As the pace of research related to COVID-19 continues at an unprecedented rate, clinicians on the front line of the pandemic are challenged to keep up with a deluge of information to ensure they are bringing best practices to their institutions and to the bedside. A session on Tuesday, October 20, featured a panel of infectious disease experts and pulmonologists who reviewed some of the most recent data regarding COVID-19 diagnosis, therapies, and prevention.
The session, From Zero to Sixty: The Fast-Changing Science of COVID-19 Care at the Bedside, is available for on-demand viewing on the virtual CHEST 2020 meeting platform through January 18, 2021, for registered attendees. Sai Haranath, MBBS, MPH, FCCP, pulmonary and critical care physician at Apollo Hospitals in Hyderabad, India, served as chair and moderator for the session.
Tatjana Calvano, DO, FACP, FIDSA, infectious disease specialist at Brooke Army Medical Center, Fort Sam Houston, Texas, opened the presentations with a discussion of COVID-19 diagnostics, in which she emphasized the importance of testing and keeping current on the indications for use of different testing methodologies and the data on performance of various types of tests.
“Testing often guides treatment, and it’s intimately interlinked with infection prevention and reduction of transmission,” Dr. Calvano said. “Testing aids us in clinical diagnosis of COVID-19 as we care for our individual patients, but it also assists us with surveillance and screening with assessment of prevalence of disease in the population, and potentially has an important role in changing the course of this pandemic when coupled with contact tracing and other interventions, such as social distancing and isolation.”
While there is an abundance of different tests for COVID-19, Dr. Calvano said there is also an abundance of uncertainty within the scientific community regarding the performance of these tests in various situations, noting that the number of tests to date that have received emergency use authorization from the FDA include 186 molecular tests, 56 antibody tests, and six antigen tests.
“There are so many possible indications and so many factors that influence performance of these different tests. And this is ever-evolving.” she said. “We still have a lot to learn regarding COVID-19 diagnostics and the indications for use of different testing methodologies.”
Ryan Maves, MD, FCCP, FCCM, FIDSA, followed with a presentation on antiviral and immunologic therapies for COVID-19. Dr. Maves is an infectious diseases and critical care medicine specialist at Naval Medical Center, and associate professor of medicine at Uniformed Services University.
Looking at the therapies that have been tried for COVID-19 over the course of the pandemic, Dr. Maves said there is very little evidence supporting any one drug as having a benefit for mortality at this point
“With the exception of corticosteroids, specifically dexamethasone but probably also methylprednisolone and hydrocortisone, which do have evidence of decreased mortality. But thus far, we haven’t found the silver bullet.” he said. “There are a number of other potentially very exciting interventions, such as convalescent plasma, monoclonal antibodies, or higher-dose anticoagulation. All of these remain investigational and await confirmation in randomized controlled trials.”
In the session’s final presentation, David Ferraro, MD, FCCM, FCCP, associate professor in the division of pulmonary, critical care, and sleep medicine at the National Jewish Health, discussed best practices that hospitals and other health-care facilities should be employing for preventing the spread of COVID-19.
“Effective infection prevention and control, simple or complex, is perhaps the most vital tool that we have so far to combat this deadly virus and mitigate further spread,” Dr. Ferraro said. “First and foremost is source control. In a respiratory-borne illness, such as coronavirus, the primary means are to cover the nose and mouth to contain respiratory secretions and prevent spread by asymptomatic persons.”
Secondly, he said that early identification of suspected or actual cases is key, as it will allow early distancing and quarantining. Physical barriers and geographic control, he noted, are crucial. “If you can identify cases prior to entrance to the hospital and you have the luxury to separate COVID[-19] patients from non-COVID[-19] patients, you can get ahead of the game,” Dr. Ferraro said. “The use of PPE can help prevent person-to-person transmission while participating in patient care. And lastly, coronavirus may be deadly, but it can be killed easily on physical surfaces.”
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