Univadis COVID-19 Weekly Overview 27 March

  • Ben Gallarda
  • Univadis Medical News
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Due to the rapidly changing nature of the COVID-19 pandemic, we at Univadis would like to share with you the most impactful and clinically relevant articles across our network from the past week.

Some of these articles are only published in local languages, but we have tried to summarize the key points for you below and provide a link to the original source of each article in case you would like to read more, with languages other than English noted in brackets.

This is a snapshot of emerging best-practices during a rapidly evolving pandemic. Any and all information related to COVID-19 is subject to change as more details become available.

We hope this information will be useful to your ongoing care for all patients, whether directly involved with COVID-19 or not.

  1. UK tips for GPs on telephone and video consults:
    • Consider using a checklist to guide and record the consultation.
    • Establish who you are talking to and what the purpose of the call is.
    • Check what are the symptoms? Key COVID-19 symptoms are the new onset of fever and continuous cough.
    • Ask if the patient has any pre-existing conditions?
    • Ask about specific signs of deterioration and give clear advice on the signs of deterioration and what to do about them.
    • Give clear advice about staying at home.
    • Check what medications the patient is taking, in case any might need to be altered or suspended during a period of fever and possible dehydration.
  2. High-flow nasal oxygenation may speed and simplify tracheal intubation:
    • Use of high-flow nasal oxygenation during intubation led to faster intubation times and reduced the need for mask ventilation vs standard mask oxygenation.
    • Preoxygenation via bag-valve-mask can lead to desaturation and put providers at risk.
    • Risk factors for viral transmission during intubation include direct laryngoscopy, inadequate sedation, coughing, manual ventilation.
  3. Which medications can aggravate symptoms:
    • France has recommended [French] avoiding self-administered NSAIDs, as they may aggravate COVID-19 symptoms.
    • From the Lancet: ACE inhibitors and ARBs for hypertension could cause side effects due to the SARS-CoV-2 mechanism of infection.
    • France has established a drug-checking site: www.covid19-medicaments.com/ [French].
  4. Lopinavir-ritonavir showed no clinical benefit in a 199-patient randomized controlled trial:
    • The combination did not improve survival or time to clinical improvement
    • Editorial also published on these results, detailing potential reasons for lack of effect.
  5. International lessons learned [French editorial]:
    • What works: test early, often and widely; rapidly isolate confirmed cases; trace contacts of confirmed cases; confinement is an essential stop-gap; masks for all.
    • Health system advantages and weaknesses: social inequality has global negative effects; freely-available care is a considerable asset; GPs play an essential role; sufficient ventilator numbers crucial; advantageous use of technology; the importance of centralized and transparent government responses.
  6. Recommendations for GPs [German]:
    • Apart from self-protection, the protection of staff and other patients has a high priority.
    • Patients with acute respiratory infections and concerned people should be encouraged to stay at home and preferably not to visit the practice.
    • Testing not in practice, but at regional test stations / Tel. 116 117 (Germany) / Health Department; or alternatively, have patient self-administer throat swab.
  7. Obstetric and neonatal outcomes:
    • Retrospective study of 7 patients with COVID-19 pneumonia.
    • Outcomes for mother and child were good: no intensive care needed, normal birth weights.
    • 1 (of 3 tested) infant positive for COVID-19, discharged after 2 weeks, no respiratory symptoms at 28-day follow up.
  8. Improving testing:
    • PCR testing standard, but faster, 45-minute test just approved in the US.
    • Antibody-based testing coming online soon, based on work by the Pasteur Institute.
  9. Registry for key patient information sharing [Spanish]:
    • The goal is to share scientific information among hospitals and use algorithms to make real-time decisions based on clinical data.
    • More than 50 hospitals throughout Spain are already using the registry.
    • Inquiries into joining can be sent to [email protected].
  10.  Initial findings from Lombardy [Italian]:
    • Transmission potential very high and large case number quickly becoming unsustainable.
    • Increased public awareness and restrictive measures applied at an early stage are likely to lead to a reduction in the number and rate of reproduction.
    • Findings from a pre-print study on arXiv.
  11. ICU best practices from ESICM:
    • Use fitted respirator masks (N96/FFP2) during aerosol-generating procedures.
    • Avoid hydroxyethyl starches for acute resuscitation.
    • Mechanically ventilated patients: use low tidal volume (4-8 mL/kg), target plateau pressures (20).
    • Use high positive-end expiratory pressure (PEEP) strategy (>10 cm H2O), monitor for barotrauma, and avoid incremental PEEP recruitment maneuvers.