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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 durin