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July 9 | Daily COVID-19 LST Report

Climate

· A survey of 195 faculty at a large academic radiology department found that 23% respondents with children reported having major gaps in their childcare needs while 53% reported minor gaps during the pandemic highlighting the need for supporting healthcare workers.



Epidemiology

· A series of acral chilblain lesion cases collected in France found that 7 of 121 cases tested positive for COVID-19 via RT-PCR and 5 of 75 tested positive via serology. Based on their findings, the investigators suggest that chilblains do not have diagnostic or prognostic value for SARS-CoV-2 infection, though the authors do not dismiss that some acral lesions could be related to COVID-19.


Understanding the Pathology

· Comparison of RNA-seq data from bronchoalveolar lavage samples from 9 COVID-19 patients found an increase in ACE2 expression and a resultant bradykinin storm leading to increased vascular permeability, infiltration of inflammatory cells, formation of hyaluronic acid membranes in the lungs, and electrolyte imbalances when compared to controls. This analysis helps characterize the mechanism of inhibited gas exchange in COVID-19.

Transmission and Prevention

· Researchers affiliated with Oxford, Harvard, Johns Hopkins, North Carolina State University, and the University of Haifa discuss the importance of human challenge trials in SARS-CoV-2 vaccine development and argue that these trials should be initiated immediately due to the lengthy process involved in conducting them.


Management

· A group of pediatricians describes recommendations for breastfeeding infants for mothers with suspected or confirmed COVID-19 citing the lack of consensus from national OB/GYN organizations in the US and UK.

· A study involving 140 patients in Singapore discusses and validates a proposed "Rule-of-6" which involves using early-infection levels of ferritin above 600 ug/L, LDH above 600 U/L, and CRP above 60 mg/L as predictors of COVID-19 disease progression and deterioration.


Adjusting Practice During COVID-19

· A retrospective cross-sectional analysis in Boston, MA found that among 327 patients who are taking systemic immunomodulatory medications for dermatologic conditions, there were 5 COVID-19 positive infections and 1 hospitalization, which is in-line with Boston's general population infection and hospitalization rate suggesting that long term immunomodulatory medications likely do not affect COVID-19 infection and outcomes.

· A 40-question survey filled out by 509 interventional cardiolo