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August 24 | Daily COVID-19 LST Report

Climate

· Physicians affiliated with the Icahn School of Medicine at Mount Sinai, Harvard School of Medicine, and Duke University Medical Center consider the downside of "pressurized research" in the context of previous healthcare crises and reflect on the shortcomings of poor research that have occurred during previous calamities, including the secondary pneumonias that followed trials of immunotherapies during the 1918 influenza epidemic and cases of Guillain–Barre syndrome following swine flu vaccination in 1976. The authors recognize the challenges to meet demands for effective therapies and vaccine development, however they urge for caution and humility in research during the current pandemic to avoid such shortcomings.

· Researchers affiliated with the University of Minnesota and Starkey Hearing Technologies examine the relationship between COVID-19 hospitalization and patient race/ethnicity in 12 states and found that White and Asian patients represented smaller proportions of COVID-19 hospitalizations relative to their respective state population proportion and Black and American Indian/Alaskan Native patients represented significantly larger proportions of COVID-19 hospitalizations relative to their respective state population proportion. The authors suggest that understanding of these ethnic and racial health disparities during the COVID-19 pandemic may help create valuable solutions.

Epidemiology

· Researchers from the Brown University Department of Epidemiology and Department of Medicine examined data from the COVID-19 Data Repository at Johns Hopkins University to determine the relationship between United States state stay-at-home orders and SARS-CoV-2 doubling time in each state and found that stay-at-home mandates correlated with virus doubling times from 2.68 days prior to mitigation efforts to 15 days after. Additionally, states without stay-at-home orders saw an increase in doubling time of 34% whereas states with stay-at-home orders saw a increase of 72%. Although limited by surveillance data, these findings support that present efforts at social distancing help control COVID-19 spread within communities.

· A team of global health and computational biology experts from Stanford University discuss how artificial intelligence (AI) has contributed to racial disparities during the COVID-19 pandemic and cite a systematic review that found high or unclear risk of bias in all (n=66) models screened with the Prediction Model Risk of Bias Assessment Tool and are particularly wary about how these models are applied in regards to allocation of resources. Moving forward, authors propose transparency in AI algorithms used for public health and regulatory frameworks that facilitate open data transfer to facilitate the creation of an accessible international database and produce unbiased representative training data for AI algorithms.

· A systematic review of 47 studies analyzed the impact of smoking on the severity of COVID-19. Authors found that:

1. Current smokers were at an increased risk of severe or critical COVID-19 but these individuals did not have

increased in-hospital mortality.

2. Patients with a history of smoking had an increased risk of severe COVID-19 as well as an increased in-hospital mortality, disease progression, and need for mechanical ventilation.

3. The use of aggregated data prevented the authors from performing covariate analyses to determine the impact of age, gender, and other variables on outcomes for current and former smokers.

The review highlights the need for further investigation into the molecular underpinnings for the relationship between smoking and COVID-19 and emphasizes the necessity of public health interventions to promote and support smoking cessation.

Management

· A retrospective cohort study using Electronic Health Record (EHR) data from the Mayo Clinic Health System in Rochester, Minnesota found 246 COVID-19 positive patients had higher plasma fibrinogen levels and lower platelet counts than COVID-19 negative patients (n=13,666) at time of testing but as the infection progressed COVID-19 positive patients showed declining fibrinogen and increased platelet counts, while 31% (n=76/246) developed at least one clot diagnosis . Authors suggest that understanding the evolution and range of COVID-19 associated coagulopathy (CAC) may provide insight for advancement in thrombophylaxis therapy.

Adjusting Practice During COVID-19

· Members of the Neuroscience Section at the University of Milan in Italy propose guidelines for care of patients with neuromuscular disorders (NMD) during the SARS-CoV-2 pandemic recommending outpatient care, minimizing immune-compromising medications and in-person interactions, and maintenance of regular follow-up by utilizing telehealth. Additionally, they suggest providers caring for NMD patients admitted to the hospital with SARS-CoV-2 consider which medications have NMD side effects and consult neurologists for all such patients., suggesting that these measures can optimize outcomes for this group at increased risk for severe disease course.

R&D: Diagnosis & Treatments

· A meta-analysis of 40 studies conducted across 31 provinces in China of severe and critically-ill COVID-19 patients (n=5,872) found severe disease was associated with older age (weighted mean difference [WMD]=10.69), higher lactate dehydrogenase (LDH; WMD=137.4), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), D-dimer and procalcitonin (PCT), as well as significantly decreased platelet count (WMD= -18.63) and lymphopenia. Authors suggest these laboratory markers and age could be useful for early detection and prediction of worsening illness in COVID-19 patients. · Researchers conducted an analysis of safety metrics and mortality rate in 5000 hospitalized patients with severe or life-threatening COVID-19 who received transfusions of ABO-compatible human COVID-19 convalescent plasma that was pre-screened for SARS-CoV-2 via clinical laboratory or antibody test and found that thirty-six patients (less than 1%) had severe adverse events within four hours of transfusion with a 0.08% mortality rate at the four hour mark; the seven day mortality rate for the study group was 14.9% compared to the case fatality rate of 10-20% for hospitalized COVID-19 patients. The authors note several risks of convalescent plasma transfusion, but given the high mortality rates expected in a critically ill population, they are optimistic that this could be a viable treatment option once further efficacy studies are performed.


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