COVID-19 Daily: Return-to-Work Guidelines, Tips From Frontline Docs

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APRIL 09, 2020 --Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

New CDC Return-to-Work Guidelines

The US Centers for Disease Control and Prevention has released new interim guidance on return-to-work rules for critical infrastructure workers, such as healthcare workers and first responders, who have been potentially exposed to COVID-19 but are asymptomatic. 

The guidelines recommend that employers measure employees' temperatures and assess their symptoms each day before work, and that potentially exposed workers monitor themselves for symptoms, practice social distancing when at work, and wear face masks for 14 days after their last suspected exposure. Previous guidance recommended potentially exposed workers stay home for 14 days. 

Clinical Tips From Frontline Docs

Over 7 days, Leora Horwitz, MD, admitted 58 patients for COVID rule-out to NYU Langone Medical Center; 50 tested positive. She recounted her exhaustion on social media, and shared practical clinical tips. Vineet Chopra, MBBS, the division chief of hospital medicine at the University of Michigan in Ann Arbor, chimed in. 

Despite the challenges of caring for COVID-19 patients, Chopra expressed some hope: "It's true, it's a bad disease. But we have discharged many people home after short hospital stays. All felt great at discharge. I'll count that as a win."

Case Reports: Guillain-Barré, Acute Hepatitis

Physicians in China have reported what they say is the first case of a patient with COVID-19 initially presenting with acute Guillain-Barré syndrome (GBS). "Our single case report only suggests a possible association between GBS and SARS-CoV-2 infection. It may or may not have a causal relationship," one of the physicians told Medscape Medical News .

Meanwhile, physicians in New York describe a patient with COVID-19 who presented with acute hepatitis as the primary symptom before developing respiratory symptoms, which they also say is the first documented case of its kind.

Pushback, More Testing for Hydroxychloroquine

In a joint statement, the nation's leading cardiology associations urged clinicians to be cautious using hydroxychloroquine and azithromycin for COVID-19 in patients with cardiovascular disease, as arrhythmias can be complications of these drugs. 


Despite limited evidence, doctors at some large healthcare systems across the US are routinely using hydroxychloroquine on patients hospitalized with COVID-19, according to Reuters. Today the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, announced a randomized, placebo-controlled trial for the drug is underway in the US and the first patients have been enrolled at Vanderbilt University Medical Center in Nashville, Tennessee. Protocol for Lung Ultrasound Triage 

A team of Italian physicians and experts who have been using lung ultrasound to assess patients with suspected COVID-19 have published their protocol in the Journal of Ultrasound Medicine. The protocol aims to provide a way to quantitatively and reproducibly assess the degree of lung involvement even when patients seem to have mild illness. Lung ultrasound is not universally used for diagnosing COVID-19 pneumonia and triaging patients. 

Concerns for Retired Clinicians

Many states have appealed to retired healthcare professionals to return to medicine to support overwhelmed hospital staff. Such redeployments, however, are raising concerns about exposing senior physicians to a virus that causes more severe illness in individuals age 65 years or older and kills them at a higher rate.

The president of the Colorado chapter of the American College of Emergency Physicians became concerned that his state's website recruiting retired clinicians initially included only a basic set of questions for interested volunteers, not a thorough screening for prior health problems or high-risk factors for COVID-19, he told MDedge News 

He and some colleagues have now provided recommendations to the state about its screening process, which he says state officials indicated they would strongly consider. 

SARS-CoV-2 May Persist in Warmer Months

Current data suggest that SARS-CoV-2 may be transmitted less efficiently in higher temperatures and humidity, but the studies are inconclusive because of poor data quality and confounding factors, according to a rapid expert consultation letter from the National Academies of Science, Engineering, and Medicine to the White House Office of Science and Technology Policy.

The influenza virus and other seasonal coronaviruses wane during warmer months, but SARS-CoV and MERS-CoV "have not demonstrated any evidence of seasonality,” the letter states, and SARS-CoV-2 has spread rapidly in Australia and Iran during their "summer" months. 


UK's Prime Minister Out of Intensive Care

United Kingdom Prime Minister Boris Johnson was moved out of intensive care Thursday. He'd been admitted to the hospital with symptoms of COVID-19 on Sunday evening and moved into intensive care on Monday. 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of 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. 

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