CDC clinical practice Guidelines- Get your Clinic Ready for COVID 19

30 year old male, 10 day history of diarrhoea and reduced oral intake, presented with lethargy and ongoing abdominal cramps. No respiratory symptoms, but O2 sats noted to be on the lower side, exertional O2 sats dropped to 86%. No past medical history of note, normal white cell count, not lymphopenic, urea 18.9 mmol/L, creatinine: 489 µmol/L, amylase 600 (30-118), ALT: 65, CRP: 100, Trop I 267 (0-46). Chest X-ray as shown. What do you think the patient is suffered from?

Doctors and other healthcare workers are paying a heavy price for doing their jobs on the frontline. Despite taking all the precautions, it is still getting difficult for them to treat the patients and keeping themself and their families safe. Apart from the risk of infection, they are also dealing with anxiety, being separated from their families, harassment and even assault. What are your thoughts on this? How can doctors protect themselves and how others can contribute to that?

In pathogenesis of COVID-19, hands play an important role by transporting virus from fomites mainly to nose and mouth. From mouth and nose virus spreads in the body. Saline wash of the nasal passage, mouth, and throat would probably eliminate or reduce viral load in the body mechanically at least in the initial stage of the pathogenesis. This could be similar to hand washing to contain the spread of the infection. Therefore, hypertonic saline gargles and nasal wash may work in preventing the disease and may also be useful in reducing nasopharyngeal viral load to provide symptomatic relief. Further, it may reduce viral shedding and reduce the transmission of the illness. This may break the chain of infection. COVID 19 disease is mild in eighty percent of patients and resolves spontaneously. Therefore, nasopharyngeal wash may be useful especially in subgroup of the population at high risk such as subjects with comorbid conditions and above 60 years of age. In this rapid systematic review to evaluate effect of nasopharyngeal wash majority of studies had methodological limitations. However, few studies using hypertonic saline gargles and nasal wash showed to prevent symptoms and reduce transmission, symptoms, need for symptomatic medication, and viral loads in patients of the common cold. Its utility, however, has to be studied for SARS-CoV-2 which has significant mutations from the coronaviruses that causes the common cold. Since it has been shown to work for a multitude of common viruses, logically, it should work for SARS-CoV-2 as well. The therapy could be studied as an easily available, and affordable add on modality to curb the transmission of the SARS-CoV-2. As we await definitive therapy to fight the pandemic this relative safe technique may give a ray of hope especially in prevention. COVID 19 infection starts in nasopharynx but involves lungs and other organs of the body. Therefore the effect of nasopharyngeal wash may have a limited action at nasopharynx; however, it may be more useful in prevention. The potential disadvantages of the nasal wash therapy are the discomfort in performing the procedure, however, in previous studies, it has been shown to be accepted in around 87% individuals. The second disadvantage would be the possible transmission of viral infection through the equipment used for the wash and the area where the procedure is performed. This limitation could be addressed easily by maintaining strict measures with each person use one's own equipment with no sharing amongst each other. Further, the washbasin/sink where the procedure is performed can be cleaned postprocedure. Certain precautions should be followed prior to the procedure including the use of clean water which can be ensured by boiling and subsequently cooling it. The technique of learning of nasopharyngeal wash should be supervised initially. To read more- http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=3;spage=246;epage=251;aulast=Singh

x-ray chest of first case of Corona virus pneumonia patient aged 61 years male who died during treatment in WUHAN city of China.

Fever, dyspnea, and dry cough 7 days ago. Diagnosed with COVID-19 with positive nasal swab and IgM antibodies. Worsening dyspnea over the past 2 days. D-dimer 9.05. What are your suggestions on this?