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June 17 | Daily COVID-19 LST Report

Climate

· A cross-sectional study of surveys comparing 2,002 people in South Korea from 2/4-4/18/2020 to 2,009 people from the same geographic region from 6/2-6/15/2020 during the MERS-CoV epidemic found an overall increase in preventative behaviors during both time periods but social distancing, willingness to wear face masks, and avoidance of activities due to perceived risk during the COVID-19 pandemic were all significantly higher than they were during the MERS-CoV epidemic.

· Data collected from the Bureau of Labor Statistics Current Population Survey during 2019 found that a higher percentage of workers in industries deemed essential during the COVID-19 pandemic are people of color, indicating that people of color are more likely to have occupations with a high risk of exposure to SARS-CoV-2.

· Statistical analysis was not performed on this data. However, given the trends identified, the authors call for these industries to supply adequate PPE for workers to mitigate any disparities that may be caused by occupational segregation.





Epidemiology

· Researchers in China analyzed 247 full length SARS-CoV-2 genomic sequences from the GISAID platform in March and postulated a rate of 26 mutations per genome per year.

· The Hunan Seafood Wholesale Market was the initial location where transmission between intermediate host and humans occurred, but they suggest that four distinct "super-spreader" genomic sequences have emerged over the course of the pandemic that can be traced to different locations of severe outbreak throughout the world.

· A study of 98 elderly COVID-19 patients from 4 hospitals in a Korean province found that age (especially greater than 80), elevated C-reactive protein (CRP) levels, a high Modified Early Warning Score (MEWS), and a high National Early Warning Score 2 (NEW2) are associated with increased need for mechanical ventilation (MV)/high-flow nasal cannula (HFNC) and mortality.

· A CRP greater than 8.0mg/dL had a higher sensitivity, specificity, and positive predictive value in predicting the need for MV/HFNC (odds ratio, 26.31; P less than 0.001) than the commonly utilized clinical scores of MEWS and NEWS2, suggesting that CRP levels may be an effective predictor of prognosis and respiratory support in elderly patients with COVID-19 in addition to MEWS and NEW2 scores.


Transmission & Prevention

· Researchers from Beijing found that purifiers with fine filters (F6 class) removed 54% of aerosols that could carry airborne COVID-19 while those with particulate air filters (HEPA, H12 class) removed 83%, suggesting that air purifiers may be an effective tool for protecting dental healthcare workers during aerosol-generating procedures, with HEPA filters possibly providing more protection than F6 filters.

· A review found that povidone-iodine (PVP-I), a topical solution used for nasal and oral decontamination, 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 it may be a safe and effective agent against some coronaviruses (i.e. SARS-CoV-2, MERS).


Management

· Radiologists have published guidelines for reporting chest x-ray findings for confirmed or suspected COVID-19 patients.

· A retrospective study of 12 hospitals in China reviewed the clinical course, duration of hospital stay, treatment, and viral shedding of 149 hospitalized COVID-19 patients and found that:

· Fever, cough, and fatigue were the most common symptoms

· The majority of patients had a lymphocyte count of the lower limit of normal, an elevated CRP and ESR, and pneumonia findings on imaging.

· Those who required ICU admission were older (greater than 70 years old) and had decreased lymphocytes, hyponatremia, elevated D-Dimer, elevated procalcitonin, elevated liver function tests, and elevated lactate dehydrogenase.

· The median length of viral shedding was 12 days

· Management was mainly antiviral treatments with oxygen supplementation.

· A retrospective cohort study in the UK evaluated the serum iron profiles of 30 COVID-19 ICU patients and found that patients with severe hypoxemia had significantly lower levels of serum iron compared to patients with non-severe hypoxemia, suggesting that serum iron levels may be a useful marker for COVID-19 disease severity.


Adjusting Practice During COVID-19

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

· Risk stratification and subsequent care guidelines for adult congenital heart disease

· Epilepsy management

· A review of potential negative effects of a mandatory stay-at-home order on the developing fetus, especially related to photoperiod and circadian rhythm, led to suggestions of providing regular circadian light exposure that may reduce the risk for and effect of chronodisruption in pregnant women and the unborn fetus during the quarantine for COVID-19.

· Analysis of incidence of systemic arterial thrombotic events in 1,419 hospitalized COVID-19 patients at Hospital Universitario Fundación Alcorcón in Madrid, Spain showed 14 patients had a systemic arterial thrombotic event (3 acute coronary syndromes, 8 cerebrovascular events, 3 limb thrombotic events), which accounts for 1% incidence in the study sample, suggesting that although COVID-19 is associated with increased thrombosis risk, arterial thrombosis appears to be relatively uncommon and specific preventive measures may not be warranted.


R&D: Diagnosis & Treatments

· The Institute of Hygiene and Clinical Epidemiology of the University Hospital of Udine 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 but then had a positive shortly after (median of two days after negative swab) suggesting that RT-PCR alone may not be a sensitive diagnostic test for SARS-CoV-2 infection and may need to be supplemented with clinical findings and CT scan analysis for ideal patient care.


Mental Health & 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.

· The authors propose evidence-based recommendations and resources to help healthcare providers be proactive and mitigate this moral distress during the continuing COVID-19 pandemic.

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