Apple Podcasts or Listen Here

We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Also, please check out Brief19.com for the latest research and policy updates regarding COVID-19

Apple Podcasts or Listen Here

We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Also, please check out Brief19.com for the latest research and policy updates regarding COVID-19

Amanat et al – A serological assay to detect SARS-CoV-2 seroconversion in humans

Apple Podcasts or Listen Here

We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Check out Brief19.com for the latest research and policy updates regarding COVID-19. If you’re looking for details on COVID-19, REBELEM and IBCC are excellent, comprehensive resources.

Apple Podcasts or Listen Here

We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Check out Brief19.com for the latest research and policy updates regarding COVID-19. If you’re looking for details on COVID-19, REBELEM and IBCC are excellent, comprehensive resources.

Hospitals and healthcare agencies across the United States are struggling to obtain adequate personal protective equipment (PPE). As a result, the US Centers for Disease Control and Prevention has created contingency plans for PPE depending on its availability. Recent updates include “crisis” plans which recommend use of bandanas, scarves, or homemade masks (because something is better than nothing). This isn’t uncharted literature territory…

Mills D et al. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control. 2018;46(7):e49-e55.

Apple Podcasts or Listen Here

We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Also, please check out Brief19.com for the latest research and policy updates regarding COVID-19

Cytokine Storm – Mehta et al describe cytokine storm or secondary hamophagocytic lymphohistiocytosis (sHLH), a hyperinflammatory state, which characterizes some presentations of critical COVID-19.

The Society of Critical Care Medicine (SCCM) updated their COVID 19 guidelines (reviewed here), in which high flow nasal cannula (HFNC) was recommended. HFNC is an aerosol generating form of oxygenation so we review some of the data around this, including an article by Will Loh et al.

Asymptomatic transmission and basic reproductive number (Ro). Aguilar et al.

Apple Podcasts or Listen Here

We are going to try to bring you near daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Also, please check out Brief19.com for the latest research and policy updates regarding COVID-19

Today we bring you the Society of Critical Care Medicine (SCCM) Surviving Sepsis COVID-19 Guidelines.

Apple Podcasts or Listen Here

We are going to try to bring you daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med. 2020; In Press

Apple Podcasts or Listen Here

We are going to try to bring you daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. 

Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Shah, N. Higher co-infection rates in COVID19. https://medium.com/@nigam/higher-co-infection-rates-in-covid19-b24965088333

Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020; doi: 10.1542/peds.2020-0702 

Fang et al. Lancet March 11 wrote that ace-inhibitors should be avoided due to concern for worsening COVID-19 severity. This was immediately debunked by the European Society of Cardiology as without any evidence.

An article in the BMJ, mistaken in the news for a study (which it is not), in addition to comments by the Health Minister in France, created a viral panic to avoid ibuprofen for fever of severity. Initially reports stated the WHO recommended individuals avoid ibuprofen, however 3/18/20, the WHO reversed this statement.

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In this episode, we reivew the evaluation and management of community acquired pneumonia (CAP), including the 2019 guidelines from the Infectious Disease Society of America (IDSA) / American Thoracic Society (ATS) [1].

Regarding Biomarker Recommendation

Regarding the recommendation against using procalcitonin (PCT) to guide decision making to initiate antibiotics in CAP, the guidelines reference an older Cochrane review. The newer review (2017) claims a mortality benefit but combines trials from ICU/ED/primary care that use PCT to both initiate and/or guide antibiotic treatment. Amongst ED trials, the OR was 0.97 (95 CI 0.70,1.36) for 30-day mortality (I2=0%). For all trials combined, the forest plot demonstrates an OR 0.89 (95CI 0.78, 1.01). However, when adjusted this resulted in an aOR 0.83 (95CI 0.70 ,0.99) [2]. A meta-analysis recently published Ebell et al claims of C-reactive protein (CRP), PCT, and leukocytosis, CRP has promising utility in the diagnosis of CAP [3]. However, no single threshold had adequate operating characteristics (for any of the biomarkers), as the sensitivity/specificity trade-off was quite large. The ACEP draft clinical policy for CAP recommends against the use of biomarkers (Level C recommendation)

Regarding Pneumonia Severity Index (PSI) Recommendation

The IDSA/ATS guidelines recommend use of PSI or CURB-65 to identify patients who should be admitted or treated as outpatients. A draft of the American College of Emergency Physicians CAP clincial policy (not yet finalized) did not come to this same recommendation and had a more tempered recommendation – “Use the PSI or CURB-65 CAP mortality decision tools to help identify low-risk patients who may be appropriate for outpatient treatment.” The PSI is long and cumbersome. While it may identify a larger number of patients that can be treated as outpatient, we believe that not all of these test are necessary if you believe a patient can be treated as an outpatient.

References:

1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
2. Schuetz P, Wirz Y, Sager R, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;10:CD007498.
3. Ebell MH, Bentivegna M, Cai X, Hulme C, Kearney M. Accuracy of Biomarkers for the Diagnosis of Adult Community-acquired Pneumonia: A Meta-analysis. Acad Emerg Med. 2020; In Press