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June 5 | Daily COVID-19 LST Report

Climate:

· High rates of moral injury and loss of social identity among healthcare workers has authors from the University of Hildesheim advocating for improved stress management techniques to promote positive coping skills. Reported stressors include separation from family, inability to speak out about unsafe working conditions, inadequate resources, and high death rate despite appropriate patient care.

· The COVID-19 pandemic continues to exacerbate health disparities, especially in these vulnerable populations:

o Elderly (>85 years of age),

o racial and ethnic minorities

o Sex workers

o Nursing home residents, especially those with high minority populations.




Epidemiology:

· A multicenter, retrospective, cross-sectional study conducted in Zhejiang Province, China, from January 17 to February 12, 2020, found that 28.2% of 788 COVID-19-positive patients had elevated liver enzyme levels (ALT >35 for men, >25 for women) on admission, which were independently associated with male sex, being overweight, history of smoking, and symptom presentation of diarrhea (Table 4). No differences were found in disease severity or clinical outcomes between the groups with and without elevated liver enzymes (Figure 1), and the authors admit that the pathogenesis of the elevation remains unknown.

· Iranian researchers review neurologic manifestations of COVID-19:

o Over 1/3 of patients experienced neurologic symptoms, commonly as the initial or only chief complaint.

o CNS manifestations: Headache, dizziness, altered consciousness, and acute cerebrovascular disease.

o PNS Manifestations: Anosmia, ageusia, muscle pain, and rarely Guillain-Barre syndrome (GBS)

· 2 surveillance studies from Seattle, WA found a relatively low prevalence of asymptomatic disease among pregnant (1.2%) and pre-procedural patients (<1%) screened with RT-PCR testing.


Understanding the Pathology:

· A cross-sectional study of 34 adult male COVID-19 patients in Wuhan, China found no evidence of SARS-CoV-2 in semen samples within 31 days of their COVID-19 diagnosis. This contradicts a previous study that found RT-PCR positivity in 6 of 38 patients, prompting the need for further investigation.

· A colonoscopy performed on a 40-year-old COVID-19 patient with pneumonia and bloody diarrhea, revealed SARS-CoV-2 infection of intestinal endothelial cells via immunohistochemistry (IHC). Authors promote IHC as a useful diagnostic adjunct, and propose direct intestinal injury as a potential disease mechanism.


Transmission and Prevention:

· Harvard physicians review the literature on asymptomatic and presymtomatic transmission of COVID-19.

· Washington State public health officials conducted extensive contact tracing on the first patient diagnosed with COVID-19 in the US. They found that none of the 78% of identified contacts who agreed to testing were positive by either RT-PCR or follow-up serology, despite 29% reporting prolonged and unprotected exposure. This lack of secondary transmission may be explained by multiple factors including exposure type, duration, and frequency, as well as the patient’s viral load, disease severity, and timing of exposure during the course of disease.


Management:

· Guidelines for management of COVID-19 patients from today includes imaging guidance for pediatric pulmonologists

· Investigators detail treatment of a COVID-19 patient with significant cardiac comorbidities with mechanical circulatory support and implantable ventricular assist devices.

· Cardiologists continue to warn of the dangers of QT-prolonging medications such as hydroxychloroquine and suggest that critically-ill COVID-19 patients be screened for cardiac abnormalities prior to treatment with these drugs.


Adjusting Practice:

· Authors from Kaohsiung Medical University Hospital in Taiwan describe an algorithm for the remote management of chronic wound care and follow up care to during the pandemic.

· A group of US neuromuscular specialists call for equitable triage decision-making during the COVID-19 crisis and propose guidelines to ensure triage algorithms take children into consideration.


R&D Diagnosis and Treatment:

· A group of Harvard investigators detail the current diagnostic methods for COVID-19 including the current status of nucleic antigen and serologic tests.

· A group of pathologists in Brazil correlated specific ultrasound findings to histological patterns through post-mortem analysis of COVID-19 lung tissue adding to the utility of ultrasound in characterization of the disease.

· Investigators compared the Roche SARS-CoV-2 serologic antibody assay to the Abbot and EUROIMMUN assays and found a specificity of 98.69% and sensitivity of 89.36%--results similar to the other two assays.


Mental Health and Resilience:

· German researchers studying psychosocial responses and coping strategies from past pandemics found that psychological reactions are often complex, contradictory, and a multi-step process.

· Lessons from Lombardy: Italian authors outline the psychological support systems that were implemented for healthcare workers, patients, and their families during the peak of the COVID-19 pandemic.

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