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Oct 25, 2020

Updates

How many COVID-19 cases are there in the U.S.? 

How can I obtain updates from clinicians in the frontlines during the pandemic? 

How can I obtain information on COVID-19 testing? 

How can I obtain clinical care guidance on coronavirus (COVID-19)? 

  • Clinical Care Guidance for Healthcare Professionals about Coronavirus (COVID-19) (CDC) and other sites listed under resources below.
  • A study published on The New England Journal of Medicine describes the results of an analysis of the clinical characteristics of COVID-19 in a selected cohort of patients (n=1099) throughout China. In summary:
    • Out of the sample, 5.0% were admitted to the ICU, 2.3% underwent invasive mechanical ventilation, and 1.4% died.
    • The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). Lymphocytopenia was present in 83.2% of the patients on admission.
    • Studies reported different mortality rates, ranging from 1.4% to 15%. Chinese national official statistics reported a rate of death of 3.2% among 51,857 cases of Covid-19 as of February 16, 2020. Authors postulate that early isolation, early diagnosis, and early management might have collectively contributed to the reduction in mortality in Guangdong. 

What are some of the cutaneous manifestations observed in COVID-19 patients so far? 

Skin manifestations in patients with COVID-19 include:

  • Skin rash with petechiae
  • Purpuric skin rash
  • Erythematous rash, urticaria and chicken pox like lesions
  • Chilblain-like lesions
  • Skin pallor and other signs of acute limb ischemia - 5Ps: acute onset of progressive pain in the affected limb (pain), pulselessness, pallor, paresthesia, and paralysis
  • In May 2020, Robles et al reported a case series 41 patients with COVID-19 with chilblain-like lesions (erythematous or purplish papules and plaques, similar to chilblain lesions caused by cold). Lesions were seen on the feet alone (80%, including "COVID toes"), followed by hands and feet (10%), hands (7%) and ears (2%).
  • A case reported by Joob and Wiwanitkit in May 2020 illustrated a case in which an afebrile patient with COVID-19 initially presented with a skin rash with petechiae that was misdiagnosed by dengue. Authors cautioned that there is a possibility that a patient with COVID-19 might initially present with a skin rash that can be misdiagnosed as another common disease.
  • Magro et al reported in April 2020 5 severe COVID-19 cases, 3 of which had purpuric skin rash. Skin biopsy showed an extensive pattern of pauci-inflammatory vascular thrombosis with endothelial cell injury. 
  • A French observational study by Bouaziz et al published in April 2020 concluded that skin symptoms of COVID-19 may include erythematous rash, urticaria and chicken pox like lesions.  
  • In April 2020 Bellosta et al reported increased incidence of acute limb ischemia (ALI) among patients with COVID-19. Authors suggested that hypercoagulability in their patients were not related to well-known blood disorders, but that rather native arterial thrombosis may be triggered by COVID-19 infection.
  • A case series by Recalcati published in March 2020 analyzed 88 patients with COVID-19 treated in Italy and found cutaneous manifestations in 18 patients (20.4%). Lesions were erythematous rash (14 patients), widespread urticaria (3 patients) and chickenpox-like vesicles (1 patient). Trunk was the main involved region. Given their transient nature, the author speculated that those skin manifestations are similar to cutaneousinvolvement occurring during common viral infections.
  • Expert opinion published by Arora et al in March 2020 highlighted that patients with rheumatologic skin diseases (e.g. systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease and rheumatoid arthritis) may present with exacerbation of these conditions triggered by active COVID-19 disease.

What do we know and what we don't know about HBOT and COVID-19?

Coronavirus disease 2019 (COVID-19) Guidelines

Guidance for Facilities

COVID-19: New ICD-10-CM Code and Interim Coding Guidance

  • In response to the national emergency that was declared concerning the COVID-19 outbreak, a new diagnosis code, U07.1, COVID-19, has been implemented, effective April 1, 2020.
  • The CDC will implement a new diagnosis code into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting, effective with the next update, October 1, 2020. Full addenda information regarding the new code and the final title will be presented at the March 2020 ICD10 Coordination and Maintenance Committee meeting. ICD-10-CM interim coding guidance can be found at: (https://www.cdc.gov/nchs/icd/icd10cm.htm) Meanwhile, the CDC provided interim coding guidance for exposure and confirmed cases of COVID-19 
  • For guidance on CMS reimbursement for diagnostic laboratory services, physician services (including telemedicine and telehealth), hospital services and drugs and vaccines under Medicare Part B, see CMS Covid-19 FAQ (3/9/20).
  • See Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) revised on 4/10/20

Handouts and Posters

Factsheet: What you need to know about coronavirus disease 2019 (COVID-19)  What you need to know about coronavirus disease (English/ Spanish/ Simplified Chinese)

Poster: Stop the spread of germs  Stop the spread of germs poster (English/ Spanish/ Simplified Chinese)

Resources

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