Editorial

CMAAO IMA HCFI Corona Myth Busters

Add to my interests Add the following topics to my interests.

1. Lopinavir–Ritonavir are the drug of choice in COVID 19

No, they are not the first line therapy, but still may be continued and given to hospitalised patients.

In a study published in hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. However, research is required in patients with severe conditions to decide upon the potential clinical benefit of the treatment.

In a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, and an oxygen saturation (Sao2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir–ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. Study results showed that treatment with lopinavir-ritonavir was not related with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.24; 95% confidence interval [CI], 0.90 to 1.72). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events.

2. The most important prevention is “Wash your hands”.

Hand-washing, with soap and water, is by far the most powerful weapon against germs than many of us believe in. The soap actually opens the virus, breaking it apart.”

Coronaviruses are covered in a lipid membrane or in simpler terms, a layer of fat. Soap can disintegrate the fat render virus unable to infect you. Soap also acts mechanically by making the skin slippery so that with enough rubbing, we can pry germs off and rinse them away.

3. Splashing and dashing is common?

Yes. In a 2013 study where researchers discreetly observed 3,700 people wash their hands. The results reported that approximately 5% of them followed all the rules. About one in four people just wet their hands without using soap -- “splash and dash.” About one in 10 individuals didn’t wash at all after using the restroom. The commonest shortcoming for most people was time. Only 5% spent more than 15 seconds washing, rubbing, and rinsing their hands.

4. Hot water is a must to wash hands?

No. It doesn’t matter if it’s hot or cold. Water temperature has no effect on the efficacy of preventing infection.

5. If you’re in a public bathroom, and there’s no soap, just rubbing your hands together under the water may help

Yes. A 2011 study from researchers at the London School of Tropical Hygiene found that washing with water alone reduced bacteria on hands to about one-quarter of their prewash state. Washing with soap and water brought bacterial counts down to about 8% of where they were before washing. However, it is important to work with whatever facilities you have and use them to maintain as much hygiene as possible.

6. The duration of washing hands should be at least 20 seconds

Yes, CDC recommends washing your hands with at least 20 seconds. An interesting analogy is to sing “Happy Birthday to You” song twice while washing hands. Studies where people smother their hands with Glo Germ -- a product used to teach proper hand-washing that glows under a black light -- before they wash reveal the areas people tend to miss.

7. Paper towels actually have a beneficial effect beyond simply washing

Yes. Rubbing your hands with a paper towel removes even more germs than just washing alone. Dry hands are also less likely to spread contamination than wet hands.

8. I can use vodka as a hand sanitizer?

No. Lipid membrane viruses like coronaviruses are killed by > 60% alcohol-based hand sanitizer. Vodka has only 40% alcohol.

9. Use a clean paper towel to open bathroom doors.

Yes, this practice is good to ensure hygiene.

10. Disinfect dirty surfaces that you use every day, like the touchscreen on your phone and your computer keyboard.

Yes

11. Hospitals are safe and cannot transmit infections?

No, 41% COVID-19 cases in Wuhan were hospital-transmitted infection. In fact, health care providers are at an increased risk for contracting and transmitting infection.

Additionally, work stress is also believed to weaken their immune systems, and close, intimate care of patients can lead to exposure to a higher viral load.

12. The virus can remain alive on plastic and steel

In a study published in NEJM, the longest viability of viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic.

13. The ventilator patient needs 14 days to recover.

No. An article published in NEJM has suggested that, “The triage algorithm should also be reviewed regularly as knowledge about the disease evolves. If we decided not to intubate patients with Covid-19 for longer than 10 days, for example, but then learned that these patients need 15 days to recover, we would need to change our algorithms.”

14. There is no difference between quarantine and isolation?

In public health practice, “quarantine” refers to the separation of persons (or communities) who have been exposed to an infectious disease.

“Isolation,” in contrast, applies to the separation of persons who are known to be infected.

In U.S. law, however, “quarantine” often refers to both types of interventions, as well as to limits on travel. Isolation and quarantine can be voluntary or imposed by law.

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Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA