J. De Greef, L. Pothen, H. Yildiz,W. Poncin, G. Reychler, S. Brilot, S. Demartin, E. Lagneaux, R. Lattenist, J. Lux,G. Pierman, G. Vandercam, S. Wallemacq, A. Scohy , A. Verroken, B. Mwenge, G. Liistro, A. Froidure, C. Pilette, L. Belkhir, J-C. YombiPublished in the journal : May 2020Category : Médecine interne et maladies infectieuses
The world is facing a serious pandemic. The disease called COVID-19 is caused by a new coronavirus, SARS-CoV-2, which started to spread in China in December 2019. COVID-19 is a condition that may be particularly serious and even fatal in elderly people, as well as in patients with comorbidities such as high blood pressure, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer. The clinical presentation is mild in approximately 80% of cases, moderate to severe in 15% of cases, and critical in 5% of cases. The most common symptoms of COVID-19 are fever, fatigue, muscle aches, and dry cough. Some patients may exhibit nasal congestion, chills, sore throat, or diarrhea. Severely ill patients can develop an acute respiratory distress syndrome (ARDS), shock, thrombosis, and multiple organ failure, and they are at risk of death. COVID-19 patients with ARDS have a poor prognosis, with an estimated mortality rate of more than 10%. SARS-CoV-2 is primarily transmitted through respiratory droplets. Airway and hand hygiene is therefore essential. The diagnosis is made by reverse transcription-polymerase chain reaction on a nasopharyngeal or oropharyngeal swab and, in suggestive cases, by chest computed tomography, which has a high sensitivity. There is currently no effective specific treatment for COVID-19. Many molecules have been tried or are under investigation. The treatment currently remains supportive.
Cédric Hermans, Catherine LambertPublished in the journal : May 2020Category : Hémostase
COVID-19, especially in its severe form, is associated with a coagulopathy responsible for an increased incidence of venous and arterial thrombosis, pulmonary embolism, and pulmonary microthrombosis. Biologically, it results in increased D-dimer levels, which is of diagnostic and prognostic relevance. Depending on its severity, the COVID-19 infection requires a treatment with low-molecular-weight heparin (LMWH) at preventive or semi-therapeutic doses. In case of proven or strongly suspected thrombosis, anticoagulation with LMWH at therapeutic doses is recommended.
Violaine Havelange, Ines Dufour, Juliette Raedemaeker, Fabio Andreozzi, Géraldine Verstrate, Sarah Bailly, Xavier Poiré, Marie-Christiane VekemansPublished in the journal : May 2020Category : Hématologie adulte
The SARS-CoV-2 pandemic poses an unprecedented challenge to the medical community. COVID-19 is potentially devastating for elderly patients, those who have comorbidities, as well as those with chronic hematological conditions.
Exceptional measures have been implemented by hospitals to prevent the spread of the virus and ensure optimal access to care for everyone, without jeopardizing the chances of recovery for patients with curable diseases. The hematological societies have issued guidelines that we summarize in this article for the diseases most commonly treated in our center, in the light of our experience.
The COVID-19 pandemic has had and still has a remarkable impact on general medicine in Belgium. From the day the first Belgian case was diagnosed on February 4, 2020 until the beginning of de-containment- three full months have passed during which general medicine needed to re- structure itself more effectively to be able to speak up with one voice, adapted itself by switching to telemedicine during the population’s confinement period, and constantly developed updated management procedures. In the first month, general practitioners (GPs) did not expect a pandemic of this magnitude to occur. In the second month, things accelerated and GPs’ offices closed their doors, with GPs applying themselves the procedures they helped convey to their patients over the phone. By the third month, while suspicious cases sharply dropped, procedures needed to be strengthened. The situation is more difficult in nursing homes. Within 3 months, relations with patients, colleagues, paramedics, and institutions were, there, entirely altered. In other countries as well, there has been a profound change that is likely to profoundly impact medical practices in the long term. On the eve of a new phase consisting of progressive de-containment, general medicine is now properly prepared to assume its role of an essential player in the fight against coronavirus in the wider community.
Isabelle Gilard, Isabelle De Brauwer, Pascale CornettePublished in the journal : May 2020Category : Geriatry
This article describes the transformation of a geriatric care unit into a COVID-19 geriatric care unit. Besides ensuring proper treatment, the multidisciplinary team adapted its care practice and procedures with the objective of preserving the patients’ functional capacities. Each dimension of health is taken into account and the adaptations are described in the light of this challenge. Along with the severity of our patients' medical and functional situations, infectious isolation is the parameter that most influences the adaptations and generates the most complexity.
Olivier Descamps, Pierre Henin, Pierre Hanotier, Francois-Xavier Lens, Jean-Paul Meurant, Michèle Pieterbourg, Sébastien Loix, Vanessa Wauters, Isabelle Reusen .Published in the journal : May 2020Category : Ethics
The region of Mons-Borinage and Center in the Province of Hainaut was one of the most affected by the COVID-19 epidemic in both the Walloon region and Belgium. While facing the constant flow of patients and threat of intensive care unit saturation in this part of the Hainaut Province, the various medical teams that were particularly involved in the care of these patients (intensive care, emergency care, department of general internal medicine and geriatrics) had to implement admission management strategies in collaboration with general practitioners, medical directors, and the ethics committees.
Laura Orioli, Michel P. Hermans, Vanessa Preumont, Audrey Loumaye, Jean-Paul Thissen, Orsalia Alexopoulou, Raluca Furnica, Maria-Cristina Burlacu, Dominique Maiter, Jean-Cyr Yombi, Bernard VandeleenePublished in the journal : May 2020Category : Diabétologie
Diabetes is one of the most commonly reported comorbidities in COVID-19-infected patients. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. However, diabetes is a risk factor for developing severe and critical COVID-19 forms, which often require intensive care unit admission and, eventually, invasive mechanical ventilation, which are associated with high mortality rates. The characteristics of COVID-19 diabetic patients and prognostic impact of diabetes on SARS-CoV-2 infection are currently under investigation. Obesity, the main risk factor for incident Type 2 diabetes, appears to be more common in patients with critical COVID-19 forms that require mechanical invasive ventilation. In diabetic patients, COVID-19 is associated with poor glycemic control and acute metabolic complications like ketoacidosis. At present, there are no recommendations in favor of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Owing to the risks of lactic acidosis and ketoacidosis, metformin and SGLT2 inhibitors should be discontinued in patients with severe COVID-19 forms. Finally, we advise a systematic screening for (pre)diabetes in patients with proven SARS-CoV-2 infection.
Marie Baeck, Caroline Peeters, Marie Cuvelier, Laetitia Fameree, Evelyne Harkemanne, Fanny Ickx, Margaux Mairlot, Marine Matthews, Nina Nielens, Laura Nobile, Romane Thirion, Anne HermanPublished in the journal : May 2020Category : Dermatology
Skin manifestations are considered uncommon presentations of COVID-19. Despite reported cases in the literature, no causal link has been formally demonstrated to date. Skin lesions associated with COVID-19 are: 1) rashes that are classically viral or paraviral in nature like exanthemas, urticaria, and erythema multiforme; 2) eruptions that are secondary to the systemic consequences of COVID-19 like vasculitis or thrombotic vasculopathy; 3) rashes induced by drugs prescribed as part of COVID-19; 4) skin lesions like chilblains that are likely to be an indirect consequences of COVID-19 and containment measures.
Christophe Scavée, Agnès Pasquet, Christophe BeauloyePublished in the journal : May 2020Category : Cardiology
From the beginning of the COVID-19 crisis, physicians alerted the scientific community to the emergence of severe acute respiratory problems related to viral lung infections. The vast majority of these patients require oxygen therapy and 5 to 10% need assisted ventilation or even extracorporeal membrane oxygenation in the event of an uncontrolled situation. Poor prognosis factors mainly include age, as well as the presence of comorbidities such as hypertension, diabetes, obesity, but also cardiovascular diseases. Coronaviruses are known to attack the cardiovascular system, and it also appears that the virus might attack the heart muscle directly. Data relayed namely by Chinese and Italian physicians show that besides the lungs, certain patients develop sometimes severe cardiac problems, such as acute myocarditis, acute coronary syndrome (ACS), or arrhythmias that in turn lead to heart failure, shock, or cardiac arrest in those most affected. Cardiac damage is therefore a factor contributing to the poor prognosis of COVID-19 and it must be detected. Patients who have an ACS but whose pulmonary picture prevails may have their cardiac management dangerously delayed. Conversely, patients who present with an exclusively "cardiological" picture may not be properly diagnosed as COVID-19. Finally, the focus on COVID-19 and the patients' fear of the contagiousness of this virus may delay their presentation at the hospital. These data directly impact the way physicians and hospitals should consider COVID-19 cardiac patients, especially at the first signs of the disease. It is therefore essential to have recommendations for the management of all patients with preexisting heart problems and those with demonstrated myocardial damage caused by the virus.
Diagnosing COVID-19, which has recently been renamed COVID, in a quick and accurate manner constitutes the cornerstone of pandemic control. However, this evidence shared by almost everyone is being challenged by the truly-multifaceted nature of the SARS-CoV2 infection, which is the well-identified viral cause of COVID. In addition to the completely asymptomatic forms, there are indeed mild or pauci-symptomatic forms, moderate-to-severe forms, the latter requiring hospital care, as well as very severe forms requiring intensive care admission and assisted ventilation. All of these viral infection manifestations are likely to contribute to virus transmission within communities. Among the diagnostic tests to confirm COVID, we have used the reverse transcription reaction followed by a real-time quantitative chain polymerization reaction (RT-qPCR) rapid diagnostic testing based on specific SARS-CoV-2 antigen detection in the early phase of infectious manifestations. In addition, we have applied serum antibody testing, such as ELISA and lateral flow assay, in both the later phase and following recovery. Owing to the lack of an optimal "reference test", the respective sensitivities and specificities reported in the different published studies must all be considered with great caution. For this reason, we shall only briefly comment on them.