Resources for Doctors

Protocols, Lab findings, Radiology, ICU, PPE, Medications...

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Section edited by Ruth Ann Crystal MD @CatchTheBaby

Thanks to Tracy Dooley MD and Da Jin MD for all that they have done!

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Please add info under the different headings (Protocols, Lab findings, Radiology, ICU, cPPE, Medications, Swab Tests, Telemedicine, Journal Articles, Helpful Tips, etc)

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Table of Contents:

START HERE for Summaries        

Quick Summary Guides

Agency Resources

Protocols

General Protocols

Triage Protocols

EMS Medical Director Resources

Findings on Examination

Lab Findings

Radiology Findings

Clinical Course

ICU/Critical Care

Intubation and Airway Management

Critical Care Guidelines

Abnormal clotting in COVID-19 patients

Critical Care for the non-ICU physician

CPR

Prone Positioning

ICU Tips

Ventilators:

Allocation of Scarce Resources in Critical Care:

Personal Protective Equipment (PPE)

Medications

GENERAL INFORMATION

Plasmapheresis and Convalescent Serum as treatment

Drug Repurposing:

COVID19 Drug and Vaccine development:

LOPINAVIR-RITONAVIR (KALETRA) STUDIES:

ANTICOAGULANTS

ACE-INHIBITORS/ARB DEBATE:

IBUPROFEN/ NSAIDS:

RESEARCH:

COVID-19 Diagnostic Tests

Medical Specialties Specific

Telemedicine

Journal Articles

Helpful Tips & Testimonials

Helpful Info for Patients

Medical Blogs on COVID19

Support for Healthcare workers well-being

Money for Medical Research on COVID19

Medical Equipment Hacks

FACE MASK HACKS

COVID19 Databases

Humor to lighten the mood

START HERE for Summaries


Brigham & Women’s Hospital: COVID-19 Critical Care
Guidelines http://covidprotocols.org/

Alibaba Global MediXchange https://covid-19.alibabacloud.com/

The Internet Book of Critical Care, an online textbook written by Josh Farkas (@PulmCrit) https://emcrit.org/ibcc/COVID19/

Up To Date (free): COVID19

RECENTLY ADDED:

NEW 4/7/20 J&J company Prisma Health introduces VESper to split ventilators

NEW (4/6/20) Open Discussion: How should we manage COVID19 DIC coagulopathy?

NEW (4/2/20) Physician mental health support line https://doxy.me/physiciansupportline

NEW (4/5/20) How to Decontaminate N95 Masks https://www.n95decon.org/

Experts from Stanford, Harvard, UCSF, UMich, UChicago, MIT printable guidelines

NEW 4/3/20: Tent Hack: Negative Pressure Intubation and Isolation Hood

NEW (4/1/20) Brief19: Daily news on COVID19 research and policy http://www.brief19.com/ 

NEW 4/3/30 CDC Recommendation Regarding the Use of Cloth Face Masks

Other helpful advice

RCOG UK: Advice for Pregnant Workers during the Coronavirus outbreak 

WHO Guidelines: Skin reactions related to hand hygiene 

Quick Summary Guides

Brigham & Women’s Hospital

COVID19 ICU One Pager by Nick Mark, MD

COVID19 Hospitalist One Pager by Kristen Rogers, MD MPH

Critical Care and COVID-19 Quick Refresher Sheets by @MDaniyalHashmi1 

        

Agency Resources


WHO: Technical guidance from WHO for COVID-19 https://buff.ly/2TYmhQZ

UK NHS/Public Health England: https://buff.ly/3aLl3Py

Europe ECDC guidelines: https://buff.ly/33bz0UD

US CDC: Coronavirus Disease 2019 (COVID-19) https://buff.ly/2Th67mE 

US Directory of Local Health Departments https://buff.ly/2Sj6zPg

UK Intensive Care Society info for the critical care community https://buff.ly/3aM8cwz

US Society of Critical Care Medicine (SCCM) | COVID-19 https://buff.ly/2W7uwNe

US Joint Commission: https://bit.ly/3dN6jC0 

IDSA resource center https://buff.ly/39X0tMe 

Johns Hopkins live COVID19 map https://buff.ly/2xgcJsD

 Official agency resources for 150 countries: https://bit.ly/covid-info-list 

        I cannot vouch for these links but looks correct.

Spain’s Protocol (03 Mar 2020 - en Español): https://buff.ly/332sgIC

France: Ministère des Solidarités et de la Santé (en Francais) https://buff.ly/2Wk3m5F

Australia and New Zealand Intensive Care Society https://buff.ly/38XrBcN

 Belgium guidelines:  https://buff.ly/3a84ZYs

Protocols

General Protocols

UW Medicine COVID-19 Protocols

Brigham & Women’s Hospital: COVID-19 Critical Care Guidelines http://covidprotocols.org/ 

Nebraska Medicine COVID19 resources for providers (Including N95 decontam w/UV)

UCSF COVID Protocols

MGH Treatment Protocols (3/18/20)

University of Michigan COVID-19 Protocols

NEW 4/6/20 Yale COVID-19 Protocols

🔸 UK King’s College (12 Mar 2020): Great educational video Intubation and Rapid Sequence Induction using simulation. Protocols included. https://www.youtube.com/watch?v=pv5A0l3p0zs

Simulation Scenarios & Exercises for system rehearsal for COVID-19 | Simulation Canada https://buff.ly/2WONyZ9

Capacity Planning Tool: CHIME, A tool for COVID-19 capacity planning,  https://pennchime.herokuapp.com/

◆ Converting Operating Rooms and Ambulatory Surgery Centers to ICUs https://www.covidvent.com/

NEW 4/5/20 APSF/ASA Guidance on Purposing Anesthesia Machines as ICU Ventilators

When the supply chain was broken, this Italian hospital used 3D printing to make new valves for ICU machines https://buff.ly/2wXCpu8

Triage Protocols

◆CDC Checklist for transport patients https://buff.ly/3cR3nUE

◆Emory & CEPAR Coronavirus Symptom Checker online: Coronavirus Checker

Triage in Emergency Dept

Triage in Primary Care

Triage remotely (See Telemedicine Section below as well)

Triage for Pregnant Patients with possible COVID-19

Outpatient Assessment and Management for Pregnant Women With

Suspected or Confirmed Novel Coronavirus (COVID-19) https://buff.ly/3btQLkE

Drive-thru or Tent ideas

One Seoul test center consists of four trailer-like offices with white canopies in front. Put car in park, turn A/C to recirculation. Doctors in full protective suits and goggles take the driver's temperature with an infrared ear thermometer and hand out a questionnaire to fill out. If you're running a fever and, in the doctor's opinion, may be at risk based on where you've been or whom you've contacted, you're eligible for a test. Samples are collected from your nose and throat Only the driver is tested — passengers are not. Results are texted the next day. The test is free.

        

        

Home Care

        WHO on home care: https://buff.ly/2TUjyrt

        CDC: Help prevent the spread of COVID-19 if you are sick https://buff.ly/39EAPvs

◆US: Free Advance Directive Forms by State from AARP https://buff.ly/2KpXRJC

◆ For Specialty Specific protocols (GI, Ob, etc), please scroll down to the “Medical Specialties” section of this document.

EMS Medical Director Resources

CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html


MN Emergency Suspension of Ambulance Services example

Sample self monitoring log for exposed providers

IEAD Dispatch 911 screen (see EIDS tool for protocol/card download in multiple languages): https://www.emergencydispatch.org/coronavirus-2019-nCoV

Updated NHS Guidelines for PPE (4/2/20) 

Findings on Examination


◆ Normal auscultation

◆ Severity in China: 81% mild, 14% severe, 5% critical, 2.3% died https://buff.ly/2Qme6wT

◆ Symptoms: Fever, dry cough but no runny nose usually https://buff.ly/2Wfo8Uj

American Journal of Gastroenterology (3/18/20): Diarrhea is a Prominent Symptom of COVID-19 https://buff.ly/3a71Yrg

 Loss of Smell (Ansomia) and Taste

◆ Incubation: It takes 2-10 days before infected person shows fever https://buff.ly/2Q8ygKB

Lab Findings


◆ WBC normal, with low Lymphocytes

◆ Mild Thrombocytopenia (> 100K)

◆ Moderate hypoxemia

◆ ABG: Mild acidosis with normal lactate and severe base deficit

◆ Elevated LDH, Very high CRP, Elevated CK

◆ Normal Procalcitonin (If elevated, may mean bacterial involvement)

◆ Glucose ____

◆ D-Dimer may be elevated

◆ LFTs elevated in 30% pts

◆ Low PTT in 30% pts

◆ DO NOT TRUST NEGATIVE COVID19 SWAB if x-ray positive or pneumonia symptoms

(3/18/20): Co-Infection of patients with COVID19 and another Virus

Radiology Findings


Chest Xray

        Bilateral interstitial pneumonia

        Bilateral infiltrates common with gravitational distribution

Asymmetry if bacterial superinfection (secondary bacterial infection is uncommon)

        

Chest CT

        

Relation Between Chest CT Findings and Clinical Conditions of COVID-19 Pneumonia: A Multicenter Study : American Journal of Roentgenology  https://buff.ly/2TK8uhH

In patients at high risk for COVID19 infection, chest CT evidence of viral pneumonia may precede positive RT-PCR test results. https://buff.ly/2U1jlmG

Lung Ultrasound (LUS)

◇ How to do a Lung Ultrasound on a COVID19 patient (3/25/20)  https://buff.ly/2ycP8d7

(3/21/20) Lung Ultrasound video gallery and triage flow chart from Dr. Mike Stone of Butterfly: https://buff.ly/33zNAFy

        ◇From GiViTI COVID19 Meeting document (10 March 2020) 

        LUS daily to evaluate the lungs

◇ Findings of lung ultrasonography of novel coronavirus pneumonia during the   2019–2020 epidemic https://buff.ly/2W7huze

        ◇ Doctor with COVID19 doing #POCUS of his own lungs https://twitter.com/yaletung

Echocardiography 

Watch for dyskinesias (myocarditis?)

COVID19 Radiology databases of patient chest X-ray and CT scans:

Clinical Course

Clinical Characteristics of Patients With 2019 Novel Coronavirus (2019-nCoV)–Infected Pneumonia in Wuhan, China https://buff.ly/37dVZig

◆ Lancet: Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study https://buff.ly/2W63buS

Severe SARS-CoV-2 infections: Practical considerations and management strategy for intensivists | Bouadma L et al https://buff.ly/2QmjOP7

Pediatrics:  Detection of Covid-19 in Children in Early January 2020 in Wuhan, China | NEJM Editorial (3/12/20) https://buff.ly/2WhwRoL

◆  (3/28/20) WHO: Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations https://buff.ly/2UqMh8S

NEW (4/6/20) JHLT: COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal

ICU/Critical Care


Intubation and Airway Management

UK King’s College: Great educational video on PPE and intubation (Rapid Sequence Induction) technique using simulation. Protocols included. https://www.youtube.com/watch?v=pv5A0l3p0zs

◆Infographic on Airway Management (mult languages) https://www.aic.cuhk.edu.hk/covid19/

◆ PulmCrit: Some Additional COVID Airway Management Thoughts https://buff.ly/38N15m1

[b]

NEW 4/5/20 Barrier Enclosure with Aerosol Box during Endotracheal Intubation

 Infographic on COVID-19 Intubation by @WeAreCanadiEM https://buff.ly/2U4hmOu

APSF: Airway Management in a Patient with Suspected COVID19 https://buff.ly/2xFMZpX

◆ SRLF Intubation simulation video (en Francais 14.3.20) https://buff.ly/2vtIFJK

◆ ICM Anaesthesia COVID-19 Airway management https://buff.ly/2Uy5OmG

◆ SIAARTI (Italy): Airway Management Infographic https://buff.ly/2U89BH9

Critical Care Guidelines

Brigham & Women’s Hospital: COVID-19 Critical Care Guidelines http://covidprotocols.org/

 NHS Guide Critical Care (3/16/20): http://bit.ly/3b8hByC

NICE (NHS): COVID-19 rapid guideline: Critical Care in adults https://bit.ly/39kx8tO 

US Society of Critical Care Medicine (SCCM) | COVID-19 https://buff.ly/2W7uwNe

SCCM Surviving Sepsis Campaign Guidelines(3/21/20): https://bit.ly/2Uc0sPb

        COVID-19 ICU Preparedness Checklist

Lista De Verificación De Preparación De La UCI (en Espagnol)

Online Training Modules:

🔸The Internet Book of Critical Care, an online textbook written by Josh Farkas (@PulmCrit) https://emcrit.org/ibcc/COVID19/

◆ PulmCrit- WHO guidelines regarding fluid administration for coronavirus are dangerously misguided: https://emcrit.org/pulmcrit/coronavirus/

Kings Critical Care COVID 19 Evidence Summary.pdf https://buff.ly/2IRwglJ

CEMIR (France): Webinar spécial COVID-19: Actualités et prise en charge (en Francais 12.3.20) https://buff.ly/39TC4qV

WHO: Clinical management of severe acute respiratory infection when novel coronavirus (COVID-19) infection is suspected (28 Jan 2020) https://buff.ly/2IyTIE7

OnePagerICU: One page summary of COVID19 available in many languages https://www.onepagericu.com/

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy:

Early Experience and Forecast During an Emergency Response | JAMA (13 Mar 2020) https://buff.ly/33gFKAj

                Video conference on this via JAMA: https://www.pscp.tv/w/1ZkKzLvQpPNJv

Abnormal clotting in COVID-19 patients

Also see Anticoagulants under Medications section

Abnormal clotting common in more severe COVID19 disease per Chinese doctors 

They recommend anticoagulation if high D-Dimer. Cardiac effects discussed.

The Internet Book of Critical Care, an online textbook written by Josh Farkas (@PulmCrit)

Prophylactic anticoagulation and COVID-19 

In patients at high risk for thrombosis, prophylactic anticoagulation with LMWH is associated with better prognosis.

UK: Practical guidance for the prevention of thrombosis and management of coagulopathy and Disseminated Intravascular Coagulation of patients infected with COVID-19

Critical Care for the non-ICU physician 

🔸 SCCM | Critical Care for the Non-ICU Clinician https://buff.ly/2X12PGa

🔸 Critical care and COVID-19 Quick refresher sheets | @MDaniyalHashmi1 

 NEW (4/2/20) BJHM (Rebecca Linssen) Free to access, refresher articles

CPR

Queen Mary Hosp HK: CPR in COVID-19 https://buff.ly/2WjX3z1

CPR in COVID-19 patients. Flowcharts, etc. | RESUS UK  https://buff.ly/39l82LD

Prone Positioning

ICU Tips

NEW (3/31/20) Dr. WenHong Zhang of Shanghai summarises how to fight Coronavirus | KashmirWatch https://buff.ly/2yoDsnH

Handling Critical CoVid-19 Patients: a Guide from Italian Anesthesiologists https://buff.ly/2QJhthA

Thread by @Chenbariatrics1: (March 10, 2020)

“Isolate, don’t wait for test. The clinical presentation is VERY typical.”

#COVID19 anecdotal crit care pearls so far:

-Stock up on HUGE doses of sedatives & analgesics

-Pts seem to have gastroparesis + diarrhea (?iatrogenic v. pathophys)

-MSSA is VAP of choice

-DIC/thrombosis while on ppx a real problem; use goal PTT 70-100

Nursing Hack: To save on PPE, move iv pumps outside the rooms to the hallway and run tubing extensions to the patients. https://www.facebook.com/groups/opensourcecovid19medicalsupplies/permalink/678144116329317/

Australian COVID-19 Repository – Collating the best resources in COVID-19 research and guidelines https://buff.ly/2WuZcYK

Ventilators:

Ventilator settings

Splitting ventilators to treat multiple patients:

Statement Takeaway: Don’t split ventilators

From SCCM guidelines:

Allocation of Scarce Resources in Critical Care:

Also see Medical Ethics section under Medical Specific Specialties

NEW (4/3/20) Fair Allocation of Scarce Medical Resources in the Time of Covid-19 | NEJM

NEJM The Toughest Triage-  Allocating Ventilators in a Pandemic

NEW (4/3/20) Allocation of Scarce Critical Care Resources During a Public Health Emergency | Univ Pittsburg 

Guidelines from SAMW (Swiss) Intensive Care Medicine (3/21/20):

Triage in case of bottlenecks

Available in English, Francais, Deutsch, Italiano

 CovidVent.com: Converting Operating Rooms and Ambulatory Surgery Centers into ICUs

Personal Protective Equipment (PPE)

◆ WhatsApp group to discuss PPE https://chat.whatsapp.com/FFaO16rDuQYGVXwWFFVWWi

WHO recommendations for which type of PPE to wear during COVID19 pandemic https://buff.ly/2UgIBGM

 NEW (4/2/20) Updated NHS Guidelines for PPE

CDC (10 Mar 2020) Healthcare PPE FAQs for COVID-19 https://buff.ly/337IxMc

How to don and doff PPE correctly

NEW 4/3/20: Tent Hack: Negative Pressure Intubation and Isolation Hood

CDC (March 7, 2020): Recommendations for Healthcare Staff with Potential Exposure in a Healthcare Setting to Patients with COVID-19 https://buff.ly/2VxwJB1

 ◆ (3/23/20)The National COVID-19 N95 Mask and Medical Equipment Clearinghouse | Andy Slavitt https://buff.ly/3bitORq

How to make a reuseable respirator as a replacement for N95 mask | Boston Children's Hospital https://buff.ly/2UtH8LU

Reusable Full-Face Snorkel Mask PPE Project | Stanford Prakash Lab https://buff.ly/2QIo0Jn

NEW (3/21/20) Where to donate PPE:

NEW (3/20/20) JAMA: Conserving Supply of Personal Protective Equipment—

A Call for Ideas https://buff.ly/2vG6Ogf

How to Decontaminate  N95 Masks

NEW (4/3/20) CDC decontamination and reuse of masks 

NEW (4/5/20) How to Decontaminate N95 Masks https://www.n95decon.org/

Experts from Stanford, Harvard, UCSF, UMich, UChicago, MIT printable guidelines

Stanford N95 mask decontamination https://bit.ly/2Jh0TkP 

◆ University of Nebraska Medical Center Protocol for decontaminating N95 masks with UV light, allowing for multiple re-uses by an individual healthcare worker: https://bit.ly/3afMIsf 

        Good pictures showing how to label masks, etc

Nebraska Medicine guidance on extended use and reuse of PPE  https://bit.ly/3bjJVhM 

◆Open source document on Reuse and Disinfection of PPE https://bit.ly/33lcqc0

Editor note: This document has not been vetted yet but may be of use in low resource and crisis settings.

For homemade face mask patterns, see the Medical Equipment Hacks section as well.  Note, homemade masks do not protect or filter virus like N95 masks but may be of use in a crisis. Homemade sewn masks can be used for patients arriving to the hospital and for families and visitors and home care givers.

Joint Commission (3/31/20): Statement supporting use of personal face masks provided from home amid COVID-19 pandemic

Why we need #Masks4all by Jeremy Howard and Rachel Thomas 

What Are The Best Materials for Making DIY Masks? 

Face Mask Sewing Pattern with insertable filter | Craft Passion  https://buff.ly/393RHKU

        Not tested

Face Mask Sewing Pattern with Insertable Filter designed by two doctors:  https://twitter.com/marklewismd/status/1240850124273672197

'Cosplayers Unite!' Medical officials in Washington state solicit homemade face masks https://buff.ly/2UncW5n

100 Million Masks Project from Providence Hospital (kit with materials to make surgical masks provided)  https://buff.ly/2UCQDc7

Medications

GENERAL INFORMATION

Also see PROTOCOLS above for therapeutic algorithms from various institutions.

Be careful of Drug-Drug interactions with COVID-19 treatments

U Liverpool: Drug Interactions with Experimental COVID19 therapies 

ASHP: Evidence for COVID-19-Related Anti-Viral Treatments: (4/3/2020)

Great table of important articles on each medication used to treat COVID19

NEW 4/6/20 ACP Physician Guide to COVID-19 Treatments

NEW 4/6/20 Yale COVID-19 Protocols and Medications to Use

Open Forum Infectious Diseases: COVID-19, A Review of Treatments (3/23/20)

◆ Experiences from GiViTI COVID19 Meeting (10 March 2020) [doc no longer available]-

        Meeting recording (Italian): https://bit.ly/2QHWV8O 

Summary Infographic from Drs. Wilkinson and Lyness: https://buff.ly/2Qk9JlK 

Twitter thread on use of drugs for #COVID19 

Hydroxychloroquine (Lupus, RA) Lopinavir/Ritonavir (HIV/AIDS) Remdisivir and Favipiravir (Ebola) and Camostat (Pancreatitis, Japan) are drugs that seem to have activity against SARSCov2 https://twitter.com/abledoc/status/1240148729317011458

Plasmapheresis and Convalescent Serum as treatment

Mount Sinai in NYC to begin transfer of COVID-19 Antibodies into Critically Ill patients via Plasmapheresis

If you would like to help, recently recovered COVID19 patients please email  [email protected]

 FDA approves use of convalescent plasma to treat critically ill Covid-19 patients

Drug Repurposing:

CURE ID (sign up for free) https://bit.ly/33HgPWQ 

Allows providers to report novel uses of existing drugs to treat infectious diseases lacking adequate treatments as well as disseminate treatment information more quickly than traditional publications. You can submit case reports.

Coronavirus puts drug repurposing on the fast track (2/27/20) | @Nature https://buff.ly/2vE3CSl

Rx: Remdesivir, Chloroquine, Kaletra

See Table 1

Could an old malaria drug help fight the new coronavirus? https://buff.ly/3cGsBVJ

Both Chloroquine and the antiviral Remdesivir were, individually, “highly effective” at inhibiting replication of the novel coronavirus in cell culture.

Drug treatment options for patients admitted with COVID-19 https://buff.ly/2TPoKgj

Translate from Dutch to English

Datapunk | Covid2019/SARSCoV2 Antivirals tested https://buff.ly/2vukVFp

 Review of Potential Medications  for Novel Coronavirus (3/11/20): https://buff.ly/2wdsIHK

COVID19 Drug and Vaccine development:

LOPINAVIR-RITONAVIR (KALETRA) STUDIES:

NEJM (3/18/20): A Trial of Lopinavir-Ritonavir in Adults Hospitalized w/Severe COVID-19 

        No benefit noted

JAMA: Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore  Treated with Kaletra (Lopinavir-Ritonavir)

PulmCrit: Preview of Lopinavir/Ritonavir efficacy in COVID-19

ANTICOAGULANTS 

Prophylactic anticoagulation and COVID-19 

Abnormal clotting common in more severe disease per Chinese doctors 

UK: Practical guidance for the prevention of thrombosis and management of coagulopathy and Disseminated Intravascular Coagulation of patients infected with COVID-19

NEW (4/6/20) How should we manage COVID19 DIC? Discussion at https://emcrit.org/squirt/covid-dic/

Steroids

◆ Emory: COVID-19 Immune Response and Steroids:

https://twitter.com/HanCardiomd/status/1245369075280175104/photo/1

ACE-INHIBITORS/ARB DEBATE:

IBUPROFEN/ NSAIDS:

UPDATED  (3/19/20): WHO does not recommend against the use of ibuprofen for COVID-19 Symptoms https://buff.ly/2IZ3u2B

For SARS I, ibuprofen but not acetaminophen was shown to exacerbate pneumonia in their discussion.

RESEARCH:

Clinical Trials.gov database: all listed COVID-19 trials https://bit.ly/2xEqSQs

Urgent Public Health Research Studies for COVID-19 | NIHR

Trials for Remdesivir

Gilead Trials

Expanded Access to Remdesivir: Limited to pregnant women and children https://bit.ly/2URrp9K 

Hydroxychloroquine trial for exposed healthcare workers: http://trialcovid.com/ 

COVID-19 Diagnostic Tests

🔸 In patients at high risk for COVID19 infection, chest CT evidence of viral pneumonia may precede positive RT-PCR test results. Don’t rely on PCR swab results if the patient has symptoms and CT findings consistent with COVID19! https://buff.ly/2U1jlmG

 

(3/27/20) Abbott launches new test that can detect COVID-19 in as little as 5 minutes 

NEW (4/5/20) Johns Hopkins: List of Serology (IgM, IgG) tests for COVID-19

Test types, tests approved in US, tests approved outside US, research tests, etc.

NEW 4/7/20: Look up nearest Drive-Through Testing Sites (beta) https://coronatestcenters.info/

◆WHO: National laboratory testing https://buff.ly/2TFKrkg

◆NHS PHE UK: Guidance for sampling and for diagnostic laboratories https://buff.ly/2Q4uhOV

◆CDC: https://bit.ly/2QUoqw2 

MGH: How to collect Coronavirus NP and OP Swab (video) https://buff.ly/3375Upe

◆UW:  Sample Collection for COVID19 Testing_Nasopharyngeal 3/8/2020

University of Washington https://twitter.com/UWVirology/status/1235675168074129408

◆Stanford- rapid test. Now in drive through clinic https://buff.ly/2TROQ3p

◆LabCorp- takes 3-4 days. Doctor’s office only.

◆Quest Diagnostics https://www.questdiagnostics.com/home/Covid-19/

◆Home Testing  

Everlywell.com As of 3/24/20, Everlywell is not sending kits to individuals yet - prioritizing healthcare organizations first.

Eric Feigl-Ding in NPR article  https://buff.ly/33gnwiB 

      Testing capacity depends on:

Medical Specialties Specific

Anaesthesia : 

Emergency Department:

Hospitalist:

ENT Otolaryngology

Nephrology:

Pediatrics: 

Neonatal Protocols, see below

Obstetrics: 

Findings suggest NO evidence for intrauterine infections or vertical transmission in women w/COVID-19 pneumonia in late pregnancy.

Scroll to end of article to see Protocols for Obstetrics Units in “Figures”

New coronavirus leaves pregnant women with wrenching choices—but little data to guide them https://buff.ly/2QSKjMe

Obstetric Anesthesia

Neonatal Protocols from UW: https://covid-19.uwmedicine.org/Pages/default.aspx

Delivery Logistics Infant of a COVID Mother Who Admitted to NICU 2020-03-19

Handling of breast milk from COVID-19 mothers_2020-03-12

Newborn Nursery COVID Guideline Update 2020-03-20

Newborn Nursery COVID-19 Talking Points 2020-03-20

Performing sterile procedures in an infant with COVID-19_2020-03-13

UWMC NICU Visitor Restrictions 2020-03-20

◆  Immunocompromised Patients 

Rheumatology

◆  Diabetes: 

Cardiology:

They recommend anticoagulation if high D-Dimer.

Cardiac effects of virus also discussed.

◆  Gastroenterology:

        Virus found in fecal sample for up to 47 days

◆  Cancer: 

◆  Ophthalmology 

Dr. Glaucomflecken: https://twitter.com/DGlaucomflecken/status/1240480768410845184

AAO.org (3/12//20): https://buff.ly/2TR2Lab

        COVID19 is contagious through conjunctivitis.

◆  Psychiatry:

◆  Urology:

◆  Geriatrics and Nursing Homes:

◆  Substance Use Disorder:

◆  Surgery:

In laparoscopy, release of CO2 may release virus. Use filters.

◆  Burn Unit:

◆  Non-Coronavirus Patients:

  Medical Ethics

  Communication/Code Status/ POLST

  Discharge Planning

Telemedicine

Telehealth changes: Medicare expands visits to the home; Non-encrypted software is allowed

BMJ: Covid-19: Remote (Telemedicine) Assessment in Primary Care (3/25/20)  https://buff.ly/2UiE2M3 

        Great infographic

◆Emory Telemedicine Assessment/Monitoring Protocol for patients with COVID-19

◆ HHS.gov (3/17/20): Telehealth remote communications no longer have to use HIPAA compliant platforms https://buff.ly/2Wmhk72

HIPAA penalties suspended to facilitate telehealth, effective immediately 

AMA quick guide to telemedicine in practice https://buff.ly/38XKP1T

HHS Discretion for telehealth remote communications: https://buff.ly/2Wmhk72

Medicare Telemedicine Health Care Provider Sheet | CMS https://buff.ly/2Qq27yh

Telemedicine EPIC smartphrase note from Sade Khorami, NP: https://buff.ly/38TxDLx

◆ ACP: Telehealth Coding and Billing Practice Management Tips https://buff.ly/2U5Zzrh

Bright.MD: Pt fills in questionnaire online. App uses CDC guidelines and AI for care automation technology. Patient’s own doctor responds and treats patient all online. https://www.bright.md/

◆ Cambridge Health Alliance: Sample workflow for how to rapidly change from in person visits to televisits https://buff.ly/3avXs61 

Some COVID19 Telehealth options

Journal Articles


Journal Collections

Collections of articles and other resources, often includes clinical reports, management guidelines, commentary, videos, and other content.

NEJM: https://buff.ly/33ptfCI

The Lancet: https://bit.ly/2xi6Rz1

◆JAMA:  https://bit.ly/3adWBXu 

◆BMJ: https://bit.ly/2U59a1y

Annals of Internal Medicine:  https://bit.ly/2U9wmfa   

◆Dynamed: https://bit.ly/396oVcU 

◆American College of Physicians:https://bit.ly/2QABhDL

◆Elsevier Information Center: https://bit.ly/39ie3Zm 

◆US CDC collection of journal articles: https://bit.ly/343mMNZ 

 Collection of best COVID19 journal articles selected by Sachin Shah of UCSF https://buff.ly/2QKfysK

Topics in Critical Care/ Anesthesia, Epidemiology, ID, PPE, Peds, Ethics, Radiology

Chest CT for Typical 2019-nCoV Pneumonia: Relationship to Negative RT-PCR Testing | Radiology https://buff.ly/2U1jlmG

Care for Critically Ill Patients With COVID-19 | @JAMA March 11,2020 https://buff.ly/33bP48F

◆WHO database of latest scientific finds and knowledge on COVID-19, compiled from daily searches of bibliographic databases: Global research on coronavirus disease (COVID-19)

 A human monoclonal 1 antibody blocking SARS-CoV-2 infection. New study, not peer-reviewed (3/12/20) https://buff.ly/2TNVtUo

 WHO declares Global Emergency: Review of the 2019 novel coronavirus (COVID-19) | Int J Surg (April 2020 issue) https://buff.ly/33jTb2x

 Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19 | Nature (3/16/20)  https://buff.ly/2TSmWED

Analysis of 25,000 Lab-Confirmed COVID-19 Cases in Wuhan: Epidemiological Characteristics and Non-Pharmaceutical Intervention Effects  https://buff.ly/2UpcH9J

Twitter thread summarizing findings: https://twitter.com/CatchTheBaby/status/1241203480053735424


Allen Institute for AI: COVID-19 Open Research Dataset (CORD-19)
https://pages.semanticscholar.org/coronavirus-research 

Helpful Tips & Testimonials

🔸 GiViTI COVID19 Meeting document (10 March 2020) 

◆Great related infographic by M. Velia Antonini : Tweet

Very helpful summary of all that is COVID19 infection including lab values, medications used, lab findings and clinical course:

For Doctors and Clinical People on COVID19 by Dr. Jordan Shlain https://buff.ly/2wOUKtl

Society for Hospital Medicine Pacific Northwest Chapter Webinar on COVID-19 [Slide Deck]: https://bit.ly/3dNzpkU 

Preparing for COVID-19 - Msg from ESICM President & colleagues https://buff.ly/2TF0Khb

ESICM COVID-19 March 9th Webinar with Prof Yaseen Arabi  https://buff.ly/2W5cj2T

◆WHO database of latest scientific finds and knowledge on COVID-19, compiled from daily searches of bibliographic databases: Global research on coronavirus disease (COVID-19)

◆What ER doctors want (Twitter thread:  https://twitter.com/grahamwalker/status/1238150836242370560

Helpful Info for Patients

◆ SF Public Health: Stay home, wash hands https://buff.ly/337Li02

◆ Flatten the Curve: https://buff.ly/3aN0SAK

◆ Wash your hands lyrics generator: https://washyourlyrics.com/

◆ Can I Kiss My Dog and Other Patient Questions | Dr. Lustbader https://buff.ly/33v0a92

◆ BMC: Great visual info for patients, low literacy poster https://twitter.com/EpiEllie/status/1238824669404368902

Poster translated into multiple languages. Download here: https://github.com/eleanormurray/COVID_19

Patient Info in Multiple languages:

King County (Seattle) COVID19 recommendations 

NHS, Red Cross, Doctors of the World:  Simple patient advice in many languages

◆ BMC: Great visual info for patients, low literacy posters translated into multiple languages. Download here: https://github.com/eleanormurray/COVID_19

NEW (4/1/20) Patient Fact Sheets in 30+ Languages.  COVID-19 Health Literacy Project in association with Harvard Health https://covid19healthliteracyproject.com/

CDC: Checklist for Elderly at home https://buff.ly/2UaVmCL

◆ NHS: Advice for patients with Diabetes: https://www.diabetes.org.uk/about_us/news/coronavirus

Kidney Care UK: Guidance for patients with Kidney Disease https://buff.ly/3bpdxdL

Patient information/discharge handouts:

◆ BJC discharge instructions: Home isolation for patients with mild COVID19 infection

◆ CDC: What to do if you are sick with Coronavirus COVID19 https://buff.ly/2TENRCu

CDC: 10 things to manage your health at home

If you know of anyone in the UK who is currently lonely and would appreciate a friendly letter in the post, I’d really like to help. http://lettersinneed.com

◆US: Free Advance Directive Forms by State from AARP https://buff.ly/2KpXRJC

Medical Blogs on COVID19

🔸 The Internet Book of Critical Care, an online textbook by Josh Farkas (@PulmCrit) https://emcrit.org/ibcc/COVID19/

Sanford Guide: COVID-19 https://buff.ly/2w2nezt

CriticalCareNorthampton.com https://buff.ly/2TYTkEg

◆ TheAnaesthesia.blog https://buff.ly/3cN5Pvb

◆ Propofology.com https://buff.ly/39IhsSe 

Support for Healthcare workers well-being

NEW (4/2/20) Physician support line https://doxy.me/physiciansupportline

NEW (4/4/20) Union of American Physicians and Dentists (currently in CA and WA) documenting incident reports

GREAT LIST: Resources About Healthcare Worker Wellbeing During COVID-19 https://buff.ly/3a7r4Gk

Annals of Internal Medicine - Supporting Clinicians during the COVID-19 Pandemic https://bit.ly/2WEfnmM

Mayo Clinic “Buddy System” for Internal Medicine Residents https://twitter.com/AmyOxentenkoMD/status/1243896091130511362

◆ Free DAILY online mindfulness and compassion sessions from Center for Mindfulness and Compassion (Cambridge Health Alliance/Harvard Medical School teaching hospital). https://www.chacmc.org/connect

FACS: Assistance and Well-Being of Healthcare Workers 

        Very helpful suggestions for physicians and for hospital administration

◆ NEW (3/26/20): Airbnb will provide housing for 100,000 COVID-19 responders around the world https://buff.ly/2WJ5Yuc

All housing will be free or subsidized for healthcare providers, relief workers, and first responders.

Health Workers: While You Combat COVID-19, We Support You | Supportiv https://buff.ly/2W8UGiA

        Peer-support chat for HC workers to vent about what is going on

Philadelphia medical students organize to provide childcare for healthcare workers’ children https://buff.ly/2xEJGiO

        Medical students also doing this at Yale, Northwestern, UCSF, Stanford, etc.

SweetGreen to deliver free salads and bowls to hospital workers: https://buff.ly/2Uh3QHk

(3/27/20): Krispy Kreme to give out free dozens of Original Glazed donuts to healthcare workers (with hospital badge) on Mondays through May 12 https://bit.ly/2QOU7qw 

Intensive Care Society: Staff wellbeing and self-care posters https://bit.ly/2W8QXBK

COVID-19 Women Physicians’ Emotional Well-Being Facebook group (@PoojaLakshmin): https://www.facebook.com/groups/235295047624227/

Headspace App: Free subscription Headspace Plus for US & NHS healthcare professionals. Enroll using your NPI. https://www.headspace.com/health-covid-19

◆ President Obama’s tweet 3.17.20: https://twitter.com/BarackObama/status/1239957076211834881

Managing Healthcare Workers' Stress Associated with the COVID-19 Virus Outbreak - PTSD https://buff.ly/3d7w4Nf

 (3/24/20): FREE ONLINE RESOURCES FOR CLINICIANS OR PATIENTS

◆(3/24/20) Yale's most popular class ever is available free online “The Science of Wellbeing”  — and the topic is how to be happier in your daily life https://buff.ly/2QW9mhN 

Money for Medical Research on COVID19

◆ US: NSF https://www.nsf.gov/publications/pub_summ.jsp?ods_key=pappg or email [email protected]

Gates Foundation: Announcing the COVID-19 Therapeutics Accelerator 

Submit treatment ideas to CDC via BARDA

 American Heart Association (AHA) Rapid Response Grant: COVID-19 and its Cardiovascular Impact https://buff.ly/2UhtA7o  (proposal due April 6)

MOSS launches COVID-19 Solutions Fund – The Mozilla Blog

Medical Equipment Hacks

Joint Statement on not splitting ventilators (from multiple societies including SCCM, CHEST, ASA) 

 CovidVent.com: Converting Operating Rooms and Ambulatory Surgery Centers into ICUs

Nursing Hack: To save on PPE, move iv pumps outside the rooms to the hallway and run tubing extensions to the patients

JAMA (3/20/20): Conserving Supply of Personal Protective Equipment—A Call for Ideas 

NEW 4/3/20 Medtronic makes their PB560 ventilator open-source 

The following links have not been vetted yet but may be of use in low resource and crisis settings:

NEW 4/3/20 Auburn design adapts CPAP machines into emergency ventilators

Open source document on Reuse and Disinfection of PPE 

Use of Non-Invasive Ventilators (eg BiPAP) in invasive ventilation 

FACE MASK HACKS

◆NEW (3/21/20) How to make a reuseable respirator as a replacement for N95 mask | Boston Children's Hospital https://buff.ly/2UtH8LU

◆ Reusable Full-Face Snorkel Mask PPE Project | Stanford Prakash Lab https://buff.ly/2QIo0Jn

Face Mask Sewing Pattern with insertable filter | Craft Passion  https://buff.ly/393RHKU

        Not tested

Face Mask Sewing Pattern with Insertable Filter designed by two doctors:  https://twitter.com/marklewismd/status/1240850124273672197

'Cosplayers Unite!' Medical officials in Washington state solicit homemade face masks https://buff.ly/2UncW5n

100 Million Masks Project from Providence Hospital (kit with materials to make surgical masks provided)  https://buff.ly/2UCQDc7

COVID19 Databases

COVID19 datasets on:

S. Korea: https://buff.ly/2QbgVQW

Italy:  https://buff.ly/338zIBO

U.S. spread: https://buff.ly/3aR8VfV

Harvard Dataverse: https://buff.ly/2vmszBA

Our World in Data: https://ourworldindata.org/coronavirus

WHO: Database of Publications updated daily https://buff.ly/388a01l

COVID-19 Open Research Dataset (CORD-19) by Allen Institute for AI https://buff.ly/38QLAtn

>29,000 scholarly articles,  >13,000 with full text, about COVID-19 and the coronavirus family of viruses for use by the global research community

COVID19 Radiology databases of patient chest X-ray and CT scans:

Clinicaltrials.gov Database on Coronavirus trials: https://bit.ly/2UA08ss 

WHO International Clinical Trials Registry Platform (ICTRP)

The COVID-19 Testing Tracking Project 

Humor to lighten the mood

Ben Phillips on Twitter: "❤️❤️❤️ To beat #Covid19, listen to this Italian grandma.… "

◆ Tom Hanks https://twitter.com/BetootaAdvocate/status/1238013005624819718

◆ Quarantine day 6 https://twitter.com/gnuman1979/status/1239523796542992387

◆ Quarantine day 69 https://twitter.com/PadmaLakshmi/status/1239985294897745922

Dr. Glaucomflecken: https://twitter.com/DGlaucomflecken/status/1240480768410845184

◆ Wash your hands lyrics generator: https://washyourlyrics.com/

https://twitter.com/CatchTheBaby/status/1238652535193337856

https://twitter.com/YoYo_Ma/status/1238572657278431234

◆ Leo AR app to entertain while in quarantine https://leoapp.com/website

https://twitter.com/BrennanSpiegel/status/1239972097985662978

https://www.youtube.com/watch?v=nSXIetP5iak

https://twitter.com/Bumble6671/status/1240734289425301506

https://twitter.com/YoniFreedhoff/status/1240990471675154432

🔸I Will Survive (dance video) https://twitter.com/ghost_wales/status/1242467534059626497

🔸“One Day More” video https://twitter.com/BBCBreakfast/status/1244990078952321028

Coronavirus Dank Meme Stash

🔗 https://www.facebook.com/groups/coronavirus.memes

[a]meta collection - 'We built a repository that includes a broad range of references and categorized them to make them easier to search' - https://covid19resources.mit.edu/

[b]"From experience in our #COVID19 ICU so far: stop intubating early & consider the following" - https://twitter.com/MRamzyDO/status/1246793802255347713