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June 9 | Daily COVID-19 LST Report

Climate

· A case series conducted in Istanbul found that of over 50% of healthcare providers working in the COVID-19 care unit had developed hand eczema, suggesting that the increased hand hygiene techniques used to combat the transmission of COVID-19 may be leading to these effects.

· Public health experts in Quebec express optimism over the recent announcement by the Quebec government stating that COVID-19 healthcare will be covered for all residents regardless of immigration status. They hope that that this could set a precedent to help address the over 2/3 of migrants previously reporting unmet healthcare needs.

· Gerontologists argue that using age to create public policies for controlling the spread of COVID-19 is unjustified in that it reinforces negative age stereotypes and violates older persons’ rights to autonomy.


Epidemiology

· A review conducted by the Centers for Disease in June characterizes the initial spread of COVID-19 in the United States and concludes that community transmission of COVID-19 began in late January or early February 2020, with the primary strain originating in China and some additional strains likely coming from Europe.

· An epidemiological study of cases in Shenzhen, China utilized three parametric models to estimate the serial interval of COVID-19 as 5.9 days, which is shorter than that reported for SARS and MERS and supports a rapid transmission model that necessitates social isolation to control disease spread.

· A study of 71 hospitalized COVID-19 patients found that 9 exhibited hyperlipasemia; however, none of these patients developed acute pancreatitis or severe symptoms, suggesting that the presence of hyperlipasemia may not significantly affect clinical outcomes in patients with the virus.

· A case series in New York describes a group of 17 COVID-19 positive children and adolescents who presented with symptoms of a COVID-19-related inflammatory syndrome and suggest that the pattern of inflammatory markers follows closely with that of Kawasaki disease and that the pattern of abnormal cardiac findings necessitate long-term follow-up in these patients.

Understanding the Pathology

· An author at Montpellier University in France discusses the similarities between Kawasaki Disease (KD) and the "multisystem inflammatory" disease reported in COVID-19 cases and hypothesizes that dysregulation of neutrophil extracellular traps, which are DNA structures with antimicrobial proteins that trap and kill microorganisms, could be a link between the development of Kawasaki Disease and COVID-19.

· In vivo and ex vivo RNA sequencing of COVID-19 related genes in human tissue and immune cells found, among other findings:

o Higher expression of ACE-2 and CD-147 related genes in male, obese, COPD, hypertensive, asthmatic, and smoking patients

o Higher expression of CD-147 related genes with increased BMI and older age

o That children had lower expression of ACE-2 related genes, but higher expression of CD-147 related genes

Transmission and Prevention

· An experiment comparing two methods of disinfection of positive pressure air supply respirators found that, compared to manual cleaning, mechanical boiling was more than twice as efficient and yielded higher degrees of disinfection.

· A retrospective cohort study conducted in North London found that 12.7% of their 631 COVID-19 cases were hospital-associated emphasizing the need for effective preventative precautions in the hospital setting.

Management

· Data from 114 COVID-19 patients in China found that viral load, C-reactive protein (CRP), and serum amyloid A (SAA) may be associated with more severe COVID-19.

· A case report of a COVID-19 patient with acute hypoxemic respiratory failure demonstrated that increased use of external therapeutic temperature modulation (TTM) in patients experiencing cytokine storm and hyperpyrexia due to COVID-19 can help avoid more aggressive interventions such as extracorporeal membrane oxygenation (ECMO).

Adjusting Practice During COVID-19

· Guidelines and recommendations for adjusting clinical practice during the pandemic include:

o Emergency services that transport COVID-19 patients

o Diagnosis of COVID-19 for internists in the outpatient and inpatient setting

o Patients with psoriasis who require immunosuppressive therapy

o Protective measures for staff and therapeutic measures for patients in cases of acute coronary syndrome

o Surgeries, treatments, and prevention of SARS-CoV-2 in lung cancer patients

o Triage of bariatric surgery

· Out of 1,067 out-of-hospital cardiac arrests (OHCA), there were 2.2% PCR-confirmed COVID-19 cases and 1.2% COVID-like-illness cases between January 1 and April 15, 2020 at the University of Washington Medical Center, with the prevalence of OHCA higher during the active period of COVID-19 after February 26.

1. After combining their data with previously reported transmission rates in CPR without use of PPE (approximately 5%), the authors conclude that the rate of rescuer death would be about 1 in 10,000, and thus more lives will be saved with rapid identification of cardiac arrest and immediate use of chest compressions and defibrillation by bystanders without delay for implementation of PPE.

R&D: Diagnosis and Treatment

· Detection rates of an enhanced fluorescence assay (CEFA) and a microsphere immunoassay (MIA) for IgM/IgG antibodies against SARS-CoV-2 (87 patients at initial emergency visits, 28 subsequently hospitalized patients, and 145 convalescent patients) were ~26% in emergency department (ED) patients but improved to 100% after 21 days from symptom onset, showing promising clinical utility in serological testing except for in early screening at initial ED visits.



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