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June 22 | Daily COVID-19 LST Report

Climate

· Researchers from the University of Wisconsin-Madison propose a framework for early communication of risks for healthcare workers that can inform future communication in public health emergencies.

· An analysis of the economic impact of COVID-19 on older adults highlights that more than 1/3 of adults 65 years or older live in counties with a high cost of living and increased COVID-19 prevalence demonstrating an overlap between "infection rates and economic insecurities" during COVID-19 with nearly 25% of these adults relying on Social Security benefits that may be insufficient to meet financial needs during a pandemic. The authors encourage employment and economic recovery strategies to take into consideration the older population.





Epidemiology

· A survey was conducted in Israel of 140 ambulatory, non-hospitalized COVID-19 patients that found that while both sexes report common symptoms (ie., cough, weakness, and myalgia), symptoms overall were more frequent among women and olfactory dysfunction, and oral symptoms (dry mouth, taste dysfunction, facial pain, masticatory pain) were common, even in the absence of other symptoms (25.8%), placing increased emphasis in exploring olfactory dysfunction and oral manifestations to diagnose COVID-19.

· A two-center retrospective study at Wuhan Pulmonary Hospital and Tongji Hospital examining 1,018 COVID-19 patients found that increased interleukin-6 (IL-6) levels (>20 pg/mL; P<0.001) and decreased CD8+ T cell levels (<165 cells/mul; P<0.001) are both independently associated with increased mortality in patients with COVID-19, suggesting that both of these indicators may help clinicians in prognostication and clinical decision making.

· Researchers at an urban teaching hospital in Lombardy, Italy examined 69 cases of hospitalized COVID-19 patients ≥80 years of age with 23 patients who died found a significant association between severe dementia and increased mortality and independent risk factors for death in this population included a lactate dehydrogenase level >464 U/L and an oxygen saturation level ≤90% at admission.


Understanding the Pathology

· A SARS-CoV-2 genomic and phylogenic analysis in India discovered four unique sequence regions that interact with the angiotensin converting enzyme (ACE)-2 receptor and may be potential targets for antibody vaccine design and revealed that bat SARS-CoV genome is the closest homolog of human SARS-CoV-2, supporting evidence that the COVID-19 outbreak originated from bat-to-human zoonotic transmission.


Management

· A case series of 63 positive end-expiratory pressure (PEEP) titrations performed in 15 patients with COVID-19-related ARDS using electrical impedance tomography (EIT) found that high PEEP were from personalized PEEP at the level of lowest relative alveolar overdistention and collapse, PEEP set was positively correlated to BMI (p< 0.001), and individualized PEEP titration could result in improved clinical outcomes but further research is needed to confirm whether this personalized PEEP titration approach is safe and effective.

· A case series of 21 rheumatic patients with COVID-19 who were admitted to Tongji Hospital in Wuhan, China were found to have symptomatology and inflammatory biomarkers that also appeared similar to flares in rheumatic conditions, emphasizing the importance of distinguishing between the two ailments to ensure patients are treated appropriately.


Adjusting Practice During COVID-19

· Guidelines and recommendations for adjusting clinical practice include:

· Practitioners from King County, Washington developed guidelines for management of sexually transmitted infections (STI).

· The Department of Pediatrics at the University of California, Davis shares the institution's methodology of stratifying pediatric patients who may need endoscopic procedures and their recommendations on use of personal protective equipment (PPE) during aerosol-generating procedures.

· Chinese authors present effective and protective measures for managing urological diseases.

· The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition distributed surveys to participating centers (102 worldwide) to determine global trends in patients with pediatric inflammatory bowel disease (PIBD) during the pandemic and found eight cases of PIBD patients testing positive for SARS-COV-2, all with mild presentation of symptoms and none-requiring hospital admission or disruption of current IBD treatment protocols.


R&D: Diagnosis & Treatments

· An experiment conducted at the University of Paris tested the efficacy of the Orient Gene COVID-19 IgG/IgM Rapid Test Cassette at multiple time points and compared it to a previously validated antibody test (Abbott SARS-CoV-2 IgG Immunoassay). In patients with known COVID-19 and results interpreted by unblinded clinical microbiologists, the Orient Gene test had a sensitivity of 95.8% and a specificity of 100%, suggesting clinical utility of this test with needed validation with a larger asymptomatic group.

· A retrospective cohort conducted at Daegu Catholic University School of Medicine in Korea found that 31 COVID-19-positive patients treated with lopinavir-ritonavir had significantly shorter times to negative conversion of viral RNA than 34 COVID-19-positive patients treated with hydroxychloroquine (median, 21 days vs. 28 days; Figure 2); however, time until clinical improvement was not found to be different between these groups.

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