· A survey of 426 emergency physicians from seven medical institutions in California, New Jersey, and Louisiana found inadequacy of PPE, inability to quickly and accurately diagnose COVID-19, and fear of infecting family members to be the most salient stressors.
· A systematic review and meta-analysis, including 148 articles comprised of 24,410 COVID-19 positive adults from 9 countries, found that the most common symptoms at presentation were fever (78%), cough (57%), and fatigue (31%), with prevalence of dyspnea in only 23% of patients. The authors conclude that the most common symptoms are fever and cough, although it is noted that these prevalence findings are about 10% less than previously reported.
· A systematic review and meta-analysis of 18 studies (n = 14,558 COVID-19 positive individuals) evaluating severe infection and mortality risk in patients with comorbidities found populations with diabetes, hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and other comorbidities may have approximately double the risk of the general population and should take maximum preventive measures to protect themselves from infection with SARS-CoV-2.
Understanding the Pathology
· A case series of 7 patients found that postmortem tissue samples from patients who died from COVID-19 pneumonia <7 days after onset of respiratory failure (RF) showed acute diffuse alveolar damage (DAD) while samples from those who died >14 days after onset of RF showed organizing DAD, with SARS-CoV-2 detected in tissues with acute DAD but not in tissues with organizing DAD.
· An analysis of 90 patients from the Affiliated Yueqing Hospital, Wenzhou Medical University to develop a predictive model for rehabilitation time for mild-moderate COVID-19 cases found that of 5 significant clinical predictors, increased partial pressure of carbon dioxide and decreased serum potassium correlated with increased rehabilitation duration. Sub-stratification of the patient group as a mild-moderate risk using a 3-tiered risk system, predicted a rehabilitation time of 17.2 ± 5.2 days and suggested that the predictive tool may be used for personalized risk management.
· Analysis of three case series with conflicting data on mechanically ventilated COVID-19 patients indicated that: 1) low respiratory system compliance (Crs) may be associated with a higher gradient of arterial partial pressures of oxygen to alveolar partial pressures of oxygen (PaO2-PAO2) in COVID-19 respiratory failure, 2) positive end-expiratory pressure (PEEP) levels should be selected by measuring Crs, and 3) increasing tidal volume can reduce both serial dead space ventilation and parallel dead space ventilation. The authors suggest that clinicians focus on individual patient's needs when operating respirators given the heterogeneity in presentations of COVID-19 respiratory failure.
Adjusting Practice During COVID-19
· An international group of physicians affiliated with the World Endoscopy Organization provide guideline on the safe operation of endoscopy centers during the COVID-19 pandemic that may help endoscopy centers continue to provide appropriate services during the different phases of the COVID-19 pandemic.
R&D: Diagnosis & Treatments
· The Korea Centers for Disease Control and Prevention COVID-19 Diagnosis Test Management Committee provides guidelines to supplement the "Guidelines for Laboratory Diagnosis of COVID-19 in Korea" and provides technical support for common laboratory challenges in COVID-19 diagnostics.
· A cross-sectional study conducted by Tulane University School of Medicine using 29 nasal swab samples and found that COVID-19 could be diagnosed within 50 minutes via a COVID-19 CRISPR fluorescent detection system (FDS) with 100% sensitivity and 71.4% specificity when compared to results obtained by a state testing laboratory via reverse transcriptase (RT)-PCR of the same samples
· A systematic review conducted among clinical trials registered on ClinicalTrials.gov regarding hydroxychloroquine (HCQ) prophylaxis for SARS-CoV-2 found that the range of HCQ loading dose across the studies was 400-1400 mg followed either by a daily dose (commonly 200mg or 400mg) or weekly dose (400 mg) with prophylaxis duration ranging from 4 to 180 days or 3 to 24 weeks. Based on this "high diversity in [HCQ] dosage and duration of prophylaxis," the authors suggest additional analysis of these trials' designs and results before determining the appropriate HCQ regimen.
Mental Health & Resilience Needs
· Authors of the Department of Addictive Behavior and Addictive Medicine in Mannheim, Germany and the Department of Psychiatry and Psychotherapy in Paracelsus Medical University evaluated the effect of social isolation on alcohol consumption during the pandemic through an anonymous online survey of 2,102 participants and found that 34.7% of participants reported drinking more alcohol since the lockdown began, highlighting the need for healthcare providers to stay informed on this increased alcohol consumption during the lockdown and to be aware of its potential long-term effects.
· A systematic review conducted at the Galatea Care Programme for Sick Health Professionals in Barcelona, Spain analyzed 30 studies and found a high prevalence of anxiety (30-70%) and depressive symptoms (20-40%) reported among healthcare professionals (HPs), raising concerns that increased psychological support is needed in these population.