What your doctor is reading on Medscape.com:
APRIL 18, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:
So How Many Coronavirus Cases Are There, Really?
Two new preprints about the likely prevalence of the novel coronavirus — both of which indicate that it may be far more widespread than confirmed cases seem to indicate — have captured the attention of a country looking for news about when it will be safe to end lockdowns. But epidemiologists and others are still poring over the findings, which rely on volunteer recruitment and lots of assumptions about testing specificity and other factors. The authors of one of the preprints have already revised their estimates from 28 million to 8.7 million, WebMD reports.
Doctor Charged With COVID-19-Related Fraud
A San Diego physician was charged with mail fraud this week for selling “Covid-19 treatment packs.” The packages — priced at $3995 for a family of four — were marketed as a “100 percent” cure and included hydroxychloroquine, azithromycin, and “anti-anxiety treatments to help you avoid panic if needed and help you sleep,” the New York Times reports. According to court documents, Jennings Ryan Staley, MD, 44, head of Skinny Beach Med Spa, told an undercover FBI agent over the phone that the drug combination was “preventative and curative…almost too good to be true.”
For his part, Staley’s lawyer says his client was simply following advice coming from the top branches of the US government. “The same executive branch that has been touting these two medications for weeks has now turned around and criminally charged [him]…for doing exactly the same thing that the administration’s been doing this whole time.”
New Day, New PPE Problems
Since the Centers for Disease Control and Prevention (CDC) issued the recommendation that everyone wear masks in public, just 2 weeks ago, hospital personal protective equipment (PPE) policies have shifted rapidly toward a masks-at-all-times approach. Many providers welcomed the change. But rolling out new policies in the middle of a pandemic is challenging. “Every day there’s a change at some places, so getting that word out is so crucial,” said the director of infection prevention and control for the Joint Commission, which has been receiving complaints from healthcare workers reflecting fear and confusion about constantly changing policies.
Elsewhere, however, nurses denied proper protection continue to push back, according to a story by the Associated Press. At Saint John’s Health Center in Santa Monica, California, one nurse tested positive for coronavirus, prompting 10 others to refuse to enter COVID-19 patient rooms without the same N95 masks physicians wore. All 10 nurses were suspended.
And PPE remains so scarce, and at such high risk of seizure, that many hospitals feel as though they must smuggle in their own supplies under cover of night.
Normal X-Ray Doesn’t Rule Out COVID-19
Early imaging studies of COVID-19 used CT to characterize and diagnose SARS-CoV-2 infections. But because X-ray machines are more widely available than CT in urgent-care settings, researchers at The Ohio State University College of Medicine wanted to know whether chest X-rays could be used to help diagnose infection with the novel coronavirus. But after asking 11 radiologists to re-read chest X-rays of confirmed, symptomatic COVID-19 patients, they found that nearly 60% appeared normal.
“Providers ordering a chest X-ray in the outpatient setting should be aware that a patient with symptoms of COVID-19 may have a negative chest X-ray and should manage the patient based on their symptoms. Doctors should not be reassured by a negative chest X-ray,” lead author Michael Weinstock, MD, told Medscape Medical News.
Panic, Then Teamwork
In the most recent installment of his daily diary for Medscape, oncologist Don Dizon, MD, director of women’s cancers at Lifespan Cancer Institute in Rhode Island, confronts how much inpatient medicine has changed since his days as a resident 20 years ago. In preparing for the patient surge, he says, “I assumed one very important thing: that we could all do what the role required….I now realize that I probably shouldn’t have assumed anything,” he writes.
Test Shortage Traced to CDC Fail
The extreme COVID-19 test shortage in the US was caused by a “glaring scientific breakdown,” according to an investigation by the Washington Post. The first round of defective tests were the result of cross-contamination at a CDC laboratory, which violated the department’s own lab standards by handling chemical components within the same space as synthetic coronavirus material.
The contamination only affected one of the tests’ three components, and one that was not essential for viral detection. “But after the difficulty emerged, CDC officials took more than a month to remove the unnecessary step from the kits, exacerbating nationwide delays in testing,” the Post reported, after examining federal documents and interviewing more than 30 people —including federal scientists — with knowledge of the events.
Trending Clinical Topic: Ventilators
Controversy has emerged regarding the treatment of certain patients with severe COVID-19. Concerns about proper protocols and the rationing of care resulted in ventilators becoming Medscape’s top trending clinical topic this week.
As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Hundreds throughout the world have died.
Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.