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July 22 | Daily COVID-19 LST Report

CLIMATE:

· A retrospective observational study of 336 severely or critically ill COVID-19 patients in Wuhan, China found that decreased lymphocyte ratios (<8.615%), elevated blood urea nitrogen levels (≥5.95 mmol/l), and raised D-dimer levels (≥1.56 μg/ml) at admission were associated with increased mortality. Using these three laboratory indicators, the authors created a model for predicting clinical outcome in critically ill COVID-19 patients.

· Italian authors propose a mathematical model to predict the rapidly evolving trends of the pandemic on a short and long-term basis considering two important variables - ICU beds and official deaths. They believe these models may facilitate planned decision-making and emergency preparedness.


EPIDEMIOLOGY:

· Biologists from Spain propose a pathophysiological mechanism for the “cytokine storm” seen in severe COVID-19 disease. They suggest that SARS-CoV-2 modulates macrophage activation by reducing cell surface ACE2 expression, causing an imbalance of increased pro-inflammatory Angiotensin-II and decreased anti-inflammatory Ang1-7. As a result, the lungs release IL-6 cytokines which have been strongly implicated in this hyperinflammatory state, suggesting that modulation of this pathway may be a key aspect of potential target for COVID-19 treatment.

· Authors from the Imperial College in London discuss how T cell response may be a critical aspect of long-lasting immunity to SARS-CoV-2 infection. This theory is supported by evidence of the well-documented finding of lymphopenia in severe disease, the cross reactive immunity of memory T cells documented in other coronaviruses, and the basic principle that CD8+ (T cells) are critical in combating both acute and chronic viral infections via the CD8 receptor to MHC-1 interaction with antigen presenting cells. Authors suggest that, while the focus has largely been on the role of neutralizing antibodies in immunity, T cell response should be strongly considered in vaccine development and herd immunity.

TRANSMISSION AND PREVENTION:

· A cohort study from China of 182 recovered COVID-19 patients under isolation found that 20 (10.99%) of these patients were repeat positives upon testing for SARS-CoV-2 RNA, despite showing no clinical symptoms and having SARS-CoV-2 antibodies. These patients tended to be younger (less than or equal to 18 years old) and have experienced only mild disease during their initial infection (p <0.05). These results further complicate policy decisions such as reopening of schools, and highlight the importance of widespread testing to detect asymptomatic spread.

MANAGEMENT:

· This case series from Switzerland describes encephalopathy in five patients intubated for COVID-19 acute respiratory distress syndrome (ARDS). They found that patients' Glasgow Coma Scores (GCSs) ranged from 4-9, and noted the presence of type IV oligoclonal bands in CSF and abnormal contrast enhancement in the intracerebral vascular walls on MRI without evidence of arterial stenosis, inflammatory plaques, or leptomeningeal enhancement. The patients were started on a course of IV methylprednisolone, which resulted in positive clinical outcomes, including improved GCSs in all patients and extubation of three of the five patients. These findings further demonstrate the potential utility of corticosteroid treatment for COVID-19 associated encephalopathy.

R&D DIAGNOSIS AND TREATMENT:

· A retrospective study of 134 COVID-19 patients compared overall clinical improvement, mortality, ICU stay, and adverse effects between patients administered hydroxychloroquine plus azithromycin and a control group. Results showed no statistically significant clinical improvement by day seven of treatment, but a higher incidence of QT prolongation (p=0.028), mortality (p=0.03), and ICU transfer (p=0.16) in the treatment group compared to the control group. The authors use these findings to illustrate the potentially hazardous effects of adopting therapeutics without adequate scientific study and peer review.

MENTAL HEALTH AND RESILIENCE:

· Researcher from Seoul, Korea investigated the psychological impacts of mandatory quarantine of 72 caregivers due to contact with a COVID-19 patient in a children's hospital. The highest reported were worrying (94.4%) and nervousness (90.3%), there were some reports of suicidal (4.2%) and homicidal (1.4%) ideations, and fear of infection of the patient (91.7%) and fear of infection of oneself (86.1%) were the most frequently reported stressors. Authors emphasize the need to balance carefully the benefits of mandatory quarantine against its psychological costs to patients and caregivers when making decisions.


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