Unbound Medicine and the Johns Hopkins POC-IT Center presents:
COVID-19: What We are Learning About this New Coronavirus
Paul Auwaeter, MD, MBA
Professor of Medicine
Clinical Director, Division of Infectious Diseases
Johns Hopkins University
Recorded on March 10th, 2020
In this 30-minute webinar, Paul Auwaerter, MD, MBA, Professor of Medicine at Johns Hopkins University, provides a thorough overview of Coronavirus COVID-19 (SARS-CoV-2) and how utilizing updated, authoritative, and evidence-based resources, such as the Johns Hopkins ABX Guide, can improve patient care.
Below are questions asked during the webinar and answers provided by Dr. Auwaeter. Additional details about COVID-19 are available here: Coronavirus COVID-19 (SARS-CoV-2
Q: Any recommendations on triaging in a primary care setting?
The CDC has advice in this regard. Personally, if patients have fever and cough but are not severely ill or short of breath or have major co-morbidities, I recommend staying at home. As testing becomes more available, clinics – if they have proper PPE and procedures – could offer evaluation with nasopharyngeal swab, but reasons for this should be similar to why you might give chemoprophylaxis for influenza, e.g., person at home at high-risk of illness, wondering if there should be semi-quarantine.
Q: Why is this not affecting children? I’ve heard that it is because children have higher amounts of surfactant thus giving them a little more protection against the respiratory component... is this true?
This is unknown. The routine coronaviruses (4) that cause respiratory infection are known in children to cause both upper and lower respiratory infection as well as shed in completely asymptomatic children. Theories include the one you state but also some sort of viral existence similar to many viruses in childhood where infection doesn’t always equal illness (such as EBV, HSV, hMPV)
Q: Any comments on the experimental treatment such as RDV, Kaletra plus RBV/INf beta, chloroquine?
There is a report from China only in press release and their National Guideline that chloroquine was effective at speeding resolution of radiograph findings and viral shedding. No data published. Kaletra unlikely effective in my view. Remdesivir trial info from China available in April, I am told. Do not think interferon-based combinations likely to help with acute infection.
Q: We have strong reason to believe that we may have seen a case of this in late December and did not recognize it because of the timing. Is there any utility in having this identified? Is there even a way to determine if this patient had the infection 2 months ago?
When serology is available, this will answer the question.
Q: What is an effective message to convince the public that masks are ineffective and shouldn’t be hoarded?
I usually say that you might contract infection by touching the mask. Sometimes I will also appeal that people who need them more will not be able to get them.
Q: Are pregnant women more susceptible and have there been any effects to the fetus?
There are some reports. It would be prudent to consider pregnant women at high risk, so to minimize contacts.
Q: Does it make sense for a patient on immonosuppressants for inflammatory bowel disease (working in healthcare setting) to go off of them for fear of being susceptible to COVID-19?
People on immunosuppresants have been described has having more severe IBD. The decision to stop use must be weighed against their IBD disease.
Q: How long does virus last on hard surfaces?
In controlled room temperatures and humidity ~40%, the virus lives 2–3 d on metal and plastic. Data from MERS-CoV suggest about 12h on fabric. In less ideal conditions, viral infectivity lessens (high humdity, higher temps or cold)
Q: Are patients on ACE inhibitors or Angiotensin II receptor blockers (ARBs)more susceptible to severe disease?
There is some concern that these drugs up-regulate the Angiotensin-converting enzyme 2 gene (ACE2) which is the viral entry receptor. This is a hypothesis, as yet not data to support this concept in humans as causing more severe COVID-19.
Q: What have we learned about the basic reproduction number (R0) from various experiences in North America... ie nursing home in BC, Cruise ships with close exposure...
These more closed environments may have a higher R naught than the general numbers reported. Sometimes this is due to a superspreader, most though probably due to crowding and vulnerability (e.g., elderly).
PAUL AUWAERTER, MD, MBA
Paul G. Auwaerter is the Sherrilyn and Ken Fisher Professor of Medicine at the Johns Hopkins University School of Medicine serving as the Clinical Director for the Division of Infectious Diseases and Director of the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases.
He serves as the Executive Director of the Johns Hopkins Point of Care-Information Technology (POC-IT) Center producing the Johns Hopkins Guides – Antibiotic (ABX) (Antibiotic), HIV, Osler, Psychiatry and Diabetes Guides. In 2018, Dr. Auwaerter served as President for the Infectious Diseases Society of America, the largest professional society worldwide related to infectious diseases.
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