After first appearing in Wuhan, China in December 2019, the coronavirus disease, COVID-19, has quickly spread across the globe and reached the United States (1).
Over the past six weeks, RubiconMD has received an influx of eConsult questions on the coronavirus outbreak. Our Head of Medical Networks, Dr. Anna Potapov, sat down with two Infectious Disease Specialists to learn more about the eConsults questions they are addressing on COVID-19.
Our specialists recommend utilizing the CDC as a standard source of information, as they are frequently updating their resources. Most recently, the criteria for the evaluation of Persons Under Investigation (PUI) expanded to a wider group of patients showing symptoms. As the CDC notes, ‘most patients with confirmed COVID-19 have developed symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are encouraged to be on the lookout for these symptoms, and to test for other respiratory illnesses, including influenza (2).’ Depending on your region, your local department of public health might have additional recommendations.
On March 4, 2020, the USCF ID Working Group shared an adult evaluation guide (3) shown on the right.
A primary care clinician recently submitted an eConsult after growing concerns about the dwindling supply of N95 masks at their clinic. Our specialist noted that the CDC has advised that there is still no conclusive transmission dynamics for COVID-19. They also highlighted that utilizing precautions for droplet transmission is likely sufficient, but the possibility of airborne transmission has not been ruled out (4). According to our specialist, prevention can be very difficult if a clinic’s suppliers are out of N95 masks. Some clinics have switched to PAPR masks or general surgical masks as a result.
Hand hygiene continues to be the best and simplest precaution: wash or sanitize your hands at every opportunity, cough into your sleeve or elbow instead of your hands, and avoid touching your face.
Testing capacity is growing, but many tests are still run through the state public health lab. According to our specialist leading the efforts to control the outbreak in the state of Oregon, if a primary care clinician sees a patient and is aware of a risk protocol, the patient is sent to the emergency room for swabbing under airborne precautions and a sample is sent to the state public health lab. Testing kits were distributed to departments of health, but there is limited capacity at the moment. As of March 9, 2020, Quest Diagnostics and LabCorp were reported to begin rolling out COVID-19 testing (5) and local facilities are working to increase their testing capacity.
Clinicians can also use eConsults to ask specialists general questions in an effort to stay on top of the latest advancements. Here are a few of those questions.
Clinician Question: Is the PubMed Chloroquine study about protection for COVID-19 valid. If so, how do you dose it?
Specialist Response: Based on my research, this paper from two pharmacologists at Qingdao University, PR China claims to have found 'in vitro' activity of chloroquine against COVID-19; and that it was superior to control on 100 patients with COVID-19 pneumonia. They do not, however, offer any details on how the clinic study was conducted (6).
Clinician Question: Are ACE inhibitors protective for COVID-19 because it binds to ACE receptors? Is there any word from academics?
Specialist Response: I found one highly speculative paper released in Chinese claiming a potential link between ACE inhibitors for COVID-19. There is currently no supporting data to back up this claim (7).
Clinician Question: Are there any promising antiviral medications under investigation? I heard that Gilead is testing Remdesivir.
Specialist Response: This study appears to have potential. The National Institute of Health (NIH) is starting a randomized placebo-controlled trial of Remdesivir (developed by Gilead). I plan to continue to stay up to date on this one, and advise the same for other health care professionals (8).
The news on this virus is moving fast. Our specialists provided a list of resources for continual reference.
The CDC website features continually up-to-date information
The CDC facts sheet provides a quick overview and FAQs
CDC’s advised steps to prevent illness
The WHO website COVID-19 resource page
A COVID-19 update video by Florian Krammer, Professor of Microbiology at the Icahn School of Medicine at Mt. Sinai NY.
RubiconMD is here to support clinicians during this time of uncertainty. If you are a clinician interested in submitting eConsults to our specialists, feel free to reach out.
Please note this blog was written on March 9, 2020, the post may be updated as the news evolves.
Disclaimer: RMD is not a healthcare provider and the opinions provided by the Specialists are not medical diagnoses, treatments or prescriptions of any kind. In addition, the Specialists never establish a doctor to patient relationship. Any information provided is merely educational material for the clinician to better understand how a relevant Specialist would approach a similar case and use the information for their own knowledge. RMD makes no representations regarding the quality of the information provided by the Specialists. The Specialists are not officers, directors, agents, members, or employees of RMD.