As a frontline ER doc and someone who was quarantined during SARS, the last few weeks have been tense. Many colleagues are in the same boat, and today I want to share with you a concept on how to quickly deal with the large numbers of patients coming our way soon 1/
COVID-19 seems to produce a mild illness in most patients, however 15-20% in Chinese data from Hubei consistently seem to require supportive care, from supplementary oxygen to mechanical ventilation 2/
Numbers in the non-Chinese outbreaks are encouraging but it may be too early to tell. We need to quickly sort the well from those that need critical care. We saw that hospitals in the Wuhan and Hubei were overwhelmed, filled with patients likely infecting each other. 3/
Let's instead put in place a Video Triage and Assessment (ViTA) system. We can use video conference tools, laptops and tablets and assess patients remotely. We can even have point of care testing, portable x-ray and try to find those that need critical care quickly. 4/
Most ED's can build an assessment zone in their waiting rooms. Anyone with flu-like symptoms gets assessed, is given supportive care. If they're found to be in distress, hypoxic, they are moved to an isolation zone where staff in full PPE can work on them safely. 5/
It's easy to improvise equipment like e-stethoscopes to use in assessment. We minimize staff contact, minimize the amount of PPE needed (now that there is a global shortage). I've created a tutorial on how to make these devices DIY-style. youtube.com 6/
Most importantly, we keep hospitals going for cancer patients, and others who can't afford for the whole system to seize up as it did for SARS in Toronto. Here's a write up with some details. Look forward to hearing any feedback!
github.com 7/
github.com 7/
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