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June 29 | Daily COVID-19 LST Report

Climate:

· A cross-sectional study of 640 adults found that COVID-19-related conspiracy theory (CT) beliefs correlated with pre-existing CT beliefs, lower education levels, and a negative perception of government responses. However, there was no correlation between CT beliefs and emotional stress during the pandemic.





Epidemiology:

· Overlap in symptomatology between e-cigarette associated lung injury (EVALI) and COVID-19 leads California health officials to urge providers to keep EVALI on the differential diagnosis

· A retrospective observational study of 91,412 women found that pregnant women with SARS-CoV-2 reported increased severe illness, chronic conditions, and risk of ICU admission than their non-pregnant counterparts. Pregnant hispanic and black women were also disproportionately affected, further highlighting the need to address social barriers.

· A multicenter retrospective cohort study from Wuhan comparing pediatric and adult COVID-19 patients found children were more likely to be asymptomatic, have lymphocytosis (vs lymphopenia in adults) and were less likely to respond to anti-viral treatments.

Understanding the Pathology:

· A prospective clinical study from the University of Utah suggest that SARS-CoV-2 infection induces activating changes in the transcriptome and proteome of platelets, possibly contributing to the immunothrombosis observed in COVID-19 disease.

· Mechanism-based research implicates genetic mutations on the SARS-CoV-2 spike (S) protein and furin cleavage site (FCS) on the evolution of disease, and differentiating between subtypes of COVID-19.


Transmission and Prevention:

· Japanese gastroenterologists present $1 disposable face shield made from cardboard, called “ORIGAMI”, for use in endoscopic procedures to mitigate SARS-CoV-2 transmission from droplet aerosolization.

· Canadian authors describe policies implemented to reduce spread of infection in a 182-bed psychiatric facility, concluding that rapid identification of cases, aggressive testing for carriers, and swift movement of patients to isolation units are necessary to reduce nosocomial spread of COVID-19.


Management:

· Spanish authors describe pulmonary parameters in COVID-19 patients with acute respiratory distress syndrome (ARDS), finding a lack of association between PaO2/FiO2 and static compliance of the respiratory system, and a significant increase in oxygenation with prone position. They propose the underlying hypoxemia in COVID-19 ARDS results from dysfunction in lung perfusion.

· A retrospective case-control study of 1,603 COVID-19 patients in Italy evaluated the use of ACEIs and/or ARBs and severity of COVID-19 infection, finding no increased likelihood of severe or lethal disease.


Adjusting Practice During COVD-19:

· A new strategy for palliative care during the COVID-19 pandemic from a Teaching Hospital in Ghana.

· The authors argue that the emergency department is an unideal setting for making medical decisions regarding geriatric patients during the COVID-19 pandemic due to the paucity of critical information and the necessity for quick decisions. The authors suggest implementing diverse triage teams with administrative leadership, informing providers with regards to advanced directives, and delaying intubation until better decision-making can be made to improve patient outcomes and promote patient autonomy and beneficence.

· A rational approach to rationing and caring for the geriatric population during a resource-limited pandemic.


R&D Diagnosis and Treatment:

· A meta-analysis of chest CT features in 2,451 COVID-19 pneumonia patients found that vascular enlargement, ground glass opacities, interlobar septal thickening, and subpleural bands are the most common findings.

· A preliminary study conducted at Clinical University Hospital of Valencia from March 17 to April 24, 2020 found 10 of the 25 (40%) COVID-19 patients (19 COVID-19 positive and 6 with high clinical suspicion of COVID-19) had detectable responses of SARS-CoV-2-reactive IFN-γ CD8+ T cells (median: 0.57 cells/μL; range: 0.43-9.98 cells/μL), although the number of these cells did not correlate with ICU admission, SARS-CoV-2 antibody levels, or inflammatory biomarkers (Figure 2). The authors conclude that SARS-CoV-2-reactive IFN-γ CD8+ T cells can be observed in a notable percentage of patients with moderate to severe forms of COVID-19, and further research is needed to assess if quantification may be of prognostic value.

· An in vivo drug trial of Remdesivir in a rhesus macaque animal model found reduced pulmonary findings on chest radiographs, reduced viral titers on bronchoalveolar lavage (BAL), and reduced lung damage on pathology, suggesting early initiation of Remdesivir may provide clinical benefit in severe COVID-19 respiratory disease.


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