geoffrey modest medical blogs

A new article confirmed reasonably conclusively what was pretty obvious from the epidemiology we know so far about SARS-CoV-2: contact tracing is superior to identifying cases through symptomatic surveillance in terms of decreasing transmission ( see covid contact tracing vs sx LancetID2020  in dropbox, or  doi.org/10.1016/S1473-3099(20)30287-5) Details: -- after the outbreak in Wuhan, China, the Shenzen Center for Disease Control and Prevention, in a retrospective analysis, identified 391 SARS-CoV-2 cases and 1286 close contacts, from January 14 to February 12 (this is a secondary site, away from Wuhan, Hubei province). 1 st  person identified of symptomatic Covid-19 in Shenzen was January 8 -- compared cases identified through symptomatic surveillance vs contact-tracing, estimating the time from symptom onset to confirmation of Covid-19, isolation of case, and admission to the hospital -- contact-based surveillance vs symptomatic surveillance: mean age 45, 7...

This blog is a reprint from   Covid-19 Compendium For Clinicians  , and written by jon pincus.  I would just add that i think Trump might consider 2 actions: drinking lysol, just to show how safe it is (though, i should note that there has been a significant uptick in calls to poison control centers for ingestions of bleach and lysol (see  https://www.nbcnewyork.com/news/local/nyc-poison-control-calls-for-bleach-lysol-double-after-trump-disinfectant-comment/2389593/  ). though that should not deter Trump, since science does not really matter (and his decidedly anti-science proclivities perhaps should encourage him to try it) using his immense power, through the Defense Production Act, to force tanning salons to redesign themselves to have ultraviolet probes to insert in all accessible body cavities (and ?create new ones) geoff Summary: a random perusal of the literature (PubMed search – Lysol, Household Cleaners) shows several reports of harm a...

A recent Italian study assessed the presenting symptoms for Covid-19, finding a very large percentage had decreased smell  or taste  (see  covid anosmia jama2020  in dropbox, or doi:10.1001/jama.2020.6771) Details: -- 283 patients were seen at the Treviso Regional Hospital between March 19 and March 22 and tested positive for SARS-CoV-2 (Treviso is high up in northeast Italy)      -- 202 (71%) completed a telephone survey -- median age 56, 48% men, never smokers 69%, no current alcohol 40%, no comorbidity 44% --   indication for testing: exposure to confirmed contact 35%/symptomatic presentation 65% -- they used a validated instrument called the Sino-nasal Outcome Test 22 (SNOT-22, I kid you not) to grade the severity of symptoms of the alteration of sense of smell or taste, on a scale from none (0) to as bad as it can be (5). Results: --presenting symptoms, per patients' recall of “during the 2 weeks preceding the s...

Hypertension has been associated with adverse clinical outcomes in those with Covid-19 infection. The concern was raised that ACE inhibitors and ARBs may be associated with increased  ACE2 levels (SARS-CoV-2 receptors), which could put the patients at higher risk of adverse Covid outcomes. A study with more granular data from China was released that suggested there was no Covid outcome difference on these medications vs other antihypertensives (see  covid ACE ARBs ok jamacardiol2020  in dropbox, or doi:10.1001/jamacardio.2020.1624 ) Details: -- retrospective single-center case series of 1178 hospitalized patients with Covid-19 in Wuhan China, from January 15 to March 15 -- overall median age 56, 46% male -- 362 (31%) had hypertension: median age 66, 52% were men,  cerebrovascular disease 19%/coronary heart disease 17%/diabetes 35%/digestive disorders 22%/neurologic disease 11%/chronic kidney disease 10%     -- labs: CBC, d-dimer, aminotran...