Inside Medicine. What Are You Seeing? [COVID-19 medical news]

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1541

Well, the department of HHS is purchasing 1.5 million rapid tests for nursing homes, and more for Alaska’s fishing industry, so why wouldn’t schools start planning to get them?

Western Michigan University got rapid tests from Quidel:

https://wmich.edu/news/2020/06/59788
WMU’s testing is voluntary, but they could translation to mandatory testing for f2f classes, dorm gatherings, sports practice etc. I think schools (businesses, etc.) should plan and push for this, rather than assuming it’s impossible. I don’t see another answer to open safely in the next year.

1542

There are about 1.3 million residents of nursing homes, plus staff. So this is about enough to test everyone once. Ridiculously inadequate for a nursing home testing program.

1543

If staff gets tested frequently, there will be not much need to test the residents who are confined and do not come into contact with anyone other than the staff.

1544

According to HHS.gov:

They could test residents for a couple weeks, and then stop and just test staff and visitors frequently (every day/every visit if possible).

1545

Only if the staff test negative.

I was just reading a paper today that said that 25% (!!!) of the workers in nursing homes in NJ tested positive during their crisis.

As I was reading this paper, it occurred to me that although Cuomo and other governors were wrong to return infected nursing home residents to nursing homes, that probably was not a big driver of infection. People are infectious right around the time they start showing symptoms. By the time patients are well enough to be released from the hospital, in most cases they won’t have been infectious any more.

https://arxiv.org/abs/2007.11789

1546

Wow, 25%! And many work in multiple facilities.

1547

Many facilities in states that are doing well, are allowing visitors with certain restrictions.

1548
"In this test, a user spits in a tube, adds a solution to stabilize it, then closes the lid and hands it off to testing staffers. They process it through a system requiring little more than pipettes, a heating source and an enzyme mixture.

If the sample turns from pink to yellow, the test is positive. If it doesn’t, it’s negative.

Because no swabs are required, and no elaborate equipment is needed, the tests are less vulnerable to backlogs and supply chain shortages, the researchers said.

“Every test that has been approved to date requires that the sample, even if it’s saliva, be processed in a clinical diagnostic lab or at a doctor’s office, using sophisticated equipment. That can take up to nine days right now,” said Sara Sawyer, a professor and virologist in the Department of Molecular Cellular and Developmental Biology, who led the development of the test."

It was my understanding that the tests mentioned in the TWiV episode 640 linked earlier used saliva on strips of paper/cardboard which sounds even less complicated than the CU Boulder tests. Was Michael Mina simplifying the procedure/details?

1549

"Researchers from King’s College London studied data from approximately 1,600 U.K. and U.S. patients who regularly logged their symptoms in the COVID Symptom Tracker App in March and April.

Typically, doctors will look for key symptoms such as cough, fever and loss of the sense of smell to detect COVID-19. The study, which has not been peer-reviewed, says the six different “types” of COVID-19 can vary by severity and come with their own set of symptoms."

Here are the 6 categories:

https://www.msn.com/en-us/health/medical/study-identifies-six-different-types-of-covid-19/ar-BB179KSE?ocid=msedgdhp

1550

Sanje Gupta on CNN reported that he is having to reuse his surgical N 95 over and over again. That is at Emory hospital, not a small regional hospital! So unacceptable! My daughter is a surgery resident at a major Boston hospital and says they sterilize their N95 masks for them. Where is the government, needing to make more PPE?

1551

Don’t look at me. I haven’t breast fed anyone in almost 25 years and it certainly wasn’t in a pandemic. :lol:

1552

Covid-19 can be a prolonged illness, even for young adults, CDC report says
From CNN’s Jen Christensen

Covid-19 can be a prolonged illness, even among young adults without underlying chronic medical conditions, the US Centers for Disease Control and Prevention reported Friday.

Thirty-five percent of those surveyed by the agency said they still weren’t back to their usual good health even two to three weeks after testing positive for coronavirus.

The CDC had survey results from 292 people who had a positive test for Covid-19 and were treated as outpatients from April 15 until June 25. The interviews were done 14 to 21 days after people were originally tested. The results were reported in the CDC’s Morbidity and Mortality Weekly Report on Friday.

Of those surveyed, 94% said they had at least one symptom when they went in for a Covid-19 test. People reported having a median number of seven of the 17 symptoms listed by the CDC. Fatigue was the most common complaint, followed by cough and a headache.

For the people whose symptoms lingered, 43% said they had a cough, 35% said they felt tired, and 29% said they were short of breath. The median time they had been interviewed was 16 days from when they tested positive.

Sixty-five percent of those surveyed said they had returned to their usual state of health between five and 12 days after they had a positive Covid-19 test.

Age seemed to play a role in whether someone still felt sick weeks after a positive test. More of the people in the 50-and-older demographic, 47%, said they still had symptoms weeks after their test. By comparison, for people ages 18 to 34, 26% said they still had symptoms. For people in the 35 to 49 age range, 32% said they still weren’t back to full health.

The more chronic conditions someone had, the more likely it was that they still had lingering symptoms. But even 1 in 5 younger people ages 18 to 34 who had no chronic medical conditions said they had not fully recovered.

The authors argue that public health leaders should remind people who may not take Covid-19 seriously that even younger, healthier adults who get a milder form of the disease can have symptoms for weeks.

People need to take precautions, the CDC said, and frequently wash their hands, wear a mask in public and keep physical distance from others to slow the spread of Covid-19.

1553

Somewhere around a quarter of young adults aged 18-35 will have symptoms if they are infected by covid. So using the CDC numbers, about 6-7% of young adults who get covid will still be sick two weeks after they first feel sick.

Here’s the CDC report @doschicos’ article references:
https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w

1554

FDA authorizes first test for asymptomatic Covid-19 cases
From CNN’s Shelby Lin Erdman

The US Food and Drug Administration has authorized the first coronavirus test for asymptomatic Covid-19 cases and for those who don’t think they’re infected with the virus at all.

The agency reissued an emergency use authorization for a LabCorp Covid-19 RT-PCR test after the company provided scientific proof that the test was able to detect the virus in asymptomatic people. RT-PCR tests amplify genetic matter from the virus so it’s detectable.

The emergency use authorization also allows the test to be used on pooled samples.

“Today’s authorization eliminates the need for a provider to consider risk factors such as exposure or community spread when prescribing this test,” the FDA said in a statement.

The test could be a game changer for hospitals, businesses, schools and others, the FDA said.

“FDA’s authorization of the first diagnostic test to be used for anyone, regardless of whether they are showing symptoms of Covid-19 or have other exposure risk factors, is a step toward the type of broad screening that may help enable the reopening of schools and workplaces,” FDA Commissioner Dr. Stephen Hahn said in a statement Friday.
The FDA’s emergency use authorization for the LabCorp test also allows the company to test pooled samples of up to five individual swabs at a time to help test more samples using fewer testing supplies, which are in high demand and short supply in some areas.

"By authorizing another test for use with pooled samples, we also further help increase the possibility that patients may be able to receive results sooner, while also conserving vital testing supplies, which are under increased demand during the pandemic,” Hahn said.

The test is only available through a prescription, the FDA said, and is only authorized for sample collection with LabCorp’s test kits or by a health provider.

The test first received an emergency use authorization in mid-March for testing only on people suspected of having Covid-19 and was not authorized for pool testing.

1555

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That’s correct. The narrative that thousands of nursing home residents died because of this policy is false. One only needs to look at Connecticut and Massachusetts who had no such policy and see the equally horrifying death rate in nursing homes to see that. It’s just a way to politicize a governor who became too well liked (for some) in this pandemic.

1556

I’m hesitant to step back in an interrupt this great discussion, but am closing the loop. My nasal swab from Monday was reported back to me on Friday afternoon: negative. After 5 days on prednisone, the odd rash is fading, and my sleep is too short, but this too shall pass.

1557

Great news @Mom22039 ! Thanks for closing the loop.

1558

Dr Seheult works with Covid pts. in the ICU at a hospital in Southern California. He’s also an Associate Clinical Professor at the University of California, Riverside School of Medicine and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He has board certifications in Internal Medicine, Pulmonary Diseases, Critical Care Medicine and Sleep Medicine.

In Dr. Seheult’s MedCram Coronavirus Update #99, he discusses “long haulers,” those who have “recovered” from the virus but continue to have issues for weeks or months post recovery. Hope this video can be of help to someone still suffering.

https://www.youtube.com/watch?v=tFXr14xmuGw

1559

Dr. Seheult also discusses At Home Testing in his Coronavirus Update #98 and explains what @3SailAway was also trying to point out in earlier posts.

https://www.youtube.com/watch?v=h7Sv_pS8MgQ

1560

BTW that youtube link is to medcram and this is referring to the TWIV with Micheal Mina. Twiv referenced medcram this week I think.