COVID-19

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    The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic. The spread of this virus is now global with lots of media attention. The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19). This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target. REBEL COVID-19 will serve as a summary of what is currently known, how to screen, when to test, and how to prevent spread, and any new data/information on COVID-19. (RebelEM)

    ICD-9 Codes:

    PPE

    – N95 on the wards
    – Face shields
    – Clothes covered with gown

    Presentation and Diagnosis

    View the Spectrum app or read the Diagnosis and Presentation Summary.
     
    Delirium (PEARL)
    • approx 30% of older adults presenting symptom of COVID was DELIRIUM (hypo and hyper active) 

    Testing:

    Inpatients: 
    • **retest if high clinical suspicion; even if 1st swab was negative**
    • ask screening respiratory symptoms on rounds every day
    Note: Alberta has had lots of outbreaks within the hospital so we can learn from them

    Mortality Scores:

    Mortality/Prognosis: 
    • very helpful for us given we will be having the MOST/ serious illness conversations (BC very lacking in resources for this) 
    • 4C Mortality score: outcome for in hospital mortality *note developed before some of the patient care practices we have now but at least provides some guidance*
    • NEWS 2 (National Early Warning ) score: helpful for assessment of hospitalized patients and whether to increase frequency of monitoring or involve higher intervention ie IM in our case 

    Treatment:

    Dexamethasone:

    • Dexamethasone: only used if patients requiring Oxygen (patients not requiring oxygen may do worse on steroids)
    • Note: patients on home oxygen (they suggested starting dexamethasone if requiring 2L above their baseline)
    • monitor for hyperglycemia
    • be aware Hep B can flare with dexamethasone. If concerned call Infectious Disease
    • Strongyloides can flare with dexamethasone (endemic in Southeast Asia, Latin America, Sub-Saharan Africa); can be treated.  If concerned call Infectious Disease as serology would take forever to get
    • don’t need to continue as an outpatient

    Bacterial Co-Infection:

    • antibiotics not routinely recommended unless you suspect bacterial co-infection
    Remdesivir:
    • role in those on low flow oxygen (may decrease duration of illness); no role outside of clinical trials in high flow or intubated patients (unclear if causes harm)
    • see attached Non-Formulary Drug Request Form and Remdesivir Availability and Criteria for use from Greg Egan (Pharmacist) 
    Unproven Treatments:
    • BC not currently supporting the use of:
      • Kaletra, oseltamivir, chloroquine or hydroxychloroquine, colchicine, Ascorbic acid, vitamin D (see full list on the BC CDC website)
    VTE Prophylaxis:
    • note: Enoxaparin recommended but also our formulary just switched to this as well 

    Discharge Instructions:

    Discharge: 
    • if high concern at discharge please speak with GP so can be followed up