Using Ultrasound in Testing for novel Coronavirus (COVID-19)
In fighting the COVID-19 virus emergency department staff have started to realize they cannot use age or comorbidity to determine which COVID-19 patients might develop severe pneumonia. As an adjunct, they have started to scan patients to help sort out and triage cases. Lung ultrasound can help determine which patients need to be admitted to the hospital and who can return home to quarantine.
In the early diagnosis for COVID-19 pneumonia, the use of bedside ultrasound is quickly becoming adopted to evaluate pleural wall thickening and areas of congestion inside the lung typical of pneumonia. Ultrasound has turned up to be positive for interstitial pneumonia even in patients with mild or almost no symptoms. Up until now, Lung ultrasound has been used to image for several respiratory conditions. Although there are no reports on the possible use of lung ultrasound for evaluating patients with suspected Covid-19, it appears that the infection can be evaluated with ultrasound.
Furthermore, POCUS allows for direct to patient scanning in tents or outside of the hospital where other imaging modalities cannot. The Butterfly IQ turns an iPhone into an FDA-cleared ultrasound device to perform imaging of multiple aspects of the body. It is the first POCUS system reported to be used for triage and monitoring of COVID-19 patients
There are additional advantages of lung ultrasound over and above the gold standard of CT. The unit is self-contained in a protective sheath, making it easier to disinfect the device rather than a room. Reduced exposure to healthcare workers and patients, repeatability during follow-up, low cost, and easy application in low-resource settings all support the convenience of ultrasound. Not to mention, that infected but relatively well-being patients that have been sent home, could be clinically examined and imaged in their homes for follow-up, thus resulting in a safer discharge of patients. This is relevant since CT findings were more frequent when CT was performed later in the disease. This all results in a better triage to determine those patients arriving at the ER that can be sent home, to the ward or ICU.
In confronting COVID-19 we are in a mad dash to implement digital health technology as quickly as we can. Eric Topol warns that this sudden rush to virtualization may risk diminishing the quality of clinical care. It will never be the same as a physical examination with the human qualities of judgment and communication. It is a trade-off that we have to accept with COVID
Let’s hope that with the integration of now virtual visits, we take advantage of lung ultrasound performed in a patient’s home setting. This allows general practitioners a clearer picture before bringing these patients into the hospital.