Doctor Sokolov: to whom and when a CT scan is indicated because of COVID-19

Doctor Igor Sokolov succinctly, meaningfully and easily disassembled in his blog who and when should have CT of the lungs if they suspect or have a confirmed diagnosis of coronavirus infection:

"This publication is a generalized answer to the question:" Do I need to do CT if I suspect Covid-19 or do I need CT if the disease has already been diagnosed?"

While the generally accepted medical point of view says - Computed tomography (CT) is not among the routine diagnostic procedures for coronavirus infection, CT is not needed in most cases, CT is not considered a standard procedure in an outpatient C-19 patient - CT loading - patient centers are impressive and hundreds of such studies are performed daily on this disease.

Let's figure it out - is it still needed? And if so, to whom and when? Because the range of opinions from “forget it, it will pass by itself” to “urgently for a CT scan!”.

First of all, I want to mention that the doctors of CT centers today "got their hands on" such classic signs of this infection as frosted glass, thickening of interlobar septa, the phenomenon of halo and reverse halo, elements of inhomogeneous fusion, etc. In fact, using a good CT scanner, we are talking about getting very close to the direct diagnosis of coronavirus disease. Yes, some other viral lesions, such as adenovirus, can give a similar picture, but in modern realities, the clinical picture of a patient, together with CT data, will be decisive in treatment tactics even with negative PCR tests or antigenic testing for Covid-19.

Secondly, one must understand that the X-ray picture of lung damage is not formed in 1 day. And CT that is done early can give a deceptive picture of mild defeat or nothing at all. The standard time for a CT scan of a patient with COVID-19 is 5-6 days from the onset of symptoms. Later it is possible, earlier - the probability of getting the wrong vision is high. Therefore, it would be reasonable to moderate the ardor in "urgency", to observe the dynamics of the disease and, if anything, to perform the procedure on the 6-11th day of the illness. (Remember these dates: 6-11 days)

And now specifically about these "If that". To whom is CT indicated and to whom will it bring real benefit? I will expand the readings like this:

1. A patient with a moderate or severe course of infection (and it does not matter if the PCR is confirmed or not), when the question of hospitalization is being decided. CT will be extremely useful and may be the drop that will indicate the need for inpatient treatment. The clinic may be late (especially in 65+), and the volume and area of the lesion will clearly indicate that this is an extremely difficult patient.
2. A patient with a mild or moderate form of the disease in the presence of serious concomitant pathology (severe forms of diabetes mellitus, vascular attacks in the recent past, autoimmune diseases or conditions), when, again, the question of the need for hospitalization is decided or left to outpatient? Here's a CT scan and tell you.
3. In patients with a worsening picture of the disease against the background of outpatient therapy: a drop in saturation below 92, an increase in respiratory rate to 26-28-30 or more, severe forms of hyperthermia (temperature 38.5 and above for 5 days + worsening response to antipyretics). And here we are also talking about the need to consider the issue of hospitalization for a patient who started out as "easy" but "loaded" ... And again, CT will be a lifesaver.
4. For DIAGNOSTIC purposes in regions (places) where there is no PCR or antigenic diagnostics, when we suspect COVID-19 and the patient gives a clinical picture, which is regarded as OT of moderate severity.
5. For DIAGNOSTIC purposes, when the PCR result is negative, but the patient persists in giving a clinic suspicious for Covid-19: loss of smell, diarrhea, respiratory syndrome, temperature reaction, etc.

Perhaps that's all ... In other words: CT is used to address the issue of HOSPITALIZATION in critically ill patients, in patients who showed negative dynamics in outpatient treatment and in a certain category of persons with serious concomitant diseases. And as well as DIAGNOSTICS in the absence of PCR or obvious doubts about the reliability of the PCR result (or antigen test).

Accordingly, CT is absolutely not indicated for persons WITHOUT clinical symptoms and with mild forms of the disease (and this is the predominant category of patients), it is also not indicated for diagnostic purposes when there are widely available PCR and antigenic test systems.

I well understand and see that medical recommendations are often at odds with reality. CT-readings from me "in this case it is necessary, but here it is not necessary" are broken into banal - Moscow, but the doctor does not come, well, there is no access to diagnostics, and the patient's condition worsens... Well, then rule 4 - we are in an area without access to PCR testing, ambulance and CT... What can you think of...

CT safety. In terms of infection, it is dangerous, even very dangerous somewhere. In terms of X-ray irradiation - I examined this in detail in my tape below, read - there is a very interesting X-ray trilogy: the basics of the safety of X-ray diagnostics, medical safety of X-ray studies, X-ray diagnostics. Instead of an epilogue..."