A letter to the editor exploring the ethics of the fast-tracked review process of COVID-19 papers currently being utilized by many scientific journals during the pandemic. The authors argue that faster publication of COVID-19-related data does not outweigh the risks of publishing possibly erroneous and lower quality papers. The authors call for a return to the normal review process to uphold publication ethics.
Telephone surveys of 38 Parkinson’s Disease (PD) patients and 20 age/sex matched controls demonstrate a significant negative impact of COVID-19 on the physical activity and mental health of Parkinson’s patients. The authors thus encourage physicians to be aware of these potentially disproportionate health consequences in patients with PD.
The authors report the results of a two-center cross sectional study in Wuhan, China, that revealed high rates of lower extremity deep venous thrombosis (DVT) (41 of n = 48) in critically ill COVID-19-positive ICU patients. Incidence of DVT was not significantly associated with mortality.
Analysis of over 43 million person-weeks of hospitalization data from the Kaiser Permanente Northern California system found that the weekly rates of hospitalizations for acute myocardial infarction declined by up to 48% during the COVID-19 period when compared to both pre-COVID-19 months in 2020 and the same time period in 2019.
An Iranian meta-analysis of nine studies with 87 COVID-19 positive pregnant persons (mostly third trimester) and 86 newborn infants in China found:
65% of the patients had a history of exposure to an infected person, and 78% had mild/moderate COVID-19 disease
92% of pregnant persons had a cesarean section (p < 0.001)
60% of babies were born prematurely (p < 0.001), and 31% suffered from fetal distress (p < 0.001)
There was no evidence of vertical transmission for the neonate
Understanding the Pathology
The Respiratory Translational Research Group at the University of Tasmania responds to a recent finding that nicotine induces an increase in angiotensin-converting enzyme-2 (ACE2) expression in human bronchial epithelial cells. The authors posit all electronic nicotine-delivery systems may increase the risk of infection, transmission, and progression of COVID-19. They urge the World Health Organization and all countries take action to reduce smoking, vaping and water pipe use until more research is done.
Researchers in Italy, Sweden, and Minnesota review the “structure and function of SARS-CoV-2 PLP (papain-like protease) in order to highlight its role in pathogenesis and facilitate drug design.” They report that PLPs essential role in viral replication and its ability to modulate the host immune response make it an ideal target for antiviral therapy and recommend further research.
Transmission & Prevention
Researchers from the University of Chicago fear that gaining herd immunity without vaccination would overwhelm most healthcare systems and lead to many deaths. They argue that our primary objective should be protecting vulnerable populations until herd immunity can be achieved.
Guidelines and recommendations for managing COVID-19 patients include:
Patients on hemodialysis
A 59 y/o female was found unresponsive and brought to the ED where ECG showed ST-elevations and chest CT showed diffuse bilateral infiltrates concerning an infectious etiology. Given unknown COVID-19 status, risk of catheterization laboratory staff exposure, and risk of deferring evaluation of her coronary artery disease to a later time, a CorPath robotic intervention arm was used to perform a percutaneous coronary intervention and minimize potential COVID-19 transmission. The patient was successfully discharged 5 days later.
A 52 y/o COVID-19 patient treated on admission with inhaled supplemental oxygen and a “bundle” pharmacotherapy was later transferred to the ICU and started on non-invasive positive pressure ventilation and recovered without more invasive procedures.
This case report led a group of Chinese physicians to suggest early non-invasive respiratory support with pharmacotherapy.
Adjusting Practice during COVID-19
Guidelines and recommendations for practice from today include:
End of life comfort care
Organ donation precautions
Performing tracheostomy (patient selection, timing, performance, and management)
Cardiologists detail the successful remote management of diuretic therapy in a heart failure patient through use of daily left atrial pressure monitoring by a battery-free implanted device. They state that this provides an effective means to limit hospital exposure during the pandemic as well as an option for heart failure management moving forward.
Pediatricians discuss the ethics of visitation restrictions during the pandemic and emphasize that the nuances of each case should be examined when coming to a decision. They advise that the importance of family-centered care needs to be balanced with protection of the public in these situations.
R&D: Diagnosis & Treatments
A retrospective cohort study of 244 critically ill adult COVID-19 patients in Wuhan, China investigated the effects of corticosteroid treatment. They found that general adjuvant corticosteroid therapy was independent from overall mortality, however, increased dosage of corticosteroids was correlated with significantly increased mortality risk after adjusting for administration duration (P = 0.003). Notably, they found that every 10mg dose increase was associated with a 4% increase in mortality risk, thus cautioning the use of corticosteroids in treatment of COVID-19, particularly being cognizant of dosing and duration.