An author at Michigan State University advocates for an interdisciplinary approach to studying and learning from this pandemic. In light of COVID-19’s possible origins from a Chinese seafood market, they call for collaboration of bioethicists with expertise in public health and social scientists with expertise in agriculture and food supply. They also suggest adapting the “One Health” approach, which seeks to coordinate veterinary and medical research and education, to bioethics and social sciences research and thinking.
Researchers conduct a two-cohort study to better understand the relationship between COVID-19 and tuberculosis (TB)
Overall, death rates were low among TB patients with COVID-19, and the authors suggest TB may not be a significant determinant for mortality in COVID-19.
A literature review of 2,597 pediatric patients with COVID-19 reported:
7.6% asymptomatic, 45.5% mild, 41.5% moderate, 4.4% severe, 0.9% critical, and 0.1% death
43.5% with no obvious abnormalities, and 56.5% with inflammatory lesions
Blood: 74.7% normal leukocytes, 8.8% leukocytosis, 21% leukopenia, and 9.8% lymphopenia.
Inflammatory markers: 40.8% increased procalcitonin, 18.8% increased CPR, 20.4% increased LDH
Liver function: 11.2% increased ALT, and 17.3% increased AST
Renal function: 2.2% increased creatinine, and 1.5% increased urea nitrogen
Myocardial: 10.6% increased creatine kinase, and 27.0% increased creatine kinase MB isoenzyme
Understanding the Pathology
Degree of androgen sensitivity in patients may predict their vulnerability to COVID-19 and may explain increased prevalence in male adults. Authors suggest that anti-androgen medications with benign side effect profiles to be considered as prophylactics.
They provide two mechanistic reasons:
1) Transmembrane protease serine 2 (TMPRSS2) primes the COVID-19 spike protein, which then enables host cell entry
2) TMPRSS2 transcription is promoted by an activated androgen receptor
Transmission & Prevention
A Cochrane systematic review of studies simulating PPE donning and doffing found that utilizing PPE with better overall coverage (PAPR vs N95, gowns vs aprons, water-repellent vs breathable) can reduce contamination rates at the cost of higher difficulty of application. Contamination rates were also reduced when PPE can be easily removed in one-step, double gloving, and after formal video or in-person donning and doffing training.
Guidelines and recommendations for managing COVID-19 patients include:
A Pulmonary rehabilitation model based on guidelines by the National Health Commission of the People’s Republic of China
Maintaining and monitoring adequate nutritional considerations from Registered Dietitian Nutritionists
A systematic review, limited to case control and cohort studies, found no association between ACEI/ARB use and risk of COVID-19 infection, severity, or mortality but observed a decreased risk of mortality in COVID-19 patients who were taking ACEIs/ARBs compared to COVID-19 patients taking non-ACEI/ARB antihypertensive medications.
A COVID-19 patient who developed acute myocardial infarction with subsequent coronary thrombosis and cardiogenic shock was given percutaneous coronary intervention and thrombolytics but eventually died.
Though thrombolytic therapy is currently not recommended for COVID-19 patients, this case suggests the potential need to incorporate swift use of these therapies in eligible patients.
A common finding of bronchoscopies performed on 93 intubated COVID-19 patients was diffuse, thick hypersecretion in the airway. Out 63 of those patients with bronchoalveolar lavage performed, 28.6% had positive cultures for microorganisms commonly found in ventilator-associated pneumonia and required antibiotic therapy. This suggests that culturing respiratory secretions may be important for preventing nosocomial pneumonia, but it is noted that the authors did not weigh the benefits of bronchoscopy against the risks to patients and clinicians.
Adjusting Practice during COVID-19
Guidelines and recommendations for practice today include:
International Committee of the Red Cross on managing infected human remains
Management of metastatic prostate cancer
Workflow for rehabilitation in a field hospital setting
A survey of over 3,800 individuals with inflammatory bowel disease found that generally adherence remained high during the pandemic; however, better communication from doctors could help alleviate worry.
64% worried that immunosuppressive treatment increased their risk of infection
96% maintained their treatment regimens
44% reported not receiving any guidance from their doctors on the matter.
Another study of patients with inflammatory bowel disease, this one including over 2,200 patients shared similar findings and noted that the disease process of inflammatory bowel disease seems to have been unaffected by the pandemic.
A 62 year old patient on chemo-radiotherapy treatment (CRT) for oropharyngeal squamous cell carcinoma tested positive for SARS-CoV-2 one month after starting therapy. The treatment was discontinued for 2 days until the disease process was noted as mild at which point CRT was resumed and his respiratory condition resolved showing that mild cases may still be treated with CRT safely.
Although the average sensitivity and specificity of our current antibody testing for COVID-19 is 84.80% and 98.63% respectively.
Statistical analysis suggests that the positive predictive value of this antibody test can be as low as 30% in areas with lower disease prevalence.
Developments in Treatment:
A retrospective cohort study of 65 hospitalized patients in Brooklyn, New York showed a higher survival rate and lower intubation rate in patients who received calcium channel blocking medications (Nifedipine or Amlodipine) as part of their COVID-19 treatment.
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Erratum: “Although the average sensitivity and specificity of our current antibody testing for COVID-19 is 84.80% and 98.63% respectively, these values are dependent on disease prevalence.“ was corrected to “Although the average sensitivity and specificity of our current antibody testing for COVID-19 is 84.80% and 98.63% respectively.”