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June 16 | Daily COVID-19 LST Report

Climate

· Public health experts discuss the difficulties in obtaining personal protective equipment and other supplies for South American countries during the pandemic due to their reliance on imported supplies and emphasize the importance of global support during these times.

· A study of 217 frontline healthcare professionals in Germany found that individuals estimated their personal likelihood of infection at a mean of 21% with a relative increase in perceived infection risk in female and younger participants. However, weekly SARS-CoV-2 IgG serology revealed only a 1-2% prevalence of infection, the authors suggest a discrepancy in perceived versus actual SARS-CoV-2 infection risk in the healthcare setting.



Epidemiology

· A systematic review and meta-analysis consisting of a total of 17,794 patients found that high cardiac troponin I and aspartate aminotransferase levels as well as advanced age were predictors of poor COVID-19 prognosis.

· A study of EEGs of 26 patients diagnosed with severe COVID-19 in various intensive care units throughout Paris found that five patients demonstrated a delta wave pattern concerning for brain injury as a direct or indirect result of COVID-19 leading the authors to encourage the use of EEGs to assess COVID-19 patients that present with unexplained changes in mental status.

· A retrospective study of 182 children, 43 of whom had history of allergic disease, found no difference between rate or severity of disease between the two populations suggesting that having a history of allergic disease does not place children at a higher risk for developing COVID-19

Understanding the Pathology

· A molecular and genetic analysis of SARS-CoV-1, SARS-CoV-2, and MERS-CoV conducted at the National Institutes of Health 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.

· A study of cardiac tissue found SARS-CoV-2 gene sequences - specifically low amounts (100-500 copies/reaction) of the SARS-CoV-2 E-gene - in endomyocardial tissue biopsies of five out of 104 patients with suspected myocarditis or unexplained heart failure showing a possible link between COVID-19 infection and cardiac involvement.


Management

· Guidelines and recommendations include proper management of infected neonates or neonates born to parents with COVID-19

· A retrospective cohort study of patients admitted to Tongji Hospital in Wuhan, China found that patients with Interstitial Lung Disease (ILD) exhibited increased severity of COVID-19 compared to non-ILD patients (39.29% vs 15.38%, P = 0.004).

· A modeling study conducted by Certara utilizing the "Simcyp (V19.1) population-based physiologically based pharmacokinetic (PBPK) simulator", found that when lung pH decreased from 6.7 to 6.0, the lung to plasma partition coefficient increased and the lung exposure of azithromycin, hydroxychloroquine, and chloroquine increased 2.7, 4.0, and 20 times, respectively, suggesting that therapeutic doses for these drugs may need to be adjusted in the treatment of patients with COVID-19 to avoid overexposure.

o Additionally, renal impairment, which is a common comorbidity with COVID-19, increased the exposure of azithromycin, hydroxychloroquine, and chloroquine in the lungs by 3.4, 8.0, and 30 times, respectively, suggesting that renal functioning must also be considered when determining therapeutic drug dosages.

· A matched cohort study in multiple surgical units of Spedali Civil Hospital found that 30-day mortality rates and post-op complications, especially pulmonary and thrombotic, were significantly higher in 41 surgical patients with COVID-19 than 82 controls without COVID-19 (mortality OR: 9.5, 95% CI: 1.77-96.53; complications OR: 4.98, 95% CI: 1.81-16.07), suggesting that COVID-19 disease is an important consideration for postponing surgery when possible.

Adjusting Practice During COVID-19

· Guidelines and recommendations for adjusting practice during the pandemic include:

o Strategies to address factors that may worsen cardiometabolic risk factors monitoring

· A retrospective cohort study involving 307 COVID-19 patients found significant co-infection rates with Influenza A (49.8%) and Influenza B (7.5%) and patients co-infected with Influenza B and SARS-CoV-2 exhibited worse prognosis as they were more likely to have chest CT abnormalities, fatigue, decreased lymphocyte count, and decreased eosinophil counts. Thus, authors recommend testing for Influenza A and B in any COVID-19 patients as early detection and treatment could potentially improve patient outcomes.

R&D: Diagnosis and Treatment

· A study of 16 COVID-19 patients in Greece received hydroxychloroquine and azithromycin and were then classified into two groups (Group A, with persistent fever and "severe radiological findings”, received lopinavir/ritonavir as a third agent with n=8 while Group B did not). Findings suggest that lopinavir/ritonavir may be effective at reducing the viral load in patients with severe SARS-CoV-2 infections.

· A newly developed rapid (30-45 minute) screening diagnostic test for SARS-CoV-2 using a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay was both sensitive (95%) and specific (90%) in detecting SARS-CoV-2 infection in patients by quantitative RT-PCR in vitro and thus warrants investigation outside of the laboratory.

Mental Health & Resilience Needs

· An online survey of 996 participants from 22 countries, using HEXACO (Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness to Experience) inventory to determine personality dimensions, found that 'Emotionality' predicted perceived threat of COVID-19 (p<0.01), which may have indirectly affected stockpiling behavior, and individuals high in 'Conscientiousness' engaged in more toilet paper stockpiling (p=0.048). Thus, it was suggested that effective communication by public authorities may lead to decreased anxiety levels and reduce commodity stockpiling during a pandemic.

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