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When your faceshield fogs in the ED, you can almost see the virus. Here's how healthcare workers have fared with COVID-19.
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At least the CDC is keeping tabs: of 50,000 COVID+ patients from mid-February to early April, almost 20% identified as healthcare personnel (HCP). More than half of participants (admittedly in a much smaller poll) reported contact with COVID only in health care settings, making on-the-job transfer the chief culprit. Ninety percent of HCP avoided the hospital, but the CDC recorded 27 deaths, 10 of which were among persons > 65 years. Alongside fever, cough, and dyspnea, two-thirds of HCP reported myalgia and two-thirds reported headache. A sixth of afflicted HCP wrote in loss of taste or smell in the ‘other’ category.
MMWR
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How does COVID escape surveillance? Mostly through asymptomatic or presymptomatic spread. Viral load peaks after symptom onset in closely-related SARS, and asymptomatic flu patients have little to no shedding from the upper respiratory tract (URT). SARS-CoV-2 bucks the trend: a study of transmission in a Washington State skilled nursing facility found that URT viral loads (as measured through nasopharyengeal swabs) were similarly high in patients with and without symptoms. While half of COVID-positive patients were asymptomatic at the time of testing, almost all developed symptoms within 4 days.
NEJM
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The antiviral remdesivir is the first COVID treatment to show efficacy in a large, placebo controlled trial. The NIH-sponsored ACTT trial enrolled 1,060 hospitalized patients with COVID-19, and a prelim analysis from an independent review board found that remdesivir reduced median time to recovery to 11 days from 15 days with placebo. Mortality trended towards a benefit (8% with remdesivir vs. 12% with placebo) but results were not statistically significant. Clinical benefit is similar to oseltamivir in the flu, meaning the drug is more a first step than a silver bullet. More data will be released soon, but the boss himself (Dr. Fauci) said remdesivir should now be standard of care when available.
NIH
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The Corona Score tells you who in the ED is likely to have COVID before PCR tests result. Daily COVID test results across the US. A COVID patient simulator taken straight from the '80s. Follow @MedicineScope on Twitter for more.
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When you've mind-melded with the EMR
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You need some time off. But we welcome the news of a 'mind-controlled' prosthetic hand that gives sensory input and receives motor commands. The device is implanted in the proximal humerus where electrodes connect to the nerves and muscles of the upper arm, and patients took between 10 and 40 weeks to gain intuitive arm control. Here are images of the prosthesis in day-to-day use.
NEJM
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When full code becomes a reflex
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COVID-19 has brought goals of care to the forefront in ways previously tough to imagine, but there's a lot of room for improvement. A retrospective study of 1,800 decedents with Physician Orders for Life-Sustaining Treatment (POLST) found that 30% of patients with comfort-only orders were admitted to the ICU, and 14% of these patients received a life-sustaining treatment. The authors estimate that around 40% of patients with treatment-limiting POLSTs received care potentially not in line with their wishes.
JAMA
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