Irene Hartmann
06/02/2020 - 14:23
- Clarín.com
- Society
Fulanito has fever lines combined with some mild respiratory symptoms: cough or sore throat. Before, he would have rested or he would have been banking on a normal life, pain reliever through. But the coronavirus altered all normality and now that person - supposing that he followed the official indications - must go to the health system to carry out the corresponding swab and the subsequent PCR. Now, can it be said that the mere manifestation of these symptoms is enough to activate the protocol or, instead, are there grays? And if there are, based on what parameters is it decided to test (or not) the patient?
The question makes vital sense now, with cold days and the increased circulation of seasonal “non-covid” viruses, such as A and B influences and colds, of which, in fact, about 20 percent are caused by less prominent coronaviruses. This without counting the classic bacterial infections that affect the lungs, throat, produce fever ...
In two private medicine companies (Galen and another with millions of affiliates who preferred not to be named) they explained to this media that, in effect, the "seasonal ones can confuse" in this context, but stressed that their specialists strictly follow the national protocol . That is, in the face of a suspicious case, they isolate and hispanic .
Medical personnel take the body temperature of a man in the triage of the Buenos Aires hospital in El Cruce, Florencio Varela. / AFP
"But in some cases there are grays ", explained Daniel Ferrante, Undersecretary of Health Planning and Network Management of the Ministry of Health of the City of Buenos Aires, in addition to an academically authorized voice: he is a cardiologist, Master in Biometrics-Biostatistics and in Clinical Effectiveness (UBA) and studied at the Harvard School of Public Health and the University of London.
In the talk with this medium, Ferrante reiterated the importance of sensitivity several times : “Given the slightest suspicion of moderate or severe disease, an ambulance is sent to the patient, isolated and tested. It is better to exaggerate the measurements. As for mild cases, the indication since the end of March is to go to the Febrile Emergency Units (UFU ) , where sensitivity is also essential ... that is, to have a broad perspective when questioning and examining clinically to the patient ”. The expert immediately clarified: "'Sensitivity' is the ability of any triage or diagnostic system to detect a problem."
Or, vice versa, to discard it. Because the official defined a couple of moments in which "the waters are divided" , taking his words. First, there is the decision that the 107 telephone operator must make about whether or not to send an ambulance to the calling patient: “To be transferred, it should be considered a moderate or severe case . In addition to fever, it weighs if the person has difficulty breathing, that is, if he is going to need oxygen. And also other factors such as age and concomitant diseases. All this means that the telephone operator, already trained to do these 'interrogations', can decide how to proceed ”.
The other separation of waters occurs in the UFU. Because many may have been left with the Buenos Aires message so reiterated of "call 107 ". However, it is enough to look at the page of the City Ministry of Health to understand that this is not the first recommendation now . The SAME number was displaced by a greater role for the UFU, "feverish units that were not previously mounted, but now operate to receive minor suspicious cases ," said Ferrante.
So, the question: Do they test absolutely all cases that come with fever plus some respiratory symptoms, or with sudden lack of taste or smell, according to the new protocol? Ferrante said that in most cases, yes, but there are exceptions .
The municipality of Rosario, Santa Fe, went out to perform swabs in different neighborhoods. Photo: Juan José García
“You have to distinguish the signs from the symptoms . 'Sign' is what is evident in the patient: body temperature, blood pressure, skin reactions ... instead 'symptom' is what the patient manifests to feel. What he relates, "he said, adding:" In general, having a fever and some respiratory manifestation would fit into the category of 'suspected case'. It is isolated and tested. But it must be ruled out that there are no other probable causes that generate these symptoms, such as influenza or a bacterial infection, the symptoms of which may overlap with the coronavirus. ”
Discrimination is very complex, but in broad strokes "if the cough is dry, it may be compatible with Covid. But if there is mucus, it could be more compatible with something bacterial ... it is an indicator to take into account when making a chest plate. And the same with the throat: if there are typical white streptococcal plaques , the fever is surely being caused by a bacterium and not a virus, "he said.
In any case, Ferrante insisted on clarifying: “There is no such categorical differentiation that leaves us alone as to say that ' if you have mucus, it is not Covid '. I don't want to give that message. Before any cough with fever, you have to isolate yourself, wear face masks and go to the consultation ”.
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Watch the specialOther "grays"? For example, people with atypical or incomplete symptoms explained: “If the case is to rule out Covid-19, the patient is sent home. But you can also tell him to leave, isolate himself and wait 48 to 72 hours, and see how he evolves. "
An example of this, explained the official, "is if the person has some very slight symptoms, such as an alteration in smell or taste, and nothing more than that. One would wait a couple of days before swabbing it (due to the risk of false negative, among other issues), to see if it develops another symptom, and then tie-break ”.
In any case, Ferrante remarked, “when in doubt, it is appropriate to exaggerate. Hyssop and do the PCR ” .
DD