By Dr. Michael Patlas MD, FRCP, FASER FCAR FSAR
These are difficult times for our healthcare system as a global pandemic sweeps the world. Reports of confirmed cases are on a steady incline and every day we are hearing more and more stories on impacted nations including our own. Radiologists have an important role to play in the diagnosis and assessment of the coronavirus (COVID-19). As an emergency radiologist at McMaster and the editor-in-chief for the CAR Journal, I have followed the COVID-19 pandemic closely examining the available scientific evidence. My radiology practice is trying to adapt to the quickly changing picture and minimize dangers to my colleagues without compromising patients care.
While there are important lessons learned, there is still so much unknown about the virus as we try to contain the spread of the disease. COVID-19 has had a tremendous impact on communities internationally and will continue to do so until we can find a vaccine. Like SARS, the best course of action is to work to minimize the spread of COVID-19 and isolate those who have contracted the virus thus preventing others from getting sick and treating those who are susceptible to graver consequences with appropriate medical care.
As we try and mitigate the effects of the virus, there are some important steps that we, as healthcare professionals, must take. Listed below is the protocol based on experience from my institution and review of the literature. In my practice, we follow this process when patients present themselves with symptoms. My role as a radiologist is primarily to assess the severity and/or impact of COVID-19 on patients who have tested positive for the virus and who are experiencing severe and/or problematic symptoms.
The Canadian Society of Thoracic Imaging has put forward a statement on COVID-19 pertaining to the assessment of the virus. The CSTR recommends against the use of routine chest CT for screening, diagnosis and surveillance of COVID-19 infection. A normal chest CT scan cannot exclude the diagnosis of COVID-19 especially for patients with recent onset of symptoms. According to the Public Health Agency of Canada (PHAC) and the World Health Organization(WHO), the final diagnosis of COVID-19 infection should be confirmed by a positive RT-PCR test. This is the reference standard.
Our protocol for assessment in Canada has been initiated from lessons learned in other jurisdictions. Noted below is the procedure for assessment for COVID-19 in independent healthcare facilities. It should be mentioned that many areas have opened special assessment centers to protect those who are vulnerable in hospitals.
Independent Health Facilities (IHF) Protocol in Canada
- Any patient with a history suspicious for coronavirus infection should not visit IHF. Instead they should be referred directly to the Emergency Department for testing and assessment. IHFs must send a clear communication to their referring physicians advising them that Emergency Departments are better equipped to deal with patients requiring isolation.
- Initial screening of all patients attending IHF will be completed by the reception staff
- Screening will confirm that patient is presenting with fever, and/or new onset of cough, or difficulty breathing AND any of the following:
- Travel to COVID affected country based on the MOH case definition in the past 14 days before the onset of illness OR
- Close contact with a confirmed or probable case of COVID-19 OR
- Close contact with a person with acute respiratory illness who has been to a COVID affected country based on the MOH case definition in the 14 days before their symptom
- If any of the initial screening question is answered yes and the patient confirms a, b or c, then patient will be considered positive screen for coronavirus
- Patients with positive screen should be asked to wear a surgical mask and be evaluated in a private room
- Infectious disease specialist should be immediately consulted
- Imaging examinations will be performed in patients with negative screen as ordered
The pandemic of COVID-19 is spreading throughout the world. We should expect more cases in Canada. It is of paramount importance to adapt our practices and be prepared for the assessment of numerous patients. The CAR Journal will continue to support the Canadian radiologist community, fast-tracking publications on this important topic.
References:
CT Imaging and Differential Diagnosis of COVID-19
https://journals.sagepub.com/doi/full/10.1177/0846537120913033
COVID-19: What Can We Learn From Stories From the Trenches?
https://journals.sagepub.com/doi/full/10.1177/0846537120913497
ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection