Episode 45: COVID-19 Part 2
Author: Eoghan Colgan @eoghan_colgan
Special Guest: Dr Alisdair MacConnachie
28/02/20
Listen
Guest Bios
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. In this epidose they cover tsting, treatments, management, predictions for the future and a whole lot more.
TAKE-HOME POINTS
TREATMENT
Standard ABCDE, Oxygen, respiratory support if needed
No good evidence for any treatmnents
Steroids don’t work
they do not alter outcome and suggestion they worsened outcomes in SARS
don’t give unless another reason to do so
POTENTIAL TREATMENTS
the virus uses ACE-2 receptors to gain entry to respiratory cells, so theoretical benefit of ACE-inhibitors (being tested)
some in-vitro data suggesting lopinovir/retonavir (used in HIV) may be helpful
Remdesovir (developed fro Ebola): some in-vitro and animal model data suggesting benefit
Majority will require only symptomatic management and isolation for public-health reasons
Respiratory failure: average time from hospital diagnosis to repiratory failure is 7.9 days
a combination of early presentation (owing to public awareness) and slow progression
so time to predict and plan if worsening respiratory problems
discussions then take place around early consideration of intubation vs high-flow oxygen
TESTING
Nose swab: take the samle from as far back in nasal cavity as you can
Throat swab from tonsilar bed
sputum sample if possible (around 50% are able)
PENDING TEST RESULTS:
if well, could go home and self-isolate but advised not to walk home or take public transport
so logistaically they may end up staying pending the result
ideally in a negative pressure room
alternatively a single room with en-suite bathroom
POSITIVE CASE
several groups of people will be involved:
Public Health
Infectious Diseases
Local Infection Control Teams
An incident-management team will be set up and coordinate the individuals care plus tracing and testing contacts
After they leave the department:
a standard deep clean with chlorine-based cleaning agents (bleach)
cleaners will need to wear full PPE
IF STAFF MEMBER EXPOSED TO POSITIVE CASE (without wearing PPE)
don;t panic: even if you get it, it will likely be an insignificant illness
the incident management team will take care of this
current advice is self-isolate at home for 14 days, and get tested if develops symptoms
CONTAGIOUSNESS
average incubation priod is 5-6 days, but has been up to 14 days (hence the guidance)
it is likely spread from symptomatic people (coughing/sneezing)
a couple of case reports of potential spread from asymptomatic patients, but this has been contested
but not a lot is known about th emilder form of the disease and we are learning more every day
ALISDAIR’S GENERAL TAKE
It is very difficult to strike a balance between over-reaction and under-reaction
Having such a broad case definition is very challenging
It is likely to be very hard to prevent it spreading within our population, with the virus having attributes suitable for pandemic spread:
can be mild
high contagious rate
respiratory spread
Current projections is of a pandemic spread similar to 1950’s Flu outbreak
the weight of numbers will be difficult to manage
those that die will likely have significant comorbidity
a suggestion that 60% of the population will contract it, and it will become a seasonal respiratory illness
PREPAREDNESS
currently we have capacity to cope with the prevention of spread
But there will come a time when higher rates in the population will make current model unsutainable
there will have to be a move to ‘well cases’ being managed at home and only those with significant symptoms being admitted
this would be similar to standard influenza management
INFLUENZA
a major issue every year, but we aren;t great at communicating that to the public
advice will become the same in time, but key differences are:
currently no interventions for COVID-19 (unlike flu) - hence the concern
Neuraminidase inhibitors: reduce lengthh of stay and need for critical care
Vaccinations: reduced need for hospitalisation, ICU, and mortality (but doesn’t reduce the risk of catching it)
COVID-19 doesn’t use neuraminidase, unlike influenza
TREatment development
Global Co-operation
within 2 weeks of first description, they had identified coronavirus and had a gene sequence
After a further few weeks they had a test
There will likely be a vaccine within 18 months (pharmaceutical companies actively researching)
THE FUTURE
Humans are NOT top of the food chain
Most scary thing he looks after is Influenza (with TB a close-second)
they’ve both been around a long time and not gone away
We are documenting a natural phenomenon: The spread of pathogens from animals to humans has likely happened for years, but we now havethe technology to identify in more detail and communicate information more easily
PREVENTING SPREAD IN FUTURE
we have developed great systems to tackle global spread
unclear if overkill or necessary
but will likely be required in the future
global travel increases risk of pandemic
most big cases have been associated with ‘movements of people’
1918 flu: people returning home after first world war
Spanish Conquests aided by introduction of flu to siouth america which incapacitated the locals
OTHER PATHOGENS OF NOTE
H5N1 (Avian Flu) - is still a worry (and causes significant mortality)
Viral Haemorrhagic Fevers: febrile illness on returning from Africa
MERS
GENERAL ADVICE
wash your hands
try not to get too paranoid
links
For the latest updates on COVID-19 - visit these excellent resources. Simply click on the iamge.
Good for patients