According to a study in France, initial signs of pressure on the emergency medical system (EMS) preceded the hospital influx of critical patients by approximately 30 days and identification of similar measures in other countries' EMS may be critical for pandemic preparation.
A study using a novel method based on statistical physics to predict the transmission/incubation time and global recovery trajectories during the COVID-19 pandemic found that the COVID-19 transmission/incubation rate was approximately five days, and different countermeasures (i.e., social isolation, distancing) led to different growth/decline trajectories worldwide.
A retrospective study of 72 non-hospitalized COVID-19 patients who presented to the emergency department (ED) and underwent chest CT-scans with CT pulmonary angiography protocols found that thirteen patients (18%) were diagnosed with acute pulmonary embolisms (APE), suggesting associations between COVID-19 and APEs, even in non-severe and non-hospitalized patients.
Researchers at University of California San Diego Health performed a cross-sectional study and found that 23 out of the 46 COVID-19 patients reported olfactory dysfunction; 18 of those 23 reported persistent subjective loss of smell despite two consecutive negative RT-PCR tests, suggesting that olfactory loss can persist even after significant viral load reduction.
A qualitative study evaluating antibody responses of rabbits to various SARS-CoV-2 spike protein antigens, including the receptor-binding domain (RBD), S1 domain, S2 domain, and S1+S2 domain, found the RBD immunogen elicited a much higher antibody response with greater affinity compared to other antigens, and the S2 domain produced the weakest response, suggesting that vaccine development based on the RBD may be a promising area of further research.
Adjusting Practice During COVID-19
Guidelines and recommendations for adjusting practice include a triphasic response to COVID-19 with phase-specific recommendations to minimize adverse effects of delaying care for gastrointestinal diseases during the earlier part of the pandemic.
A Health Belief Model and self-reporting questionnaire sent to 90 residents (mean age 84.9 years) across three nursing home facilities in Israel to determine the accuracy of self-reporting in the elderly found the difference between true BMI values and self-reported values varied by an average of 1.43, which would have a minimal impact on the physician's clinical evaluation of a patient, and the positive predictive value for self-reporting normal blood pressures was 77.78% and 78.57% for abnormal blood pressures.
In the COVID-19 era where minimizing physical encounters remains necessary, elderly self-reporting on health measures may potentially become an essential telehealth tool.
R&D: Diagnosis & Treatments
In a case series of 105 COVID-19 patients in Germany 14 patients had severe hyperinflammation associated with COVID-19 by a COVID-19 Inflammation Score (CIS) and were subsequently treated with the Janus kinase (JAK) 1/2 inhibitor drug ruxolitinib of which 12 demonstrated statistically significant reduction in CIS on the seventh day, suggesting that ruxolitinib may be efficacious in patients with hyperinflammation in the setting of COVID-19. A phase II clinical trial for this drug is underway.
A scoping review of clinical trials for treatments of COVID-19 registered with the WHO or clinicaltrials.gov, completed on 26 March 2020 by epidemiologists at Johns Hopkins University (United States), found:
A total 92 different experimental agents tested as either single or combination therapies
201 ongoing clinical trials, of which 75.7% (152) were randomized trials
Within the randomized trials group, only 36.2% (55) were at least single-blinded studies.
Thus, while there are a wide variety of drugs undergoing testing, results of most studies are expected to only provide preliminary information on efficacy.