CMAAO IMA HCFI Corona Myth Buster 24

You can drink sanitizer alcohol

Isopropyl alcohol is commonly ingested intentionally, either as an ethanol substitute or as a means to cause self-harm, or in accidental exposures. It is commonly used as a disinfectant, antifreeze, and solvent, and typically comprises 70 percent rubbing alcohol. When ingested, isopropyl alcohol acts as a central nervous system (CNS) inebriant and depressant. Its toxicity and treatment are similar to that of ethanol.

The hallmark of isopropyl alcohol metabolism is marked ketonemia and ketonuria in the absence of metabolic acidosis.

Isopropyl alcohol is rapidly and completely absorbed following oral ingestion. 200 ml can be the toxic dose and it could be less if the patient is on anti-depressants.

 

COVID-19 cannot be air-borne

WHO: Airborne transmission may be possible in specific circumstances wherein procedures that generate aerosols are performed, such as endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. An analysis of 75,465 COVID-19 cases in China did not report airborne transmission.

Like SARS, COVID-19 can travel through feco-oral root

WHO: No. Some evidence suggests that COVID-19 infection may cause intestinal infection and be present in feces. Until today, only one study has cultured the COVID-19 virus from a single stool specimen. There have been no reports of fecal-oral transmission of the COVID-19 virus till today.

In hospitals, virus can infect up to 3 hours

WHO: No. An experimental study published in the New England Journal of Medicine assessed virus persistence of the COVID-19 virus. In this study, aerosols were generated using a three-jet Collison nebulizer and fed into a Goldberg drum under controlled conditions. This high-powered machine does not reflect normal human cough conditions. Further, the finding of COVID-19 virus in aerosol particles up to 3 hours does not mirror a clinical setting in which aerosol-generating procedures are performed. This means that this was an experimentally induced aerosol-generating procedure.

WHO has no final recommendation

WHO continues to emphasize the significance of frequent hand hygiene, respiratory etiquette, and environmental cleaning and disinfection, besides the importance of maintaining physical distance and avoidance of close, unprotected contact with people with fever or respiratory symptoms. (WHO)

The R0 is an intrinsic feature of the virus

The pandemic seems to be guided by direct, human-to-human transmission. As a result, people have been told to practice social distancing, which seems to be a simple but effective way to drive down the virus’s reproductive number — i.e., R0 (R naught). This represents the average number of new infections generated by each infected person.

R0 is not an intrinsic feature of the virus. It can be reduced by means of containment, mitigation and herd immunity.

For the epidemic to begin to end, the reproduction rate has to come down to below 1.

In the early days of the outbreak in China, before extreme travel restrictions were imposed in Wuhan and nearby areas, and before everyone could realize the exact impact that the epidemic might have, the R0 was 2.38, as per a study published in the journal Science. This means a highly contagious disease.

On January 23, China imposed intense travel restrictions and put hundreds of millions of people into a sort of lockdown as authorities aggressively limited social contact. The R0 declined below 1, and the epidemic has been controlled in China, at least for now.

The virus does have an innate infectivity, as it appears from the way it binds to receptors in cells in the respiratory tract and then takes over the machinery of the cells to multiply. Its ability to spread depends also on the susceptibility of the human population, including the density of the community.

If someone has a seriously infectious virus and is sitting by himself in a room, the R0 is zero. He/she can’t give it to anybody. This is also the basis of lock down. [Excerpts from The Washington Post]

Aerial spraying should work

It is not possible to fight the virus through aerial spraying or by dousing the public drinking water with some potion.

We have not been able to trace patient zero

A shrimp seller at the wet market in the Chinese city of Wuhan, could possibly be the first person to have tested positive for the disease.

The London-based Metro newspaper stated that the 57-year-old woman, named by the Wall Street Journal as Wei Guixian, was selling shrimp at the Huanan Seafood Market when she developed what she thought was a cold last December. Chinese digital news outlet, The Paper, stated that she may be patient zero.

Knowing viral load has no significance

(The Lancet Infectious Diseases): Lescure and colleagues have described the first cases of COVID-19 in Europe, reported in France. The clinical features of five patients with COVID-19 are aligned with the quantitative SARS-CoV-2 viral RNA load from nasopharyngeal and other sampling sites.

While the authors make a case for COVID-19 presenting as three distinct clinical patterns, a distinction based on such small numbers seems highly speculative. On the basis of the assumption that viral RNA load correlates with high levels of viral replication, insights need to be gained from this time-course analysis.

Our understanding of the relationship between viral RNA load kinetics and disease severity in patients with COVID-19 continued to be disintegrated. Zou and colleagues had reported that patients with COVID-19 with more severe disease requiring intensive care unit admission were found to have high viral RNA loads at 10 days and beyond, after symptom onset.

Contrary to that, Lescure and colleagues reported the viral RNA kinetics of two patients who developed late respiratory deterioration despite the disappearance of nasopharyngeal viral RNA. It would be interesting to know whether viral RNA load in lung tissue, or another sample such as tracheal aspirate, mirrors the reduction in nasopharyngeal shedding. It appears that these late, severe manifestations might be immunologically mediated. This observation has significance for the use of immune-modulatory therapies for this subset of patients. This finding is consistent with recent reports that corticosteroids were beneficial for acute respiratory distress syndrome, and possibly those with COVID-19.

 

Lescure and colleagues noted the implications for transmission from patients with few symptoms but high viral RNA load in the nasopharynx early in the course of disease. Individuals within the community, policy makers, and frontline healthcare providers, particularly general and emergency room practitioners, should remain alert and prepare to manage this risk. The persistently high nasopharyngeal viral RNA load, and the detection of viral RNA in blood and pleural fluid, of the older patient (aged 80 years) with severe multi-organ dysfunction is disturbing.

Presence of viral RNA in specimens always correlate with viral transmissibility

No, in a ferret model of H1N1 infection, the loss of viral culture positivity but not the absence of viral RNA corresponded to the end of the infectious period. Real-time reverse transcriptase PCR results continued to be positive 6-8 days after the loss of transmissibility. [Lancet Infectious Diseases]

In SARS, live virus was detected for 4 weeks

No, for SARS coronavirus, viral RNA can be detected in the respiratory secretions and stool of some patients after onset of illness for more than 1 month, but live virus could not be detected by culture after week 3. [Lancet Infectious Diseases]

It’s easy to differentiate between infective and non-infective virus

The inability to differentiate between infective and non-infective (dead or antibody-neutralized) viruses is a huge limitation of nucleic acid detection. However, given the difficulties in culturing live virus from clinical specimens during a pandemic, using viral RNA load as a surrogate is reasonable for generating clinical hypotheses. [Lancet Infectious Diseases]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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