COVID-19 Daily: Lung Ultrasound Triage, Telemedicine Guide

What your doctor is reading on Medscape.com:

MARCH 24, 2020 — Here are the latest coronavirus stories Medscape’s editors around the globe think you need to know about today:

Proposed Triage Protocol

Physicians in the emergency department of a hospital in Turin, Italy, quickly realized that they couldn’t use age or comorbid conditions to predict which patients coming in with COVID-19 would develop severe pneumonia. “We see otherwise healthy patients with acute symptoms of pneumonia due to the virus,” Giovanni Volpicelli, MD, told Medscape Medical News. He developed a new protocol to triage patients using bedside lung ultrasounds. Now he and his colleagues are convinced ultrasound assessment effectively distinguishes patients who need to be admitted from those who can be sent home to convalesce under quarantine.

Physician Stories on Social Media

The simple act of going to work these days may put clinicians’ lives at risk. Many of them are sharing their stories on social media, and we’ve pulled together a few from Instagram. Standards for personal protective equipment (PPE) have changed as supplies became scarce, one emergency department physician from Tennessee said: “Last week we would not have accepted this, and that concerns me.”

Fateful Early Testing Decisions

In early February, the US Centers for Disease Control and Prevention (CDC) distributed 200 test kits it had produced to more than 100 public health labs run by states and counties, each kit containing material to test 300 to 400 patients. Problems with those test kits quickly emerged. Experts now say the flawed tests and lack of targeted distribution call into question whether states such as New York and Washington “even stood a chance to contain the outbreaks that would emerge,” according to a Kaiser Health News report.

Telemedicine Startup Guide

The Centers for Medicare & Medicaid Services (CMS) have changed a bunch of rules about telemedicine use for the duration of the COVID-19 public health emergency. Now, it’s possible for many types of clinicians to get paid for telehealth visits with Medicare patients while they remain at home, in nursing facilities or hospital outpatient departments, and even across state lines. Here’s what clinicians need to know to get started.

ICU Report from Italy

In hard-hit Italy, the number of patients in intensive care with COVID-19 doubled every 2 to 3 days at first, according to an Italian engineering professor who analyzed official data. The doubling rate later slowed slightly, with patients staying in the ICU an average of 15 days. “Every day counts,” the professor stressed.

Chloroquine Death

After preliminary scientific reports that the anti-malaria drug chloroquine could be tested as a treatment for COVID-19 — and President Trump’s endorsement in a press conference — a Phoenix-area man and his wife consumed chloroquine phosphate, a different formulation of the compound used to clean fish tanks. The man died and his wife was in critical condition.