Clinical Practice and Operations

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Panelists also provided answers to additional questions that were not answered live: Panelist Responses

Time Question
1:10:03 Overall Alberta data thus far: What percent of admitted patients under and over 70 years old require intubation? What percentage of intubated patients under and over 70 years old do not survive?
1:12:45 Do we have current epidemiological data on local presentation and symptoms accoding to age?
1:15:45 Is anyone using point of care ultrasound to look at lung/pleural involvement?

Comment from Dr. Irene Ma: For those interested in POCUS - please see our Canadian website: https://sites.google.com/site/calgaryimus/covid-pocus. Lung POCUS findings are not specific but correlate quite well with CT, given COVID is peripherally-based. More sensitive than CXR, so benefit over CXR. Handhelds are easier to disinfect than the larger machines, but AHS is currently finalizing a provincial-based IP&C protocol for POCUS machines. In the mean time, a locally FMC based approved protocol is on our website.

1:17:38 The german experience seems to suggest not using NIV in Covid patients is increasing the mortality of the Covid patients especially considering that Ett / PPV requires more sedation and difficulties with ventilator induced lung injury as well as ventilation associated pneumonia { 25% in Wuhan patients)
1:22:45 Why is HOC risk as in QT elongation when this medication has been used over 50 years for malaria and other inflammatory issues why with COVID- 19 then ?
1:25:59 If patient are admitted and they are on the HQ RCT, are we too avoid Azithromycin?
1:26:15 Do we know how long viral shedding or positive swab goes on for in immunocompromised patients? I think the recommendation is for q7day Covid testing until negative.. if viral shedding for a long time, presumably these patients are committed to self isolating for a very long time?
1:29:03 Any information on arterial manifestations of hypercoagulable state or does this appear under vascular surgery?- lots of discussion on vascular surgery forums. Or does this not show up on Med service? Worthwhile to keep in mind.
1:30:05 Should d dimer be monitored serially in all patients? Even if initial ddimer not significantly elevated
1:32:04 What about early prone positioning/ prone ventilation?
1:35:07 I think you all are doing great work, rather than re-inventing the wheel, I think it would be great if your MEOC could perhaps connect with ECC/ZEOC (more operational) or simply with the different zones to give access to all physicians in Alberta to these great resources. awareness could also be spread through the AHS Daily Staff Update on the has website, and in the CEO’s daily email. Thanks!!
1:36:59 How does the Alberta ICU data compare to other countries? Mortality? I would find it hard to extrapolate data from China to the Alberta population.
1:38:30 For patients with bilateral pneumonia, should I have a high index of suspicion, even if 1 NP swab came back negative? Repeat another NP or throat swab is better?
1:40:30 Does an increased late febrile reaction response suggest impending cytokine storm? If they are recovering at home are there any symptoms which would give them a clue at the 7 to 9 day stage? China data suggest there are some lab data that change about 24h before rapid deterioration.
1:49:43 Has a guideline for discharge and removal of isolation been released for those COVID+ that have clinically recovered?
1:52:16 Have you noticed reinfection in your hospital discharged pt ( similarly seen in S Korea , China?
1:56:30 Have we been seeing heparin resistance in covid patients treated with unfractionated heparin? Especially in ICU patients? Are antithrombin levels significantly lower in these patients or is this all related to protein binding and inflammatory responses?
1:57:42 Given many nursing home patients are M or C-GOC patients and many/most deaths come in this population any trials going on that might ultimately guide us toward improved outcomes other than virus isolation/prevention strategies.

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