CMAAO IMA HCFI Corona Myth Buster 19 (For attention of Doctors)

Maximum cases are in China: No, the cases in USA are now over 85377

ICU is manageable:  No. A nurse, not named by CNN, posted on social media that patients are streaming in with “non stop coughing, sweaty, fevers” and with “fear in their eyes.”

“I cry for the ones who passed away. I cry because we intubated 5 patients within 10 min and I am terrified. I cry for my co workers, because we know it will get worse and I already feel like that is impossible and we are already at our breaking point, I cry for the parents, children, siblings, spouses who cannot be with their loved ones who may be dying but cant have visitors because there is no visiting allowed,” stated the nurse. [NBC Palm Springs]

Handwash will do

No, SANITIZE all ITEMS YOU TOUCH REGULARLY

Cellphones

Computer keyboard and mouse

House and car keys

Re-usable water bottles

Car steering wheel

Clothing pockets

Door handles

Toilet seats

Stop disinfection after patient is discharged

No. COVID-19 virus can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be inactivated by means of surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute.

Other biocidal agents including 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate seem less effective.

Hence, terminal disinfection is important even after the patient gets discharged [INTERNATIONAL PULMONOLOGIST’S CONSENSUS ON COVID-19]

There is no urban rural difference

In US, all the hotspots are in urban areas or the communities near them, and about 55% of all cases and new cases continue to be in the New York Metropolitan area. [WebMD]

COVID-19 is not seasonal

COVID-19 will likely become seasonal, says Anthony Fauci, MD, director of the National Institute on Allergy and Infectious Diseases and a member of the White House Coronavirus Task Force.

Tracking suggests that cases are appearing in the Southern Hemisphere as they transit into their winter season.

Respiratory failure does not increase the risk

Respiratory failure portends a poor prognosis. A retrospective cohort study from Wuhan, China of 191 seriously ill patients with confirmed COVID-19 disease reported only a single survivor among 32 patients who received mechanical ventilation. [https://www.thelancet.com/pb-assets/Lancet/pdfs/S014067362305663.pdf]

CPR success rates are as in any other illness

The survival to hospital discharge for all critically ill patients receiving CPR is very low (<15%), with already being on mechanical ventilation, older age, and co-morbidities reducing that likelihood even further. [https://www.atsjournals.org/doi/full/10.1164/rccm.200910-1639OC.] As such, CPR may be medically inappropriate in a significant portion of elderly, critically ill patients with COVD-19 and underlying comorbidities.

The COVID-19 pandemic also poses a significant public health risk. Like other infectious diseases such as MRSA or TB, providing CPR to COVID-19 patients poses risks to first responders and healthcare personnel, who must don personal protective equipment (PPE) to safely attempt resuscitation.  Donning PPE may mean a delay initiating CPR in COVID-19 patients. However, this delay is necessary to protect the healthcare workforce, other patients in their care, and the public.

 

CPR has to be given to all

 

If treating clinicians, including more than one physician, determine that CPR is not medically appropriate, a Do Not Attempt Resuscitation Order (DNR) may be written without explicit patient or family consent. In all cases; however, the patient and/or appropriate surrogate should be informed of this decision, along with the rationale in support. Patient or family “informed assent” should be sought but is not required.

[https://www.sciencedirect.com/science/article/pii/S0012369215366332?via%3Dihub]

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Give time to people to accept DNR

Under normal circumstances, if a terminally ill patient or their family were reluctant to accept a recommendation for DNR, they would be given more time.  The COVID-19 outbreak influences DNR decisions because we will need to make code status determinations earlier to ensure that we do not perform medically inappropriate codes.  Any patient, COVID-19 or not, for whom clinical assessment suggests CPR is unlikely to be beneficial should have a DNR.  Early goals of care discussions are encouraged.

Dr K K Aggarwal,

President CMAAO, HCFI and Past National President IMA

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