Episode 44: COVID-19 Part 1

Author: Eoghan Colgan  @eoghan_colgan
Special Guest: Dr Alisdair MacConnachie

26/02/20

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Guest Bios

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Dr Alisdair MacConnachie is an Infectious Diseases Physician working in Glasgow and Clinical Lead for the service. Although he has a particular interest in travel-related infection, he describes himself as a "Jobbing" ID Physician with a varied clinical caseload. He also works as an acute Physician in the Immediate Assessment Unit at the Queen Elizabeth University Hospital in Glasgow.

Show Notes

Dr Alisdair MacConnachie is a Consultant in Infectious Diseases in Glasgow. Eoghan and Alisdair discuss what we know about Coronavirus and the new strain COVID-19: why the concern, what we know, how to manage suspected cases, and a whole lot more.

TAKE-HOME POINTS

Coronavirus

  • a group of viruses that can cauise the ‘common cold’

    • runny nose, coryza, cough, headache, fever

  • most originated in other mammals (bats contain the widest variety of the virus)

why the current concern?

  • There have been recent cases of new coronavrius with more significant symptomatology:

    • SARS (severe acute respiratory syndrome)

      • originated in China/SE Asia

      • likely spread from civet cas

      • causes a severe disease with patinets requiring respiratory support

    • MERS (Middle-East Respiratory Syndrome)

      • originating in camels

      • not as severe as SARS but easily transmissable

  • COVID-19 is another one of these events

    • development is due to close proximity to animals

    • likely from bats but might be through an intermediary (such as snakes)

    • clustered around seafood market in Wuhan China that was selling many animals/animal products

Coronoavirus vs Influenza

  • it is mostly about perspective

    • Influenza is an horrendous disease and many die every year

    • but there is familiarityu and this likely breeds complacency

  • Coronavirus likely more infectious (every case infects 2.5 more)

    • we don’t yet know how severe it is

    • definite lack of familiarity and predictability

TYPICAL DISEASE PROCESS

  • Coronavirus typically causes an upper respiratopry illness (like the common cold)

    • typically above level of corina, so no pneumonitis or secondary bacterial infection

    • but can exacerbate COPD and heart failure

  • COVID-19

    • we know quite a lot about the severe end and less about the milder end of the disease

      • fever is the commonest symptom (>90% report this at presentation) - however this is from a cohort admitted to hospital

      • cough 50-60%

      • others inclu;de myalgia, GIT upset etc

    • At the severe end - we only know what is published

      • median age of admission is in the 40’s

      • young can get severe disease (bilateral infiltrates, gas-exchange problems, ground-glass changes)

      • a sizeable proportion needing ventilation

      • those that die tend to be older with underlying cariorespiratory illness, hypertension, renal disease etc (same that typically die from influenza each year)

Community management

  • No Contact with disease

    • unless the patient has travelled to somewhere with high numbers of cases, or has had contact with someone who is proven positive, don’t consider COVID-19 as the reason for the respiratory illness

    • stay at home, symptomatic relief, seek help if SOB (GP or NHS 24)

  • If had contact with disease (returned from high-risk area)

    • if develops respiratory illness within 14 days of return - phone NHS 111

    • they will be assessed for where appropriate to test

      • could be at hospital (Infectious Diseases unit)

      • or at home (get tested in the community)

        • Public Health teams in Scotland are testing at home

          • Throat Swab, Nose Swab and Sputum if possible

        • Results can be obtained within 1 day if tests in early

  • POSITIVE TEST AND WELL

    • hasn’t occurred in Scotland yet but current advice is all positive patients should be admitted for isolation and management if needed

Hospital management

  • If don’t fit current case definition then treat as a non-COVID-19 case

  • if they fit the definition then treat as a possible case

    • don’t forget there is a patinet who isn’t well - be safe but prioitise their care

    • remember they are more likely not to have the disease

    • isolate in a physical location that can manage

      • ideally a negative pressure room with a lobby

      • in ED: ideally a single room with ensuite toilet

  • PPE (Personal Protective Equipment) must be worn by all staff caring for at-risk patinet

    • FFP3-level facemask

    • Eye cover/face cover on top

    • full length (full arm) water repellent gown

    • gloves

    • Remember - wearing PPE makes it harder to look after your patients

  • Spread is via droplets (coughing/sneezing)

  • Can put facemask on patient

    • a fluid-repellant surgical mask can greatly reduce environmental exposure

  • Keep same staff looking after patient

    • ID use a sign-in sheet so keeps track of individual expsoure

Removing PPE in a non-negative pressure facility

  • understanding is being >2 meters from patient is a safe distance to avoid significant exposure

  • Can remove most of the PPE within the room (but leaqve mask on until outside)

  • Take most contaminated items off first

    • Put alcohol gel onto gloves and let it dry

    • remove gloves and add more alcohol gel to hands and let dry

    • remove gown, then clean hands again with alcohol gel and let druy

    • remove visor, then clean hands again with alcohol gel and let dry

    • keep facemask on and exit room

    • more alcohol gel on hands

    • remove facemask, then clean hands with soap and water

links

For the latest updates on COVID-19 - visit these excellent resources. Simply click on the iamge.

Good for patients

Good for patients

Hannah BellRP5Comment