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June 1 | Daily COVID-19 LST Report

Climate

· A research letter published in JAMA that analyzed pharmacy records during the pandemic, found a 1,977% increase in fills for Hydroxychloroquine/Chloroquine. The authors warn that this sharp increase in demand may lead to medication shortages for patients who require these for treatment for their chronic conditions, such a s Systemic Lupus Erythematosus and Rheumatoid Arthritis.

· Clinical statisticians outline recommendations on how to adapt clinical trials both during and after the pandemic, emphasizing the balance between safety and protecting the integrity of the trials.




Epidemiology

· A retrospective cohort study of 92 patients in Italy analyzing obesity and COVID-19 severity, found that younger obese patients (67.0±12.6 years vs. 76.1±13.0 years, p<0.01) had a higher risk of ICU admission and assisted ventilation, even after adjusting for age, sex, and commodities.

· In pediatrics, a case series conducted at the Children’s Hospital of Philadelphia found evidence to support Multisystem Inflammatory Syndrome in Children (MIS-C) in six patients with COVID-19. They report two notable findings associated with the condition include the development of neurological symptoms and hyponatremia. They note MIS-C resembles Kawasaki disease in clinical features and response to therapeutics, emphasizing the need for further research to determine if MIS-C is distinct clinical syndrome or an atypical presentation of Kawasaki disease.

Understanding the Pathology

· Molecular docking analysis found an increased affinity (–8.6 kcal/mol) between dithymoquinone (an active ingredient in black seed) and the SARS-CoV-2 S protein: human ACE2 receptor interface. This binding could disrupt host recognition and the S-protein pathway for disease progression, suggesting dithymoquinone as a potential natural antiviral worth further studying.

Management

· Guidelines for COVID-19 patient management from today include:

o Nutritional therapy delivery to critically ill patients

o Heart failure

· Clinicians at New York Presbyterian Hospital describe their protocol to place non-intubated, awake, mobile, and hemodynamically stable COVID-19 patients in the prone position in order to prevent worsening respiratory failure.

· A case series of 98 COVID-19 patients found that corrected QT intervals were longest when azithromycin and hydroxychloroquine were used in combination when compared to each drug alone. Additionally, 62% of patients in the study taking both drugs reached critical QT prolongation of over 500 milliseconds or 60 milliseconds above baseline.

Adjusting Practice

· Guidelines and recommendations for practice from today include:

o Resumption of electrodiagnostic testing

o Promoting psychosocial well-being in children

· A retrospective study comparing colorectal cancer surgery patients before and during the pandemic in China found that other than slightly longer hospital stays and increased patients from out of town, all other data, such as safety and outcomes, revealed no significant differences, suggesting it is safe and feasible to perform colorectal surgery during this time

R&D: Diagnostics and Therapeutics

· A cohort study of 11 COVID-19 positive children found that 18.2% of children had negative buccal swabs in spite of positive nasopharyngeal swabs, and buccal SARS-CoV-2 was undetectable by day 8 of illness despite continued viral detection in the nasopharynx. These results suggest that buccal specimens are inferior to nasopharyngeal specimens for COVID-19 screening.

· A prospective cohort study of 1788 patients in an Australian screening clinic found that the presence of either anosmia or ageusia exhibited a positive predictive value (PPV) for COVID-19 positivity of only 9.3%, suggesting that while these are more common in COVID-19 positive patients than negative (39.3% vs 8.9%, p<0.001), these should not be used as a screening tool for COVID-19.

Mental Health and Resilience

· Social scientists in the United Kingdom suggest that social representations of COVID-19, such as social distancing and mask wearing, will be resisted as they lead to identity threats (loss of routine, interpersonal relationship changes, disconnection), indicating the importance of adaptive ways to address this threat.

Silver Linings

· The COVID-19 pandemic has negatively impacted the antibiotic supply chain for life-threatening infections from antimicrobial resistant bacteria (AMR), although increased global awareness of the public health impacts of personal hygiene from the pandemic contributes to a first-line defense in combating AMRs.

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