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May 29 | Daily COVID-19 LST Report

Climate

· Irish psychiatrists urge the international community to take action to reduce transmission among prisoner populations. They make recommendations for public health and screening, psychiatric and medical care. Finally, they call for reforms in the accommodations provided for prisoners in addition to those the criminal justice system itself.


Understanding Pathology

· Physicians from Duke University School of Medicine hypothesize that the mortality in COVID-19 patients may arise from autonomic dysfunction. They suggest that targeting the cholinergic pathway would have an anti-inflammatory effect due to the suppression of the cytokine storm, and promote further study surrounding the role of the parasympathetic nervous system in SARS-CoV2’s hyperinflammatory effects.

Transmission & Prevention

· A study conducted at the Virginia Tech Carilion School of Medicine by the authors found no statistically significant difference in filtration efficiency between expired P100 filter cartridges and N95 respirators, suggesting that expired P100 respirators could potentially be effective during PPE shortages.

Management

· Guidelines and recommendations for managing COVID-19 patients include:

o The International Society on Thrombosis and Hemostasis’ report on venous thromboembolisms

o Extracorporeal blood purification


· Elevated soluble E-selectin and angiopoietin-2 levels (markers of endothelial activation/microvascular dysfunction) were strongly correlated with admission to the ICU, suggesting potential prognostic value of these biomarkers – based on a prospective study of 40 consecutive patients with COVID-19 admitted to Georges Pompidou European hospital in Paris, France.

· The Neutrophil to Lymphocyte Ratio (NLR) on admission for non-survivors was significantly higher than for survivors in a retrospective cohort study of 1,004 COVID-19 patients.

o Multivariate logistic regression modelling showed an NLR greater than 11.75 was significantly associated with all-cause mortality in the hospital.

Adjusting Practice During COVID-19

· Guidelines and recommendations for practice from today include:

o Drug conservation strategies and alternatives

o Triage guidelines for dermatological surgery

o Use of systemic medications for psoriasis and atopic dermatitis

o Management of patients of warfarin

o Gynecologic oncology


· Case reports illustrating devastating complications due to intracranial hemorrhage in severe COVID-19 patients lead clinicians to urge the close monitoring of neurological status in critical patients.

· Through a review of the literature, surgeons in Europe and Asia found no literature demonstrating SARS-CoV-2 transmission through surgical smoke--though they suggest that laparoscopy may have lower risk than laparotomy for possible transmission through surgical smoke

R&D: Diagnosis and Treatments

· Researchers in Hong Kong compared point-of-care reverse transcriptase PCR (Xpert Xpress) on posterior oropharyngeal saliva samples to nasopharyngeal (NPS) swabs and found no significant difference in SARS-CoV-2 detection rate, supporting the potential use of saliva specimens in COVID-19 testing.

· An analysis of remdesivir therapy indicates that a combination of nebulizer inhalation and IV administration should be performed for increased efficacy. This is based on observations in monkey model studies that plasma concentrations of remdesivir may not be associated with effectiveness and currently utilized IV doses may provide drug concentrations insufficient to eliminate SARS-CoV-2 in the lungs.

Mental Health & Resilience Needs

· A cross-section study of 2,025 people in the United Kingdom found a positive correlation with anxiety and somatic symptoms, particularly gastrointestinal and fatigue symptoms, suggesting the possibility of additional public health strain resulting from the COVID-19 pandemic.

· Researchers at Dartmouth College analyzed public Google search data between March 16 and 23, 2020 and found that stay-at-home orders were associated with a “flattening of the curve” for mental-health related searches, suggesting that increased mental health concerns due to the COVID-19 pandemic leveled off following implementation of state-wide stay-at-home orders.


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