[AGL] What's the death rate for us? Read on. Do the math.

Mon Mar 16 13:46:02 EDT 2020

> Friend of mine is a medical professional, says this is one of his trusted sources—sort of a digest of actual medical journals.


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> COVID-19 | Spoon-Feed Version <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=914031d937&e=df48a27992>Mar 16, 2020 01:00 am
> Updated March 16, 2020
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> Written by Clay Smith <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=3de6c67779&e=df48a27992>
> Spoon Feed
> This post compiles the most authoritative answers to your questions about COVID-19 all in one place.
> 
> Why does this matter?
> COVID-19 is considered a global pandemic <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=ad5a770cb7&e=df48a27992>. In the U.S. alone, there are 330 million people <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f5526e1401&e=df48a27992>. Estimates are that 60-70% of the population will become infected. That’s between 160 million and 214 million infected in the U.S., of which an estimated 200,000 to 1.7 million may die <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=01ebd46bb8&e=df48a27992>. The U.S. has only 924,000 staffed beds <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=c0be9079c2&e=df48a27992>. These numbers assume no mitigation strategies and may be better than expected. This is a very important topic.
> 
> COVID-19 - Authoritative Answers In One Place
> We have previously written about COVID-19 in a broad overview <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=56b1f848ac&e=df48a27992> and a deep dive on the clinical presentation. <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=a1f72e4a61&e=df48a27992> This post is a quick way to find the most reliable sources of information to answer your clinical questions about COVID-19. If you see something that should be added, please help me and leave a comment or use the website’s contact form <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=53bfe46738&e=df48a27992> to let me know.
> 
> Basic Science
> Where can I learn about the coronavirus, SARS-CoV-2, that causes the disease COVID-19?
> 
> This article in Nature takes a deep dive into the basic science of coronaviruses <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f145b059b7&e=df48a27992>. Free full text.
> 
> Mark Denison, MD, Vanderbilt Pediatric Infectious Disease, has been researching coronaviruses for almost 30 years. See this treasure trove of publications from the Denison Lab <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=7e7b2fcf8a&e=df48a27992>.
> 
> For more on taxonomy and where SARS-CoV-2 fits among other coronaviruses, see this from Nature Microbiology <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=5e60c44556&e=df48a27992>. Free full text.
> 
> Epidemiology
> What is the incubation period?
> 
> It is 2-14 days <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=293f2f0a8e&e=df48a27992> (CDC); median 4-5 days.
> 
> How is COVID-19 spread?
> 
> Respiratory droplets <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=d62f4c5fa4&e=df48a27992> (CDC)
> 
> SARS and MERS can live on surfaces for days <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1139e7aa27&e=df48a27992>. SARS-CoV-2 is likely to behave similarly.
> 
> Here is a list of EPA-approved disinfectants with activity against SARS-CoV-2 <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=47a9d445a6&e=df48a27992>.
> 
> If I am infected, can I get infected again?
> 
> We don’t know yet <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1ba55d7ad2&e=df48a27992>.
> 
> If other coronaviruses are any indication, immunity wains and reinfection is common.
> 
> What is the case fatality rate for COVID-19?
> 
> It depends on the age of the patient.
> 
> There was 0% mortality in children 0-9 years and 14.8% mortality over age 80. It was a little worse than seasonal influenza in those aged 10 - 39 years, with case fatality rate of 0.2%. But case fatality steadily rose with age over ≥40.
> 
> Case fatality among healthcare providers was 0.3%.
> 
> This came from the China CDC <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=666809af9c&e=df48a27992>, which loads very slowly. Here is a PDF version <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=11ad509022&e=df48a27992> you can rapidly download. Citation credit: The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
> 
> How do I protect myself as a healthcare provider?
> 
> See this guidance from the CDC <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=76f20a3897&e=df48a27992>. Wear a surgical mask, gown (if possible), eye protection, and gloves.
> 
> If intubating or doing a procedure that creates aerosols, an N-95 mask is recommended <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=e89fefc070&e=df48a27992>.
> 
> What are general ways to protect myself and my family?
> 
> The basics make a big difference <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=c20f22ca48&e=df48a27992> (CDC).
> 
> Keys: Handwashing (or hand sanitizer with 60% alcohol); social distance (6 feet); don’t touch eyes, nose, or mouth; avoid close contact with sick people (obviously meant for a non-healthcare audience); stay home if sick; cover coughs and sneezes; wear a facemask if sick; disinfect high-touch surfaces like counters, doorknobs, etc.
> 
> Who is at higher risk from infection with COVID-19?
> 
> Older patients and those with comorbidities are at greatest risk <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=5b3c3e59c3&e=df48a27992>.
> 
> Comorbidities may include diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease.
> 
> It is unknown if COVID-19 is more dangerous in pregnancy. The WHO stated, “pregnant women do not appear to be at higher risk <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=232a8d5d91&e=df48a27992> of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.” The CDC has an entire section devoted to pregnancy and breastfeeding <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=2322792423&e=df48a27992>.
> 
> How widespread is the disease, COVID-19?
> 
> The best map is from Johns Hopkins <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f563db5bff&e=df48a27992>.
> 
> The WHO map <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=55efda2ed7&e=df48a27992> is here.
> 
> The New York Times <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=9f6293854f&e=df48a27992> has a frequently updated map as does the CDC <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=7203484ef6&e=df48a27992>.
> 
> What are the best sites to keep informed about this emerging pandemic?
> 
> CDC <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=1180cdc8a4&e=df48a27992> | WHO <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=08876a378d&e=df48a27992> | NEJM <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=6b6fecf077&e=df48a27992> | Lancet <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=154e06e644&e=df48a27992> | BMJ <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=01f88a32f7&e=df48a27992> | JAMA <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=47ce181adf&e=df48a27992> | UpToDate <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=125702aca1&e=df48a27992>
> Clinical Pearls
> What is the clinical presentation?
> 
> Acute cough is common.
> 
> Fever on initial presentation was noted in 44% of patients and in almost 90% during hospitalization at some point. “Fever” was defined as an axillary temperature ≥ 37.5°C in this large Chinese case series <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=ba75991602&e=df48a27992>.
> 
> Some patients had fatigue, headache, myalgia, sore throat, or shortness of breath. (NEJM).
> 
> GI symptoms were uncommon. Rhinorrhea, conjunctival injection, tonsil swelling, and rash were also uncommon.
> 
> Around 80% have mild disease. They may be treated at home <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=b01df9adf0&e=df48a27992>.
> 
> Approximately 14% will develop severe disease <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=971d8ab91d&e=df48a27992> requiring hospitalization, and 5% will need critical care <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=70c52e6a0c&e=df48a27992> (JAMA).
> 
> 83% of hospitalized patients with pneumonia had lymphocytopenia, <1,100. About one-third of these patients had leukopenia and thrombocytopenia.
> 
> Over half of early presenters (in the first 2 days) may have no CT changes <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=dbba92f6c9&e=df48a27992>. However, most hospitalized patients with pneumonia from COVID-19 develop bilateral consolidation and ground glass opacities. See these images <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f22a171b08&e=df48a27992> (AJR). The American College of Radiology <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=9e09bacaa7&e=df48a27992> does not recommend CT be used to screen for COVID-19.
> 
> Which patients should be tested for possible COVID-19?
> 
> The CDC recommendations are found here <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=88af2c4ad5&e=df48a27992>. These are evolving over time.
> 
> Patients who have symptoms and are hospitalized, those with comorbidities, and healthcare workers should be prioritized.
> 
> How do I test for it?
> 
> This is what you need to know <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=fb090d5910&e=df48a27992> from the CDC. We use universal viral transport medium and FLOQSwabs in my facility.
> 
> If collecting a specimen, you need to watch this 41 second video <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=00f68d84dc&e=df48a27992> on proper nasopharyngeal sampling technique.
> 
> What lab test is done to test for SARS-CoV-2?
> 
> It is a Real-Time RT-PCR test.
> 
> Here are all the details <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=04949d6fed&e=df48a27992>.
> 
> How is COVID-19 treated?
> 
> There are no drugs approved for use yet.
> 
> The CDC recommends avoiding corticosteroids if possible.
> 
> Trials of remdesivir <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=b23c5db3af&e=df48a27992> are underway.
> 
> For now, it is supportive care.
> 
> How long do infected patients remain infectious?
> 
> According to the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=e445dadbfc&e=df48a27992>, “ virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset and persist for 7-12 days in moderate cases and up to 2 weeks in severe cases.”
> 
> What should healthcare workers do if they are exposed to patients with confirmed COVID-19?
> 
> It depends on the risk of the exposure.
> 
> See this CDC guidance <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=a8f7f1cc55&e=df48a27992>.
> 
> What should healthcare workers do if they develop symptoms?
> 
> You should be tested <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=0c1ea6b83a&e=df48a27992> (CDC).
> 
> When should healthcare workers return to work if they test positive for COVID-19?
> 
> This must be determined by your employer on a case-by-case basis at this point.
> 
> How should EMS handle confirmed or potential cases of COVID-19?
> 
> Here are recommendations for EMS <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=0fbc4124a9&e=df48a27992> related to COVID-19.
> 
> Will there be a vaccine for COVID-19?
> 
> It will likely be a while <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=f411565f94&e=df48a27992>.
> 
> But phase 1 trials may begin has early as April. 
> 
> 
> What additional questions would you like to see answered here?
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> Please contact us <https://journalfeed.us3.list-manage.com/track/click?u=827fa052009e49f904cc3c386&id=bdc2e383b6&e=df48a27992>. We would love to hear from you.
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