CMAAO IMA HCFI Corona Myth Buster 21

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Loss of Smell & Taste is not a screening test

NEJM: The American Academy of Otolaryngology — Head & Neck Surgery has proposed to add anosmia and dysgeusia to the list of screening items for potential COVID-19 disease.

Informally, these symptoms have been noted among some patients whove tested positive for COVID-19, and in some cases, anosmia was the only symptom.

Depression is uncommon in COVID-19

JAMA Network Open study of 1300 healthcare workers in China (mostly from Hubei) in late January and early February noted that 50% of the subjects had symptoms of depression, 45% had anxiety, 34% had insomnia, and 72% had symptoms of distress. Nurses, women, frontline workers, and those in Wuhan had more severe symptoms.

The infection rate is 3.4%

No. A report published in MMWR provides details of COVID-19 cases aboard cruise ships. On the Diamond Princess, 19% of the 3700 passengers and crew got infected. Nearly half were asymptomatic when they tested positive, although many developed symptoms later.

Cardiac injury is uncommon in COVID-19

No. Cardiac injury is a common complication among those hospitalized with COVID-19 and it is associated with significantly increased mortality as per a report in JAMA Cardiology.

Researchers studied over 400 patients hospitalized with COVID-19 in Wuhan, China. Around 20% had cardiac injury, defined as elevated cardiac biomarkers (e.g., high-sensitivity troponin).

Patients with cardiac injury were more likely than those without cardiac injury to require non-invasive ventilation (46% vs. 4%) and invasive ventilation (22% vs. 4%). Patients with cardiac injury also had a higher mortality rate (51% vs. 5%). After adjusting for confounders, including acute respiratory distress syndrome, cardiac injury was still a significant predictor of mortality.

We cannot predict the advantage of social distancing

A new study published in Lancet Infectious Diseases bolsters support for strict social distancing measures. Making use of simulation models, researchers in Singapore estimated the number of SARS-CoV-2 infections that would occur at 80 days after the first 100 cases of community spread were confirmed, assuming that 7.5% of infections were asymptomatic.

In a setting when the virus was least infectious (assuming each case infects another 1.5 people), a median 279,000 infections is estimated to occur by day 80. This would decrease with increasing social distancing measures, coming down to 1800 when all of the following were put into place: isolation of infected individuals and family quarantine, workplace distancing, and school closures.

Notably, assuming that the virus is more infectious (one case infects another 2.5 people), there would be over 1.2 million infections at day 80 with no social distancing measures — and 258,000 with all measures in place.

Italy’s 7.2% mortality is not true

JAMA viewpoint analyzed the high case-fatality rate in Italy — 7.2% as of mid-March.

The authors note that this could be attributed to three major factors: 1) nearly one-fourth of Italys population is 65 years of age and above; 2) some deaths may have been due to comorbid illness rather than the SARS-CoV-2 infection; and 3) mild and asymptomatic cases were rarely tested after late February and were therefore, not included in the denominator.

Still, the 7.2% rate in symptomatic cases is higher.

Undocumented COVID-19 Infections are linked to Transmission

No, it’s a hidden disaster. In China, undocumented infections fueled the rapid early spread of SARS-CoV-2. The number of individuals infected with SARS-CoV-2 with minimal symptoms is an important determinant of the pathogens pandemic potential, as these infections are likely to go undiagnosed.

Using mathematical modeling, investigators estimated the number of undocumented infections and their contribution to SARS-CoV-2 transmission in China.

Subjects were segregated into two groups: those with symptoms severe enough to elicit care-seeking and a documented COVID-19 diagnosis, and those with undocumented infections. The model also accounted for changes in human mobility between cities based on recent historic data adjusted for the escalating restrictions on such movement.

At the beginning of the epidemic, the estimated basic reproductive number (R0) was 2.38 and the percentage of undocumented infections was 86.0%. Undocumented infections were estimated to cause 86.2% of all infections.

Later in the epidemic and with increased testing, the proportion of undocumented infections fell to 35%, and the R0 dropped to 1.36 and then to 0.99 as restrictions on geographic movement tightened. (Science 2020 Mar 16)

Lung involvement is unilateral

No. In a report from a hospital in Shanghai, investigators reviewed the key initial CT findings in 51 consecutive patients hospitalized due to COVID-19 disease. All patients had thin-section noncontrast scans. Mean age was 49 (range, 16–79), and median time from symptom onset to CT was 4 days. (Radiology 2020 Apr)

Almost all patients had extensive multifocal involvement; bilateral abnormalities were seen in 86% of cases. Lesions were seen in the lower lobes, posterior lung fields, and peripheral lung zones. Three quarters of patients had ≥3 involved lobes.

Various combinations of pure ground-glass opacities (GGOs), GGOs plus reticular or interlobular septal thickening, and GGOs plus consolidation were commonly noted. GGOs were predominant in patients whose symptoms started ≤4 days prior to CT, and areas of consolidation became increasingly evident in those with >4 days of symptoms.

Pleural effusion is common in COVID-19

No. Only four patients had pleural effusions. [Radiology 2020 Apr:]

Coronavirus update india

How lockdown  can save india from Coronavirus

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Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Budget 2019 must focus on making One Health a reality in India: HCFI

Health Care, Heart Care Foundation of India, Medicine Comments Off

All health-related aspects must come under the ambit of single department

New Delhi, 28th June 2019: As the nation gears up for the first set of policies to be announced by the new government, it remains to be seen what the powers-that-be have in store for India’s healthcare sector. Making simple, accessible, and affordable healthcare a reality is the need of the hour as is the idea of ensuring that the concept of One Health turns into a reality in the country.

In most nations world over, inter-sectoral coordination has been established by the concerned governments, to consult with each other, share their knowledge, and provide effective and efficient means to control emergence of such diseases as per protocols set by the World Health Organization under their one health programme.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The time has come for health professionals, environmentalists, and agriculture professionals to work collaboratively and develop solutions to various problems which are increasing with each passing year. Although the One Health programme is in place in India, it does not seem to be getting the right results due to different administrative and ministerial controls. It has often been seen that allocation of budgets are spread over different ministries looking after the human, animal, agriculture, and environmental health programmes.”

One Health is a concept that incorporates human, animal, plant, and environmental health (air, water, earth) under one roof. It recognizes that the health of people is connected to the health of animals, plants and the environment.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “At present, the ministries of health, agriculture, rural development, environment, road transport, climate change, earth sciences, water, Women and child development, Swatch Bharat Program, ICMR, ICAR, IARI, etc., are looking after their respective matters of human concern.”

The Heart Care Foundation of India (HCFI would request the government to consider the following while framing guidelines for the budget.

  • Bring administrative and budgetary control of all such schemes of all segments that deal with health of humans, animals, environment-climate change, agriculture production, and disease control, under one roof namely “One health Program”. This will enable the scientists working in these sectors independently on prevention and control of diseases that have potential to shift their host from one sector to other, and these can be better researched and controlled.
  • Allocate common budget or link these budgets for these programmes so that more intersectoral cooperation and sharing of knowledge takes place. Besides, overlapping of programmes in these ministries will also go away to a large extent and thus would also result in more saving of financial outflow.
  • Provide emergent care services free of cost or reimbursed to the private sector by the government.

Precaution and not panic is the key in preventing Nipah infection: HCFI

Heart Care Foundation of India, Medicine, Social Health Community Comments Off

Monitoring and surveillance are the need of the hour

New Delhi, 6th June 2019: A total of 314 people have been quarantined and placed under observation for having been in immediate contact with the 23-year-old youth diagnosed as having contracted the Nipah virus. The boy, however, is stable and eating well. Two more persons were admitted to the Government Medical College (GMC), Ernakulam, taking the numbers of suspected Nipah infections to seven. The need of the hour is to educate the public on taking precautions and not panic.

Nipah virus infection is a newly emerging zoonosis, which causes severe disease in both humans and animals. The associated mortality is high. The natural hosts for the Nipah virus are the fruit bats of the Pteropus genus, which are symptomless carriers.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “About 60% diseases in humans and 75% of emerging infectious diseases are zoonotic in nature and are spread from animals to humans. Nipah is an emerging disease. Many re-emerging diseases such as avian influenza are also transmitted from animals to humans. Animals are also susceptible to some diseases and environment hazards similar to humans. Hence, they may also be early warning signs of impending human illness. Zoonotic diseases should be identified at their animal source itself and acted upon at that point of time in the cycle. And, instead of considering a human patient as the index case, the infected animal should be the index case.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “There are lessons to be learnt from the Nipah outbreak. Monitoring systems should be in place preempt any future outbreaks. Disease surveillance should be continual and not episodic. It is also of utmost importance to increase public awareness about these diseases so that they can take due precautions. Otherwise, a small outbreak such as this may well turn into an epidemic.”

With geographical boundaries fast disappearing today, the pathogens get greater opportunity to rapidly travel around the world to different locations where they were previously unknown. However, there is no need to panic and some precautions must be taken to prevent the infection from spreading.

  • Ensure that the food you eat is not contaminated by bats or their feces. Avoid consuming fruits bitten by bats.
  • Avoid drinking toddy that is brewed in open containers near palm trees.
  • Avoid contact with anyone who has contracted the disease. Sanitize and wash your hands thoroughly if you happen to visit someone with NiV.
  • Clothes, utensils and items typically used in the toilet or bathroom, like buckets and mugs, should be cleaned separately and maintained hygienically.
  • It is important to cover the face while transporting the dead body of anyone who dies after contracting Nipah fever. Refrain from hugging or kissing the dead person and take precautions while bathing the body before cremation or burial.

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