Ethicists, microbiologists, and public health experts discuss strategies for optimizing the pandemic response. Considerations include:
The ethical implications of quarantine laws and clinical research
Integrating a comprehensive pandemic preparedness strategy for Latin America
Canadian scientists conducted a meta-analysis of 22 articles published between January 24 and April 2, 2020 exploring the virulence of SARS-CoV-2 found that: - the basic reproduction number of SARS-CoV-2 is 3.15, - the average incubation time is 5.08 days, - the asymptomatic infection rate is 46%, and - the case fatality rate is 3.34% (when asymptomatic cases are accounted for in a sensitivity analysis, case fatality rate is 1.8%).
Genetic analysis from 84 COVID-19 patients in New York found “clear evidence of multiple independent SARS-CoV-2 introductions into NYC during the first weeks of March”, with the majority coming from Europe.
Understanding the Pathology:
Czech researchers studying the immunologic aspects of COVID-19 conclude:
Both innate and adaptive immune systems are crucial in mounting a response, but it is unknown whether failure to mobilize the adaptive immune system leads to severe disease
IgA response is stronger than the other antibodies generated and more persistent
Interleukin(IL)-6 is elevated in greater than 50% of patients
"Macrophage Activation Syndrome" may explain the unusual finding of elevated CRP in some COVID-19 patients.
A review of mechanisms that predispose obese and diabetic patients to increased risk of severe COVID-19 disease, implicates a chronic inflammatory state, impaired T cell function, and dysfunction of the RAS system.
Transmission and Prevention:
A pilot study of a contact tracing strategy in Kentucky reported underwhelming cooperation with contact tracing, finding only 19 of 58 cases provided contact information, with others stating inability or unwillingness to cooperate. This highlights the need for a unique approach to contact tracing in the US.
A cross-sectional study from Singapore found SARS-CoV-2 RNA present on 56.7% of surface and air samples from airborne infection isolation rooms (AIIR) of COVID-19 patients. They also found highest contamination rates within the first 2 weeks of illness.
A case-study of 4,500 liver transplant recipients found that only 5 patients (0.1%) contracted COVID-19 post-transplant. All cases were mild and experienced a full recovery. Authors speculate this relatively low incidence rate may result from strong adherence to social isolation and/or a beneficial effect of their immune suppression.
A prospective cohort study from Tel Aviv conducted echocardiography on 100 adult COVID-19 patients. They found 32% had a normal echocardiogram, while 20% had clinical deterioration with ventricular deterioration more commonly on the right than left. Authors recommend echocardiography should be limited to patients with clinical decompensation, where it offers most benefit to guide clinical management.
The COVID-19 pandemic continues to catalyze the implementation of telemedicine:
A research letter discusses whole-body skin self-examinations (SSE) via teledermatology as a potential method to screen for melanoma. Authors cite recent studies showing at-home SSE have a high degree of sensitivity (>75%) and specificity (>87%) at detecting suspicious lesions, suggesting this may be a useful tool in combating transmission and delayed presentation during the pandemic.
A Penn State physician describes their new journal club format designed to adapt the huge influx of research during the pandemic.
R&D Diagnosis and Treatment:
Clinical microbiologists at NYU found the 5-minute Abbott ID NOW COVID-19 test had a positive predictive value of 94.4% and a negative predictive value of 83.1% (n=101) when compared to the Xpert Xpress SARS-CoV-2 test, suggesting this test may be a useful tool to rule-in disease. However, they caution that a single negative result may not be useful as a rule-out.
Mental Health and Resilience:
A US random sample survey from March 10 to March 31, 2020 found that older-aged respondents perceived greater risks of COVID-19 fatality, but overall lower risks of becoming infected or quarantined, losing their job, or running out of money, in addition to less reported depression and anxiety. These findings suggest older-aged adults appeared to have relatively greater optimism and better mental health than their younger counterparts during the early stages of the COVID-19 pandemic in the US.
Researchers in India assessed the understanding of quarantine and level of compliance in a cohort of 121 children (ages 9-18) and compared their psychological well-being to a cohort of 131 non-quarantined children. They found that while the majority of the quarantined children (73.55%) understand the reasoning behind quarantine, there was variable compliance to protection measures (only 7.53% correctly following all measures) and that feelings of worry, helplessness, and fear were more commonly reported in the quarantined cohort.
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