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July 23 | Daily COVID-19 LST Report

CLIMATE:

· Authors from Saarland University in Germany propose a method for prioritizing allocation of a SARS-CoV-2 vaccine during a resource shortage. These recommendations include a three-tier preference list for vaccine distribution: beginning with hospital workers and public safety/security officers, followed by immunocompromised/suppressed individuals such as organ transplant recipients, and finally all others in the general population in order from oldest to youngest. This idea highlights one potential method of solving the key issue of vaccine prioritization for individuals with high susceptibility to COVID-19 infection.

· A sharp peak in rates of intestinal obstruction (IO) during the lockdown period in Kerela, India (referred to as "lockdown belly") leads authors to propose four common risk factors, 75% are modifiable with diet and physical activity. These include: 60 years of age or older, prior abdominal surgery, strict adherence to lockdown restrictions, and poor quality diet.

· Researchers explore the impact of COVID-19 on immigrants in the United States, with an emphasis on those in Houston, Texas. They found that higher rates of comorbidities (obesity 71%, hypertension HTN, 27%, and diabetes (9.6%) and increased risk of occupational exposure (20% of essential workers are immigrants) are factors that lead to health disparities in this population. They are also more vulnerable to the effects of unemployment, food insecurity, child support, and access to healthcare during the pandemic. Thus, the authors suggest expanding Medicaid, eliminating immigration requirements for CHIP, banning of ICE in healthcare, and ensuring immigrants receive adequate aid from economic relief packages as measures to reduce disparities.


UNDERSTANDING THE PATHOLOGY:

· A cross sectional study from Columbia University that analyzed kidney biopsies of SARS-CoV-2 infected patients (n=17), revealed a spectrum of glomerular and tubular injuries, acute kidney injury (88%), and lack of SARS-CoV-2 detection in kidney cells as evidence against direct viral injury as a pathophysiologic mechanism of disease. Authors conclude that the principle nephrogenicity of SARS-CoV-2 likely results from ischemic damage and a dysregulated immune response.

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TRANSMISSION AND PREVENTION:

· A group of psychologists found that habit reversal training (HRT) was an effective method of treating repetitive behavior problems, such as face touching, and therefore may be an effective strategy for decreasing transmission of SARS-CoV-2. The principles of HRT are centered on mindfulness and behavior modification, and authors include a practical guide to implementing these practices.

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MANAGEMENT:

· Italian authors describe how the anti-coagulant Defibrotide may be the “drug of choice” for treating the hypercoagulable state associated with severe COVID-19 disease because of its profibrinolytic, antithrombotic, and anti-inflammatory effects. These would theoretically protect from the growing evidence implicating the role of endothelial damage and a hyperinflammatory state in SARS-CoV-2 infection.

· A literature review of 9 studies describes the effect of T cell imbalance, specifically between Treg and Th17, on uncontrolled systemic inflammation in severe COVID-19 cases in pregnancy found that: - Treg cells decreased and Th17 cells increased, with a consequent decrease in the Treg/Th17 cell ratio. - Treg cells dysregulation in COVID-19 was shown trigger hyperinflammation and tissue damage. - Increased Th17 is associated with fetal allograft rejection at the feto-maternal interface. - COVID-19 infection puts pregnant persons at higher risk for pregnancy complications.


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