Cleveland Clinic journal of medicine
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SARS-CoV-2, the virus that causes COVID-19, is transmitted through respiratory secretions and saliva. The virus can also live for short periods of time (1 to several hours) on fomites such as doorknobs, handrails, and tables. ⋯ Asymptomatic shedding of the virus does occur and may account for up to 60% of cases. Risk factors for a more severe course of COVID-19 include age 65 and older, living in a nursing home or long term care facility, chronic lung disease, and others.
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Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage.
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COVID-19 is a novel respiratory disease leading to high rates of acute respiratory failure requiring hospital admission. It is unclear if specific patient populations such as lung transplant patients are at higher risk for COVID-19. ⋯ Efforts to ensure the safety of wait-listed patients, transplant recipients, and healthcare workers are underway. Recommendations for the care of lung transplant patients during the COVID-19 pandemic are discussed and will likely change as the pandemic evolves.
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Pulmonary hypertension (PH) is a pulmonary vascular disease characterized by pulmonary arterial remodeling and vasoconstriction leading to elevated pulmonary artery pressure and, ultimately, right heart failure. So far, few cases of COVID-19 disease in patients with PH have been reported. ⋯ In addition, PH is a rare disease, and because testing is not universal, we could be underestimating the number of cases. Other hypothetical factors to consider are the underlying pathophysiology of PH and the medications used to treat PH and their implications in COVID-19.
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During the COVID-19 pandemic, Cleveland Clinic has put in place several pulmonary function testing precautions to reduce the risk of infection. Precautions include efforts to perform only essential testing, wear personal protective equipment, reduce exposure to aerosolized particles, manage virtually by phone conference, conserve scare medications, clean equipment as recommended, consolidate testing, and defer testing.