. However, the transmission rate is very high and the impact on our healthcare system is the most worrisome problem- this should be our chief concern. Because the virus has the potential to infect so many at one time, a high number of individuals will die. Onset from exposure to symptoms is approximately 5 days, but viral shedding occurs prior to symptoms. In fact, it is now reported that symptoms spread the most in the first week.
The result of an overburdened system will result in children with broken limbs or other trauma waiting longer at Emergency Rooms. Strokes will go undiagnosed resulting in higher morbidity and mortality. “Heart Attacks” will not receive rapid intervention from cardiac catheterization that could save their lives. Motor vehicle accidents will have a higher mortality. Bed space will be at a premium. Riskier decisions will need to be made. Mistakes will be made. Many tests will not be available without significant wait times due to time needed to properly disinfect the machines.
Further, healthcare workers are 3-5 x more likely to have severe illness and death compared to others, even among young individuals.. We hypothesize this could be due to viral load of intimate exposure and the wide dispersion of the virus during emergent care requiring ventilation procedures.
These outcomes are very likely based on a comparison to China and Italy. San Francisco, Seattle, New York, and Boston are showing us what may happen in our own areas soon. However, based on our geographical layout of our country, we may have pockets of areas that are hit hardest. This will also cause a disproportionate burden on resources. Concentrated clusters of people in bigger cities may spread the virus more. Sparse resources in small towns may cause serious burdens and higher mortality.
Social distancing plays a big part in this fight. We are slowing the transmission by splitting up into cohorts and limiting exposure to other people. After all, we do not know who has the virus. This is not the flu. It is not Ebola. It is not a hoax. This is different. I am now part of a social media group of over 100,000 Physicians, PAs, NPs, and CRNAs that are sharing information on what is happening with their own patients as well as tips and strategies to combat this. This is a real thing.
Our only hope is that an unknown external factor helps us in this fight. Perhaps warmer weather will positively affect this virus like influenza (unknown). Perhaps we will solidify pharmaceuticals which will mitigate the severity and mortality. There are studies underway now on ideas that work, in theory. And perhaps social media will continue to hasten the way towards a cure with the instant transfer of information between specialists.
COLLECTED CONTENT
- The Nasopharngeal test has at least a 20% false negative rate.
- Swabs which are not performed accurately (appropriate depth) as well as early disease duration may lead to higher false negative tests.
- SOURCE: radiol.2020200642
- SOURCE: https://emcrit.org/ibcc/covid19/#labs
- Virus General Info
- The virus is believed to be stable in the air for 3 hours, copper for 4 hours, cardboard boxes for 24 hours, stainless steel for 48 hours, and Plastic for 72 hours (New England Journal of Medicine)
- Is the Virus Airborne? (sorta)
- The virus is aerosol, but it appears to linger in the air. Suggestion is at least 6 feet separation, but we’re not 100% certain.
- Information on mask choices and why:
- Source: https://www.wired.com/story/they-say-coronavirus-isnt-airborne-but-its-definitely-borne-by-air/
- Two different Major Strains identified with 278 mutations
- One major strain is more virulent (worse symptoms) than the other
- Hypothesized that the weaker strain is more prevalent currently, potentially due to human pressures to suppress it
- Why Social Distancing Matters
- We do not have the bed space to care for everyone. Social distancing slows the spread.
- If we flatten the curve to 6 months duration, we project 274 percent potentially available capacity) and 295,350 ICU beds (508 percent potentially available capacity). Strokes, heart attacks, injuries to kids, and others will not have a bed for admission when at 274 % of capacity. THIS IS A PROBLEM.
- “Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.
- Undocumented Infections defined as: “These undocumented infections often experience mild, limited or no symptoms and hence go unrecognized, and, depending on their contagiousness and numbers, can expose a far greater portion of the population to virus than would otherwise occur.”
- Source: https://science.sciencemag.org/content/early/2020/03/13/science.abb3221?rss=1&fbclid=IwAR0ChPtRbw0NyJ-O2z2cn_oEwIoyLRSM5XIaFtvfKwjwklYu9bCfsyZ3UQg
- Can N-95 Masks be re-used?
- There is no way of determining the maximum possible number of safe reuses for an N95 respirator as a generic number to be applied in all cases. Safe N95 reuse is affected by a number of variables that impact respirator function and contamination over time
- Source: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html?fbclid=IwAR1gl5crMKxQlSqm81Bcs85no0aFwUHB7kzZ_slgXaPECbeznwx3dbq7diI
Very Early relevant reports not yet substantiated:
- Ibuprofen may be harmful in COVID-19. Suggesting Tylenol for fever control may be better. Max 3 grams daily for adults without any contraindications.
- WHO now recommending against choosing ibuprofen based on reports of otherwise healthy individuals who developed severe symptoms and pneumonia after using ibuprofen. GROWING EVIDENCE TO AVOID NSAIDS
- Source: https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center?utm_content=bufferc15e0&utm_medium=social&utm_source=facebook&utm_campaign=buffer&fbclid=IwAR13lRxR8ow6zVSSoRBjxXUKrsp3rFjaSv_EDsOcGmM6xZCA_O6aZhJqRmQ
- ACE inhibitors (a type of blood pressure medicine) may worsen disease. Current guidance by American Heart Association and others is to continue medicine at this time due to lack of evidence.
- Pregnant women hypothesized to not be at increased risk, but suggested caution due to limited evidence and numbers so far. Earlier pregnancies may be riskier, but unknown. Limit visits in person and use telehealth, when possible.
- Source: Center for Disease COCA Group webinar
- There may be a correlation between disease severity and blood type
- Blood Type A may be more likely to get the virus as well as have harsher symptoms. Early reports and not yet peer reviewed. No reason given between possible link.
- Source: https://www.medrxiv.org/content/10.1101/2020.03.11.20031096v1?fbclid=IwAR3g8rZRKsJNmbbyAa3f-3TZc1qkB1Yn595ziRQYzKrhbQUAzuPCECQJPw4
WEBSITES FOR MORE INFO:
- HARVARD University Website on COVID-19, and FAQ (Highly recommended)
- CDC Website for Cleaning and Disinfecting Against the Virus; Laundry
- EPA Website for list of Disinfectants for use against SARS-COV2
FOR PROVIDERS:
One of the best collected sources for current information is from EM Crit. Link Here.
This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.