Climate
A social media questionnaire of 270 men and 189 women in China found reduced sexual behaviors during the COVID-19 era.
Reduced sexual desire in 25% of participants
Decreased sexual satisfaction in 35%
Reduced number of sexual partners in 44%
A 48 year old male with chest pain waited two days before presenting to the emergency department due to fear of COVID-19. He was diagnosed with ST-elevation myocardial infarction requiring extensive treatment and prolonged recovery, which could have been avoided if not for delayed presentation secondary to concerns for COVID-19 infection.
Epidemiology
In a meta-analysis of 21 studies examining the incidence of gastrointestinal symptoms and liver injury in patients with COVID-19, researchers found that 9.1% of patients had diarrhea, 5.2% had nausea/vomiting, and 3.5% had abdominal pain. There was no significant difference in diarrhea or nausea/vomiting between severe and non-severe cases of COVID-19, and these symptoms did not have prognostic value.
A systematic review of 11 studies (249 patients) characterizing COVID-19 infection in the pediatric population and 6 studies (69 patients) investigating vertical transmission found:
The most common presenting symptoms in the pediatric population include cough (49%), fever (47%), sore throat (36%) and GI symptoms (17%)
Pneumonia was diagnosed in 60% of pediatric cases with 4% of cases needing admission to the ICU and a case fatality rate of 0%.
4 neonates tested positive for COVID-19, all of whom were born via cesarean section and one who subsequently died.
COVID-19 disease in the pediatric population is mild and while there were possible cases of vertical transmission, further studies are needed to determine if this is characteristic of COVID-19.
Understanding the Pathology
Researchers present a comprehensive review on SARS-CoV-2 immunopathology, describe putative mechanisms for cell-specific pathogenesis based on current research and studies on SARS-CoV and MERS-CoV. Notable mechanisms in pathogenesis include early interferon production and activation of NK cells as crucial steps to mitigate COVID-19 severity. Additionally, mention of spontaneous recovery in cases of agammaglobulinemia highlights that antibodies are not essential. However, other evidence suggests that they may play a role in recovery or disease enhancement.
Management
Guidelines and recommendations for:
Managing seizure episodes
Changing the delivery method of aerosolized medications
Managing and treating acute kidney injury
Coordinating rectal cancer treatment
In a case series of 24 awake, hospitalized COVID-19 patients without mechanical ventilation, 15 tolerated prone positioning with 6 responding with more than 20% increase in partial pressure of arterial oxygen, leading the authors to recommend further studies to explore its efficacy.
A case report of a 42-year old patient with a history of multiple sclerosis (MS) presented with relapsing neurological symptoms and developed COVID-19 symptoms 6 days later, leading to speculations of COVID-19 as a possible cause of relapse in MS patients.
Adjusting Practice during COVID-19
Guidelines and recommendations for practice during the pandemic:
Dental care
Control of infection in trauma surgery
Diagnosis, treatment, and monitoring of obstructive sleep apnea
Treatment of opioid addiction
Thoracic oncology specialists highlight how cancer patients can often experience respiratory symptoms and fever similar to COVID-19 due to chemotherapy, radiation treatment, or other opportunistic infections and note that additional care should be taken when working up a cancer patient for suspected COVID-19.
A cross sectional study in Zhejian, China found that outpatient visits in pediatrics decreased by 75% compared to this time last year leading to concern that many parents whose children need care may not be seeking it.
Mental Health & Resilience
A review of current experiences in child and adolescent psychiatry treatment found that the main burdens and risk factors for poor mental health were associated with social distancing, increased pressure on families, and reduced access to support services.
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