Clinical COVID-19 update by Andrew Morris
- Diagnosis hasn’t changed substantially, other than recognizing that a) travel history is now totally irrelevant, and b) we anticipate nosocomial spread to arrive soon in Canada, so should consider COVID infection in hospital-acquired illness.
- We are starting to see new tests get up and running. Overall, this will help us, but it makes understanding sensitivity and specificity very challenging—it is something that will need to be addressed over time.
- Anosmia is common in upper respiratory tract infections. Data is limited and is almost certainly not the real deal. Let’s wait and see.
- The evidence for all the various empiric therapies is very poor: HCQ study was of poor quality, a small number of patients, and comparators were uncontrolled. If this were anything but COVID, we would think it was Gwyneth Paltrow recommending. We have ZERO data on remdesivir (which has temporarily become unavailable except for children and pregnant women). Tocilizumab has a retrospective case series of 21 patients who seemed to respond miraculously well. And the lopinavir-ritonavir trial was a mixed bag—no clinical improvement or virological improvement, but mortality seemed lower (with a VERY WIDE confidence interval).
- There is lots of talk about increased mortality with high BMIs, but the quality of evidence is sorely lacking at present.
Global online meeting 5pm MST Wednesday 25 March 2020
Led by The International Federation for Emergency Medicine
This meeting will be held using Zoom. To join the meeting please click this link: //zoom.us/j/855206316.
If you’re having trouble you can also dial into the meeting. A list of international numbers is available here: //zoom.us/u/adsfME57JG. Webinar ID: 855 206 316
Topics covered will range from PPE preservation, ED design strategies, advocacy opportunities and caregiver well-being and psychological support.
This will be an interactive meeting including a live chat-box mediated Q & A.
This blog post is based on Level C evidence – consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes and require modification for your particular needs as well as approval by your hospital before use in clinical practice.