Covid19 War Room: 2-22-20

I looked at two resources today, both located at the Lancet Respiratory Medicine site.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30071-0/fulltext#articleInformation

The first report is a flow chart of treatment and triage. See Figure One in the link above. The authors (Zhang, et al) start their treatment assessment with a patient who presents with a sore throat, chills and or a cough. The first test is for oxygen saturation in the patient’s peripheral blood system by oximeter. Any patient with SpO2 levels below 93% can be shunted directly to treatment Measure #4 (Supplemental Oxygen, Admission to an isolation ward. Arbidol, memonoxacin or linezolid.), given a SARS-CoV2 virus test and if positive on that test, given Measure @#5, “transfer to a designated hospital”.  Since maybe an eighth of patients present without a fever, the authors use a lymphocyte count. If found to be lymphocytopenic, <1100/microL, they are sent for a chest CT scan and if virus is detected there, a diagnosis of viral  pneumonia is considered, and if that looks probable they can be sent for treatment measure #3: Isolated observation, Sars-Cov-2 testing, Respiratory quinolones and Arbidol. And, if their SpO2 is now below 93% they are shunted to treatment measure #4 discussed above.  Figure one shows that a patient can be sent forward to a CT scan from three directions: with or without shortness of breath and SpO2<93%, with or without a fever >99.14’F.

For those who are visual learners, I recommend drawing your own version of this chart, paying attention to all of the ‘yes’ and ‘no’ flow directions.

The second study narrowly focuses on a sample of patients with the Covid 19 illness  who are in critical care.

https://www.thelancet.com/pb-assets/Lancet/pdfs/S2213260020300795.pdf

The study at the above link observes the transit of 52 critically ill patients through the ICU in Wuhan, China. I should caution the reader that what I am going to say does not apply to entire populations, does not represent the rate of mortality for this virus among those who are infected; does not represent the mortality rate of the 14% who have severe infections; and only represents the vulnerability of the most vulnerable, most critically ill, five percent who require hospital ICU care.

It is upsetting to read that the most critically ill who are infected with Sars Cov2 virus and who develop, Covid19 illness, are just as likely to die from this version of Sars as they did from the last version of Sars. For this critically ill group, only 50% will survive. All of the patients had virus related pneumonia. As a group the non-survivors were older, and were more likely to develop ARDS, and to require mechanical ventilation. The overall more severe, more critical condition of the non-survivors appears to reflect how poorly they will do in intensive care.

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