Climate
· Researchers call attention to ways the COVID-19 pandemic is unmasking healthcare disparities in two widely different groups, truck drivers and tuberculosis patients. In the words of London analysts who examined the impact on TB patients, care for these vulnerable populations should not be “sidelined”.
· On a similar theme, Australian researchers discuss the ethical dilemmas around distributive justice and fair resource allocation.
Epidemiology
· Adding to the literature on liver dysfunction and COVID-19, a meta-analysis of 20 retrospective cohort studies continues to support the use of liver function tests for monitoring disease progression.
· Literature reviews and case reports continue to clarify the diagnostic and prognostic value of dermatologic findings in COVID-19.
o Spanish researchers report the case of a 57-year old female who presented with erythema nodosum
o Egyptian physicians postulate herpes zoster reactivation may indicate latent COVID-19.
· Out of 3,406 COVID-19 patients, those younger than 50 with BMI above 40 kg/m^2 were associated with an 11.4% increase in mortality compared to those with lower BMI (p=0.019). Patients over 50 with elevated BMI were also associated with mortality, but to a lesser extent.
o Demonstrating that obesity over age being a stronger predictor of disease outcome
Understanding the Pathology
· A UK Biobank (UKB) to analysis of 322,948 subjects (mean age 68-years-old) found an association between the ApoE e4e4 allele and a positive COVID-19 test. Similar results were obtained after excluding patients with pre-existing conditions linked to COVID-19 severity, suggesting the ApoE e4e4 allele independently increases the risk of severe COVID-19 infection.
Transmission and Prevention
· An assessment of viral load in two COVID-19 patients in Seoul, Korea via nasopharyngeal and oropharyngeal swabs, saliva, sputum, and urine cultures using rRT-PCR found that the viral load was consistently high in saliva and relatively higher than in the oropharynx during the subclinical period which raises concerns for occult transmission.
Management
· The Asian-Pacific Association for the Study of the Liver (APASL) COVID-19 Taskforce published clinical practice guidelines for "management of liver injury, liver transplantation, autoimmune diseases, chronic liver diseases, delivery of elective and emergency services, and conduct of clinical trials" in the Asia-Pacific region during the COVID-19 pandemic
Adjusting Practice
· Today, there are guidelines for performing laparoscopic hysterectomy during the pandemic.
· A case series of 9 patients who presented to King’s College Hospital in March with pulmonary embolism secondary to COVID-19 prompt clinicians to lower their threshold for ordering CT angiography in patients with prolonged history of illness and immobility, elevated D-dimer, and worsening respiratory illness.
· A retrospective observational study in Beijing found that during the pandemic, acute ischemic stroke patients exhibited on average a 40 minute longer hospital arrival to reperfusion time than before the pandemic, suggesting the need to streamline COVID-19 screening and hospital admission protocols for suspected stroke patients.
R&D
· Authors in Italy describe four patients who initially tested negative for SARS-CoV-2 infection by nasopharyngeal swab then tested positive on swabs collected a few hours later by an otolaryngologist, suggesting that inadequate swab technique may contribute to false-negative SARS-CoV-2 testing.
· A double-blind, randomized, placebo-controlled trial found shortened time to recovery in remdesivir treated patients (median 11 days compared to 15 days, P<0.001), supporting the preported therapeutic potential of remdesivir for patients with COVID-19.
· An in-silico modeling study by authors in India investigates chloroquine and chloroquine analogs’ binding affinity to the SARS spike glycoprotein-human angiotensin converting enzyme (ACE) 2 complex with the hope of guiding novel drug development for treating COVID-19.
Mental Health & Resilience
· A study of 2,094 participants in the United States, United Kingdom, and France found that weight discrimination rather than body mass index (BMI) is a stronger predictor of a person's concern about the virus, engagement in preventative behaviors, mistrust in public health agencies in tackling the pandemic, and sense of social isolation.
o This suggests that obesity as a risk factor for COVID-19 should be communicated in a way that does not stigmatize individuals.
· Neuropsychiatric symptoms (most commonly agitation, apathy, and aberrant motor behavior) worsened in patients previously diagnosed with Alzheimer's Disease (AD) or Amnesic Mild Cognitive Impairment (MCI) after five weeks of national lockdown in Santa Maria, Spain. There was no statistically significant change in quality of the participants or caregivers.
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