Spreading facts among an outbreak of fears and rumors.
Everyone’s talking about – and wondering about – Coronavirus (COVID-19). Here are the answers to some common assertions, to better educate your patients, families, and colleagues.
Coronavirus is a family of viruses that typically causes the common cold and upper respiratory symptoms. It is spread mainly through respiratory droplets, coughing and sneezing, though can spread by face touching (particularly eye) with a recently exposed hand. The time of onset of symptoms is 2-14 days from exposure, with about 80% of patients exhibiting few if any symptoms.
With the rapid spread of news and misinformation, there are many myths being circulated about COVID-19. The EPM board crafted a list of myths people are spreading faster than the virus along with the reality of this strain and its impact. See the full list at epmonthly.com.
MYTH 1: COVID is a respiratory illness. Patients present with coughing, fever and dyspnea
TRUTH: Partially true. While COVID patients most commonly develop respiratory symptoms, the symptoms of a COVID infection can vary widely. Almost half of COVID patients have nausea, vomiting or diarrhea some time during their illness and 7 of 204 COVID patients in one Chinese study had solely GI symptoms. In addition, COVID patients with GI symptoms tended to have worse outcomes. One-third of COVID patients have a loss of smell as a presenting symptom and often have mild to no respiratory symptoms. A small percentage of COVID patients have conjunctivitis as a presenting symptom and coronavirus has been isolated in human tears.
Don’t rely on an absence of typical symptoms to rule out coronavirus. COVID symptoms can be anything but typical.
MYTH 2: SARS-CoV-2 will be picked up on current respiratory antigen panels
TRUTH: False! Typical respiratory pathogen panels test for influenza, pertussis, chlamydia, human metapneumovirus, rhinovirus, RSV, and several subtypes of coronavirus (including 229E, HKU1, NL63, and OC43) but not SARS-CoV-2. Panels may be updated in the future to include novel coronavirus testing.
MYTH 3: N-95 masks will help protect average people from contracting the disease
TRUTH: The CDC is recommending people NOT wear N-95 masks in public. It’s true that a properly fitted N-95 mask, sealed around the chin, mouth and nose can block about 95% of airborne particles from being inhaled. That’s probably going to cut down on COVID transmissions in controlled, limited healthcare encounters. But fitting and sealing the mask properly takes work. Staff needs to take breaks and take the mask off frequently. Wearing an N-95 mask for long periods of time, and frequently adjusting it with potentially contaminated fingers may well negate any protective effect.
MYTH 4: I have to shave my beard now to take care of COVID patients
TRUTH: PAPR (powered air-purifying respirator) ought to be available to you in your ED — a lot of hospitals stocked up during the Ebola epidemic of 2014. The sequence to secure the rechargeable battery to your person, then properly donning the head covering, is more elaborate than an N95 respirator and the level of protection is actually higher (PAPRs’ HEPA is capable of filtering 99.97% of 3 micron diameter particles). However, if you want to wear an N-95 mask, the CDC’s blog says that proper fitting may permit you to keep the moustache or the soul patch, but will require that you lose the neck beard.
MYTH 5: I should stockpile masks and take antibiotics
TRUTH: Neither of these actions will help. Antibiotics have no effect on viruses.To limit the spread of COVID, prevention is important. Wash your hands. Cough or sneeze into your arm or into a tissue, not into your hands. Avoid touching your eyes, nose and mouth, which makes it more likely to spread germs. Avoid contact with other sick people. Think “social isolation.” Clean objects before touching them (like shopping cart handles, door handles, your car’s steering wheel, and computer keyboards).That being said, a 42 patient nonrandomized trial in France showed hydroxychloroquine plus Zithromax significantly reduced the viral load in COVID patients. At six days, 100% of patients with the two drug combination had negative SARS-CoV-2 PCR titers compared to 57.1% of patients with hydroxychloroquine alone and 12.5% of control patients. So those requests for Z-packs may become more common.
On the other hand, an Arizona man died and his wife is in critical condition after they ingested chloroquine from a fish tank cleaning kit in order to try to prevent COVID infections. Wait for larger clinical trials before ingesting cleaning chemicals.
While hoarding toilet paper may become the new norm, hoarding and taking antibiotics probably won’t help.
MYTH 6: It isn’t safe to go to spaces where people with coronavirus have occupied
TRUTH: While we still don’t know how long it takes for coronavirus to clear from the air in a room, CDC studies on other pathogens show that clearance rate of airborne pathogens from the air in a room is, in part, determined by air flow rate — or how many “air changes per hour” occur in that room. The more ventilation that occurs, the less time it takes to remove airborne pathogens. For 99% of an airborne contaminant to be removed from a room, it takes 28 minutes of ventilation if there is the equivalent of 10 air changes in the room per hour. It takes more than two hours (138 minutes) to remove 99% of airborne pathogens if there are only two air changes in the room per hour. Keep this in mind when you’re sitting in the ED waiting room … or riding the subway.
MYTH 7: I can catch Coronavirus from my dog
TRUTH: Possible, but unlikely. However, a Chinese scientist and epidemiologist working on the Coronavirus said that mammal to mammal transmission is possible. In addition, the one case of Coronavirus was documented in a Pomeranian dog from Hong Kong. Just to be on the safe side, don’t go kissing your animals on the lips. Oh, and vets recommend against masks for dogs, even though puppy PPE is becoming commonplace in China.
What else can we do as EM physicians?
- Know that hospitals have been working on infectious disease-related surge capacity issues for 20 years. It’s time to involve your hospital administration, dust off the playbook, making sure there’s a way to prioritize your negative pressure rooms and discuss resource allocation.
- Get to know your county and state public health officials and refer patients to health department web sites. They can help divert patients, provide appropriate discharge instructions, and facilitate protocol development.
- Protect your staff. Make sure everyone knows how to don/doff properly. *Please reference the CDC link below for guidance on the donning and doffing process and share it with your teams.
Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949
Other resources on Corona Virus:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/identify-assess-flowchart.html (FLOW CHART for patient workup)