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| My Practice Page
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| {{CMG}}; {{AE}} {{GDS}}
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| __NOTOC__ | | __NOTOC__ |
| {{Polio}} | | {{Frequently Asked Inpatient Questions}} |
| {{CMG}}; {{AE}} {{JS}} | | {{CMG}}{{AE}}{{GDS}}{{Aisha}}{{HAR}}{{RAB}}{{Nuha}}{{IF}}} |
| | | ==Treatment Based Questions== |
| ==Overview==
| | ===I read about the retraction of the two articles that halted the use of hydroxychloroquine in COVID-19 patients, can I currently receive this medication if infected?=== |
| Poliovirus enters the body orally, and infects cells of the [[gastrointestinal]] tract, from the mouth to the [[ileum]] and [[mesenterium]]. After [[replication]], the virus may either be secreted in feces, contributing to the [[transmission]] of the disease, or reach the [[bloodstream]], and be transported to other cells of the body, such as those of the [[reticuloendothelial system]]. Although the precise mechanism of infection of [[CNS]] is not fully understood, the most supported hypothesis is the retrograde axonal transport, according to which the virus enters the [[axoplasm]] of a motor neuron, travels to its cell body, where it replicates, and leads to neuron death. In the [[CNS]], [[poliovirus]] shows [[tropism]] for cells of the [[anterior horn]] of the [[spinal cord]], [[hypothalamus]], [[thalamus]], [[cerebellar vermis]], [[vestibular nuclei|vestibular]] and deep cerebral nuclei. Death of the [[motor neuron]] is responsible for the [[paralysis]] often seen in poliomyelitis.
| | ===Does every patient with a positive COVID-19 test need to be admitted to the hospital?=== |
| | | ===What are the chances of recovery in a hospital admitted COVID-19 patient?=== |
| ==Transmission==
| | ===Are antibiotics effective in preventing or treating COVID-19?=== |
| Poliovirus is mostly transmitted through the [[fecal-oral route]], by ingestion of contaminated food or water. In some instances, the oral-oral route may be relevant through [[pharyngeal]] secretions. <ref name="pmid20978089">{{cite journal| author=Nathanson N, Kew OM| title=From emergence to eradication: the epidemiology of poliomyelitis deconstructed. | journal=Am J Epidemiol | year= 2010 | volume= 172 | issue= 11 | pages= 1213-29 | pmid=20978089 | doi=10.1093/aje/kwq320 | pmc=PMC2991634 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20978089 }} </ref><ref name=CDC>{{cite web | title = Poliomyelitis | url = http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi }}</ref> Poliomyelitis is highly contagious and spreads easily through human-to-human contact.<ref name=Kew_2005>{{cite journal |author=Kew O, Sutter R, de Gourville E, Dowdle W, Pallansch M |title=Vaccine-derived polioviruses and the endgame strategy for global polio eradication |journal=Annu Rev Microbiol |volume=59 |issue= |pages=587–635 |year=2005 |pmid=16153180}}</ref> In [[endemic]] areas, wild polioviruses can infect virtually the entire human population.<ref name=McGraw>{{cite book |author = Parker SP (ed.) | title = McGraw-Hill Concise Encyclopedia of Science & Technology |publisher=McGraw-Hill |location=New York |year=1998 | isbn=0-07-052659-1| page= 67}}</ref> Viral particles are excreted in the [[feces]] for several weeks, after initial infection. Although the virus can cross the [[placenta]] during pregnancy, the [[fetus]] does not appear to be affected by either maternal infection, or polio [[vaccination]].<ref name=UK>{{cite book |author=Joint Committee on Vaccination and Immunisation (Salisbury A, Ramsay M, Noakes K (eds.) |title = Chapter 26:Poliomyelitis. ''in:'' Immunisation Against Infectious Disease, 2006 | url=http://www.immunisation.nhs.uk/files/GB_26_polio.pdf | format = PDF |publisher=Stationery Office |location=Edinburgh |year=2006 |pages = 313–29 |isbn = 0-11-322528-8}}</ref> Maternal [[antibodies]] can also cross the [[placenta]], providing [[passive immunity]] that protects the infant from polio infection during the first few months of life.<ref>{{cite journal |author=Sauerbrei A, Groh A, Bischoff A, Prager J, Wutzler P |title=Antibodies against vaccine-preventable diseases in pregnant women and their offspring in the eastern part of Germany |journal=Med Microbiol Immunol |volume=190 |issue=4 |pages=167–72 |year=2002 |pmid=12005329}}</ref>
| | ===What anti-viral medications are available to treat COVID-19?=== |
| ==Pathogenesis== | | ===Should I stop my ACE Inhibitors and ARBs while on admission for COVID-19?=== |
| Poliovirus enters the body orally and most often infects nearby [[cell]]s, such as those of the mouth, nose, and throat. It infects cells by binding to an immunoglobulin-like receptor known as CD155 on the cell surface. The most common course of [[infection]] is the replication of [[poliovirus]] in cells of the [[gastrointestinal]] tract, followed by viral shedding in feces. The specific cells of the [[gastrointestinal]] tract, where poliovirus replicates, are not known, however, the virus was successfully isolated from [[lymphatic]] cells of the [[GI tract]], including:<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| * [[tonsils|Tonsillar]] cells
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| * [[Peyer's patches]] of the [[ileum]]
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| * [[Lymph nodes]] of the [[mesenterium]]
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| The virus enters the [[bloodstream]] and migrates to the [[reticuloendothelial]] cells across the body. [[Poliovirus]] is able to reach the [[central nervous system]] in a small fraction of the [[symptomatic]] patients.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref> Not only is the disease not a phase of the [[viral replication]] cycle, it also does not benefit the virus in any way. The molecular mechanism behind this disease process is not known.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| [[Poliovirus]] replicates inside [[monocytes]], which allows for secondary hematogenous spread. The pathological mechanism responsible for the clinical manifestations of CNS poliomyelitis is characterized by selective destruction of [[motor neurons]]. Depending of the involved site, motor neuron loss may lead to focal or generalized symptoms. Most commonly observed signs and symptoms include asymmetric limb paralysis in spinal polio and respiratory disturbance with cranial nerve defects in bulbar polio.
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| Although the mechanism of viral spread to the [[CNS]] is not fully understood, two main hypotheses have been proposed:<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| # [[Poliovirus]] diffuses directly through the [[blood brain barrier]] from the [[bloodstream]] to the [[CNS]], regardless of cellular receptors.
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| # [[Poliovirus]] is transported from the peripheral [[muscles]] to the [[brain]] and [[spinal cord]], through retrograde axonal transport. This hypothesis has been experimentally proven in mice, after [[CD155]] transformation.
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| Once at the [[cell body]] of the [[neuron]], the change from [[axoplasm]] to [[cytoplasm]] is thought to interfere with the stability of the viral coat, leading to the exposure of the viral [[RNA]]. [[Viral replication]] interferes with [[neuron]] stability, killing the [[motor neuron]]. Death of a [[motor neuron]] paralyzes the respective [[muscle fiber]].
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| ===Retrograde Axonal Transport Hypothesis===
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| Several recent findings supporting the retrograde axonal transport hypothesis have been reported:<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| * Detection of axonal poliovirus in patients with poliomyelitis.
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| * Interruption of a nerve connection between a site of multiple intramuscular injections and the spinal cord in mice with poliovirus viremia led to improved clinical course of infection. This supports the ''provocation poliomyelitis'' hypothesis which states that muscle injury in patients with poliovirus viremia triggers retrograde axonal transport of the virus. This phenomenon is seen in children receiving intramuscular vaccines in areas endemic for poliovirus.<ref name="pmid9573275">{{cite journal| author=Gromeier M, Wimmer E| title=Mechanism of injury-provoked poliomyelitis. | journal=J Virol | year= 1998 | volume= 72 | issue= 6 | pages= 5056-60 | pmid=9573275 | doi= | pmc=PMC110068 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9573275 }} </ref>
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| * In mice [[genetically]] transformed to express [[CD155]], injection of [[poliovirus]] in the left limb led to viral detection in the left anterior horn of the [[spinal cord]] only. When the [[sciatic nerve]] was promptly sectioned after injection of the virus, the risk of paralysis in the injected limb was greatly reduced.
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| * [[Bulbar poliomyelitis]] following [[tonsillectomy]] may possibly be explained by the previously described mechanisms.
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| * Overexpression of [[CD155]] in the [[muscle fiber]]s of patients with paralytic poliomyelitis. To note, [[CD155]] directly interacts with the [[dynein]] retrograde complex through Tctex-1.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| <br>
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| The main explanation for increased susceptibility to retrograde axonal transport of poliovirus in areas of injured muscle has been explained. In a neuronal [[synapse]], the rate of [[endocytosis]] is related to the level of [[neuron]] activity. Correspondingly, for a [[motor neuron]], the level of [[neuron]] activity and rate of endocytosis at the [[neuromuscular junction]] is related to the extent of [[muscle]] contraction. This explains the connection between extreme exercise or muscle injury and development of poliomyelitis in patients with [[viremia]]. Also, since most of [[CD155]] receptors are transported back to the [[cell body]], the virus is carried along, supporting the retrograde transport hypothesis.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| ===Affected Tissues=== | |
| Poliovirus commonly targets specific tissues in the CNS such as:<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| * [[Anterior horn]] cells of the [[spinal cord]] (in severe cases of the disease, the intermediate, intermediolateral and posterior gray columns may also be affected)
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| * [[Hypothalamus]]
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| * [[Thalamus]]
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| * [[Vestibular nuclei]]
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| * Deep cerebral nuclei
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| * [[Reticular formation]]
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| * [[Cerebellar vermis]]
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| The different clinical forms of [[poliomyelitis]] will depend on the most affected area of the [[CNS]]. Individual host factors and the neuropathogenicity of the [[virus]] influence the severity of the lesions.<ref name="pmid15885840">{{cite journal| author=Mueller S, Wimmer E, Cello J| title=Poliovirus and poliomyelitis: a tale of guts, brains, and an accidental event. | journal=Virus Res | year= 2005 | volume= 111 | issue= 2 | pages= 175-93 | pmid=15885840 | doi=10.1016/j.virusres.2005.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15885840 }} </ref>
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| ==Vaccine mediated polio infection==
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| [[Polio vaccine|Oral polio vaccine (OPV)]] is one of the safest and most effective vaccination programs that prevented millions of cases of [[polio]] not only through direct [[immunization]] but also through [[herd immunity]]. In rare occasions, the [[vaccine]] is associated with [[Polio|paralytic polio]].
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| There are two subtypes of paralytic polio related to [[Polio vaccine|OPV]] vaccine: vaccine associated paralytic polio and vaccine derived paralytic polio.
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| ===Vaccine associated paralytic polio===
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| *Vaccine associated paralytic polio (VAPP) occurs when the [[Attenuated virus|attenuated strain]] used in the [[vaccine]] reverts inside the intestine into more [[virulent]] form.<ref name="urlwww.who.int">{{cite web |url=http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/VAPPandcVDPVFactSheet-Feb2015.pdf |title=www.who.int |format= |work= |accessdate=}}</ref><ref name="pmid3029445">{{cite journal |vauthors=Nkowane BM, Wassilak SG, Orenstein WA, Bart KJ, Schonberger LB, Hinman AR, Kew OM |title=Vaccine-associated paralytic poliomyelitis. United States: 1973 through 1984 |journal=JAMA |volume=257 |issue=10 |pages=1335–40 |year=1987 |pmid=3029445 |doi= |url=}}</ref><ref name="pmid7476613">{{cite journal |vauthors=Sullivan AA, Boyle RS, Whitby RM |title=Vaccine-associated paralytic poliomyelitis |journal=Med. J. Aust. |volume=163 |issue=8 |pages=423–4 |year=1995 |pmid=7476613 |doi= |url=}}</ref>
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| *The more virulent form is capable of causing the disease only in the vaccinated child or a close susceptible contact. Therfore, no outbreaks are associated with VAPP.
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| *The [[prevalence]] of (VAPP) is 1 in 2.7 million doses of the vaccine.
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| *In developed countries, the risk of VAPP is increased with the first dose of the vaccine while in developed countries, It’s increased with subsequent doses.
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| ===Vaccine derived paralytic polio===
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| *Vaccine derived paralytic polio (VDPP) is caused by very rare [[mutation]] of the original strain of polio in the vaccine.<ref name="urlwww.who.int">{{cite web |url=http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/VAPPandcVDPVFactSheet-Feb2015.pdf |title=www.who.int |format= |work= |accessdate=}}</ref><ref name="pmid14673763">{{cite journal |vauthors=Khetsuriani N, Prevots DR, Quick L, Elder ME, Pallansch M, Kew O, Sutter RW |title=Persistence of vaccine-derived polioviruses among immunodeficient persons with vaccine-associated paralytic poliomyelitis |journal=J. Infect. Dis. |volume=188 |issue=12 |pages=1845–52 |year=2003 |pmid=14673763 |doi=10.1086/379791 |url=}}</ref>
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| *VDPP has the ability to cause the disease in any non immune person whether the vaccinated person or a contact, therefore it has the ability to cause [[Outbreak|outbreaks]] or even [[epidemics]] especially in communities that are not properly covered with the [[vaccination]] program.
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| *When it causes [[outbreaks]], VDPP is called circulating vaccine derived paralytic polio (cVDPP).
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| *In the last 10 years, 24 VDPP reported [[outbreaks]] happened in 21 countries causing 750 cases of [[Polio|paralytic polio.]]
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| *The management of VDPP is conducting extensive vaccination campaigns in the affected community aiming for vaccinating every child and thus preventing the spread of the [[infection]].
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| ==Gallery==
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| <gallery>
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| Image:Poliomyelitis1.png|A photomicrograph of skeletal muscle tissue revealing myotonic dystrophic changes as a result of Polio Type III.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
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| Image:Poliomyelitis2.png|A photomicrograph of the lumbar spinal cord depicting an infarct due to Polio Type III surrounding the anterior spinal artery.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
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| Image:Polio3.jpg|A photomicrograph of the lumbar spinal cord depicting an infarct due to Polio Type III surrounding the anterior spinal artery.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
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| Image:Polio4.jpg|A photomicrograph of the lumbar spinal cord depicting degenerative changes due to an infarct caused by Polio Type III.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
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| Image:Polio5.jpg|A photomicrograph of the thoracic spinal cord depicting degenerative changes due to Polio Type III.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Complications Based Questions== |
| | ===What population is most at risk for severe disease from COVID-19?=== |
| | ===What risk factors result in severe complications from COVID-19?=== |
| | ===Will I be placed on a ventilator?=== |
| | ===What systems other than the Respiratory system can be involved?=== |
| | ===Does prolonged ventilation in hospitalized patients worsen the outcome of COVID-19?=== |
| | ==Co-Morbidity Based Questions== |
| | ===Should I stop my ACE Inhibitors and ARBs while on admission for COVID-19?=== |
| | ===If I experience an Asthma exacerbation, should that exacerbation be treated any differently to reduce the risk of COVID-19?=== |
| | ===Can I continue receiving Hemodialysis in a hospital where other COVID-19 patients are treated?=== |
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| Image:Polio6.jpg|A photomicrograph of the thoracic spinal cord depicting degenerative changes due to Polio Type III.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Hospital Discharge Related Questions== |
| | ===I no longer have symptoms but my tests still came back positive for COVID-19, can I be discharged?=== |
| | ===If after discharge I show new symptoms of COVID-19, should I be isolated and tested again?=== |
| | ===If after discharge, a close contact test positive, should I self-isolate again?=== |
| | ===After I have been discharged, should I continue to wear a face mask?=== |
| | ===After discharge, how soon can I get back to my job?=== |
| | ===After discharge can I use public places and transportation?=== |
| | ===What can I expect after I leave the hospital?=== |
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| Image:Polio7.jpg|A photomicrograph of the cervical spinal cord in the region of the anterior horn revealing Polio Type III degenerative changes.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Re-Infection Related Questions== |
| | ===Do I become immune after I have recovered from COVID-19?=== |
| | ===Is re-infection worse than the initial infection?=== |
| | ===Will a re-infected person show the same symptoms as the initial infection?=== |
| | ===Are clinically recovered persons infectious to others if they test persistently or recurrently positive for SARS-COV-2 RNA?=== |
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| Image:Polio8.jpg|A photomicrograph of the cervical spinal cord in the region of the anterior horn revealing Polio Type III degenerative changes.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Pregnancy Related Questions== |
| | ===If I deliver in the hospital will that increase my chances or my baby's chances of contracting COVID-19?=== |
| | ===Should intrapartum fever be considered as a possible sign of COVID-19 infection?=== |
| | ===I am currently pregnant and hospitalized due to COVID-19, is my unborn child infected?=== |
| | ===What is the guidance available for labor and delivery Health Care Personnel with potential exposure in a healthcare setting to patients with COVID-19 infection?=== |
| | ===Are Pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19 infection?=== |
| | ===Can I proceed with a scheduled cesarean delivery if hospitalized with COVID-19?=== |
| | ===Are glucocorticoids contraindicated in pregnant patients with COVID-19?=== |
| | ===Are pregnant women more susceptible to infection or at increased risk for severe illness, morbidity, or mortality with COVID-19?=== |
| | ===I have heard that some hospitals are testing all women for COVID-19 who arrive at the hospital for labor—even women without any symptoms. Will I be tested?=== |
| | ===If I contract COVID-19, will I still be able to breastfeed?=== |
| | ===How many people can be present in the room during my birth?=== |
| | ===If I have COVID-19 at the time of my birth, will my baby be able to stay with me?=== |
| | ===Can COVID-19 be transmitted via breastmilk?=== |
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| Image:Polio9.jpg|A photomicrograph of the cervical spinal cord in the region of the anterior horn revealing Polio Type III degenerative changes.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Pediatrics Related Questions== |
| | ===My child has congenital heart disease, is he at increased risk of COVID-19?=== |
| | ===Are children with underlying conditions at increased risk of hospitalization?=== |
| | ===I am currently hospitalized due to COVID-19, can I breastfeed my infant child?=== |
| | ===What is KAWASAKI disease? What is the association with COVID-19?=== |
| | ===What is a multisystem inflammatory syndrome? What is the association with COVID-19?=== |
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| Image:Polio10.jpg|Under a low magnification, this photomicrograph of pontine tissue at the level of abducens nucleus reveals histopathologic changes in a poliomyelitis patient.<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Visitors Related Questions== |
| | ===Can I have visitors while I’m in the hospital?=== |
| | ===Is there anything I can to do to help others who have COVID-19?=== |
| | ==General In-Patient Questions== |
| | ===Does being hospitalized with other COVID-19 patients worsen my outcome?=== |
| | ===What are the diet recommendations if I get hospitalized?=== |
| | ===What can I expect while I’m in the hospital?=== |
| | ===When can I leave the hospital?=== |
| | ===Is blood been tested for COVID-19 before blood transfusion?=== |
| | ===Do wastewater & sewage workers need additional protection when handling untreated waste from hospitals with COVID-19 patients?=== |
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| Image:Polio11.jpg|Photomicrograph of the Cervical Spinal Cord Affected by Polio Type III Virus<SMALL><SMALL>''[http://phil.cdc.gov/phil/ Adapted from Public Health Image Library (PHIL), Centers for Disease Control and Prevention.]''<ref name="PHIL">{{Cite web | title = Public Health Image Library (PHIL), Centers for Disease Control and Prevention | url = http://phil.cdc.gov/phil/}}</ref></SMALL></SMALL>
| | ==Management of Dead Bodies from COBD-19?== |
| </gallery>
| | ===Do any special procedures exist for the management of bodies of persons who died from COVID-19?=== |
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| ==References==
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| {{Reflist|2}}
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| [[Category:Primary care]]
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| [[Category:Disease]]
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| {{WH}}
| | ==Health Care Practitioner (HCP) questions== |
| {{WS}}
| | ===I have underlying health conditions, are there work restrictions in place for me?=== |
| | ===Is post-exposure prophylaxis currently available, and when can it be used?=== |
| | ===Can routine vaccinations still be administered to patients?=== |
| | ===Should I use face mask/respirator while taking care of pregnant patients with known/suspected COVID-19 infection?=== |
| | ===I am a Health Care Practitioner living with someone who is at a higher risk of severe illness from COVID-19 infection. What precautions should I take?=== |
| | ===I am pregnant and a health care worker. Can I work with patients who are potentially infected with COVID-19?=== |
| | ===Whom should healthcare providers notify if they suspect a patient has COVID-19?=== |