"Hot Zones" for Otolaryngologists: Assessing the geographic distribution of aerosol-generating procedures amidst the COVID-19 pandemic.
耳鼻喉科医生的 “热区”: 评估新型冠状病毒肺炎大流行中气溶胶产生程序的地理分布。
- 作者列表："Quereshy HA","Jella TK","Ruthberg JS","Kocharyan A","D'Anza B","Maronian N","Otteson TD
OBJECTIVE:Given high COVID-19 viral load and aerosolization in the head and neck, otolaryngologists are subject to uniquely elevated viral exposure in most of their inpatient and outpatient procedures and interventions. While elective activity has halted across the board nationally, the slow plateau of COVID-19 case rates prompts the question of timing of resumption of clinical activity. We sought to prospectively predict geographical "hot zones" for otolaryngological exposure to COVID-19 based on procedural volumes data from 2013 to 2017. METHODS:Otolaryngologic CPT codes were stratified based on risk-level, according to recently published specialty-specific guidelines. Using the Medicare POSPUF database, aerosol-generating procedures (AGPs) were mapped based on hospital referral regions, against up-to-date COVID-19 case distribution data, as of April 24, 2020. RESULTS:The most common AGPs were diagnostic flexible laryngoscopy, diagnostic nasal endoscopy, and flexible laryngoscopy with stroboscopy. The regions with the most AGPs per otolaryngologist were Iowa City, IA, Detroit, MI, and Burlington, VT, while the states with the most COVID-19 cases as of April 24th are New York, New Jersey, and Massachusetts. CONCLUSIONS:Our study provides a model for predicting possible "hot zones" for otolaryngologic exposure based on both COVID-19 case density and AGP-density. As the focus shifts to resuming elective procedures, these potential "hot zones" need to be evaluated for appropriate risk-based decision-making, such as "reopening strategies" and allocation of resources.
目的: 考虑到高新型冠状病毒肺炎病毒载量和头颈部雾化吸入，耳鼻喉科医生在大多数住院和门诊手术和干预中都会受到独特的病毒暴露升高。虽然在全国范围内，选择性活动已经全面停止，但新型冠状病毒肺炎发病率的缓慢平台提示了恢复临床活动的时间问题。我们试图根据 2013-2017 年的程序卷数据前瞻性预测耳鼻喉科暴露于新型冠状病毒肺炎的地理 “热区”。 方法: 根据最近发表的专业特定指南，根据风险水平对耳鼻喉科CPT代码进行分层。使用Medicare POSPUF数据库，根据医院转诊区域，根据截至 2020 年 4 月 24 日的最新新型冠状病毒肺炎病例分布数据，绘制了气溶胶生成程序 (AGPs)。 结果: 最常见的AGPs是诊断性软喉镜、诊断性鼻内镜和弹性喉镜与频闪镜。每个耳鼻喉科医生AGPs最多的地区是爱荷华市，IA，底特律，MI和Burlington，VT，而截至 4 月 24 日病例最新型冠状病毒肺炎的州是纽约，新泽西和马萨诸塞州。 结论: 我们的研究提供了一个基于病例密度和AGP密度预测耳鼻喉暴露可能新型冠状病毒肺炎 “热区” 的模型。随着重点转向恢复选修程序，这些潜在的 “热区” 需要进行评估，以进行适当的基于风险的决策，如 “重新开放战略” 和资源分配。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.