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July 10 | Daily COVID-19 LST Report

CLIMATE:

· Using data from the IQVIA Total Patient Tracker, researchers found that between February 2020 and March 2020 the number of dispensed hydroxychloroquine prescriptions nearly doubled and that the number receiving this medication in combination with azithromycin increased by 1044%. Authors warn that evidence behind the efficacy and safety of hydroxychloroquine is limited in regard to COVID-19 treatment and that this surge will limit the amount available to patients that rely on this drug for other disease processes.

· American health policy experts found that the case rate among prisoners was 5.5 times higher than the general US population (3251 vs 587/100,000) with an adjusted death rate three times higher than expected, corroborating suspicions that prison conditions heighten SARS-CoV-2 transmission risk.

· Hospital survey data from five low-income countries identified shortages in PPE, sanitation, respiratory supplies, diagnostic tests, and inadequate storage and delivery of vaccines in these countries. The authors attribute these shortages to decreased global resources, unequal sale of supplies favoring wealthier countries, and limited bargaining power of low-income countries; thus, they advocate for increased international action for equal global distribution of vital pandemic control resources.



EPIDEMIOLOGY:

· A retrospective cohort study of 515 COVID-19 patients in Rome, Italy found that liver test abnormalities were present in 161 (31.3%) patients, but this was not associated with increased mortality (OR=0.84 [95%CI 0.49-1.41], p=0.51). However, peak values of ALP (alk phos) were predictive of a worse prognosis (odds ratio [OR]=1.007 [95%CI 1.002-1.01], p=0.005), suggesting liver involvement in COVID-19 patients without severe underlying liver disease is mild, not associated with increased mortality, and tends to resolve over time.


UNDERSTANDING THE PATHOLOGY:

· To update SARS-CoV-2’s phylogenetic classification and origins, virology and microbiology researchers from India conducted in silico comparisons of key residues from receptor binding domains (RBDs) of the S-protein and O-linked glycans in bat (RaTG13) and Pangolin-CoV genomes with that of SARS-CoV-2. Their analysis showed that 11 SARS-CoV-2 isolates were closely related to RaTG13 (97.41%) and Pangolin-CoV (92.22%), supporting existing theory that represents the formation of a new clade within the beta-CoV division of Coronavirinae.


MANAGEMENT:

· A retrospective cohort study of 79 critically-ill COVID-19 patients found that patients with serum IgM ≥ 50 AU/ml at day 25 of infection had higher in-hospital mortality (p=0.026); and was also correlated with risk of ARDS, septic shock, mechanical ventilation, and corticosteroid usage. Antibody remeasurement in 42 patients found a correlation between decreased IgM titers and reduced mortality (p=0.031), suggesting that prolonged seroconversion from IgM to IgG (>25 days) may be a useful prognostic indicator of inadequate immune response and more severe disease.


ADJUSTING PRACTICE DURING COVID-19:

· A review by Belgian anesthesiologists identifies risk factors in patients undergoing nonoperating room anesthesia (NORA) as the need for this intervention has increased during the COVID-19 pandemic. They found the highest risk factors for poor outcomes were respiratory infections (OR 23.55-17.46), respiratory commodities (OR 8.18), upper GI endoscopy (OR 5.66), and morbid obesity (OR 4.25), emphasizing the importance of preoperative screening for COVID-19 to minimize exposure risk for staff and decrease perioperative morbidity and mortality.


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