Climate
The group of Italian psychologists propose guidelines to mitigate sleep deprivation in frontline healthcare providers during the COVID-19 pandemic. These authors call attention to the negative effects of emergency-induced sleep deprivation and advocate for taking care of those who are providing care during the pandemic.
Analysis of 1,855 people booked and 2,129 released from Cook County Jail in March found that cycling people in and out of jails for trials and hearings is associated with 15.7% of all COVID-19 cases in Illinois, 15.9% of cases in Chicago, and accounts for 55% of variance in case rates across zip codes in Chicago. The authors highlight these findings as support for broader criminal justice reform by reducing reliance on arrest and incarceration.
The Boston Health Care for the Homeless Program tested 1,297 individuals experiencing homelessness over 6 weeks and found 33% to be positive for COVID-19, suggesting the homeless population is especially susceptible to large outbreaks of COVID-19 and a reduction in morbidity and mortality in this population should remain a cornerstone of public health efforts.
Public policy experts at Harvard advocate for a hospital funding budget model in which patient volume does not determine revenue to help alleviate the disproportionate financial stress encumbered by rural hospitals across the United States in light of the COVID-19 pandemic.
Epidemiology
An international group of researchers utilized case data in combination with linear regression models and best-subset model selection to determine that a 1 day delay in implementing social distancing protocols resulted in a SARS-CoV-2 containment delay of 2.41 days.
A retrospective chart review utilizing data from 15 hospitals in China shows that 55 of 252 COVID-19 positive patients were afebrile with similar rates of severe illness in febrile versus nonfebrile patients emphasizing that fever alone may not be an adequate measure of COVID-19 presence or progression.
Among 87 pregnant persons who tested positive for COVID-19 and delivered (41 vaginal and 37 cesarean) within the next 14 days, nine women who had cesarean delivery developed severe adverse outcomes and eight showed clinical deterioration compared to vaginal delivery which had no severe adverse outcomes and only two cases of clinical deterioration.
A retrospective case series of 44 children hospitalized with COVID-19 found that fever (100%) and gastrointestinal symptoms (84.1%) were the predominant presenting symptoms associated with multisystem inflammatory syndrome in children.
Understanding the Pathology
Presence of lipid droplets characteristic of a fat embolism found on autopsy of a COVID-19 patient led a group of Italian researchers to posit that destruction of adipocytes by SARS-CoV-2 and subsequent fat embolism could play a role in poor clinical outcomes for obese patients.
Transmission and Prevention
Investigators from the Imperial College London describe a "semi-mechanistic, joint, Bayesian hierarchical model" which demonstrated that expected deaths due to SARS-CoV-2 for 11 European countries significantly decreased following the implementation of lock downs, social distancing, school closures, banning of public events, and self-isolation, suggesting that more than 3 million lives in Europe have been saved as a result of these measures.
Investigators from Taiwan discuss measures to reduce the need for healthcare providers to re-enter isolation rooms, reduce the consumption of personal protective equipment (PPE), and minimize risk of exposure. Using contact free monitoring equipment, remote control of ventilators, and telemedicine for psychiatric consultations and patient consents, the authors indicate it is possible to effectively deliver patient care while limiting consumption of PPE.
Management
An algorithm developed by obstetricians from Baylor College of Medicine recommends prone positioning for refractory hypoxemia in pregnant women to improve oxygenation through diaphragmatic and aortocaval decompression.
o This algorithm can provide a low cost and low harm intervention in the presence of severe respiratory distress related to COVID-19.
Adjusting Practice During COVID-19
Guidelines and recommendations include how to adjust anticoagulation management during lockdown and reopening phases of the COVID-19 pandemic.
Analysis of data from stroke centers in Michigan comparing incidence rate ratios (IRR) of ischemic stroke, hemorrhagic stroke, and stroke-related interventions in March 2020 to the control periods of February 2020 and March 2019, specifically the significantly reduced incidence rates in ischemic stroke admissions and mechanical thrombectomies, reveal a negative "bystander effect" during the COVID-19 pandemic.
A case report of an aortic aneurysm patient discussed using a thoracic endovascular aortic repair (TEVAR) with provisional extension to induce complete attachment (PETTICOAT) technique to decrease rates of spinal cord ischemia and postoperative paraplegia that also minimized surgical time and reduced postoperative recovery stay in the hospital.
o Authors suggested this technique may reduce COVID-19 transmission rate for patients undergoing aortic aneurysm repair in the hospital.
R&D: Diagnosis and Treatments
A study of 100 patients suspected of COVID-19 (31 positive) in France developed a predictive COVID-19 diagnostic model that utilized lung ultrasound in combination with clinical features, resulting in an area under the receiver operating curve of 0.82 (95% CI 0.75-0.90), sensitivity of 97% (95% CI 83–100%), specificity of 62% (95% CI 50–74%), positive predictive value of 54% (95% CI 41–98%), and negative predictive value of 98% (95% CI 88–99%), suggesting that a multi-location lung ultrasound in combination with easily obtainable clinical features may be an effective way to detect COVID-19 in patients presenting to the emergency room.
An in vitro cell line study in the Netherlands found that the drug suramin inhibits SARS-CoV-2 replication (EC50 = 20 uM) and decreases viral load in a human lung epithelial cell line (Calu-3).