Climate
· Policy advisors from the American Association of Retired Persons (AARP) highlight the importance of social and emotional connections between care facility residents and their family caregivers, especially as recent federal guidelines have restricted family visitation to limit the spread of COVID-19. The authors suggest increasing communication between care facilities and families to clarify restrictions and allow the continuation of meaningful connections, encouraging families to work together to provide emotional and logistical support to each other, and increasing geriatric social work to mitigate the emotional toll on residents of healthcare facilities.
Epidemiology
· A retrospective study of 98 convalescent patients with COVID-19 found that nucleic acids for SARS-CoV-2 were found in sputum or nasopharyngeal samples in 17 of the 98 patients (17.3%) after hospital discharge, despite two negative COVID-19 tests as a requirement for hospital discharge. This may suggest that continuous shedding or relapse of SARS-CoV-2 is possible post-discharge, making it incredibly important for continuous quarantine and follow-up for these patients.
· A retrospective chart review from 15 hospitals in China from January 19 to March 6, 2020 (n=252 patients with COVID-19) to highlight the high proportion of non-febrile patients with COVID-19 (55/252, 21.82%) who became critically ill and required oxygen supplementation (43/55, 78.18%) (Table 1). These findings emphasize that fever alone may not be an adequate measure of COVID-19 presence or progression.
· A retrospective analysis of 105 hospitalized patients with COVID-19 performed at 3 University of Washington found a high incidence of severe disease (49%) and mortality (33%) among hospitalized patients, in which 55% had 3 or more comorbidities. These two major findings suggest the need for rapid implementation of preventive measures, especially to protect elderly individuals with co-morbidities who may be the most susceptible to severe disease.
Understanding the Pathology
· Stanford researchers profiled peripheral blood mononuclear cells (PBMCs) via single-cell RNA sequencing (scRNA-seq) from seven patients hospitalized for COVID-19 and describe an immune cell phenotype with heterogeneous interferon-stimulated gene signature, HLA class II downregulation, and a developing neutrophil population that appears closely related to plasmablasts in the ARDS group, highlighting potential targets for immunopathologic study and therapeutic intervention (Figures 1, 2, and 4). Peripheral monocytes and lymphocytes did not produce notable inflammatory cytokines, suggesting they likely do not contribute to the cytokine storm seen in COVID-19.
Transmission and Prevention
· Italian Association of Human Milk Banks recommend
o That mothers wear a surgical mask while breastfeeding or during intimate contact to mitigate infecting infants via respiratory route.
o Emphasize the importance of hand hygiene, disinfecting surfaces as well as thoroughly cleaning plastic and glass milk containers as the virus can remain stable on these materials for several days.
o Allocating human milk “to the smallest and most at risk preterm infants (e.g., birth weight <1500 grams or a gestational age <30 weeks) to prevent NEC and other severe illnesses occurring in these extremely fragile infants.”
· Researchers in Hong Kong collected air and environmental samples inside airborne infection isolation rooms suggesting that COVID-19 is not predominantly transmitted via the airborne route, however, the researchers recommend additional investigation in the cohort ward setting or during aerosol generating procedures.
Management
· Today’s report included guidelines and recommendations for management of
o Effects of methylprednisolone on CT imaging lesion absorption COVID-19 patients under 50 years of age
o Why, when, and how to use lung ultrasound during the COVID-19 pandemic: enthusiasm and caution
o COVID-19-White matter and globus pallidum lesions
o Heparin resistance in COVID-19 patients in the intensive care unit
o SARS-COV-2 and Male Reproductive Health
Adjusting Practice during COVID-19
· Today’s report included guidelines and recommendations for adjusting the practice
o Hand Eczema Pandemic Caused by SARS-CoV-2 Hygiene Measures
o IL-16 as a possible indication for deeper targeting IL-6
o Practical considerations and challenges in Cardio-Oncology services during the COVID-19 pandemic
o Procedural sedation in the COVID-19 era
o Practical recommendations for gynecologic surgery during the COVID-19 pandemic
o When Separation is not the Answer: Breastfeeding Mothers and Infants affected by COVID-19
R&D: Diagnosis and Treatments:
· A group of French clinicians track lopinavir plasma pharmacokinetics using liquid chromatography tandem mass spectrometry in 12 admitted patients with COVID-19 that received various dosages of lopinavir/ritonavir dual therapy 1 to 4 days post-admission (Figure 1). Few adverse effects were noted, including diarrhea (n=6, also taking amoxicillin/clavulanate), and nausea/vomiting (n=2), leading the authors to conclude that lopinavir/ritonavir was safe in their study, though they acknowledge that further study is needed on pharmacokinetic profile and routes of administration.
· This study conducted by the University of Washington (UW) and Stanford University retested a percentage of 20,912 patients who initially tested negative for SARS-CoV-2 via RT-PCR between March 2nd, 2020 to April 7th, 2020. They were able to retest patients whose symptoms were persistent/worsening (Figure 1) and found that of the 4.1% of the patients from UW and 2.6% from Stanford they retested, 3.5% of these cases (22 patients) returned positive within 7 days, suggesting an initial false negative test that turned positive after a mean of 4 days.
· A study of different antiviral therapies (lopinavir/ritonavir, hydroxychloroquine sulfate, emtricitabine/tenofovir) and the immunosuppressive agent azathioprine in SARS-CoV-2 inoculated ferrets revealed
o Antiviral therapies decreased overall clinical scores, with emtricitabine-tenofovir being the only therapy to reduce virus titers in nasal washes at 8 days post infection
o Delayed virus clearance and reduced serum neutralization antibody titers in the azathioprine-treated ferrets signifies that immunosuppressant drugs can elongate illness duration
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