Sunday 29 November 2020

The 37th WACEM-ACAIM Weekly Summit: Week 9 of e-EMINDIA2020


Oxygenation Protocols

This week began with a review of two of WACEM-ACAIM team's publications - "Optimizing respiratory care in coronavirus disease - 2019: A comprehensive, protocolized, evidence-based, algorithmic approach" and "Short Term Home Oxygen Therapy for COVID-19 patients: The COVID-HOT algorithm". When we began to understand the impact COVID-19 was already beginning to have back in March, the WACEM-ACAIM team put together a clinical task force to address some of problems we foresaw. There was much new about the disease, and in fact, our understanding is still evolving. But we recognized fairly early that there may be disparities in care based on resources available to individual healthcare settings. We developed algorithms that are easy to follow and applicable to various settings. The first algorithm provides a step-wise escalation of care that follows the patient from the time they have their initial assessment. The latter paper classifies COVID-19 by severity, and provides a protocol for home oxygenation, aiming to reduce hospital burden.

Israel in the Corona Era: From the beginning and hoping for the end

Dr. Eran Tal-Or
Director of Emergency Department, 
Pade-Poria Medical Center,
Secretary of the Association for Emergency Medicine

We are grateful for Dr. Tal-Or sharing his Israeli experience and wisdom with us. Politics and medicine become intertwined something as impactful as this pandemic. In Israel, various experts present their assessments before the corona cabinet, who then weigh up the medical and political decisions. In mid April, there was a slow release of restrictive measures that were installed to curb infection rates, but as the restrictions were relaxed, the numbers inflated, bringing about their second lockdown. Some of this was a contribution from religious communities, local culture, sports. 
Interestingly, Israel has been tracking SARS-CoV-2 RNA through the wastewater treatment process, providing preliminary evidence for the importance of tertiary treatment and chlorination in reducing dissemination of the virus. They have developed a novel test, that provides results within seconds, which showed great accuracy in trials. All it takes is gargling a specially developed mouthwash and spitting it into a tube which then goes into the analyzer. They also have a big data analysis system allowing for healthcare systems to screen mass population. They ran a study assessing the outcome of treatment with convalescent plasma in patients with moderate to severe COVID-19. They are developing a promising vaccine as well. 
There is much to be learnt from clinicians and scientists from different aspects of the world, and with these weekly conferences, we get access so some of the most brilliant minds and best practices which we can amalgamate within our own systems towards global clinical betterment.

The national residency program this week featured the Medical Trust Hospital, Kochi, moderated by Dr. Murtuza Ghiya.

Medical Trust Hospital, Kochi

The Mask: Superhero in COVID-19

Dr. Mohammad Haneef 
Consultant and HOD,
Department of Emergency Medicine,

Among the advice for prevention of transmission of COVID-19, encouragement to use masks features prominently. Dr. Haneef brought some science to the debate. First describing virus transmission via drop infection, contact and inhalation, with a short deep dive into fluid flow behavior, he explained the concept of droplet transmission via facemasks. There are two key aspects to choosing a mask - it's thermal comfort - particularly important in tropical countries, and flow resistance. He shared with us these facts - 70% mask use could eradicate the pandemic, N95 masks are more effective than surgical masks which are more effective than cotton masks, and faceshields are effective.

Role of CXR in COVID-19

Dr. Muhammed Jezin, 
DNB Emergency Medicine

CT chest is considered the gold standard for imaging of the thorax in COVID-19. Dr. Jezin reviewed a study conducted to assess chest x-rays of COVID positive patients using the modified RALE score in correlation with clinical spectrum of disease. They collected data of 108 patients over 2 months, of patients with COVID-19. The imagining findings were correlated with predefined clinical severity of disease. Among the positive patients in their study, 35% showed chest X-ray abnormalities. Of these the predominant finding was ground glass opacities involving mainly the peripheral areas. When correlating to severity, most patients fell into the mild category. 

CRP as a screening tool for COVID suspects

Dr. Rohini J W,
Junior resident, Emergency Medicine

In this study presented by Dr. Rohini, 67 patients were isolated for a month, of whom 10 were RT-PCR positive. Chest X-ray was abnormal 40% of these patients, and CRP values were noted for all. Their study concluded that CRP has limited value as a standalone investigation, but may be used for prognostication, and as an early marker for severe disease. It appears earlier than CT changes. However she ended her presentation with the message to hold a high index of suspicion for the disease, and to consider more than any one screening tool to minimize risks.

Tune in for more next week

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