Friday, April 10, 2020

COV 19 Mortality collapse pending.

The mortality curve for COV 19 is already collapsing as global social distancing succedds in stalling the spread of this virus.  With the additional advent of a clear understanding of COV 19 biological role and the effective elimination of mortality using anti malarial drugs, we are now in position to rotate the economy back on by April 30th.  It will still be necesasary to practise avoidence strategies.  That means using masks for all non household contact and quick testing and positive quarantines.  that is exactly what is done in Wuhan now.

We can run a food service this way in which the servers do wear masks and test often.  The customers will need a little room though as they obviously will need to also eat.  We can do tnis though.

Testing is the key though.  We can prove the problem and then quickly apply anti maralial drugs to stop its progress.  This is not pneumonia, but acts like it.  Allowed to do so, the body will defeat the virus, while we act to limit negative effects.  For most of us it may still not be much fun but it is beatable without a close encounter.

This item shows present protocols.  Expect it all to become more invasige as we get back to work.

Lab Testing

B.C. is conducting COVID-19 diagnostic testing for patients who need it with compatible symptoms and risk of exposure.

Testing and laboratory guidance

Who to test

Testing is available for  all patients who need it, but not everyone requires a test.  Testing is not required if a patient has no symptoms, mild symptoms or is isolating at home because they are a contact of a confirmed case or a returning traveller. 

At this time, any physician can order a test for COVID-19 based on their clinical judgment. Testing should be focused on individuals for whom the results will change the clinical care they receive or the public health management of their case. 

Broadly, testing is recommended for groups that are more vulnerable to complications due to COVID-19, or people who care for these vulnerable people.

B.C. is currently testing those with new respiratory or gastro-intestinal symptoms who are:

  1. Residents and staff of long term care facilities 
  1. Patients requiring hospitalization, or likely to be hospitalized including pregnant individuals in their 3rd trimester, patients on hemodialysis, or cancer patients receiving radiation or chemotherapy.
  1. Part of an investigation of a cluster or outbreak.
COVID-19 testing is also recommended for individuals with a fever and a new (or worsening) cough or shortness of breath who are:

  • Health Care Workers 
  • Residents of remote, isolated or Indigenous communities
  • People living in congregate settings such as work-camps, correctional facilities, shelters, group homes, assisted living and seniors’ residences
  • People who are homeless or have unstable housing
  • Essential service providers (e.g. first responders)
  • Returning travellers identified at a point of entry to Canada.
In addition to these priority groups, health care providers can order a COVID-19 test for any patient based on their clinical judgment.

If an individual has no symptoms, mild symptoms, or is a contact of a confirmed case returning traveller and isolating at home, they do not require a test. This group can be managed at home.

Please advise patients, with or without a history of travel, who have respiratory symptoms that can be managed at home, to isolate at home for a minimum of 10 days after onset of their symptoms.  After 10 days, if their temperature is normal and they feel better, they can return to their routine activities. Coughing may persist for several weeks, so a cough alone does not mean they need to continue to self-isolate for more than 10 days.  More information for patients is available on the If you are sick page.

What about household contact of a patient with respiratory symptoms? 

People who live in the same household as a patient with respiratory symptoms are at higher risk of being exposed. We are asking household contacts to self-isolate and monitor for respiratory symptoms for 14 days.  As much as possible, household contacts should distance themselves from the patient (e.g. stay in separate rooms, sleep in separate beds and use separate bathrooms if possible). More information on the self-isolation page.  

Personal protective equipment 

Use contact and droplet precautions with a surgical mask and eye protection when collecting a nasopharyngeal or throat swab or sputum. A N95 respirator is recommended for aerosolizing procedures. For more information, visit the page on personal protective equipment or read the Respiratory protection guidance (PDF) document.

Specimen collection 

In the outpatient setting, collect a Nasopharyngeal (NP) Swab using the procedure described by the New England Journal of Medicine: Collection of Nasopharyngeal Specimens with the Swab Technique.

Use the swab/collection device provided by your institution.  The most common swab types used are the Copan Universal Transport Medium (UTM) System and BD™ Universal Viral Transport System.

For hospitalized patients and/or patients with evidence of lower respiratory tract disease, collect a lower respiratory tract sample (e.g., sputum, endotracheal aspirate, bronchoalveolar lavage, etc.) in a sterile screw-top container in addition to a nasopharyngeal swab.

Please submit each specimen in an individual, sealed biohazard bag.  Include a paper requisition which clearly states the patient information, the ordering physician, and the test requested (COVID-19 NAT).  

To prioritize testing, label the requisition as coming from:

  • ZHCW1 – Health Care Worker – Direct Care
  • Essential service providers (incl. first responders)
  • HCW2 – Health Care Worker – Non Direct Care
  • LTC – Long Term Care Facility
  • OBK – Outbreak
  • Including people who are homeless or have unstable housing
  • HOS – Hospital (Inpatient)
  • Emergency Department (with intent to admit)
  • Symptomatic pregnant woman in their 3rd trimester
  • Renal patients
  • Cancer patients receiving treatment
  • CMM – Community (Outpatient)
  • Residents of remote, isolated or indigenous communities
  • Primary Care Centres and Doctor’s office
  • Emergency Department (non-admitted)
  • Surveillance
  • Returning travellers identified at point of entry.

Testing time

Tests are run multiple times throughout the day in laboratories across B.C.  Patients who test positive will be contacted by Public Health. 

Patients who do not hear from public health are asked to wait 72 hours to call to confirm negative test results. Physicians should call the medical microbiologist if the test needs to be expedited or if they have not received test results after 72 hours. 

The BCCDC COVID-19 Negative Results line is staffed from 8:30 AM to 4:30 PM, seven days a week at 1-833-707-2792. It may be easier to get through to someone on the line in the afternoon when the call volume is generally lower.

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