John R. Greenland, Marilyn D. Michelow, Linlin Wang, Martin J. London; COVID-19 Infection: Implications for Perioperative and Critical Care Physicians. Anesthesiology 2020;132(6):1346-1361. doi: https://doi.org/10.1097/ALN.0000000000003303.
This is a clinical decision support tool developed by a commercial global health care collaborative based on patient data on over 20,000 COVID patients from the >1,000 hospitals world-wide (85% US/Europe).
NEJM review " includes a discussion of the clinical picture, diagnosis, and management of mild-to-moderate disease. The authors delineate the categories of medications that clinicians have given to patients with COVID-19, with an emphasis on the lack of convincing data to support any intervention"
NEJM review " focuses on severe disease, requiring admission to an intensive care unit. The authors discuss strategies for respiratory support, including decision to intubate, mechanical ventilation, and adjunctive interventions for refractory hypoxemia. They prioritize use of established evidence-based principles to treat acute respiratory distress syndrome (ARDS)"
ECRI is the new guidelines.gov - the latest information and life-saving resources available to help hospitals, ambulatory care, and aging care facilities protect healthcare workers, residents, and patients.
Covers potential emergency use, off-label and/or experimental use of medications and immunosuppression management for transplant patients as well as a suggested laboratory
work up. It does NOT cover recommendations for infection control, personal protective equipment
(PPE), management of hypoxemia or other complications in patients with COVID-19. This is a living document that will be updated in real time as more data emerge.
The AAMC COVID-19 Clinical Guidance Repository includes content from academic medical centers (AMCs) as a resource for hospitals and clinicians across the United States. The goal is to identify, summarize, and highlight areas of alignment in clinical practice during the pandemic. Here you will find up to date COVID-19 treatment and management guidance to help clinicians optimize patient care. Clinicians can view, access, and download clinical guidance that has been collected from AMCs.
Hulsbergen AFC, Eijkholt MM, Balak N, et al. Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation [published online ahead of print, 2020 May 14]. Acta Neurochir (Wien). 2020;1‐6. doi:10.1007/s00701-020-04375-w
This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.
The HHS Office for Civil Rights (OCR) has provided guidance that helps explain civil rights laws as well as how the HIPAA Privacy Rule allows patient information to be shared in the outbreak of infectious disease and to assist patients in receiving the care they need.
Authors assign points for likelihood of surviving to hospital discharge and points for likelihood of long-term survival (based on underlying life expectancy). Age itself is a “tie-breaker,” favoring younger patients when point scores for two patients are equal.
Bledsoe TA et al. Universal do-not-resuscitate orders, social worth, and life-years: Opposing discriminatory approaches to the allocation of resources during the COVID-19 pandemic and other health system catastrophes. Ann Intern Med 2020 Apr 24; [e-pub]. (https://doi.org/10.7326/M20-1862)
Pourmand A, Ghassemi M, Sumon K, Amini SB, Hood C, Sikka N. Lack of Telemedicine Training in Academic Medicine: Are We Preparing the Next Generation? [published online ahead of print, 2020 Apr 15]. Telemed J E Health. 2020;10.1089/tmj.2019.0287. doi:10.1089/tmj.2019.0287
Based on our understanding of the emerging literature, we aim to provide in this short commentary a simple list ([Table 1]) of laboratory tests, as may be recommended for patients with COVID-19 and to potentially assist in prognostic monitoring of such patients.
Background: The outbreak of novel coronavirus pneumonia (NCP) caused by 2019-nCoV spread rapidly, and elucidation the diagnostic accuracy of different respiratory specimens is crucial for the control and treatment of this diseases. Methods: Respiratory samples including nasal swabs, throat swabs, sputum and bronchoalveolar lavage fluid (BALF) were collected from Guangdong CDC confirmed NCP patients, and viral RNAs were detected using a CFDA approved detection kit. Results were analyzed in combination with sample collection date and clinical information. Finding: Except for BALF, the sputum possessed the highest positive rate (74.4%~88.9%), followed by nasal swabs (53.6%~73.3%) for both severe and mild cases during the first 14 days after illness onset (d.a.o). For samples collected ≥ 15 d.a.o, sputum and nasal swabs still possessed a high positive rate ranging from 42.9%~61.1%. The positive rate of throat swabs collected ≥ 8 d.a.o was low, especially in samples from mild cases. Viral RNAs could be detected in all the lower respiratory tract of severe cases, but not the mild cases. CT scan of cases 02, 07 and 13 showed typical viral pneumonia with ground glass opacity, while no viral RNAs were detected in first three or all the upper respiratory samples. Interpretation: Sputum is most accurate for laboratory diagnosis of NCP, followed by nasal swabs. Detection of viral RNAs in BLAF is necessary for diagnosis and monitoring of viruses in severe cases. CT scan could serve as an important make up for the diagnosis of NCP. Funding National Science and Technology Major Project, Sanming Project of Medicine and China Postdoctoral Science Foundation.
A group of experts from the federal government, industry, and academia call for additional research into whether the presence of antibodies protects against reinfection and stressed that, for now, antibody tests "should not be used as a stand-alone tool to make decisions about personal safety related to SARS-CoV-2 exposure."
"Healthcare workers point to several factors that influence their ability and willingness to follow IPC guidelines when managing respiratory infectious diseases. These include factors linked to the guideline itself and how it is communicated, support from managers, workplace culture, training, physical space, access to and trust in personal protective equipment (PPE), and a desire to deliver good patient care. The review also highlights the importance of including all facility staff, including support staff, when implementing IPC guidelines."
Finegan O, Fonseca S, Guyomarc'h P, et al. International Committee of the Red Cross (ICRC): General guidance for the management of the dead related to COVID-19. Forensic Sci Int. 2020;2:129‐137. Published 2020 Mar 31. doi:10.1016/j.fsisyn.2020.03.007
Sud SR. COVID-19 and Keeping Clean: A Narrative Review to Ascertain the Efficacy of Personal Protective Equipment to Safeguard Healthcare Workers Against SARS-CoV-2 [published online ahead of print, 2020 May 8]. Hosp Pediatr. 2020;hpeds.2020-0135. doi:10.1542/hpeds.2020-0135
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, Tikka C, Ruotsalainen JH, Kilinc Balci FS. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD011621. DOI: 10.1002/14651858.CD011621.pub5.
We found low‐ to very low‐certainty evidence that covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort. More breathable types of PPE may lead to similar contamination but may have greater user satisfaction. .. a one‐step glove and gown removal, double‐gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance.
The app estimates how many days a PPE supply will last given current inventory levels and PPE burn rate. It allows entry by # of individual units or boxes of supply, can calculate for a wide variety of specific PPE (such as small N95s), and varying number of patients.
Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate FFRs. This document summarizes research about decontamination of FFRs before reuse.
Cramer A, Tian E, Galanek M, et al. Assessment of the Qualitative Fit Test and Quantitative Single-Pass Filtration Efficiency of Disposable N95 Masks Following Gamma Irradiation. JAMA Netw Open. 2020;3(5):e209961. doi:10.1001/jamanetworkopen.2020.9961