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June 19 | Daily COVID-19 LST Report

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 pr