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November 13 | Daily COVID-19 LST Report

Understanding the Pathology

· A literature review on thromboembolic events in COVID-19 patients identified each element of Virchow's Triad in the context of COVID-19: endothelial cell disruption due to SARS-CoV-2 binding to angiotensin-converting enzyme 2 receptors, hypercoagulability due to subsequent over-expression of neutrophil extracellular traps, and blood stasis from illness-related immobilization and extended bed rest.

Adjusting Practice During COVID-19

· A prospective survey study of 66 patients who had undergone image-guided corticosteroid injections for pain management by musculoskeletal imaging specialists at Massachusetts General Hospital in Boston found no significant difference in rates of new COVID-19 cases between patients who received corticosteroid injections (n=1/66, 25 year-old male, 19 days following injection) and the general population (p=0.44), suggesting that corticosteroid injections are safe to perform during the COVID-19 pandemic.

R&D: Diagnosis & Treatments

· A primarily retrospective cohort study conducted at Johns Hopkins University analyzed specimens from 2,194 patients that completed multiple RT-PCR tests for SARS-CoV-2 and found a correlation between cycle threshold (Ct) values (used to determine positivity) and SARS-CoV-2 growth on cell culture, though some high Ct samples produced viral growth. Droplet digital PCR on samples from individuals with multiple negative RT-PCR tests found multiple samples positive. Generally, these results indicate correlation between ability to culture the virus and Ct values from RT-PCR tests, though some variability in these tests demonstrates the need to continue CDC protocols for isolation by symptoms rather than cessation of isolation after a negative RT-PCR test.

· A multidisciplinary team affiliated with the Rwanda Joint Task Force on COVID-19 proposes an algorithm for pooled testing of SARS-CoV-2 that is "based on the geometry of a hypercube" currently being trialed in Rwanda and South Africa. Proof of concept experiments demonstrated that positive specimens can be detected even after 100-fold dilution, suggesting this pooled testing strategy could reduce costs, maximize speed of large-scale testing to monitor and reduce further spread of infection, and repeated group testing could be performed to address the loss of sensitivity due to dilution.

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