· 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