Climate
Two Cincinnati physicians present a point-counterpoint argument on the fine line between duty, autonomy, and nonmaleficence when young physicians without specific critical care training are called to serve in an ICU during COVID-19.
Based on a historical cohort study investigating mortality rates during the 2017-2018 flu epidemic, Netherland investigators urge strict distancing precautions and early detection in individuals with intellectual disability and their caregivers.
Epidemiology
Artificial intelligence (AI) is increasingly a topic of interest. However, based on this systematic review of 8 papers investigating AI’s use in diagnosing different coronaviruses, more research is still needed.
Two groups from London continue the search for the best predictive and prognostic indicators in COVID-19 with two different systematic reviews and meta-analyses. One analysis of seven studies (n=1813 COVID-19 patients) determined dyspnea was a reliable predictor of severe disease. A second analysis of 28 studies on a more heterogenous population underscores the importance of long term follow-up for psychological and physical complications.
Understanding the Pathology
Hepatologists summarize the pathophysiology of liver injury in patients with COVID-19, and propose that SARS-CoV-2 may cause cytopathic damage to hepatocytes by inducing cellular stress, cytokine dysregulation, or disrupting essential functions of cholangiocytes expressing angiotensin-2 converting enzyme (ACE2).
Management
A link between hypoalbuminemia and COVID-19 was found after a systematic review and meta-analysis of 11 studies conducted by researchers from the University of Toledo.
Specifically, weighted mean serum albumin on admission for severe COVID-19 [3.50 g/dL (CI 3.26–3.74 g/dL)] was significantly lower than non-severe COVID-19 [4.05 g/dL (CI 3.82–4.27 g/dL)] (p<0.001).
Based on these results, the authors suggest low serum albumin may aid recognition of severe disease.
A positive association (p=0.031) between hyponatremia and severe outcome (ICU admission, ventilation, death) in high-IL-6 patients and increased sodium levels in severe patients with high IL-6 (n=8) 48 hours post-tocilizumab treatment were found in a retrospective analysis of COVID-19 patients (n=29).
Authors suggest a mechanism of IL-6-induced vasopressin release that results in hyponatremia.
Adjusting Practice
Guidelines and recommendations for practice today include:
Accommodating for drug shortages during the pandemic
Cardiac imaging from the European Society of Cardiovascular Radiology
How psychiatrists can help reduce the pandemic’s toll on mental health
A survey of 114 healthcare workers in Munich, Germany found that 90% of respondents reported symptoms of acute hand dermatitis likely due to increased hand washing suggesting that better skin care measures should be taken to ensure protection of healthcare workers’ hands.
A global survey of orthopedic oncologists found that 20% reported delays and 21% reported cancellations in surgery for bone sarcomas leading the authors to stress the urgent need for these patients to safely access cancer care.
A retrospective cohort study of 1,754 pregnant persons found that pregnant patients during the COVID-19 pandemic were more likely to report higher levels of depressive, anxiety, dissociative, and PTSD symptoms than a comparable cohort of pre-COVID-19 pregnant patients. Given the harmful effects of maternal distress on fetal wellbeing, providers should watch for mental health symptoms.
R&D Diagnostics and Therapeutics
In an in-silico study, authors determined the most likely configurations in which the S-protein of SARS-CoV-2 binds the angiotensin converting enzyme (ACE) 2 receptor and screened already approved drugs. Results suggest that compounds with hydroxyl groups and monosaccharide moieties may have the highest binding affinities.
Cetylpyridinium chloride (a quaternary ammonium compound) causes virus inactivation by lysosomotropic action, suggesting the need of further study of this drug in the form of a mouthwash or nasal spray to combat SARS-CoV-2 at its point of entry.
Authors describe methodology used to develop and implement the first COVID-19 convalescent plasma program at the New York Blood Center enterprises and provide recommendations for optimizing future COVID-19 convalescent plasma programs.
Mental Health and Resilience
A self-reported questionnaire of healthcare and non-healthcare workers during the peak of infection in Spain found that healthcare workers had increased stress compared to non-healthcare workers, nurses scored higher in all emotional assessments (depression, anxiety, and stress) compared to other health professionals, and trainee-physicians had higher depression scores than their senior colleagues.
The Children’s Hospital at Zhejiang University School of Medicine in Shanghai launched the Children Health Initiative for Children and Adolescents (CHI), an internet-based interactive platform designed to support children and adolescents during the COVID-19 pandemic by promoting physical and mental wellbeing.
Silver Linings
A review in Australia suggests that current adjustments during the COVID-19 pandemic -- emergence of phone- and online-based services, streamlined pharmacy services and specialist consultations -- offer insight into what more accessible and inclusive primary care could look like.
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