COVID-19 Daily: Vent Debate Continues, Screening for Taste/Smell

Ellie Kincaid

April 21, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Ventilation Debate Continues

Some physicians treating COVID-19 patients have questioned the standard use of ventilators, particularly in patients whose disease they say looks more like high-altitude pulmonary edema (HAPE), while others with a presentation more like acute respiratory distress syndrome may be well served by standard treatment. 

But in a new commentary, clinicians with experience treating both HAPE and COVID-19 note that the comparison between the diseases is potentially risky. "Trying to equate HAPE and COVID-19 is just wrong," one coauthor told MDedge. "HAPE and COVID-19 may share several features...but those are features that are shared by a lot of different forms of respiratory failure." 

Their main concern, they say, is making sure that the anecdotal experiences and observations of clinicians struggling to find answers don't spiral out of control without proper vetting, and then lead to patient harm.

Loss of Taste/Smell in COVID-19 Screening

A number of new publications show that a high proportion of people infected with COVID-19 report loss of smell and/or taste. Their authors are amplifying calls to recognize these symptoms as potentially useful in screening efforts.

The Centers for Disease Control and Prevention (CDC) has now added "new loss of taste or smell" as a symptom on its COVID-19 information page, but the World Health Organization has not done so.

Checklist to Manage Hyperglycemia, DKA

With evidence accumulating that hyperglycemia and diabetic ketoacidosis (DKA) are contributing to morbidity and mortality in COVID-19 — including among people without a prior diabetes diagnosis — experts have developed best practices for managing often-extreme glucose dysregulation in patients hospitalized with COVID-19.

At-Home Test OK'd

The US Food and Drug Administration (FDA) has authorized the first diagnostic test for COVID-19 with a home collection option. After swabbing their noses with a self-collection kit of nasal swabs and saline, users send the samples to a LabCorp laboratory for testing. LabCorp intends to make the test available to consumers in most states via doctors' orders. 

Are We Ready to Reopen Society?

A study recently published in the New England Journal of Medicine provides the best data yet available on the community spread of the novel coronavirus, says Medscape contributor F. Perry Wilson, MD, MSCE — at least, in Iceland. The study suggests answers for questions important to make decisions about removing social distancing provisions, such as, how many COVID-19 cases are we missing because they are minimally symptomatic?

"More than anything else, the Iceland data show us the value of a robust community-testing apparatus, something that we are sorely lacking in the US," he writes. "Making decisions about reopening society without information about the population prevalence of this disease is like trying to land a plane blindfolded."

NIH Treatment Guidelines

A panel of government agencies and medical societies including the CDC, the Department of Defense, the National Institutes of Health, the FDA, the Infectious Diseases Society of America, and the Society of Critical Care Medicine have developed new treatment guidelines for clinicians caring for patients with COVID-19

"The Panel recommends that promising, unapproved or unlicensed treatments for COVID-19 be studied in well-designed controlled clinical trials," states the introduction page for the guidelines. "The choice of what to do or not to do for an individual patient is ultimately decided by the patient together with their provider." 

COVID-19's Effects on the Body

Physicians and researchers are beginning to document many potential effects of SARS-CoV-2 on multiple body parts — not just the lungs. Science Magazine brings together what is known so far, from the eyes to the toes. 

What Do You Think About the Reported Rates of COVID-19? 

According to official statistics, 0.2% of the US population had been infected with SARS-CoV-2 in late April, but the proportion of people who have had COVID-19 varies by state. Tell Medscape here: Based on what you are seeing in your practice, what do you think are the actual proportions of people who have been infected? 

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Hundreds throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

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