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July 20 | Daily COVID-19 LST Report

Climate

· Results of pooled data from the Medical Expenditure Panel Survey (MEPS) between 2014-2017 (100,064 person-year observations on adults ≥18 years) suggest differences in exposure via employment between races and ethnicities may lead to COVID-19 risk disparities in minority groups. However, other risk factors (age >65, obesity, tobacco use and comorbidities) also play an important role in severity of illness.

Epidemiology

· A systematic review (n=69 studies) and quantitative review (n=61 studies) of case-control, cohort, and cross-sectional studies demonstrate epidemiological evidence for an association of male gender, older age, and comorbidities with COVID-19 disease severity and prognosis, suggesting awareness of these associates can aid in prevention and individualized treatment but urge further studies exploring COVID-19-related factors.

Understanding the Pathology

· A structural analysis of the SARS-CoV-2 virus performed by the Gene Center at the University of Munich in Germany found the Nsp1 protein shuts down host protein translation by binding to the 40S ribosomal subunit, resulting in immune suppression, suggesting that the Nsp1 protein of SARS-CoV-2 could be the starting point for a structure-based drug design incorporating this Nsp1-ribosome interaction, allowing the host immune system to combat the virus.

Transmission & Prevention

· An evaluation of the effect of the South Korean response system responsible for early detection of COVID-19 in the Gyeongsangnam-do Province reveals that out of 17,400 tested residents and 111 positive cases (25 asymptomatic), only two individuals required mechanical ventilation and there were no reported deaths (January 24 - April 15, 2020). The authors believe that this response system's rapid quarantine protocol for positive cases, in addition to all their possible contacts, is responsible for these encouraging outcomes, giving a potential example for other countries to follow while combating the COVID-19 pandemic.

Management

· A systematic review of 204 kidney transplant recipients (74% men) with COVID-19 through 12 case series conducted in multiple countries from January 1 to June 4, 2020 found a higher mortality rate of 21.2% compared with a 5.8% mortality rate in the general population. Mortality was strongly correlated to advanced age, ICU admission, and intubation and a majority of the patients were treated with immunosuppression and hydroxychloroquine, 34% were admitted to the ICU, and 19.7% were administered mechanical ventilation.

· A retrospective cohort study of 326 COVID-19 patients at Shanghai Public Health Clinical Center from 20 January to 24 February 2020 found that 20 patients who had Hepatitis B virus (HBV) co-infection (6.1%) had lower pre-albumin levels yet similar liver function tests, hospital stay duration, and discharge rates compared to patients with COVID-19 alone, potentially suggesting that HBV does not exacerbate COVID-19-related liver damage or cause a worse prognosis for this population.

Adjusting Practice During COVID-19

· Dental guidelines are included for optimized pediatric care and to minimize the risk of COVID-19 transmission during office visits and emergency situations (ie., cellulitis, severe tooth pain, and dental trauma).

· A survey study of 220 participants at five major pediatric dialysis centers in China conducted by Children's Hospital of Fudan University found that among families with children on long-term kidney replacement therapy (KRT) 78% (n=171) reported COVID-19 had influenced treatment, 61% (n=135) described current difficulties, 79% (n=173) worried about difficulties in the next 2, 13% (n=29) had depressive symptoms, and 11% (n=24) endorsed anxiety, suggesting that the COVID-19 outbreak has had a negative impact on both medical accessibility for children on long-term KRT and the mental health of their families.

R&D: Diagnosis & Treatments B working on now

· A longitudinal study found that 21.1% of 217 laboratory confirmed, hospitalized COVID-19 patients had detectable SARS-CoV-2 RNA in anal swabs and that detectable viral RNA in anal swabs is associated with increased risks of disease severity, ICU admission, and development of gastrointestinal symptoms.

· A study compared the ability of 6 commercial enzyme immunoassays and 8 lateral flow point of care assays to test for antibodies to SARS-CoV-2 in the serum of 28 COVID-19 patients and found that while commercial enzyme immunoassays and lateral flow point of care tests were both able to detect SARS-CoV-2, Abbott, Affinity, and BioRad enzyme immunoassays had the highest clinical sensitivity and specificity.


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