Climate:
Researchers with the European Monitoring Centre for Drugs and Drug Addiction report a 27% increase in online cannabis sales and a paradoxical 17% decrease in estimated revenue from January to March 2020 due to a suspected shift in cannabis purchasing towards “dark net” drug sales.
Public health officials in Singapore and the United Kingdom draw parallels regarding the stigma seen in the HIV and COVID-19 pandemics stating that stigma may hinder individuals from coming forward to be tested for COVID-19, leading to further spread.
Epidemiology:
A retrospective cohort study utilizing the data from the 17.4 million patients in the National Health Service in the United Kingdom determined that male sex, older age and deprivation, uncontrolled diabetes, severe asthma, along with both black and Asian ethnicity were associated with a higher chance of in-hospital death in people with confirmed COVID-19.
Investigators in Pittsburgh utilized Bayesian statistics to support the notion that when a patient has a high RT-PCR pretest probability of COVID-19, such as an emergency room nurse who has evaluated several positive patients, a negative test result may not be sufficient to rule out infection.
An observational study in Italy found a moderate to strong negative correlation between people over the age of 65 who received the influenza vaccine and COVID-19-related deaths in Italy leading experts to call for experimental studies to investigate potential causal links.
A systematic review of literature found that of 92 pregnant persons diagnosed with COVID-19 via RT-PCR or CT, 64% were symptomatic, 76.6% of RT-PCR tests were positive, 8.7% had pneumonia diagnosed with CT, and there were no reports of maternal mortality or confirmed vertical transmission supporting that mothers and neonates are at relatively low risk of severe infection.
Transmission and Prevention:
An author from Oxford argues that two recent publications that indicate low effectiveness of public mask-wearing fail to take into account the source control that masks provide by preventing large droplet aerosolization by the user.
A group of American physicians points out that well-established vaccines against pathogens such as respiratory syncytial virus (RSV), streptococcus species, and seasonal influenza only have modest efficacies around 60-70% and explain that an initial SARS-CoV-2 vaccine will likely be less effective due to our naive immune systems.
A cohort study of 14,000 people in Vietnam who were tested for SARS-CoV-2 via RT-PCR found that 43% of the 30 who tested positive were completely asymptomatic and would otherwise not have been identified as infected with the virus.
A retrospective study of data in the states of Colorado, Minnesota, Ohio, and Virginia from seven consecutive days before and 17 consecutive days after the implementation of stay-at-home orders revealed that these efforts were effective in preventing hospitalizations from growing at an exponential rate.
Management:
Guidelines and recommendations for management of COVID-19 patients include:
The role of imaging in the COVID-19 pandemic
Delivering care in patients with heart failure
A group of pulmonary and critical care specialists discuss the current data on the utility of noninvasive ventilation techniques for management of acute hypoxemic respiratory failure and indicate that these approaches may prevent the need for intubation in some patients.
A case series of 85 asymptomatic cancer patients found that seven were positive for COVID-19 on nasopharyngeal RT-PCR. Their findings suggest that universal screening of immunocompromised patients, especially patients on anti-cancer therapy, may be beneficial in mitigating progression to severe disease and preventing further transmission of SARS-CoV-2.
Adjusting Practice
Guidelines and recommendations for adjusting practice during the COVID-19 pandemic include:
Reopening hospitals and maintaining patient safety
Management of gynecologic malignancies and patients with acute stroke
A cohort study found that neck circumference was significantly associated with risk for invasive mechanical ventilation (95% CI:1.120-1.417; p<0.001), when adjusted for age, sex, diabetes, hypertension, COPD, and BMI, suggesting that neck circumference may be a useful independent predictor upon admission for invasive mechanical ventilation in COVID-19 patients.
In a survey, 88 of 106 academic orthopedic institutions in the US using telehealth services stated that COVID-19 was a major factor in implementing the services and the geographic location of the programs providing substantially increased telehealth services was positively correlated with COVID-19 disease burden, indicating the "impressive measures" needed in these areas to provide quality care for their orthopedic surgery patients.
R&D: Diagnosis and Treatment
A systematic review including 4 randomized controlled trials, 10 cohort studies, and 9 case series found that evidence was conflicting and insufficient regarding the use of hydoxychloroquine and chloroquine in decreasing mortality, disease progression, clinical symptoms, and viral clearance in patients with COVID-19.
A pilot randomized controlled trial analyzed the effect of 3 months of colchicine on 35 COVID-19 patients with characteristics of high BMIs (over 30 kg/m^2), metabolic syndrome, and no significant chronic medical conditions. Findings were a significant decrease in concentration of 26 molecules associated with neutrophil function and the innate immune system (including IL-6) and an increase in 8 molecules associated with metabolism and tissue repair.
Mental Health and Resilience Needs
A cohort study evaluated the efficacy of social media-based counseling via two daily face-to-face sessions on WeChat for 63 patients hospitalized with suspected COVID-19 during hospital quarantine and found a significant reduction in both anxiety and depression among the 15 qualified patients (initial score of 8 or higher on the Hospital Anxiety and Depression Scale [HADS]) two weeks after the first intervention.
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