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June 4 | Daily COVID-19 LST Report

Climate:

· Delayed presentation for stroke may prohibit time-sensitive treatment with tissue plasminogen activator (tPA).

· Theories attempting to explain the relatively low case fatality rate (CFR) in Africa (3%) compared to the Americas (6%) and Europe (9%) include:

o Minimal early transmission from Asia and Europe

o Younger population and warm, dry climate

o Underestimation of the CFR due to limited resources and testing


Epidemiology:

· Data from the Korean Centers for Disease Control and Prevention estimates the burden of disease from the pandemic to be 4.930 Disability-Adjusted Life Years (DALYs) per 100,000 population.

· Belgian authors studying anosmia in COVID-19 found:

o 87% of those reporting anosmia for less than 12 days were RT-PCR positive for COVID-19 (vs 23% >12d).

o However, olfactory performance testing found 25% patients were actually normosmic.

Understanding the Pathology:

· Data from the University of Washington hospital system found <1% of asymptomatic patients without known exposure tested positive for COVID-19, compared to 10.3% in symptomatic patients.

· A retrospective study of the first 1000 COVID-19 patients at New York-Presbyterian Hospital found a bimodal distribution in time-to-intubation after symptom onset (3-4 days & 9 days), suggesting careful monitoring for patients who are 5-8 days post-symptom onset to anticipate disease progression.

Transmission:

· Scant evidence of detectable SARS-CoV-2 in semen and breastmilk has researchers calling for more robust research to understand implications of potential sexual and vertical transmission.

· Serologic and RT-PCR testing of an entire otolaryngology unit staff (n=58) in a high-prevalence region of Italy found 9% positivity; however, survey results showed out-of-hospital COVID-19 exposure was associated with a higher risk of infection (p=0.008).

Management:

· An international interdisciplinary group of physicians review the literature, and outline a multidisciplinary approach for managing COVID-19 patients, emphasizing the importance of early identification and proper timing of interventions.

· Authors argue against using two consecutive negative PCR tests as a guide for discontinuation of isolation precautions, especially considering nearly 1/5 patients test positive after two negatives and the substantial amount of PPE and resources required.

Adjusting the Practice:

· European pathologists release guidelines for maintaining safe and effective laboratory procedures during the COVID-19 pandemic.

· A case series from the University of Washington Medical Center describes a successful and timely organ transplantation procedure.

R&D Diagnosis and Treatment:

· Brazilian authors comparing lung ultrasonographic findings to histopathological analysis of 10 fatal COVID-19 cases found full agreement between the two diagnostic modalities. This adds to growing evidence of the utility of ultrasound in screening and monitoring disease progression in COVID-19 patients.

· A systematic review and meta-analysis of 9 studies (n=200) evaluating efficacy of mesenchymal stem cells (MSCs) in treating COVID-19 acute respiratory distress syndrome (CARDS) displayed a trend towards reduced mortality that was not statistically significant. However, given the lack of adverse events associated with MSC, authors posit that further research is warranted.

Mental Health and Resilience:

· Authors from Brown University discuss combating misinformation during the COVID-19 pandemic.

· A cross-sectional study of 339 psychotherapists found 62.7% experienced moderate levels of vicarious trauma and 15% experienced high levels. Higher levels were seen in younger and inexperienced clinicians, highlighting the importance of managing countertransference.

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