Epidemiology
· A meta-analysis of 2,765 patients in 6 studies conducted by authors at Lanzhou University in China found that tuberculosis (TB) was neither associated with increased mortality risk in COVID-19 patients (odds ratio [OR]=1.40, 95% CI: 0.10-18.93, p=0.80, I^2=31%) nor associated with an increased risk of developing severe COVID-19 (odds ratio [OR]=2.10, 95% CI: 0.61-7.18, p=0.24, I^2=36%), suggesting TB may not predispose individuals to COVID-19 related mortality, but based on having previous lung disease those with TB might have a higher chance of serious COVID-19.
Understanding the Pathology
· A cross sectional study from 23 March to 12 May 2020 found that a majority of serologic testing samples across 10 US states (n=16,025) were negative for SARS-CoV-2 antibodies, with positive results ranging from 1.0% in San Francisco Bay to 6.9% in New York City, but the number of infections was still much greater than number of reported cases at all testing sites. Authors suggest those with asymptomatic or mild infections may not seek healthcare and are often unaware of SARS-CoV-2 infection, so the general public should continue taking preventive measures (i.e. wearing cloth face coverings, social distancing, washing hands, and staying home when sick) to reduce COVID-19 transmission.
Transmission & Prevention
· The Infectious Disease Surveillance Center and National Institute of Infectious Disease in Japan investigated the Diamond Princess cruise ship COVID-19 outbreak between January and February 2020 and 58 of 601 environmental surface samples from cabins with COVID-19 patients remained positive for SARS-CoV-2 RNA for up to 17 days after cabin was vacated with no statistical difference between symptomatic and asymptomatic individuals. However, there was no evidence of viable transmission through air or wastewater samples, and no viral isolates were obtained from any sample suggesting proper disinfection and hygiene precautions are important in preventing direct and surface transmission during COVID-19 outbreaks.
Managements
· Guidelines and recommendations for management of COVID-19 patients include a clinical algorithm for determining appropriate therapeutic strategies for concomitant atrial fibrillation
Adjusting Practice During COIVD-19
· Guidelines and recommendations for adjusting practice during the pandemic include a set of triage algorithms and symptomatic management guidelines for geriatric patients diagnosed with or suspicious for COVID-19 infection.
· Researchers from Spain assessed data on COVID-19 outcomes in an ongoing randomized controlled trial comparing the use of ramipril to standard care following transcatheter aortic valve replacement and found that of 102 participants (50 ramipril, 52 control), 11 developed COVID-19 (5 ramipril, 6 control), yielding a hazard ratio of 1.150 (95% CI 0.351 - 3.768) for COVID-19 development with ramipril and found no difference in mortality between groups. Since ramipril did not result in higher COVID-19 incidence or mortality, the authors conclude that discontinuation of ACE-inhibitors as a precautionary measure may actually result in increased cardiovascular mortality.
o Another study of 157 COVID-19 cases from Wuhan City, China found that the use of angiotensin converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) had no significant impact on the prognosis or severity of COVID-19 in hypertensive patients when compared to use of calcium channel blockers (CCBs). They report no differences between in-hospital mortality (p=0.191), chest CT improvement time (p=0.87), nucleic acid conversion time (p=0.18), or in-hospital time (p=0.83), and efficacy was similar between both anti-hypertensive groups, suggesting there was no support for increased viral entry and replication of SARS-CoV-2 into host cells with the use of ACEIs/ARBs. Authors recommend their continued use for the treatment of hypertension in COVID-19 patients.
· An observational study of healthcare personnel (n=5) found that wearing powered air-purifying respirators (PAPR) impaired hearing threshold (4.5 ± 3.6 to 38.6 ± 5.6 decibels in hearing level, P≤0.001) and decreased word discrimination (mean decrease from 100% to 48% ± 14%, P≤0.001), while positioning of PAPR did not alter either, suggesting a need for additional communication strategies, such as closed loop communication, for healthcare providers wearing PAPR to maintain patient and worker safety during the COVID-19 pandemic.
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