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June 15 | Daily COVID-19 LST Report

Climate

· A case report of an ectopic pregnancy presenting late--after 15 days of abdominal pain--highlights the dangers of avoiding care due to fear of contracting COVID-19

· Investigators in South Africa discuss the effects of lockdowns on low- and middle-income countries and recommend that governments ensure health and resource information is both easily accessible and effectively disseminated to their populations by providing resources such as e-banking, water, food, and sanitation, as well as forming community partnerships.



Epidemiology

· A retrospective cohort study at the Cleveland Clinic found that the pandemic has significantly decreased the daily number of patients presenting to the hospital and requiring emergent transfer in general (4.5 patients per day to 2.4) and specifically with ST-elevation myocardial infarction and stroke. These results add to the evidence that patients may be reluctant to seek care during the pandemic, leading to an increase in mortality and morbidity outside of the hospital.

· Physicians from New York report six patients hospitalized with COVID-19 who developed hyperpyrexia with peak body temperatures of 107.2 – 109.2°F and onset 6-12 days following admission, and universal mortality within two days of onset. The authors propose hyperpyrexia may result from SARS-CoV-2-related brain injury, immune system dysfunction, and/or hypercoagulability leading to thrombus formation.

Understanding the Pathology

· Researchers reviewed two prospective multicenter cohorts of children hospitalized with bronchiolitis pre-COVID-19 and found that 12% had one of the endemic coronaviruses, 85% of whom had co-infection with another virus. While co-infection was not associated with severity of the disease, higher coronavirus viral load was associated with more severe illness.

· A molecular and genetic analysis of SARS-CoV-1, SARS-CoV-2, and MERS-CoV found that key changes in the nuclear localization sequence and distinct insertions in the spike glycoprotein of the virus may be responsible for the high pathogenicity of SARS-CoV-2 compared to SARS-CoV-1 and MERS-CoV

Transmission & Prevention

· Researchers from Beijing measured the size-dependent filtration efficacy of air purifiers with fine filters (F6 class) and particulate air filters (HEPA, H12 class) and found purifiers with F6 filters removed 54% of aerosols that could carry airborne COVID-19 while those with H12 filters removed 83%.

· A literature review found that povidone-iodine (PVP-I) can be safely administered in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for up to 5 months suggesting that PVP-I as a topical solution, may be a safe and effective agent against some coronaviruses.

Management

· A meta-analysis of 14 clinical studies found that the odds of mortality in patients treated with a combination of Hydroxychloroquine and Azithromycin was significantly higher than in patients treated with supportive care alone.

· A group of researchers argue that early initiation of mechanical ventilation and intubation to prevent more severe lung injury in COVID-19 patients is not substantiated and may in fact, cause fatal complications.

· A retrospective of 84 COVID-19 patients found that quantitative analysis programs for CT scans could be used to predict severity of COVID-19 related pneumonia with severe cases exhibiting significantly higher ground-glass opacity scores, consolidation scores, and total lesion scores than the non-severe group.

Adjusting Practice During COVID-19

· Guidelines and recommendations for practice during the pandemic include:

o Workflow recommendations for radiology departments

o A method for extubating patients that limits aerosolization

o Epilepsy management

o Risk stratification and care guidelines for patients with adult congenital heart disease

o GI motility and function testing

· Dental professionals in Saudi Arabia believe the current recommendation to delay dental treatment on COVID-19 positive patients 14 days after onset of symptoms is too short of a period based on reports of several cases of COVID-19 reactivation well beyond 14 days. To mitigate the risk of transmission, the authors recommend extending the recommendation to 28 days of quarantine after onset of symptoms to ensure adequate time for recovery.

· A review indicates that transcatheter aortic valve replacement is a safe and efficient alternative to surgical aortic valve replacement, and that a modified version of the procedure can be performed during the COVID-19 pandemic to limit potential exposure.

R&D: Diagnosis and Treatments

· A cross-sectional study of 34 CT images from RT-PCR-positive COVID-19 showed typical COVID-19 pneumonia abnormalities in 94% of patients, and 29% showed abnormalities with an initial negative RT-PCR test. Authors support use of CT analysis for diagnosis of COVID-19, even if RT-PCR is negative, and for monitoring disease progression and prognosis.

· A data analysis conducted in Italy found that 19.4% of confirmed COVID-19 patients (84 out of 433) had a false negative test reading on reverse transcriptase (RT)-PCR at some point in their series of swabs.

Mental Health and Resilience Needs

· Authors from the Cleveland Clinic report an overview of ethical issues that are causing moral distress in healthcare workers during the COVID-19 pandemic. Areas of distress highlighted include visitation restrictions impacting patients’ well-being, risk for safety to self and loved ones, reduced provision of healthcare services and limited allocation of resources.

· Data from 217 participants using smartphone mobile sensing concluded an increase in sedentary time, depression, and anxiety during the pandemic versus the same time frame in the previous term suggests that there has been an impact on mental health and behavior for this population during the COVID-19 pandemic.

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