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Plain sticky notes

Current Covid Disease Clinical Management Outline

DIAGNOSIS - Surveillance testing is widely available. It is required for youth school, congregate settings, and workplaces. Children are tested in large groups making testing more convenient and accessible. Rapid antigens tests are impacted by viral load, timing, and sampling Sensitivity and specificity are ~90%- similar to PCR tests when there is active viral load. The virus reacts with an impregnated antibody gel. People who test positive for the virus but never develop symptoms over the following 10 days after testing are probably no longer contagious, but there are documented exceptions. TESTING - Rapid tests include Abbott BinaxNow, and IDNOW, LumiraDx , Becton Dickinson, Veritor system, Quid, and Sofia Sars. Rapid test require more viral load than PCRs thus are only 50 % for asymptomatic. They were studied for high pretest probabilty ie symptomatic with the high sensitivity ratings. VARIANTS- B.1.1.7 - vaccine similar efficacy to the common type. B.1.351 strain - 50-60% efficacy. VACCINES- Sputnik-V study 15,000 patients vaccinated, 5,000 placebo. Adenovirus vector vaccine - efficacy 91.6% re symptomatic disease. No cases of moderate or severe disease after the second dose. TREATMENT - Remdesivir - has a modest benefit in moderate illness in reduction of symptoms. It is a viral RNA Polymerase Inhibitor. Dexamethasone 6mg qd 10 days for intubated is supported. Reduced deaths and ~30% less pts on vents. Dexamethasone has the best evidence for effectiveness when used for severe illness. CLINICAL COURSE Day 0 - exposure, Day 2 possible sx and asymptomatic infectousness, Day 5 avg symptoms, contagious 2 days prior to sx, Day 7 usual resolution sx , usually no longer contagious 10 days after symptoms resolve (day 14 or so, still rare onset sx. ) Average - presentation to doctor was seven days. In a study on 181 confirmed cases, COVID-19 had an estimated incubation period of approx. 5.1 days (95% confidence interval is 4.5 to 5.8 days) (Lauer et al., March 10). This analysis shows 97.5% of those who develop symptoms will do so in 11.5 days (95% confidence interval is 8.2 to 15.6 days). MORTALITY - According to NYU, from 3/20, the Covid hospitalized death rate to 9/20, dropped from 25.6 to 7.6 percent. The average age of patients dropped from 63 to 49 . There were 81 percent with chronic risk conditions which is reduced from 72 percent. Lower case fataility might be due to more vulnerable patients sheltering and therefore are less likely to have surveillance testing.

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