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RE: Respiratory presentations during a Covid-19 pandemic

  • Anthony J Walter, Retired family physician, Surrey Memorial Hospital, retired
9 January 2021

The January 4th 2021 CMAJ report of a fatal respiratory diphtheria case in a 69 year-old visitor to Canada, is a sobering reminder of unusual diseases that one needs to consider in primary care medicine. The Key Points included with this article are important, but is there one missing?
A "telemedicine clinic" review advised the patient to present to the Emergency Department immediately; was this the Covid-19 hot-line? If so, the assessing nurse is to be congratulated in recognizing the urgent nature of the patient's symptoms.
A relative presenting to the 811 phone line with a cough, was told to phone her GP, who in turn recommended that she make an appointment with the local hospital Covid clinic for appraisal and get a naso-pharyngeal swab taken; there, the physician's recommendation was to presume a diagnosis of corona virus and to isolate oneself for 14 days.
Over the next few months of persistent cough, this sequence was repeated 3 times (in addition to chest imaging and bloodwork). Eventually, resolution of the coughing bouts occurred within a few hours of prescription of a broncho-dilator.
Like the old adage "all that glitters is not gold", during the pandemic all coughs are not caused by Covid-19, a key point.

Competing Interests: None declared.
References 
Scott Cholewa, Fareen Karachiwalla, Sarah E. Wilson, et al. Fatal respiratory diphtheria in a visitor to Canada. CMAJ 2021;193:E19-E22.
See article »

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Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

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