Climate
· In this study, investigators from Canada compared mean change in driving from baseline (using Apple Mobility Trends) and COVID-19 mortality rate as of April 30th, 2020 in 36 countries with the highest number of COVID-19 cases globally, excluding those for which driving distance data was not available. They found decreased driving to be associated with lower COVID-19 mortality ( p<0.001), highlighting the importance of social distancing measures to curb the spread and mortality associated with COVID-19.
Epidemiology
· Newborns of COVID-19 mothers: short-term outcomes of colocating and breastfeeding from the pandemic's epicenter: A retrospective cross-sectional study conducted at Elmhurst Hospital Center, New York between March 19 and April 22, 2020 by researchers from Icahn School of Medicine at Mount Sinai found 73.3% of newborns of SARS-CoV-2 positive mothers were roomed-in together (94% also breastfed) and 6.7% overall tested positive for COVID-19, but none required NICU admission for SARS-CoV-2 related illness. Authors suggest that rooming-in and breastfeeding newborns of mothers with COVID-19 may be low risk and could provide educational opportunities regarding isolation, PPE use, and safe breastfeeding to equip mothers to better care for their newborns at home.
· A retrospective cohort study of 3,248 adults with COVID-19 (confirmed via RT-PCR) conducted at 5 hospitals within Mount Sinai Health System, New York between March 1 and May 1, 2020 found patients with a history of stroke had a statistically significantly higher risk of in-hospital death (adjusted odds ratio 1.28 [95% CI 1.01-1.68], adjusted for medical comorbidities). They suggest stroke may be an independent risk factor for in-hospital death and that this warrants further research to confirm the association and explore underlying pathophysiologic mechanisms.
· Severe vitamin D deficiency may be a marker for poor prognosis in COVID-19 patients with acute respiratory failure and advocate for further research. A retrospective study conducted at the Respiratory Intermediate Care Unit (RICU) of the Hospital Policlinic in Bari, Italy from March 11 to April 30, 2020 found 81% of COVID-19 patients with acute respiratory failure had vitamin D deficiency. Additionally, the subset of patients with severe vitamin D deficiency (<10 ng/mL, n=10, 24%) had increased mortality risk (50% chance of dying after 10 days of hospitalization) compared to those with vitamin D ≥ 10 ng/mL who had a 5% mortality risk (p = 0.019).
Understanding the Pathology
· A literature review by interdisciplinary researchers in Iran examined bacterial co-infection and secondary infection in patients with COVID-19 and discuss numerous possible microbiologic mechanisms including elevated bacterial adhesion, impaired mucociliary clearance or chemotaxis, reduction of surfactant levels, and enhanced susceptibility via immune cell dysfunction. The authors hope these findings will promote understanding of pathophysiological mechanisms, which can assist in developing novel management and control strategies in COVID-19 patients with bacterial co-infection.
Transmission & Prevention
· Among these 29 seropositive individuals (59% of whom did not self-isolate), 15 had anosmia, which was the only positive predictor for seropositivity (OR 18.2, p<0.001), while 10/29 were completely asymptomatic, indicating the need for frequent testing for staff in maternity units (and beyond) to minimize risk of transmission. A cross-sectional study of 200 healthcare professionals conducted in the UK from 2 tertiary-level maternity units from May 11, 2020 - June 5, 2020 investigated prevalence of IgG anti-SARS-CoV-2 immune seroconversion among the healthcare professionals. They found that 5/40 anesthetists, 7/52 obstetricians, and 17/108 midwives were seropositive (total 29/200, 14.5%).
Management
· A cross sectional study conducted in Wuhan, China from January 1 to February 8, 2020 by Zhongnan Hospital of Wuhan University followed 108 patients with mild COVID-19 treated with oseltamivir and found that the majority self-reported nearly full adherence to a 14-day home isolation protocol, though fewer patients maintained separate toilets and daily exercise (22.2% and 47.2% vs. 70% for other measures). Nearly half (45.37% [n=49]) of patients had negative SARS-CoV-2 PCR at 14 days, and authors suggest that home isolation along with regular contact between patients and doctors could be an effective strategy for saving medical and social resources.
R&D: Diagnosis & Treatments
· Early administration of lopinavir/ritonavir plus hydroxychloroquine does not alter the clinical course of SARS-CoV-2 infection: a retrospective cohort study: A retrospective study conducted at Luigi Sacco Hospital in Milan, Italy from February 21 to March 20, 2020 found patients with COVID-19 in early (≤5 days from symptom onset) versus late (>5 days from symptom onset) treatment with hydroxychloroquine (HCQ) 200 mg twice daily and lopinavir/ritanovir (LPV/r) 400/100 mg twice daily (minimum 5-day course) had no significant difference in clinical outcomes (p=0.213) or 30 day mortality (adjusted odds ratio 1.45; 95% CI: 0.50-4.19). However; age, obesity, and mechanical ventilation were all independently associated with increased probability of death. Authors suggest timing of treatment with LPV/r plus HCQ may not affect clinical outcomes, calling into question the benefits of this regimen in treatment of COVID-19.
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