11 June, 2020
A new proposal of COVID-19 diagnosis and its possible effects
In the de-escalation phase of the COVID-19 pandemic in which we find ourselves, it is, and will be, fundamental to correctly diagnose the illness. Furthermore, it is going to be vitally important to identify those persons who have recovered from the illness and its possible post-recovery consequences. Therefore, in barnaclinc+ we have designed various diagnostic protocols for distinct patient profiles: diagnosis of COVID-19 before admittance, confirmation of contact, and evaluation and treatment of the effects post COVID-19.
What does the diagnosis of COVID-19 in barnaclinic+ consist of?
Grupo Hospital Clinic de Barcelona has been a centre of reference in the management of COVID-19, with the result that our teams have had months acquiring experience and developing studies and protocols of best practice. In barnaclinic+, based on the scientific evidence and experience acquired by our staff, we have developed various diagnostic protocols adapted to the different profiles of current and post COVID-19 patients.
Diagnosis of COVID-19 adapted to the type of patient
PATIENTS WHO SHOULD BE ADMITTED OR SUBJECTED TO AN INTERVENTION
To ensure the safety of our patients and professionals, we should control the state of those people who are admitted to a hospital ward or who are going to be subjected to an intervention. For this, we control the clinical examination of the patient to see if they present any symptoms of COVID-19: a cough, fever, breathing difficulty, etc. Furthermore, we continue with the protocol of safety and protection of other patients and staff. Among other things, we do a PCR test for the diagnosis of COVID-19 by taking nostril and larynx swabs.
PCR Test for COVID-19 is a type of test that is done to identify the presence in the respiratory airways of any genetic material of coronavirus SARS-CoV-2, the cause of COVID-19. This is a standard diagnostic test that it is highly sensitive (it doesn’t give false negatives) and has good specificity (it doesn’t give false positives).
PATIENT WITH SUSPECTED CONTACT
Now that the pandemic is reducing or, practically disappearing, we will find that more people will want (or need) to know if you they have been infected by COVID-19. Dr. Alfons López-Soto, Associate of Welfare Management and specialist in Internal Medicine at barnaclinic+, explains that they are dealing with patients “who have had a PCR and comparable symptoms, or those who have not, but who would like to know if they have been in contact”. For these cases we have developed a protocol which permits us to identify the presence of antibodies against COVID-19. This is done through a serological blood test. This type of laboratory test allows for the detection of the immunological response due to the presence at any moment of COVID-19. The serological test detects, above all, the antibodies IgG (those which adhere to coronavirus in order to deactivate it).
Why is the interpretation of COVID-19 tests by an expert important?
In order to obtain reliable results and rule out false positives or negatives, it is fundamental that the tests are collected by experienced professionals, and that the interpretation of the diagnostic COVID-19 tests is undertaken by a medical team with expertise in the management of the illness. In explanation, Dr. López-Soto underlines the importance of the method of collection for obtaining high sensitivity: “the PCR, with a nasal or pharyngeal smear, if done by expert personal has an elevated sensitivity of up to 90 per cent”. For the analysis of the remaining 10 per cent an expert team is vital, as Dr. López-Soto explains: “a negative PCR does not rule out, in the initial phases, COVID-19 infection”.
The same is true of the diagnosis of COVID-19 by means of a serological test, as Dr. López-Soto says: “Not all patients produce antibodies in the same way”. There are patients, who in the initial phases, between the seventh and tenth day, have a low production of antibodies. In these cases it is fundamental to interpret the results and, if necessary, repeat the test within a few days.
For this reason, it is essential to combine the analysis of the clinical data of the patient with the results of the diagnostic test for COVID-19. In this regard, confirms Dr. López-Soto, “The only thing that you can do to make a suitable interpretation, and to avoid false positives or negatives, is to use a qualified medical professional who has experience in the diagnosis, treatment and management of COVID-19“.
“The PCR test, with a nasal or pharyngeal smear, if done by expert personal has an elevated sensitivity of up to 90 per cent”
Diagnosis and treament of post COVID-19 complications
Post COVID-19 respiratory effects
“We believe that a percentage of patients who have recovered from COVID-19 will present with medium to long term fibrotic damage or pulmonary effects” Dr. Jacobo Sellarés, a barnaclinc+ pulmonologist and co-ordinator of the Pulmonary Interstitial Illness group of Hospital Clinic, Barcelona. Here, a centre of national reference for COVID-19, they are seeing patients, above all those that have had a serious condition, continuing with imagines in the lung and the sensation of lacking breath, even once they have passed the most acute stage of the illness.
“We believe that a percentage of patients who have recovered from COVID-19 will present with medium to long term fibrotic damage or pulmonary effects”
Dr. Jacobo Sellarés
For this reason, we are developing an offer of services for those patients that have overcome COVID-19 but who continue with respiratory difficulties. Complications from COVID-19 such as pneumonia bilateral, the persistent inflammation of the respiratory airways or pulmonary embolism can cause medium- or long-term effects. These types of complications need to be diagnosed, followed by attention and treatment by experienced medical professionals experienced in managing viral pathologies similar to COVID-19. Our multidiscipline team has defined a series of protocols, adapted to each case which contemplates tests such as TAC thoracic, lung scanning and diverse tests of pulmonary function.
Post COVID-19 loss of Smell and Taste
“According to the latest studies, up to 88% of patients with COVID-19 show a loss of smell and taste”, explains Dr. Isam Alobid, a barnaclinic+ and Hospital Clinic rhinologist. The majority of them, around 80%, will recover their smelling capacity spontaneously, with the passage of time. However, experience with other post-virus anosmias would indicate that some of these patients will continue to have this sensory loss in the medium to long term. For this portion of patients there currently exists only one type of treatment: olfactory training.
“According to the latest studies, up to 88% of patients with COVID-19 show a loss of smell and taste”
Dr. Isam Alobid
To this effect, in barnaclinic+ we have developed a protocol for the diagnosis, monitoring and treatment of anosmia post COVID-19. Those patients who have suffered from COVID-19, lost their sense of smell and taste and who feel that they have not recovered all of their olfactory capacity, should be evaluated and tracked.
Our team will make an indepth investigation using endoscopy and a magnetic resonance scan of the olfactory bulb, in order to rule out that the loss is not produced by an endonasal alteration. This is followed by an olfactometry.
In barnaclinic+ we have an olfactometry of 8 odours, which provides exact and clarifying data about olfactory capacity. Finally, and depending on the results, olfactory training will be recommended. This consists of repetitive and structured exposure to distinct odours which permits recognition of them.
In our experience with post-virus anosmia, this training has produced optimal results. Dr. Alobid confirms: “one out of every three anosmia patients recover their sense of smell with an average of six months training”.