Understanding the pathology:
· Highlights from a literature review conducted by a Japanese cardiologist:
- SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) receptors for cellular invasion.
- Renin-Angiotensin-Aldosterone System (RAAS) inhibitor drugs are not associated with a higher risk of mortality from COVID-19.
- An increased number of ACE receptors found in male and diabetic subjects may contribute to an increased susceptibility to the SARS-CoV-2 virus. In conclusion, the author urges more research on ACE2 and SARS-CoV-2 infectivity and whether medications for cardiovascular disease may affect disease severity and mortality.
Transmission and Prevention:
· This survey conducted at 26 Detroit skilled nursing facilities (SNF) found that after two repeated point prevalence surveys (testing all healthcare workers regardless of symptoms), separated by a median time interval of 15 days (IQR=14-17 days), the percentage of positive test results for SARS-CoV-2 decreased from 35% (n=373/1063 residents, 26 SNF) to 18% (n=115/637 residents, 12 SNF). The findings suggest that repeated point prevalence surveys may reduce SARS-CoV-2 transmission rates by initiating infection prevention and control activities and the authors recommend frequent surveys of healthcare workers as testing availability increases.
· This review article written by a multidisciplinary group of researchers aims to summarize the current state of COVID-19 vaccine development. The authors grouped vaccine attempts into five general groups: DNA/RNA-based, viral vectors, protein subunit, inactivated virus, and live attenuated virus; experimental vaccines of all of these subtypes are currently in preclinical development, Phase I trials, or Phase II trials. The authors also bring up concerns about vaccine development, including the lack of cost-effective animal models of COVID-19 for vaccine testing and worries about viral mutations that could prevent vaccines from enabling long-lasting immunity, which altogether represent significant potential pitfalls standing in the way of societal use of a novel vaccine.
Management:
· A case series of 5 COVID-19-positive patients in Italy found neurological manifestations (namely polyradiculoneuritis and cranial polyneuritis), clinical neurophysiology indications (conduction block, absence of F waves, etc.), and albuminocytological dissociation (in 3/5 patients) suggestive of Guillain Barré syndrome (GBS). Intravenous immunoglobulin (IVIG) therapy at 0.4 g/kg for 5 days partially resolved neurological symptoms in 4/5 patients. These observations suggest that clinicians should be aware of neurologic signs similar to GBS in COVID-19 patients and may consider the use of clinical neurophysiology and IVIG therapy in the management of these patients
Adjusting the practice during COIVID-19
· A narrative review conducted by the Department of Emergency Medicine at Singapore General Hospital discusses how Singapore's largest hospital turned a multi-story car park (MSCP) into a flu screening area (FSA) during the COVID-19 pandemic. The authors label this FSA as a physical component of Singapore General Hospital's surge capability, highlighting its use as a means to confront the recent COVID-19 outbreak. This operation is yet another example of efforts to repurpose facilities to accommodate growing COVID-19 infection rates.
· Researchers from China and the United States argue that, given the potential risks faced by pregnant patients during the pandemic, widespread use of online antenatal care should be encouraged. In an online survey of 983 pregnant patients, the authors observed increased fear of accessing general healthcare and antenatal care. They propose that online programs can alleviate this fear while maintaining many vital aspects of antenatal care, including blood pressure observation, fetal heart tone assessment, urine dipstick tests, blood glucose monitoring, patient education, and mental health evaluations. However, they also acknowledge the significant challenges in implementing these programs, including those related to ensuring quality of care, the lack of internet access in certain regions, and the reality that some antenatal conditions will always require in-person evaluation and management.
Physicians from Italy performed a retrospective study on pregnant persons with pre-gestational diabetes (9 with type 1 diabetes mellitus [DM], 5 with type 2 DM) and found that 2 out of 14 patients tested positive for COVID-19. Both patients had type 1 DM and greater mean daily glycemic values compared to the patients who tested negative (134±4 vs 108±2 mg/dl, P=0.03). While this study has a small sample size, the authors suggest that the observed low prevalence of COVID-19 may reflect the impact that lockdown measures, continuous glucose monitoring at home, and use of telehealth services may have in reducing COVID-19 transmission.