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July 7 | Daily COVID-19 LST Report

CLIMATE:

· Authors from Washington University outline the challenges that U.S. colleges face in reopening for fall 2020 which include lack of a central authority to implement policies, financial issues, and adherence to safety measures by the academic community. They propose symptom-based screening, widespread testing, contact tracing, quarantine of cases and contacts, use of masks, and dedensification of campuses to mitigate the risk of reopening.

· Authors review the literature on healthcare worker (HCW) exposure to COVID-19 and describe how the University of Washington (UW) implemented an effective system for returning HCW to work after exposure. This system implemented rapid testing to identify cases, and then required symptom resolution and negative RT-PCR testing before returning. The researchers conclude that this model provided UW's healthcare team with institutional support and transparency and recommend other healthcare facilities implement a similar framework for their frontline employees.




EPIDEMIOLOGY:

· To estimate the burden of deaths from COVID-19 in the US, authors from the Yale School of Public Health compared data from the National Center for Health Statistics (NCHS) to Centers for Disease Control and Prevention (CDC) reports from the same time frame in years prior. Out of an estimated 122,300 excess all-cause deaths, 78% were attributed to COVID-19. The authors postulate that the total COVID-19 related death toll is underestimated, though some of the additional excess deaths likely result from reduced access to care for chronic conditions.

· A case report of a 16-year-old girl with COVID-19 associated dactylitis that was successfully treated with naproxen (500mg every 12 hours for 5 days) suggests that similar cutaneous manifestations of COVID-19 may result from a Kawasaki-like vasculitis or inflammatory disease process that is responsive to NSAIDs.


UNDERSTANDING THE PATHOLOGY:

· A review of the minimal data on the association of COVID-19 severity and Vitamin D deficiency proposes decreased UV light and lower temperatures in the Northern hemisphere may partially explain the estimated 4.4% increase in mortality for each 1-degree latitude north of 28 degrees found in one study. Additionally, evidence from laboratory and clinical studies suggest that vitamin D may inhibit viral replication and downregulate inflammatory cytokines (IL-6 and TFN-alpha), leading authors to recommend replacing Vitamin D in deficient individuals with COVID-19, however more research is needed.


TRANSMISSION AND PREVENTION:

· Researchers at Johns Hopkins University analyzed anonymous mobile phone data of people in the top 25 U.S. counties most affected by COVID-19. They found a positive correlation between reduced mobility patterns and decreased COVID-19 cases (r > 0.7) in 20 of 25 counties, with mobility decreases ranging from 35%-63%. These findings highlight how social distancing is a key factor in effectively decreasing the number of new COVID-19 cases.

· An investigation launched by the Public Health Department in Pasadena, California found that in nine long-term care facilities, the proportion of asymptomatic COVID-19-positive residents and staff was over 40%, suggesting symptom screening alone is not enough to prevent spread in these facilities; residents and staff must also get tested routinely in the absence of symptoms.


MANAGEMENT:

· An analysis of 321 hospitalized COVID-19 patients in Chicago found co-infection in 3.7% of patients overall and 41% of patients admitted to the ICU while antibiotics were used in 69% of all patients. The authors concluded that antibiotics may not be indicated in most patients as co-infection was infrequent and often viral, but ICU patients may require antibiotic therapy due to higher incidence of co-infection.

· A multi-center study from Wuhan, China of 482 confirmed COVID-19 patients found that a mild elevation in liver biochemistries is common in COVID-19 patients, possibly from chronic hypoxia and excessive inflammation, and that elevations in these values are associated with chest distress or pain, dyspnea elevated C-reactive protein level, increased hemoglobin, and elevated white blood count.


ADJUSTING PRACTICE DURING COVID-19:

· Guidelines and recommendations for practice during the pandemic include:

o Assessing and treating bipolar disorder

o Resumption of respiratory outpatient services

· In light of data showing that elderly individuals were visiting the hospital pharmacy for refills at significantly lower rates during the pandemic, a group of investigators in Taiwan created an outdoor dispensary for multi-month drug refills which effectively returned pharmacy refills among the elderly to pre-pandemic numbers. These results suggest that the creation of alternative medication delivery mechanisms for citizens most at risk of COVID-19 disease may help prevent nonadherence to medical regimens for chronic disease.


R&D DIAGNOSIS AND TREATMENT:

· A prospective cohort study conducted at Tongji Hospital found improved accuracy of SARS-CoV-2 nucleic acid testing via oropharyngeal secretions (OS) as opposed to nasopharyngeal sampling (NPS), with false negative rates of 14% and 59%, respectively. This suggests the potential use of OS sampling as a key screening and diagnostic tool for detection of SARS-CoV-2 in the future.

o However, a separate study of 95 patient-matched samples found no significant difference in the rates of viral detection between the two sampling methods suggesting that further study is needed in this area.


MENTAL HEALTH AND RESILIENCE:

· Investigators administered the General Anxiety Disorder and Patient Heath Questionnaire surveys to health care workers at a tertiary hospital in Dublin and found that 20.3% of respondents exhibited moderate to severe depression and 21% exhibited moderate to severe anxiety contributing to mounting evidence that the COVID-19 pandemic has had a significant negative psychological effect on healthcare workers as they continue to serve patients.


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