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January 04 | Daily COVID-19 LST Report

Climate

· A systematic review by an international team of researchers highlights the significant underrepresentation of geriatric patients in published COVID-19 randomized control trials (RCTs). In the 12 RCTs included in the review, patients had mean age of 56.3 years, and were on average 20 years younger than patients from large observational trials. One explanation for this discrepancy is the strict exclusion criteria used for RCTs, which commonly exclude patients with cognitive impairment and multiple comorbidities frequently seen in the elderly population. The authors strongly advocate for future RCTs to include this vulnerable population that has been disproportionately affected by the COVID-19 pandemic.

Epidemiology

· Pediatric ischemic stroke is an infrequent complication of SARS-CoV-2. Physician members of the International Pediatric Stroke Study Group surveyed 61 international sites to assess the prevalence of SARS-CoV-2 infection in pediatric stroke patients. They found 3.6% (6/166) of pediatric arterial ischemic stroke, 0.9% (1/108) of neonatal arterial ischemic stroke, 1.9% (1/54) of pediatric cerebral sinovenous thrombosis, and zero (0/33) neonatal cerebral sinovenous thrombosis patients were positive for SARS-CoV-2. Authors suggest these results indicate that SARS-CoV-2 does not appear to increase the risk of stroke in neonatal and pediatric populations but acknowledge that more robust testing is needed to determine any role the virus has in pediatric stroke.

Transmission & Prevention

· Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators. Internists and microbiologists from University of New Mexico assessed whether dry heat incubation could decontaminate N95 respirators and found SARS-CoV-2 was not inactivated when N95 coupons inoculated with the virus were heated to 60-75 degrees Celsius for either 30 or 60 minutes when placed on parchment paper but was inactivated when placed on tissue culture plates. When intact 3M 1860 N95 respirators were incubated at 70-75 degrees Celsius for 60 minutes, SARS-CoV-2 was not inactivated. Authors suggests that dry heat incubation is not a consistently effective method for deactivating SARS-CoV-2 on N95 respirators.

· SARS-CoV-2 appears to persist on personal protective equipment (PPE) for up to several days post exposure. Virologists from the United States Army Medical Research Institute of Infectious Diseases in Detrick, Maryland compared the stability of SARS-CoV-2 on multiple models of personal protective equipment used during airway procedures following 4.3 log10 plaque-forming units (PFUs) of SARS-CoV-2 exposure. They found that even 72 hours after exposure, between 1.1 and 2.3 log10 PFU/mL of SARS-CoV-2 was detectable, depending on material. Authors suggest that the persistence of SARS-CoV-2 on personal protective equipment highlights the importance of appropriate doffing, disposal, and disinfection in order to prevent fomite transmission.

· Decontamination of SARS-CoV-2 contaminated N95 filtering facepiece respirators (FFRs) can be achieved with moist heat generated by a multicooker. A multidisciplinary team of scientists from Battelle Memorial Institute in Ohio inoculated patches/coupons from N95 respirators with SARS-CoV-2 virus suspended in simulated saliva or lung fluids and subjected the samples to a temperature of 65°C for 30 minutes in a multicooker (i.e. crockpot) filled partially with water. They found that SARS-CoV-2 virus was undetectable by 20 minutes regardless of the respirator's model. All masks met performance criteria for collection efficiency (>95%) and inhalation resistance (<35 mmH2O) after 10 cycles if placed in a paper bag to absorb moisture during decontamination and allowed 30 minutes to dry. The authors conclude that moist heat treatment (65°C for 30 minutes) with a multicooker can successfully decontaminate N95 respirators which could allow for re-use during times of limited supply.

R&D: Diagnosis & Treatments

· Efficacy of lopinavir/ritonavir in the treatment of COVID-19 was not found to be considerable according to a systematic review. An international research team from Nested Knowledge, Inc conducted a systematic review of 16 studies assessing the effectiveness and safety of lopinavir/ritonavir (LPV/r) in the treatment of COVID-19 and found the majority of included studies showed no significant improvement in clinical outcomes (RT-PCR negativity, chest-CT findings, mortality, adverse events) following LPV/r treatment, though they could not perform meta-analysis due to the high heterogeneity of the comparison groups. Though their review suggests little survival or clinical benefit of LPV/r in COVID-19, authors recommend larger clinical trials are needed to more definitively explore its potential benefits due to the limitations of currently available data. · What is the efficacy of COVID-19 vaccines and how good were the trials? Researchers at the Fred Hutch Institute in Seattle, WA collaborate with the University of North Carolina Department of Biostatistics to discuss limitations of current COVID-19 vaccination trials. The main critique of current study designs is the primary endpoint of "virologically confirmed symptomatic COVID-19 disease", which does not provide accurate data on mild or asymptomatic individuals. The authors propose an alternative model that includes 3 primary endpoints: 1) SARS-CoV-2 infection 2) Symptomatic COVID-19 disease 3) Severe COVID-19 disease. They assert that this strategy would provide important data on the vaccine's ability to protect against severe disease and also prevent mild and asymptomatic disease. Simulation studies are included to demonstrate these advantages. Mental Health & Resilience Needs

· Experiences of New Zealand registered nurses of Chinese ethnicity during the COVID-19 pandemic are brought to light in one study. Nurses from the Waikato Institute of Technology in New Zealand conducted an anonymous online questionnaire of 51 Chinese nurses to assess their experiences at work during the COVID-19 pandemic. They found 47.06% experienced racial hostility due to being Chinese, 41.18% were concerned about catching SARS-CoV-2, and 57.14% felt supported in the workplace by their colleagues. Authors suggest that because New Zealand has a large ethnic-minority nursing base, health organizations must understand and support healthcare workers experiencing racial discrimination during the COVID-19 pandemic to adequately meet the demands on the healthcare system.


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