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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 cardiologists found a significant decrease in procedures, an increase in personal safety measures, suboptimal COVID-19 pre-testing, a limited amount of FIT-tested N95 masks, and adoption of telemedicine during the pandemic helping identify areas of improvement for interventional cardiology departments.


R&D: Diagnosis and Treatments

· Chinese researchers investigated the SARS-CoV-2 immune response using prospectively collected samples from all hospitalized patients with RT-PCR confirmed COVID-19 in four hospitals in Guangdong Province. They found that severely ill patients demonstrated longer viral shedding, had higher neutralizing antibody titers, and were more likely to demonstrate IgM response than mildly ill patients. Additionally, they also found SARS-CoV-2 S and N proteins did not cross react with MERS-CoV.

· Researchers at Johns Hopkins, Mayo Clinic, and Albert Einstein College of Medicine cite prior research indicating a lack of antibody response to SARS-CoV-2 in the first 10 days of COVID-19 infection and suggest that administration of convalescent antibody via plasma therapy in early stages of disease course could support viral clearance, improve function in immune modulation, limit viral proliferation, and dampen the detrimental inflammatory response.

· In response to a press release about the preliminary results of clinical trials evaluating dexamethasone's possible mortality benefit for COVID-19 treatment, a group of clinicians at Harvard propose a set of minimum requirements for disseminating clinical results during the COVID-19 pandemic citing the importance of facilitating scientific scrutiny before allowing limited, potentially rushed, study results to influence clinical practice.

Mental Health and Resilience Needs

· A survey of 233 psycho-oncology patients and 41 of their family members found that although patients had increased fear of infection and feelings of loneliness, about half of patients and family members had an increased sense of peace and belonging to society as a result of the lockdown and subsequently reduced pressures of daily living.


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