Coronavirus Update 1120 GMT Mar 12

One test determines who lives and who dies.

Other new learning: hospitalized patients shed virus for 8-37 days so isolation is ALWAYS necessary inside the hospital

Okay, it is possible some of you will end up going to the hospital with a possible infection. A study published 72 hours ago from Wuhan teaches that, of all the diagnostic tests you can do when you show up at the hospital, and there are dozens, only ONE matters. This includes all blood tests as well as even chest x-rays.

Before diving into it I want to pause and say again, even if you end up in a hospital, like the 191 patients in this study did in Wuhan, China, in the middle of a completely swamped medical system, 72% of the patients still survived!

We’re going to make it through this folks!

Okay, preparing for the worst case scenario:

Write the words “d-dimer test” on a slip of paper and put it in your wallet or purse with your driver’s license/ID.

Why? read on:

Findings: A simple blood test called “d-dimer test” looks for blood clots. Every hospital in the world can run it. In this study, patients arriving at the hospital with a value above 1.0 microgram/mL had an ‘odds ratio’ (OR) of 18.4 of dying compared to patients below 0.5, who were defined as 1.0. Between 0.5 and 1.0 it was an increased chance of dying but not significant. This means you are over 18 times more likely to die if you fail this blood test. 93% of the folks above 1.0 at entry didn’t make it.

Age: NOT a factor. Don’t let them say ‘ you’re old so you will die more easily.’ While the average age of survivors (56 y) was younger than non-survivors (69 y) the impact of this difference was only an odds ratio of 1.1, or a 10% higher risk, compared to a 1840% increased risk for d-dimer!

Other organ problems: as expected, if you show up with this virus and problems with other organs you are worse off. Surprisingly, heart disease was the worse, OR 21.4; chronic lung disease, OR 5.4; hypertension, OR 3.1; diabetes, 2.9. So heart disease alone is worse than the d-dimer test but when the whole clinical picture is looked at heart disease drops out, leaving the d-dimer test. Detail: in this study they used something called the SOFA=Sequential Organ Failure Assessment for this part of the analysis. So tell them to calculate this as well.

Let’s thank the doctors on the front lines in Wuhan, China for putting this together to benefit the rest of the world!

The figure, which contains a clinical summary of surviving and non-surviving patients, contains the reference to the article in Lancet.

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