Saturday, March 14, 2020

How are physicians preparing for coronavirus?

The above is an hour long video with Stanford University Dept. of Medicine physicians discussing how they're preparing for the coronavirus. What Stanford is doing seems similar to how physicians at other academic medical centers are preparing for the coronavirus too (e.g. UCLA, USC).

However, I presume many people would find it boring to watch the whole thing. To be honest, I haven't watched it either, but I plan to watch it soon.

So, instead of watching the video, people might find the following easier to digest: Dr. Joy Wu offers her take-home points:


Now I'd like to comment on her comments, just to clarify to people what they mean. I'll put my comments below her comments. I've bolded her comments.

  • 6 ft is farther than you think

    The coronavirus is primarily transmitted via droplets such as in coughing or sneezing. Apparently coronavirus droplets can be propelled up to 6 feet in distance.

    By the way, the virus is likewise transmitted via fomites. Fomites are inanimate objects like door handles and tables.

  • Trials starting with remdesivir

    Remdesivir is a drug that has been studied in Ebola as well as against other coronaviruses including SARS and MERS. Stanford is going to start enrolling coronavirus patients in clinical trials and using remdesivir.

    See this Wiki entry for the stages of clinical trials. I presume the trials are still in the earliest stages.

  • In-house RT-PCR test screens for Envelope, confirms with RNA-dependent RNA polymerase

    All this refers to is how Stanford is testing - screening and diagnosing - for the coronavirus.

    Of course, in-house refers to Stanford themselves, not (say) an outsourced commercial lab.

    PCR is commonly used in medicine to amplify genetic material (DNA, RNA). It's fast, cheap, and reliable.

    The "envelope" refers to the part of the coronavirus they're targeting.

    Coronavirus is an RNA virus, not a DNA virus. Coronavirus hijacks an infected cell's inner machinery to reproduce itself and spread.

  • Now running >300 tests/day for Bay Area hospitals, ramping up to 1000 tests/day

    That's good to hear. Of course Stanford alone can't do all the testing. Private companies are needed too. See Scott Gottlieb's tweet to see the testing capacity we currently have around the US. Gottlieb updates this daily.

  • Clinical presentation is not like influenza, instead a slowly progressive hypoxia

    Clinical presentation refers to what a patient "looks like" when they first come to see a doctor. Their signs and symptoms. Such as a patient who is pale, blue, wheezing, coughing, sputum, etc.

    Doctors are clinicians, along with nurses, PAs, and others.

    Influenza refers to the seasonal flu. It's been thought coronavirus "looks like" the flu, clinically speaking. Apparently that's not the case.

    Hypoxia refers to oxygen deficiency. Hypoxia often goes hand-in-hand with ischemia. Ischemia refers to reduced blood supply. That's because red blood cells carry oxygen, so if there's reduced blood supply (ischemia), then it often results in oxygen deficiency too (hypoxia). Ischemia in turn can lead to cell/tissue/organ damage and, if not reversed, even death.

    Likewise people can Google for radiologic images of people's lungs infected with coronavirus to see how all this could affect our lungs.

  • May be associated with leukopenia and transaminitis

    Leukopenia refers to low or decreased white blood cells. White blood cells help fight infection.

    Transaminases are liver enzymes like ALT and AST. So this could suggest liver damage (if elevated).

  • Stanford ED triage for flu-like illness now done outside by RN in PPE

    The triage starts with a nurse in full PPE (personal protective equipment) in the parking lot outside the emergency department. Rather than people coming directly into the ED. The nurse is supported by a physician inside the ED.

    If a person is identified as a PUI (person under investigation) for coronavirus, then they'll be moved to a negative pressure room. However there's only a limited number of negative pressure rooms. If there are no more available negative pressure rooms, then patients will be moved to a closed room with a HEPA filter.

  • Stanford Healthcare has activated an Emergency Operations committee that meets daily

    Self-explanatory. Physicians need to stay on top of things. Tons to do. Hence the daily meetings.

  • Outpatient testing ramping up at Express Care: screening via video visit, then drive-through specimen collection if indicated

    Outpatient refers to patients not admitted into a hospital. By contrast, inpatient refers to patients who are admitted into a hospital.

    Like many if not most academic medical centers today, Stanford University has their own primary care services (e.g. family medicine, pediatrics). Express Care is part of Stanford's primary care services.

    Screening can be compared to diagnosis. If someone is diagnosed with a disease, then it's definite they have the disease. If someone is screened for a disease, they potentially but not definitely have a disease.

    I assume video visit means telemedicine.

    There can be different specimens collected. I presume Stanford does nasopharyngeal or oropharyngeal swabs.

    Indicated basically means if there's a valid reason to do so.

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