I am deeply appreciative of the heroic work and unique perspective offered by Dr. Consantini (sp?). We must prepare. No doubt about it. At the same time, I cannot help but wonder what is the reason for the very high case fatality rate in Italy. As of the 16th of March, with 2,158 deaths and 27,980 cases, the fatality rate in Italy is at 7.7%, much higher than the worldwide rate of 7,121 deaths out of 179,238 cases, for a rate of 4%. Dr. Consantini denies that significant rationing of critical care is occurring beyond the usual decisions that we make, in response to the overstretched healthcare system. It is true that Italy has an older population distribution, but that is not enough to explain a near doubling of the fatality rate. It is certainly possible that the denominator is incorrect due to continued undiagnosed cases. We must answer this question.
Is there any way to get more details about how the Italian ED lay out was changed from pre to post COVID? Any specifics regarding negative pressure versus simply source control via mask and doors would be appreciated. I have taken the info gleaned from the podcast back to our administration but the more details to assist us the better. Of note we have added HVAC to as many rooms as possible but a morphing a whole portion of the ED into negative pressure is not going to happen. Thanks for as much details as to change in structure and process as possible would be very appreciated.
Working to get more of those details now. Salim Rezaie has a post coming soon on rebelem.com with much of this detail and we'll see if we can reproduce here as well
Eric - basically viral pattern. There are some good posts out there with images: https://rebelem.com/covid-19-the-novel-coronavirus-2019/ https://radiopaedia.org/articles/covid-19-2?lang=us https://pulmccm.org/uncategorized/an-illustrated-guide-to-the-chest-ct-in-covid-19/
However, due to logistical issues (need to decon CT after use with a COVID patient (can take 2+ hours) and, we don't know how sensitive it is.
In China the number was 22-60%. I have not seen data from other countries ahead of on the infection curve yet.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585 ArticlePubMedGoogle Scholar
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China. Lancet Respir Med. 2020. S2213-2600(20)30079-5
Great work! I was wondering whether, during the height of the epidemic , was doctors/nurses that tested positive but feeling well, allowed/utilized to work in the HOT ZONE with covid positive patients? Extreme times = Extreme measures?
Thanks for the heads up about the rebelem segment on the Italian transformation of their ED. One rumored issue which surrounds the mass infections are that hospital spread is a big factor in the growing COVID problem. I am asking if any other ED are trying to truly split ED populations, not just via tents but in splitting up the ED into a dirty and clean pathway to mitigate this possibility. ED docs in the dirty section would have more and better equipment to minimize their risk as much as possible. Also thank to Jess and the live Segment where MSE exams were briefly discussed. Still much to talk about. Thanks again!!
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Benjamin M. S., M.D. - March 16, 2020 10:27 PM
I am deeply appreciative of the heroic work and unique perspective offered by Dr. Consantini (sp?). We must prepare. No doubt about it. At the same time, I cannot help but wonder what is the reason for the very high case fatality rate in Italy. As of the 16th of March, with 2,158 deaths and 27,980 cases, the fatality rate in Italy is at 7.7%, much higher than the worldwide rate of 7,121 deaths out of 179,238 cases, for a rate of 4%. Dr. Consantini denies that significant rationing of critical care is occurring beyond the usual decisions that we make, in response to the overstretched healthcare system. It is true that Italy has an older population distribution, but that is not enough to explain a near doubling of the fatality rate. It is certainly possible that the denominator is incorrect due to continued undiagnosed cases. We must answer this question.
brendan c. - March 17, 2020 2:08 PM
Is there any way to get more details about how the Italian ED lay out was changed from pre to post COVID? Any specifics regarding negative pressure versus simply source control via mask and doors would be appreciated. I have taken the info gleaned from the podcast back to our administration but the more details to assist us the better. Of note we have added HVAC to as many rooms as possible but a morphing a whole portion of the ED into negative pressure is not going to happen. Thanks for as much details as to change in structure and process as possible would be very appreciated.
Anand S. - March 17, 2020 2:12 PM
Working to get more of those details now. Salim Rezaie has a post coming soon on rebelem.com with much of this detail and we'll see if we can reproduce here as well
Eric C. - March 17, 2020 3:48 PM
What are your CT findings you are finding on for COVID?
Anand S. - March 17, 2020 3:51 PM
Eric - basically viral pattern. There are some good posts out there with images:
https://rebelem.com/covid-19-the-novel-coronavirus-2019/
https://radiopaedia.org/articles/covid-19-2?lang=us
https://pulmccm.org/uncategorized/an-illustrated-guide-to-the-chest-ct-in-covid-19/
However, due to logistical issues (need to decon CT after use with a COVID patient (can take 2+ hours) and, we don't know how sensitive it is.
Donald W. C. - March 17, 2020 6:28 PM
Do we know how many patients who end up on ventilators actually survive?
Mel H. - March 17, 2020 6:46 PM
In China the number was 22-60%. I have not seen data from other countries ahead of on the infection curve yet.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585
ArticlePubMedGoogle Scholar
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China. Lancet Respir Med. 2020. S2213-2600(20)30079-5
Donald W. C. - March 18, 2020 2:42 PM
Mel,
by way of clarification....is that 22 patients or 60 % of total.... or is that a range of 22 to 60 %
donald w crowe, md
Mel H. - March 18, 2020 2:58 PM
Sorry 22% to 60%
Hendrik V. - March 20, 2020 11:34 AM
Great work!
I was wondering whether, during the height of the epidemic , was doctors/nurses that tested positive but feeling well, allowed/utilized to work in the HOT ZONE with covid positive patients?
Extreme times = Extreme measures?
brendan c. - March 22, 2020 8:04 PM
Swami,
Thanks for the heads up about the rebelem segment on the Italian transformation of their ED. One rumored issue which surrounds the mass infections are that hospital spread is a big factor in the growing COVID problem. I am asking if any other ED are trying to truly split ED populations, not just via tents but in splitting up the ED into a dirty and clean pathway to mitigate this possibility. ED docs in the dirty section would have more and better equipment to minimize their risk as much as possible. Also thank to Jess and the live Segment where MSE exams were briefly discussed. Still much to talk about. Thanks again!!