Medicine Grand Rounds- SARS-CoV-2: Outpatient and non-ICU Hospital Evaluation and Care - Shared screen with speaker view
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The CME code for today’s grand rounds is: 04cast
for those joining the eeds passcode is 04cast
would the grocery store workers or cafeteria workers qualify for being tested at Tufts as they may spread it too?
how worried are we about GI symptoms? Does that require testing?
Have persons with asthma had more asthma exacerbations secondary to COVID19?
Your screening is helping us in the ED. Thank you!
How are you addressing quarantine (the need for strict distancing from people in their own house) without confirming testing in patients with mild symptoms.
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Could you talk about hypoxia as a criteria for admission--is it age dependent? Would you admit a young patient with no comorbidities and a sat of 91% as well ?
Also can you talk about the "end" of illness and clearning folks after illness for return to work or "off quarantine"
Is there concern the oropharyngeal swabs are not as sensitive as nasopharyngeal swabs? Other institutions seem to be using nasopharyngeal preferentially. Especially as the test is 70-90% sensitive?
Are we still checking routinely for urine for strep and legionella, flu?
Stephanie Wrobel Goldberg
can you comment on hydroxychloroquine, azithromycin, BCG vaccine on all of this
charles murphy, MD
Any insight as to the availability of a reliable antibody test so that HCWs can be screened for immunity?
mark - if all of the questions can’t be answered during grand rounds, could someone please respond to the questions over an email afterwards?
I also thought that teams are tracking LDH daily along with CBC, CRP, and ferritin as disease markers
With regards to COVID swabs, there has been some confusion on the floor as to who is responsible for obtaining. MD? Nursing? Can we clarify please.
There seems to be evidence individuals shed virus after 14 days -- as of now employee health and the organizations guidelines are not in line with DPH, to return to work 7 days or 3 days after symptom resolution. even with universal masking, aren't we risking dissemination to our other staff and patients in the long run?
we will get to as many questions as possible then will try to answer the ones we do not get to. will do
Hi, could you also comment on role of single dose hydroxychloroquine for HCW as chemoprophylaxis for HCW in high risk setting? What is your opinion?
so is WELL controlled asthma not a RF for bad outcome?
How is poorly controlled diabetes defined by CDC, what is A1c cut off?
If asthma is fairly controlled on inhaled steroids, is the risk factor still high?
Absolute ferritin or rise?
Are healthcare workers in direct contact with COVID patients at higher risk for severe disease if they contract it due to repeated exposure? Should the docs in direct contact (not just aerosolized procedures) be wearing N95 masks?
is there a covid bundle order set that includes all of these labs?
Is there any role for using labs (LFTs, LDH, D-dimer) in the outpatient setting ?
In multivariate analysis, what markers are significant?
should the covid 1/2 team have regular nightcapps type rounds with ICU teams or at least fellow on for people who are worrisome especially as we go into the night?
yes great job Vidya!
are residents involved in helping with the trials
Any role for NSAIDs like Naproxen and Indomethacin as anti-inflammatory agents?
What about ibuprofen? Also, if we're not using hydroxychloroquine as part of a trial, should we rethink its use?
Hi, could you also comment on role of single dose hydroxychloroquine as chemoprophylaxis for HCW in high risk setting? What is your opinion?
Is it possible to check blood for antibody for sars coV2? to look for exposure.
What is the sensitivity/specificity for the test at Tufts? Should we re-test someone who has typical symptoms but has 1 negative test?
I’m struggling to understand our hesitancy to test broadly given how minimal the symptoms are in some people
Inpatient teams could use guidance about criteria for discharge. I'm told that NY hospitals are discharging pts improving clinically and by lab markers but with continued fever and on supplemental 02. Would we do that in a bed crunch? Do we need to make f/u calls to patients at home if discharged before danger window (days 5-9)?
Should we suggest non healthcare workers who return to work prior to 14 days wear a mask?
Are we retesting outpatients who are initially negative, but symptoms are progressing?
Maria Antonietta Mazzola
Has there been any serological testing for COVID done to assess for prior exposure ?
Any protocol on post discharge monitoring recommendation? There are a number of case reports that people who discharged came back with worsening symptoms around day 8, some with rapid decline. Also any thought on prevalence of pulmonary emboli in COVID patients?
Stephanie Wrobel Goldberg
any hope with better outcome with weather getting warmer?
What is our limiting step in testing. Is it swab availability? It seems we should be testing as many as possible