What do I need to know about coronavirus?

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Angry Birds

Angry Birds

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I've been living in a cave and haven't worked in the last few weeks. What do I need to know about this coronavirus epidemic in case my patients ask me? Any change in our practice? Looking for some high yield ER-centric bullet points...

Thanks!
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2019-2020 US Deaths


Influenza: >8,000 (including >50 children)

Coronavirus: 0


-CDC
 
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Angry Birds said:
I've been living in a cave and haven't worked in the last few weeks. What do I need to know about this coronavirus epidemic in case my patients ask me? Any change in our practice? Looking for some high yield ER-centric bullet points...

Thanks!
Click to expand...


If traveled to china or contacts that traveled to china, with cold/viral symptoms. Isolate first, ask questions later.
 
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Birdstrike said:
2019-2020 US Deaths


Influenza: >8,000 (including >50 children)

Coronavirus: 0


-CDC
Click to expand...

Yeah man I know. But I gotta learn a little more than that to at least pretend to sound educated to my patients.
 
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Flu symptoms + China in the past 14 days = negative pressure, combination contact/droplet (w/ N95) precautions, probably call your hospital on call infection control for advice on how to proceed. Oh, and swab them for flu because it's still probably just flu.
Angry Birds said:
Yeah man I know. But I gotta learn a little more than that to at least pretend to sound educated to my patients.
Click to expand...
 
The CDC website has a very easy algorithm to follow. No need for negative pressure. Put a mask on them. PPE for the nurses. The first call should be to your local health department.
 
I don't know if there is anyway for you to PM your email to me, but I can send you the information.
 
Well, technically, I'm sure there is probably more than 1 coronavirus death in the US, given that is an extremely common respiratory virus, secondary to rhinovirus for colds. It is annoying how the media has conflated the novel coronavirus by just calling it coronavirus. Waiting in anticipation for the next outbreak which will be called "VIRUS outbreak".
 
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TXEMC344 said:
The CDC website has a very easy algorithm to follow. No need for negative pressure. Put a mask on them. PPE for the nurses. The first call should be to your local health department.
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We are setting with negative pressure rooms. So we don't necessarily need them?
 
thegenius said:
We are setting with negative pressure rooms. So we don't necessarily need them?
Click to expand...

The CDC does suggest using negative pressure rooms:
"Ensure that negative-pressure airborne infection isolation rooms are available and functioning correctly and are appropriately monitored for airflow and exhaust handling."

From
Hospital Preparedness Checklist for 2019-nCoV Patients | CDC
and then click on
https://www.cdc.gov/coronavirus/2019-ncov/downloads/hospital-preparedness-checklist.pdf
 
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If you're in academics, please make this a staff only patient. The attending's gotta see them regardless - no need to have a med student go in, then a resident, then you...
 
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WilcoWorld said:
If you're in academics, please make this a staff only patient. The attending's gotta see them regardless - no need to have a med student go in, then a resident, then you...
Click to expand...

This is the approach being taken with these patients in at least one major academic center. I assume most will do the same thing, just like with Ebola.
 
Clinical features and epidemiologic risk
Clinical Features&Epidemiologic Risk
Fever1 or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)ANDAny person, including health care workers, who has had close contact2 with a laboratory-confirmed3,4 2019-nCoV patient within 14 days of symptom onset
Fever1 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath)ANDA history of travel from Hubei Province, China5 within 14 days of symptom onset
Fever1 and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization4
 
If they don't meet this criteria, we are being told not to even test. Again first call to your local health authority, they will then contact the state.

For a known, positive result, perhaps a negative pressure room. That being said, it's a virus. A lower respiratory tract problem.

Many many facilities do not have negative pressure rooms as I'm sure you know. Have the patient and all staff members wear a mask, N-95 preferably, and everyone use basic contact precautions.
 
Example, had a guy present to our walk-in clinic with a chief complaint of a sore throat. Low and behold, he just got back to the states from China. He was at Shanghai Disneyland (didn't know there was such a thing). Two days after he got home developed the sore throat. No other symptoms at all.

I hate to say that we didn't have a process in place. Infection Control and lab director immediately called the state, who actually was irritated that we hadn't first called our local health department.

We performed the algorithm, and were told that testing was not indicated.

He was placed in a mask at the clinic, everyone is because flu is still running rampant. Only three people ever entered the room. All wearing masks and using basic contact precautions.

He did have a horrible case of strep pharyngitis.
 
Well I guess this thing has actually (finally) given us a reason to use rapid strep, flu, RSV and whatever other viral swabs the nurses seem to perform automatically on every patient...
 
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Looks like the virus is finally starting to spread globally.

New outbreak in Iran with likely hundreds of cases.
 
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Angry Birds said:
I've been living in a cave and haven't worked in the last few weeks. What do I need to know about this coronavirus epidemic in case my patients ask me? Any change in our practice? Looking for some high yield ER-centric bullet points...

Thanks!
Click to expand...

Avoiding the deep fried bat at the cafeteria these days...
 
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Here's something never to forget for as long as you live, in your work and personal life: Emotion more persuasive than logic, by a factor of thousands.

Ask 100 people right now, what they're more afraid of, flu or coronavirus, and 99 out of 100 will answer, "Coronavirus." Yet, as of 2/26/20, these are the U.S. deaths from:

Flu: 14,000 (CDC).

Coronavirus: 0 (CDC).

14,000 Americans dead from the flu. 105 American children dead. From the flu. Right now. This year. Still, zero American deaths in U.S. from Coronavirus. Zero American children dead from Coronavirus.

Yet, people are still panicking about coronavirus, and still refusing to get flu shots for their kids, or themselves. It's for the same reason that when people go into the ocean they fear getting killed by a shark yet ignore the thing right next to, under, and around them, that's 300 times more deadly: The water (1 U.S. shark death per year; 300 U.S. drowning deaths per year).

Emotion is more persuasive than logic, by a factor of thousands, in all aspects of our lives. Don't ever forget this, in your work, or in your personal life.
 
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SCCM's coverage of COVID019.
www.sccm.org

SCCM | Crisis Response

SCCM assists the critical care community during disasters and emergencies by providing resources and updates.
www.sccm.org www.sccm.org

Personally, I'm still waiting to die from bird flu, swine flu, ebola, SARS, MERS, and Zika
 
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Birdstrike said:
Here's something never to forget for as long as you live, in your work and personal life: Emotion more persuasive than logic, by a factor of thousands.

Ask 100 people right now, what they're more afraid of, flu or coronavirus, and 99 out of 100 will answer, "Coronavirus." Yet, as of 2/26/20, these are the U.S. deaths from:

Flu: 14,000 (CDC).

Coronavirus: 0 (CDC).

14,000 Americans dead from the flu. 105 American children dead. From the flu. Right now. This year. Still, zero American deaths in U.S. from Coronavirus. Zero American children dead from Coronavirus.

Yet, people are still panicking about coronavirus, and still refusing to get flu shots for their kids, or themselves. It's for the same reason that when people go into the ocean they fear getting killed by a shark yet ignore the thing right next to, under, and around them, that's 300 times more deadly: The water (1 U.S. shark death per year; 300 U.S. drowning deaths per year).

Emotion is more persuasive than logic, by a factor of thousands, in all aspects of our lives. Don't ever forget this, in your work, or in your personal life.
Click to expand...

@Birdstrike Remind me to tell you something about this later on, maybe a few months from now.
 
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Birdstrike said:
Here's something never to forget for as long as you live, in your work and personal life: Emotion more persuasive than logic, by a factor of thousands.

Ask 100 people right now, what they're more afraid of, flu or coronavirus, and 99 out of 100 will answer, "Coronavirus." Yet, as of 2/26/20, these are the U.S. deaths from:

Flu: 14,000 (CDC).

Coronavirus: 0 (CDC).

14,000 Americans dead from the flu. 105 American children dead. From the flu. Right now. This year. Still, zero American deaths in U.S. from Coronavirus. Zero American children dead from Coronavirus.

Yet, people are still panicking about coronavirus, and still refusing to get flu shots for their kids, or themselves. It's for the same reason that when people go into the ocean they fear getting killed by a shark yet ignore the thing right next to, under, and around them, that's 300 times more deadly: The water (1 U.S. shark death per year; 300 U.S. drowning deaths per year).

Emotion is more persuasive than logic, by a factor of thousands, in all aspects of our lives. Don't ever forget this, in your work, or in your personal life.
Click to expand...

Meh...I see plenty of people freaked out by the flu. I have parents bring in their completely fine kids because "it might be the Flu(!)". My ED is backed up because the midlevels test every kid or adult with the sniffles for the flu(!).

7500 Americans die every day. We all gotta die of something, and for some of us (the sickest ones) it'll be the flu
 
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Anyone want to predict how long it takes for the masses to freak the f out and come to the ED en masse for coronavirus fears/testing?
 
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TimesNewRoman said:
Yea, but how many of them have a BMI of 45, 4v CABG, DM with an A1c in the mid-double digits, HIV and NASH cirrhosis?
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Culling the herd? I for one am not happy about the prospect of having to intubate all these people:(

Now if I can hire boatswain2PA to pull some shifts for these "viral URIs", I'll be happy to give him my shifts. After all he was kicking ass and taking names while I was still in diapers.
 
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sylvanthus said:
Anyone want to predict how long it takes for the masses to freak the f out and come to the ED en masse for coronavirus fears/testing?
Click to expand...

Had my first one last night. Dr. ******* sent her for "LP to rule out meningitis" with stone cold normal exam. Lady demanded that I test for Coronervirus (sic).
 
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RustedFox said:
Had my first one last night. Dr. ******* sent her for "LP to rule out meningitis" with stone cold normal exam. Lady demanded that I test for Coronervirus (sic).
Click to expand...

I feel like so many of your patients are literally memes.
 
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TimesNewRoman said:
Yea, but how many of them have a BMI of 45, 4v CABG, DM with an A1c in the mid-double digits, HIV and NASH cirrhosis?
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Rate of healthy young mortality appears to be in the 0.1-0.2% range from all the stuff I've read, but many sources are likely overestimating due to mild and asymptomatic cases
_111074816_death_ratio-nc.png
 
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First US death reported as woman in her 50s in King County Washington.
 
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sylvanthus said:
Anyone want to predict how long it takes for the masses to freak the f out and come to the ED en masse for coronavirus fears/testing?
Click to expand...

Just happened at my place! (I'm in NorCal). Not masses but we've had a few people ask.

The thin line between panic and caution.
 
From the infection preventionist side, I’m not looking forward to panicked masses here either. :confused:

Plus in the past week we've had a public freakout about exposure to a meningitis case (it wasn’t) show up in the ED, increasing influenza A, and now possible chickenpox at the local mega daycare on top of coronavirus prep.

I’m trying to strike a balance between getting our docs to take this at least somewhat seriously while reassuring the CNAs, nursing staff, etc. that there’s no meed to panic, really. It’s just going to be a strain on the system and our resources.
 
I would be curious to see how are colleagues on the west coast are handling it right now. At our FSEDs, I have plenty of unnecessary URI/cough visits. I can't imagine what would happen if they all started flooding in demanding SARS-Cov-2 testing. I really wouldn't even be able to do anything (unless they were actually sick) except give them masks to go home with, call Infection Prevention every 15 minutes with another "possible case", and refer them to the health department for actual testing.
 
My theory is that this type of coronavirus could easily have been here all along and no one has bothered to, cared to, or had a means to test for it. But now, since it has a name, and has caused a large amount of deaths in a huge, densely populated country with poor health care, plus media panic, it's gaining attention. Just think about it. Prior to two months ago, if someone shows up in your ED with a pneumonia, you do a CXR, it shows pneumonia, you treat them with antibiotics. Many are bacterial, some are viral. You can never know for certain, which is which. You may culture them if admitted. Some of the bacterial ones with grow an organism, but not all will. You wouldn't order any tests to determine which type of virus might be causing their pneumonia, if viral. And unless you get a positive bacterial culture, which not all bacterial pneumonias will give you, you can't be certain it's not from a viral pneumonia. The only test for viral pneumonia you'd order, might be a flu swab. But of the numerous viruses that cause pneumonia, you'd never test for any of them. The vast majority will get better, while (but not because) you're giving your antibiotics. A small percentage will get worse, develop ARDS and die. That's just a fact, whether it's coronavirus or one of the others. Out of a thousand rhinovirus, adenovirus, influenza virus, parainfluenza, RSV and coronavirus cases, the vast majority never get very ill. A tiny percentage get pneumonia. And only a tiny percentage with the viral pneumonia, get ARDS, hypoxic and die. It's always been that way.

People have been getting cases of viral pneumonia all along, and dying (albeit a very small percentage) all along, and it never makes news or even gets diagnoses other than "culture negative pneumonia." But now that this has a name, a test, and a worldwide media whipping the public into a 24/7 frenzy, people are paying attention. Whether or not COVID-19 has been here all along, causing 0.1-2% of it's hosts to die, is only a thought exercise. But it's 100% certain, that viruses that do the same exact have been here spreading among us, all along, just without the mass hysteria and media panic.

Oh, and wash your hands.
 
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BoardingDoc said:
You can't even do that, unless you're going to fit mask test them as well. Regular surgical masks are ineffective. You need an N95. And a face shield for that matter.
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Surgical masks are fine for such patients - b/c in these cases the mask is intended to prevent spreading to others. You need an n 95 if you're trying to prevent contraction (which presumably we aren't aiming for in a symptomatic patient).
 
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Surgical masks help some as a reminder not to touch your face.

People love to bite their nails, pick their nose, rub their eyes, stroke their beard, cough in their hands, etc etc.

The mask helps in that regard.
 
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BoardingDoc said:
You can't even do that, unless you're going to fit mask test them as well. Regular surgical masks are ineffective. You need an N95. And a face shield for that matter.
Click to expand...

Is an N95 really necessary? My understanding is that this is spread throughout respiratory droplets just like the flu and common cold and does not need airborne precautions. I would think that a surgical mask, gown and gloves would be sufficient. If an N95 were truly necessary than a negative pressure isolation would also be necessary I would assume.
 
A surgical mask on a sick person helps muffle their cough, decrease spread, and effect a modicum of source control.

For HCP--
A surgical mask likely DOES provide a pinch of protection. An N95 provides superior protection. Review the Canadian SARS data; 10% of Anesthesiologists intubating SARS patients caught SARS. Most of them were wearing N95s. Thus the recommendation to wear face mask / eye protection, or better yet PAPRs when intubating.

I don't understand you educated people who think this virus has just always been circulating. We have excellent genetic analysis of this virus, its drift as it moves around the globe, its presumed animal source, etc. It is novel, at least in our lifetimes.

If you want to know what its going to be like, and what we need to do, I would ask our colleagues in Wuhan who are fighting this outbreak... this WHO paper is instructional:

Read it, and see how they made the numbers decrease. It took their entire society single-mildly fighting this epidemic. The numbers of new hospital beds, the immediate organization of tiers of care, the immediate cessation of travel and most social activities. It is incredibly impressive. And I'm not all that convinced the USA can pull off a similar feat.
 
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