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July 31 | Daily COVID-19 LST Report

CLIMATE:

· Recent United States healthcare policy updates related to COVID-19 include: - The Supreme Court will be hearing California versus Texas to determine if the Affordable Care Act (ACA) is invalid due to the potential unconstitutionality of its “individual mandate” that implements a fine for citizens that do not have health insurance and opt out of coverage; this is a move that Democrats say poses extra risk during COVID-19 due to the potential for individuals to lose healthcare coverage - The House passed the Health and Economic Recovery Omnibus Emergency Solutions Act, which includes a special enrollment period for both ACA coverage and Medicare, broader vaccine coverage, and increased federal Medicaid matching - The House passed the Patient Protection and Affordable Care Enhancement Act, which will make ACA and marketplace subsidies more generous and expand Medicaid coverage for pediatric and postpartum care



EPIDEMIOLOGY:

· A surveillance study of 696 participants in Atlanta, Georgia from 28 April to 3 May 2020 (during statewide shelter in place mandate) by the Center for Disease Control and Prevention COVID-19 Response Team found 2.7% (n=19) were positive for SARS-CoV-2 antibodies, 13/19 had a COVID-19 compatible illness (based on clinical criteria in the Council of State and Territorial Epidemiologists COVID-19 case definition) and just 5 had been tested for SARS-CoV-2. Authors suggest case-based/syndromic surveillance alone could lead to missed SARS-CoV-2 detection thus community level seroprevalence estimates may be useful in understanding population based transmission.

· A cross sectional study of 169 countries found that higher COVID-19 mortality rate was positively associated with an increased aged 65+ population (p-value<0.001) and transport infrastructure quality score (p-value = 0.002). Mortality rate was also negatively associated with government effectiveness score (p-value = 0.017), COVID-19 test number per 100 people (p-value = 0.001), and number of hospital beds (p-value < 0.001). This study suggests that these factors may increase risk for higher COVID-19 mortality rates in certain countries.


MANAGEMENT:

· An opinion piece by the School of Nursing and Midwifery at Western Sydney University argues that health practitioners and policy makers should learn from the mistakes during the HIV epidemic, making a case for COVID-19 infected mothers to breastfeed their newborns (Figure 2) as opposed to bottle feeding during the COVID-19 pandemic. The authors believe infants will be more likely to thrive if COVID-19 infected mother and her child are allowed more skin-to-skin contact and close proximity (Figure 1), despite current SARS-CoV-2 status, suggesting practitioners and policy makers should support breastfeeding in new mothers.


ADJUSTING PRACTICE DURING COVID-19:

· The authors report a simple way to create a cover for the patient’s mouth during esophagogastroduodenoscopy by using a piece of non-woven fabric that can be attached to a patient's mouthpiece with a band around the head (Figure 1, Video in primary article). This covering should help to reduce the spread of coarse respiratory droplets during esophagogastroduodenoscopy and similar procedures to minimize the transmission of COVID-19.


R&D: DIAGNOSIS AND TREATMENT:

· A cohort study of COVID-19 patients (confirmed n=129, suspected n=20) conducted at Tianjin Haihe Hospital, China found sensitivity and specificity of lateral flow immunochromatographic assay (LFIA) and magnetic chemiluminescence enzyme immunoassay (MCLIA) to IgM and IgG were >90% with no significant difference when compared to real-time reverse transcription polymerase chain reaction (RT-PCR; p>0.05), while blood lymphocyte subset measurements revealed significant lymphocytopenia in. Authors suggest strong antibody (IgM/IgM) response but weak T-cell response in those with COVID-19 may cause difficulty managing inflammation, but LFIA and MCLIA could be useful in early COVID-19 detection and risk assessment regarding vaccine immunization and reinfection.


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