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Shinkicker

Shinkicker

For what it's worth
Jan 30, 2016
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I'm working at a hospital in The Oakland area.

Great. Just fuk'n great.

But I may already have it.
 
Splinty

Splinty

Shake 'em off
Admin
Dec 31, 2014
44,116
89,915
From a physicians list serve I'm on:

Sharing:

3/8/2020

Notes from the front lines:

I attended the Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7. In attendance were physicians from Santa Clara, San Francisco and Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence hospitals, who has 2 affected Seattle hospitals under his jurisdiction. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.

1. The most common presentation was one week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the second week of illness. It is an average of 8 days to development of dyspnea and average 9 days to onset of pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent.
2. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China.
3. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
4. Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as well. Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.
5. To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.
6. If our local MCHD lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation. Presumably, this would only affect inpatients though since we (CHOMP) have decided not to collect specimens ordered by outpatient physicians.
7. At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temperature check and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.
8. Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort.
9. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.
10. All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines.
11. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments.
12. Health Departments (CDPH and OCHD) state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.

Feel free to share. All PUIs in Monterey Country so far have been negative.

Martha.

Martha L. Blum, MD, PhD
Medical Director, Infection Prevention and Antimicrobial Stewardship
(831) 333-3040
(831) 886-3639 fax
martha.blum@montagemedicalgroup.org
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Splinty

Splinty

Shake 'em off
Admin
Dec 31, 2014
44,116
89,915
Shinkicker said:
I can't believe I missed something on the internet. Lol

But I wouldn't say that lightly. I traveled via airplane Feb 17. Fever started (or I finally noticed enough to check) 4 days ago. Slight dry cough started yesterday.
It can't be the flu. I got the vaccine.

I'm keeping a log. But I gotta work, y'all. Sorry.
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It can still be the flu even if you got the flu vaccine. You could get a different strain and you would be expected to get more mild symptoms due to your flu vaccine.

If you have a fever you shouldn't be at work anyway. No fever and I agree with you. Life goes on and wear a mask like usual.
 
Shinkicker

Shinkicker

For what it's worth
Jan 30, 2016
10,404
13,872
Splinty said:
It can still be the flu even if you got the flu vaccine. You could get a different strain and you would be expected to get more mild symptoms due to your flu vaccine.

If you have a fever you shouldn't be at work anyway. No fever and I agree with you. Life goes on and wear a mask like usual.
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I was being sarcastic about the flu vaccine. It doesn't resemble the flu as my symptoms are coming on too slow.
 
Shinkicker

Shinkicker

For what it's worth
Jan 30, 2016
10,404
13,872
Splinty said:
It can still be the flu even if you got the flu vaccine. You could get a different strain and you would be expected to get more mild symptoms due to your flu vaccine.

If you have a fever you shouldn't be at work anyway. No fever and I agree with you. Life goes on and wear a mask like usual.
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And about the Fever, typically I wouldn't work with a fever. Noticed it Thursday but by that night fever was gone. I was off Friday and spot checked it. Once, it was 99. No fever that night or Saturday morning so went to work Saturday and Sunday. Noticed a cough last night and again very mild temp 100. I don't go back to work until Wednesday so I'm monitoring. I'm not freaking out or anything but I don't want to be irresponsible if I truly am having symptoms.

Btw, I don't know about you but I was sick off and on the whole first year that I worked in healthcare. But I (knock on wood) rarely get sick now. I have many times went through this (very mild symptoms) and not actually get "sick". Nothing boosts the immune system like working in a hospital.
 
lueVelvet

lueVelvet

WHERT DA FERCK?
Aug 29, 2015
5,045
7,439
Work is testing the BCP systems/procedures to see if we can support everyone in our NYC office can WFH should they need to. This will be fun. :cool:
 
FINGERS

FINGERS

Banned
Nov 14, 2019
17,004
19,803
lueVelvet said:
More disinfo that has found its way into these types of videos. There is no evidence that Pangolins are a vector for this bug.

Mystery deepens over animal source of coronavirus
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I didn't get that they flat out stating it was a bat crossed with a Pangolin but they were suggesting it was a possible way the virus mutated to humans.

But scientists have now examined those data — along with three other pangolin coronavirus genome studies released last week — and say that although the animal is still a contender, the mystery is far from solved

Even your link suggests it might be that.

Point is is it those disgusting wet markets that create these mutations.
 
lueVelvet

lueVelvet

WHERT DA FERCK?
Aug 29, 2015
5,045
7,439
Conor McGregor nut holder said:
I didn't get that they flat out stating it was a bat crossed with a Pangolin but they were suggesting it was a possible way the virus mutated to humans.

But scientists have now examined those data — along with three other pangolin coronavirus genome studies released last week — and say that although the animal is still a contender, the mystery is far from solved

Even your link suggests it might be that.

Point is is it those disgusting wet markets that create these mutations.
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I don't disagree that we don't have a definitive source but everyone I've spoken to (wildlife researchers etc) all believe it was from bats.

Here is an interesting article regarding Bats as a potential (and most likely) vector...

Coronavirus outbreak raises question: Why are bat viruses so deadly?
 
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