EM:RAP Live: COVID-19 Update | March 11th 2020

On March 11th 2020 the EMRAP team went live to bring you the latest on the COVID-19 virus. Don't worry if you missed the stream! You can watch the whole thing right here. 

William B., MD -

Is Intubation helpful in this scenario or are we prolonging the inevitable. Are there numbers for people that survived after intubation or are we having extreme exposure to clinicians for no demonstrated benefit.

Mel H. -

People recover post intubation - so it is totally responable.

Byron F., M.D. -

what about convalescent serum to treat severe disease? WHO recommended in Ebola, it has been used in other illnesses like Argentine Hemorrhagic fever. Could Dr Talan please comment on this. This seems like a good option for severe disease.
Byron F

Mel H. -

Indeed this has been done in prior epidemics - no data currently, no CDC recommendation currently. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30141-9/fulltext

Kurt C. -

Below is the "Sequence for Donning and Removing Personal Protective Equipment" from the CDC.

https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf

Alyssa D., M.D. -

Can you please post a link for the Hong Kong study showing low health care transmission using standard PPE?

Alyssa D., M.D. -

THANKS!!

Kaitlin A. -

Are dogs vectors? I know you mentioned transmission from cats in China. Do dogs and owner need quarantine together? ex: no doggy daycare if owner works in Emergency Medicine? Thanks!

Mel H. -

Dogs are not vectors and there are no confirmed cases of it being passed to dogs (one suspected case but it seems it was a contaminant). https://www.avma.org/resources-tools/animal-health-and-welfare/covid-19

Kaitlin A. -

Thank you! :)

Ketan P. -

Not trolling, completely for humor which we can all use in these times...stolen from the internet:

"The World Health Organization has announced that dogs cannot contract Covid-19. Dogs previously held in quarantine can now be released. To be clear, WHO let the dogs out."

Mel H. -

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/escalating-infection-control-response-to-the-rapidly-evolving-epidemiology-of-the-coronavirus-disease-2019-covid19-due-to-sarscov2-in-hong-kong/52513ACC56587859F9C601DC747EB6EC

Michel L. -

What are peoples action plans with optiflow and BIPAP? Do people plan to do a trial of either prior to intubation? With these aerosol generating machines it may be more adviseable just to intubate these patients if ventilator numbers are not an issue... what is the general opinion?

Mel H. -

Yes Dr. Talans advice was intubate rather than BiPAP. If we get overwhelmed you got to do what you got to do. But intubate and viral filters on every port is best!

Micelle H., micellehaydel4@gmail.com -

Is there any evidence that we can need to admit patients with abnormal chest xray but normal pulse ox?

Mel H. -

A lot of patients in China had radiological changes (but again probably a select group). I think we can treat this as we otherwise would a viral pneumonia. If they look good and are healthy, outpatient therapy might be reasonable knowing they might get worse and have to return. I suspect if this really takes off we will have to do this as a routine as there will be too many patients to admit. Just make sure you got the diagnosis right and this is not some other pneumonia...

John P. -

Regarding length of use of N95 masks - I have heard that they can only be used for 1 hour or once per patient encounter because the filter that makes them effective gets clogged. Were you able to uncover any further information regarding safe length of use of N95s?

Mel H. -

8 hours according to CAL Public Health department
https://www.cdph.ca.gov/Programs/EPO/Pages/Wildfire%20Pages/N95-Respirators-FAQs.aspx

John P. -

Thanks Mel!

John P. -

Another question - what is everyone else doing at your institutions for PPE with patients who present to the ED with an undifferentiated viral illness? Is anyone doning full kit for these patients or are you simply masking the patient and wearing a surgical mask and gloves yourself? If they end up testing positive for COVID-19, it would appear that the CDC is recommending self monitoring for 14 days for you as a provider.

SD -

You mention someone named 'Anisha Daya'? Can you link to some of their stuff, I can't find anything by googling.
Thanks.

Jordan T. -

First I would like to say, I have benefited so much from EM:RAP first as a medical student, then resident and now as a new attending.

My question is this. I have been trying and trying to find a map or resource that has areas where COVID-19 has been found to be community spread. Is there such a resource? Reason being is we don't currently have enough testing kits to test everyone with respiratory symptoms. But I know we should at least be trying to broaden out who is higher risk so I have been asking about travel outside of my county, no just country. But other than the obvious places like Seattle I don't have any information on where COVID-19 is endemic to help guide testing. The John Hopkins map is helpful but only so much. It's really the community acquired cases that I want to focus on and it doesn't help with that.

Any advice on this?

John P. -

Your state department of health might be putting out data. New York State is reporting confirmed cases by county.

Mel H. -

The John Hopkins map is the best I know -we have no good idea about community spread until we can do some testing. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Gregory P., M.D. -

Anyone have a workflow for offsite or drive through testing that is working smoothly? We are working on a workflow which will likely use initial screening over the phone or video and then sending individuals to an offsite area for testing. Of course, currently, we are still severely limited in our ability to test large numbers.

Michael V. PA -

Has anyone seen any information about co-infection with COVID-19 and influenza?

Mel H. -

Initially is was thought < 2% coinfection rate but a Chinese study had closer to 6% COVID-19 and influenza and MUCH higher in critically ill patients using IgM antibodies as a gold standard. So if you have a viral syndrome and test positive for flu you are at lower risk of COVID-19 than if you test negative but it doesn't rule out co-infection. The data are not great as you can imagine so we wait for more. https://www.emrap.org/corependium/chapter/rec906m1mD6SRH9np/Novel-Coronavirus-2019-COVID-19?MainSearch=%22covid%22&SearchType=%22text%22

Michael V. PA -

Great information. Thank you!

richard m., jr -

thanks for the excellent video. Can you please spell the name of the JH guy you mentioned: Adaya?

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