Epidemiology
· An epidemiological modeling study that used confirmed COVID-19 cases and deaths from January 31–April 22, estimated adjusted case fatality rates in both Canada and the US of less than 2% when assuming an estimated reporting rate of less than 50%.
· An observational study of 73 COVID-19 patients, 53 of whom were admitted to the ICU, found that patients who experienced a vascular event were more likely to have a low serum albumin.
· A prospective cohort study in England, Wales, and Scotland reports disease course and demographic data from over 20,000 COVID-19 patients, representing 34% of all hospitalized COVID-19 patients in these countries. The authors believe that the rapidity by which this data was collected emphasizes the importance of forward-preparedness planning for pandemics.
Understanding the Pathology
· A prospective cohort study of 5,279 COVID-19 positive patients found that age was the strongest risk factor for hospitalization; however, when looking at patients with critical illness, admission oxygen saturation < 88%, troponin > 1, C-reactive protein > 200, and D-dimer > 2500 exhibited stronger associations than age.
Transmission and Prevention
· An analysis of human nasal mucus and sputum mixed with SARS-CoV-2 under different environmental conditions found that the viral half-life and viral load were decreased under conditions with warmer temperature and higher humidity, suggesting possible seasonal drive for future outbreaks peaking during cold and dry periods.
· A case series from a skilled nursing facility in California demonstrated successful prevention of further infections after two residents tested positive for SARS-CoV-2. Their approach included screening all residents and staff members with RT-PCR, serial testing for positive SARS-CoV-2 residents, and cohort isolation for those who tested positive.
Management
· Guidelines and recommendations for caring for COVID-19 patients include:
o A novel epidemiological risk score to predict diagnosis of COVID-19
· A retrospective cohort study in Italy found that among 173 patients admitted to the general or vascular neurology unit with neurological diseases, those who had COVID-19 were more likely to be older, have higher quick Sequential Organ Failure (qSOFA) score on admission, and be admitted with cerebrovascular disease.
· A study of 101 patients hospitalized with COVID-19 found that those on maintenance hemodialysis were less likely to present with the classic COVID-19 symptoms of fever and cough; though were more likely to develop complications such as shock, acute respiratory distress syndrome, arrhythmia, and acute cardiac injury and had poorer clinical outcomes than controls.
Adjusting Practice During COVID-19
· The European Myeloma Network released a consensus statement to guide treatment decisions for multiple myeloma patients during the COVID-19 pandemic and urged participation in international registries to record data on multiple myeloma patients and COVID-19 to further guide management.
· An in vitro study conducted by the University of Connecticut Health Center in Farmington, Connecticut in May 2020 found that povidone-iodine (aka PVP-I or Betadine) in concentrations of 0.5% can completely inactivate SARS-CoV-2 in 15 seconds compared to 70% ethanol, which took 30 seconds to inactivate the virus, suggesting that PVP-I oral rinse prior to dental or prosthodontic procedures could decrease the risk of transmission in dental practice.
R&D: Diagnosis and Treatment
· A GRADE-guided systematic review of six studies of therapeutic convalescent plasma (CP), using results from four influenza randomized trials and one non-randomized study of both SARS-CoV and Ebola, found no therapeutic efficacy across patient outcomes, length of hospital or ICU stay, or viral load reduction.
o Given the use of hemagglutination inhibition to nonspecifically categorize CP in some trials herein, direct study of verified CP from recently recovered COVID-19 patients to gauge its efficacy is recommended.
· A trial of 62 hospitalized COVID-19 patients in China from January to March 2020 compared the control group, treated with Asmeton, Eucalyptol, and Moxifloxicin (n=20), to the intervention group, receiving the same treatment in addition to Arbidol (n=42), and found that the intervention group had a shorter duration of cough and fever, suggesting that COVID-19 symptom duration may be shortened with the addition of Arbidol to standard treatment.
Mental Health and Resilience Needs
· A cross sectional study of 4,618 health professionals in the Chinese provinces of Sichuan and Yunnan found a higher Huaxi Emotional Distress Index (HEI) for those exposed to the COVID-19 outbreak with 24.2% experiencing higher levels of anxiety and/or depressive symptoms since the start of the COVID-19 outbreak.
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