Diagnostic Model of COVID-19 Infection Based on the Combination of Clinical Symptoms, Chest Radiography and Laboratory Test.

BACKGROUND: COVID-19 is an infection caused by SARS-COV 2.For screening the patient, Rapid antigen for COVID-19 is used with a high diagnostic value. However, there are still some cases of false-negative even with clinical symptoms suggesting COVID-19. Undetected COVID-19 patients certainly will increase  transmission. A simple and practical diagnostic model, using determining factors, is required to guide physicians through a quicker decision making process, especially when deciding the need for the isolation rooms for patients with COVID-like symptoms. METHODS: This study is a cross-sectional study. The study was conducted at CiptoMangunkusumo Hospital, Jakarta.History of contact with COVID-19, clinical symptoms, laboratory examination, and chest radiograph data were taken from medical records. Bivariate and multivariate analyses were conducted to assess the effect sizes of patient factors on the diagnostic results.ROCcurve and Hosmer-Lemeshow calibration was used to make the scoring. RESULTS: There were 187 patients with the majority of subjects in the age group < 60 years old. The selected variables in this scoring systemwere contact history,fever/history of fever, dyspnea with respiratory rate >20 breaths/minute, leucocyte ≤ 10.000 cells/mLand typical chest radiography. The area under the curve for this model was 0,777 (CI95% (0,706-0,847), P<0,001). The probability was 82% with a cut-off point ≥ 4. CONCLUSION: Determinant models based on the combination of contact history, presence or history of fever, dyspnea, leucocyte count ≤ 10.000 cells/mL and typical chest radiography provides good accuracy to aid physicians in managing isolation room needs for patients with suspected COVID-19.

Physician’s Hesitancy in Treating COVID-19 Patients and Its Associated Occupational Risk Factors in Indonesia: An Online Cross-Sectional Survey (preprint)

This study is a cross-sectional survey involving physicians around Indonesia aimed to explore physician hesitancy to treat COVID-19 patients after experiencing COVID-19 infection coupled with associated occupational risk factors. The questionnaire was distributed via contact information from the Indonesian Physician Association database. Out of 383 participants, 25.6% suffered from moderate symptoms of COVID-19 and 2.9% were admitted for critical care. Hesitancy to treat suspected, probable, or confirmed COVID-19 patients was found in 20.3% of physicians. A higher hesitancy rate was found in older physicians and those with less experience in treating COVID-19 patients. Specialist trainees and those who work in public hospitals were physicians with the lowest hesitancy in treating COVID-19 patients. There is a significant hesitancy in treating COVID-19 patients among physicians who have suffered from COVID-19 which calls for further action by management and policy makers.

COVID-19 Associated Pulmonary Aspergillosis: A Case Series.

Coronavirus disease 2019 (COVID-19) has been a worldwide pandemic with several problems, one of which is the lack of definitive treatment. COVID-19-associated pulmonary aspergillosis (CAPA), the presence of invasive pulmonary aspergillosis (IPA) in COVID-19 patients, is one of the concerning secondary infections associated with higher mortality and worse clinical outcomes. Diagnosing CAPA may be challenging due to the possible absence of classic host factors and clinical symptoms or obscured radiological findings. We described two CAPA cases, which were suspected due to persistent respiratory failure despite standard treatment of COVID-19 with additional therapies and antimicrobial agents for secondary infections, eventually diagnosed with serum galactomannan testing. Clinical conditions of both patients improved significantly after the administration of voriconazole. This case series emphasizes the importance of being aware of clinical suspicions indicating CAPA followed by galactomannan testing as a relatively fast, noninvasive test for its diagnosis, which leads to appropriate antifungal treatment.

COVID-19 Among Doctors in Indonesia: Risk of Moderate-Severe and Behavior Adaptation in Personal Protective Equipments Usage After Infection (preprint)

Doctors have a greater risk of acquiring COVID-19 due to occupational exposure. Personal protective equipment (PPE) is an essential factor in reducing COVID-19 transmission. We aimed to evaluate the risk of moderate-severe COVID-19 infection and behavior adaptation in PPE usage among doctors who survived COVID-19 in Indonesia. This was an online population-based cross-sectional survey among Indonesian doctors of COVID-19 survivors. Bivariate and multivariate analyses were performed to determine factors associated with moderate-severe COVID-19 infection. A total of 389 doctors who survived COVID-19 infection across in Indonesia was included in this study. Most participants were young doctors (20-39 years: 69.7%), general practitioners (50.4%), working in COVID-19 designated hospitals (62.5%), and worked more than 40 hours/week (57.8%). Factors associated with moderate-severe COVID-19 were IMA moderate occupational risk (aOR 4.14, 95% CI: 1.11-15.47), age 40-59 years (aOR 3.24, 95% CI: 1.99-5.29), working in COVID-19 designated hospital (aOR 1.89, 95% CI: 1.18-3.01), and higher BMI (aOR 1.88, 95% CI: 1.00-3.54). N95 respirator and other PPEs use improved after these doctors recovered from COVID-19 infection in isolation and non-isolation rooms. In conclusion, working COVID-19 designated hospital, moderate occupational risk, higher BMI, and age 40-59 were associated with moderate-severe COVID-19 among doctors in Indonesia.

Coronavirus Disease 2019: Tinjauan Literatur Terkini

Pada awal 2020, dunia dikejutkan dengan mewabahnya pneumonia baru yang bermula dari Wuhan, Provinsi Hubei yang kemudian menyebar dengan cepat ke lebih dari 190 negara dan teritori. Wabah ini diberi nama coronavirus disease 2019 (COVID-19) yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Penyebaran penyakit ini telah memberikan dampak luas secara sosial dan ekonomi. Masih banyak kontroversi seputar penyakit ini, termasuk dalam aspek penegakkan diagnosis, tata laksana, hingga pencegahan. Oleh karena itu, kami melakukan telaah terhadap studi-studi terkait COVID-19 yang telah banyak dipublikasikan sejak awal 2020 lalu sampai dengan akhir Maret 2020. Kata Kunci: COVID-19, pandemi, SARS-CoV-2, Wuhan Coronavirus Disease 2019: Review of Current Literatures

Diagnostic Model of Covid-19 for Resource-Limited Countries Based on The Combination Of Clinical Symptoms, Chest Radiography and Laboratory Test (preprint)

Background: COVID-19 is an infection caused by SARS-CoV 2. RT-PCR test is the gold standard  for COVID-19 diagnosis, detecting the virus nucleic acid. However, this test is not yet available in every healthcare center, thus making the diagnostic process lengthy. A prompt diagnosis and immediate management are important to decrease mortality and morbidity rate, as well as to prevent transmission. A simple and practical diagnostic model using determinant factors is needed to guide the physician for a quicker decision-making. Method: This study is a cross sectional study using consecutive sampling method. The study was conducted at RSUPN Cipto Mangunkusumo, Jakarta from March to June 2020. History of contact with COVID-19, clinical symptoms, laboratory examination, and chest radiographs data were taken from medical records. The steps of analysis were univariate, bivariate, and multivariate analyses, followed by ROC curve and Hosmer-Lemeshow calibration. Result: There were 187 patients with the majority of subjects in the age group < 60 years old (65,2%) and male sex (53,47%). The most frequent comorbidities were diabetes mellitus and hypertension. The selected variables in this scoring system were contact history, fever/history of fever, dyspnea with respiratory rate >20 breaths/minute, leucocyte ≤ 10.000 cells/mL and typical chest radiography. The area under the curve for this model was 0,777 (CI 95% (0,706-0,847), P<0,001). The probability was 82% with a cut-off point ≥ 4, PPV: 74%, NPV: 77%. Conclusion: Determinant model based on the combination of contact history, fever/history of fever, dyspnea, leucocyte ≤ 10.000 cells/mL and typical chest radiography provides a good accuracy to establish COVID-19 diagnosis.