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August 25 | Daily COVID-19 LST Report

Epidemiology

· Australian systematic review and meta-analysis further confirms that patients with chronic disease are at higher risk for worse outcomes with COVID-19. The most common comorbidities were hypertension (22%), diabetes (14%), and cardiovascular diseases (13%). Crude case fatality rate (CFR) was 7% overall but increased significantly with increasing number of comorbidities.

· Patients with elevated C-reactive protein (CRP), older age (≥60 years), underlying comorbidities, and severe COVID-19 pneumonia were at a higher risk for cardiac involvement.

Understanding the Pathology

· A retrospective cross-sectional study by Chest Diseases specialists in Turkey enrolled 123 adult COVID-19 pneumonia patients with pulmonary infiltrates on CT chest (34 mild, 89 severe), comparing 91 BCG-vaccinated and 32 unvaccinated patients and found increased age (p<0.001) and low income (p<0.001) to be predictors for severe pneumonia, whereas BCG vaccination was not found to be associated with severe COVID-19 pneumonia.

· Researchers in clinical pharmacy, genomics, and cellular/organismic biology at Taipei Medical University in Taiwan utilized genome databases to analyze expression of transmembrane protease serine 2 (TMPRSS2) and identified four genetic variants associated with increased expression of TMPRSS2 particularly in lung tissue. American and European populations had the greatest frequency of these up-regulating variants and homozygosity for one particular allele (rs469390, missense mutation) yielded the highest expression of lung-associated TMPRSS2, suggesting that examining allelic frequency of TMPRSS2 variants may give epidemiological insight into populations with greater susceptibility to COVID-19.

Management

· A prospective study, conducted by fungal experts from the Center of Expertise in Mycology in the Netherlands, of 108 mechanically ventilated COVID-19 patients with ARDS to assess for prevalence of pulmonary aspergillosis found a 27.7% incidence of COVID-19 associated pulmonary aspergillosis (CAPA), with a 25% lower survival rate among this population than in the non-CAPA patients (19% vs 44%). A correlation between bronchoalveolar lavage (BAL) Galactomannan-index (GM) and odds of death was observed, justified by lower mortality, and reduced GM-index in 11/19 CAPA patients receiving voriconazole and indicated the importance of early identification of clinical and host risk factors for CAPA in critically-ill COVID-19 patients. Adjusting Practice During COVID-19

· Cardiologists conducted a prospective cohort study at two referral centers (n=1,372 heart failure [HF] patients) in London, England from January 7th, 2020 to June 14th, 2020 and found HF hospitalizations decreased during the COVID-19 pandemic as compared to 2019 (p<0.001) but in-hospital HF mortality significantly increased (p=0.015) and hospitalization for HF in 2020 was independently associated with worse outcomes (hazard ratio: 2.25, p=0.002). Authors suggest patients hospitalized for HF may be at higher risk for adverse outcomes during the COVID-19 pandemic and further investigation of prognosis predictors is needed to inform on management within this population.

R&D: Diagnosis & Treatments

· A retrospective observational study conducted at Third Hospital in Wuhan, China involving 191 COVID-19 patients and 50 healthy controls investigated the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) discrepancies among the infected patients and controls. They found higher NLR, higher CRP, and lower lymphocyte% among the COVID-19 group than the controls (p<0.001), in addition to higher NLR, higher CRP, and lower lymphocyte % among patients with severe infection when compared to those with moderate disease (p<0.05). The authors believe these results highlight NLR, CRP, and lymphocyte % as independent risk factors and NLR+CRP can improve diagnostic efficiency. Mental Health & Resilience Needs

· A survey study conducted by special education and child development experts from California and Oregon interviewed 77 primarily Hispanic parents of children aged 3-5 who have intellectual and developmental disabilities (IDD) to determine the impact of and challenges that the COVID-19 pandemic has brought upon their families and found the following: the biggest challenge for families is being stuck at home, a majority of child programs and services have decreased, a silver lining is being able to spend more time as a family, coping strategies include implementing routines and schedules, and a majority of families are concerned about long term economic challenges. The authors demonstrate the importance of further research into the short-and-long-term impact of the pandemic on children with IDD and their families.


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