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August 4 | Daily COVID-19 LST Report

CLIMATE:

· An article by Talha Burki in The Lancet argues that the COVID-19 pandemic has had a more negative impact on women compared to men across the globe. She suggests this is in large part due to the indirect effects of the pandemic on women's health, such as an increase in economic, social, and political disparities between men and women, increased domestic violence against women, and decreased access to care for pregnant women. In short, despite COVID-19 causing a disproportionately higher number of deaths in men, there is mounting evidence that the indirect effects the pandemic has on women may even be worse.

· In the article titled, “Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During the COVID-19 Pandemic”, ethicists discuss whether age should guide rationing of scarce life-saving resources after a pediatric hospital sought to establish guidelines for the use of extracorporeal membrane oxygenation (ECMO) devices based on age. The authors recommend a multi-pronged approach in allocating resources by prioritizing the "worst off" and maximizing benefits based off of prognosis, saving the most lives, extending life-years, an individual's instrumental value in society, and treating people equally with dignity.



MANAGEMENT:

· Physicians in Seattle, WA describe characteristics and basic outcomes of a retrospective cohort of 83 adults hospitalized with COVID-19 between March 16, 2020 and April 17, 2020, 42 of whom received the IL-6 antagonist tocilizumab with 41 matched controls. They found overall mortality was similar in both groups, but patients with severe illness treated with tocilizumab had lower mortality by day 7 compared to controls (14.2% vs. 28.6%) and critically ill patients (14.2% vs 28.5%). The authors imply tocilizumab may improve outcomes for select patients and suggest randomized controlled trials are warranted to better understand its potential benefits.


ADJUSTING PRACTICE DURING THE COVID-19 PANDEMIC:

· A review by the American Heart Association discusses several ways healthcare workers can provide critical care for COVID-19 patients that have sustained concurrent cardiopulmonary complications including ARDS, MI, and pulmonary circulatory disease. The article additionally outlines proper use of PPE, limiting exposure to COVID-19, and following pre-planned procedures to deal with these diseases as means to help promote safety for the patients and the providers.


R&D DIAGNOSIS AND TREATMENT:

· Researchers in Madrid, Spain analyzed samples from 53 hospitalized COVID-19 patients and discovered a unique immunofluorescence (IF) pattern involving staining of the gastric mucosa and hepatocytes for autoantibodies. This IF pattern was found in 12 of the 53 patients and was associated with increased incidence of neurologic and thrombotic complications. This implicates cross-reactive autoantibodies in the thrombotic and neurologic complications of COVID-19, and may be a potential therapeutic target for immunomodulatory treatments. Because of the continued demonstration of an autoimmune component to COVID-19 this also brings up concerns for molecular mimicry and proceeding towards mandatory vaccinations for all with caution.


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