COVID-19

Close-up of a**hole COVID-19

COVID-19, also known as the novel coronavirus, was discovered in Wuhan, China in December 2019 and has been a goddamn pain-in-the-ass ever since.

Epidemiology

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According to the World Health Organization, Centers for Disease Control and Prevention, and our friend Tim, there are currently more than 35 billion confirmed cases of COVID-19. This speaks to the huge burden of disease considering the Earth's population is less than 8 billion.

The first reports were first reported in first reports by the Chinese Centers for Disease Control and Prevention on December 2019 in the city of Wuhan, China. The first document U.S. case occurred in a 35-year-old patient in Washington State, who returned from Wuhan, on January 20, 2020. For Americans, this is when sh*t started to get real.

In a matter of months, COVID-19 had spread to all continents except Antarctica, suggesting that Antarctica somehow has some partial immunity. The World Health Organization declared that COVID-19 was officially a pandemic, thus becoming the last major medical society to realize this. With the exception of China, Taiwan, and South Korea, measures aimed at containment have largely failed. Bribery has failed. Most nations now are looking at strategies involving mitigation or masturbation, whichever one means "to reduce the severity or spread."

In the United States, the NBA was suspended when its first player, Rudy Gobert, tested positive for coronavirus. As students or teachers tested positive for COVID-19, schools closed, including New York City's public school system, which is the largest in the country. As patients and health care professionals tested positive for COVID-19, hospitals followed suit and closed as well. Batman was infected, thus becoming the first case of human-to-Batman transmission. The situation got so dire that aliens postponed their invasion of Earth due to concerns over COVID-19.

Reports suggest that coronavirus is capable of moving back in time.

Virology

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Something about betacoronavirus and angiotensin-converting enzyme 2 (ACE2)?

Symptoms

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Symptoms can range from no to yes. The most common include fever, nonproductive cough, shortness of breath, myalgias, and anorexia. Less common symptoms include sore throat, rectal prolapse, and urethral discharge. In very rare instances, it can present as a scrotal abscess.

Signs

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Don't be fooled: though the documented respiratory rate reads as 16, it is most likely 17. Objective fever supports subjective fevers and hypoxemia supports a patient's complaint of "I'm feeling hypoxemic." Chest X-ray is an important diagnostic tool. If Radiology recommends clinical correlation, please defriend them.

Differential Diagnosis

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1. Upper GI bleed
2. Lower GI bleed
3. Diabetic foot ulcer

Diagnosis

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Diagnosis is best achieved through diagnostic kits, whose status is currently listed as "theoretical" in the United States despite being 3 months into the pandemic. With the eventual coordination of U.S. private and public sectors, over 1 million flawed kits are expected to be available by the end of March 2020. The optimal specimen is an upper respiratory tract sample obtained via nasopharyngeal swab. The U.S. has had difficulty obtaining appropriate specimens, though this is largely attributable to frontline OB/GYNs collecting samples from the vagina and not the nasopharynx.

Prevention

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There are no known vaccines at the moment for the public to refuse.

Treatments

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Treatment is largely supportive in the form of excess toilet paper. There are currently no known treatments for COVID-19. Interventions such as prayer, screaming "WHY GOD WHY?!" and remdesivir are currently ongoing. A study involving Kaletra (lopinavir/ritonavir) produced disappointing results, as did the ones that looked at sodium barb and precordial thumps. There was controversy when French health minister, Olivier Véran, warned that NSAIDs should be avoided In patients with confirmed COVID-19. This recommended has not been implemented in the United States due to large opposition on behalf of military health care professionals who state that eliminating NSAIDs essentially eliminates all that a military health care professional can offer.

Special Considerations

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• Supply of N95 respirators & surgical masks - Supplies have been dwindling worldwide. Decreased availability of N95 respirators has forced health care professionals to use lower quality N94, N93, N92, N91, N90, N89, N88, N87, N86, N85, N84, N83, N82, N81, N80, N79, N78, N77, N76, N75, N74, N73, N72, N71, N70, N69, N68, N67, N66, N65, N64, N63, N62, N61, N60, N59, N58, N57, N56, N55, N54, N53, N52, N51, N50, N49, N48, N47, N46, N45, N44, N43, N42, N41, N40, N39, N38, N37, N36, N35, N34, N33, N32, N31, N30, N29, N28, N27, N26, N25, N24, N23, N22, N21, N20, N19, N18, N17, N16, N15, N14, N13, N12, N11, N10, N9, N8, N7, N7, N5, N4, N3, N2, and N1 masks, and even these are running low. In the United States, health care professionals are depleting surgical masks even though COVID-19 hasn't peaked. The Centers for Disease Control and Prevention has suggested the use of homemade PPE such as bandanas and scarves as a last result. Gomerblog has suggested other creative items should the supply of bandanas and scarves become depleted. Some of these include: sweaty sports cup, jock strap, pantyhose, turtleneck (pulled upwards), winter cap (pulled downwards), Saran Wrap, large condom, tampons (placed in nostrils), ski or SCUBA masks, snorkels, and horse feed bags.

• Supply of health care professionals - Contact tracing of the first U.S. cases of COVID-19 led to the 2-week self-quarantine of anywhere from 40 to 200 health care workers. In the event of a patient surge, such quarantine protocols would eventually deplete the work force. Subspecialists are the most sensible back-ups given their prior training in medicine or surgery. OB/GYNs have already volunteered their services on the front line, but radiologists are already being drafted, putting them in the unique position of performing their own clinical correlations. Orthopedic surgeons are relearning ICU things. In the extreme event that shortages still persist, first-year medical students and undergraduate students contemplating a career in health care will serve as backup.

• Supply of ventilators - It is very possible that the American trajectory of COVID-19 will lead to a Northern Italy-like surge that will lead to a shortage of hospital beds & ventilators. To bridge the gap, the American Medical Student Association will provide medical students who will bag patients until ventilators become available.

• COVID-19's Effect on the Global Economy - COVID-19 has arrested economic activity, causing markets to crash worldwide. The United States has been trying to combat recession with stimulus packages aimed at providing Americans with more toilet paper and Xanax (alprazolam). It speaks volume that all of the blame has been directed at COVID-19, not Anesthesia.

• Match Day 2020 - Fourth-year medical students weren't able to congregate, instead moving their celebrations online. This did not dampen their spirits as they all were excited to learn that they had matched at their respective No. 1 COVID-19 hotspot. Some students hope to inoculate themselves with novel coronavirus immediately after Match Day in the hopes it doesn't interrupt workflow starting on July 1. Other students are eager to get infected at their new residency program.

Resources

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• Gomerblog's "An Orthopedic Surgeon Explains Coronavirus"

References

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