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October 19 | Daily COVID-19 LST Report

Epidemiology

· Sex differential in COVID-19 mortality varies markedly by age according to collated data from the National Institute for Demographic Studies of pooled aggregate rates of infection and mortality of almost 400 million COVID-19 patients in Europe and Korea. Mortality risk ratio was found to be higher in men (overall RR: 1.35, no measure of significance provided). This risk was increased between the ages of 40-79 (RR: 1.87, no measure of significance provided). Authors suggest their findings corroborate prior data reporting equivalent rates of SARS-CoV-2 infection between men and women but higher rates of mortality in men, and hypothesize that both social and genetic factors contribute to this disparity.

· COVID-19 length of stay (LOS) at the hospital was evaluated in a systematic review of 52 studies (46 in China; 6 outside of China) to find the median LOS to be 14 days in China (interquartile range {IQR} 10-19) and 5 days outside China (IQR 3-9), with median ICU LOS of 8 (IQR 5-13) and 7 (IQR 4-11) days, respectively. Authors suggest that this data may be helpful for predicting when hospitals will reach capacity and determining how to appropriately distribute resources.

Transmission & Prevention

· COVID-19 Precautions Helped Limit Cases Linked to Milwaukee Primary. A Centers for Disease control case report described preventative measures enacted for the primary election in Milwaukee, Wisconsin which suggested that preventative measures such as mail-in ballots (69% of votes), early voting, social distancing, PPE for poll-workers, and frequent disinfection at polling sites (which were crowded due to reduction of polling sites from 181 to 5) resulted in no substantial increase in COVID-19 cases after the event. Management

· Anaemia is associated with severe illness in COVID-19 according to a retrospective cohort study (n total=222, n anemic=79). Authors found anemic patients developed more severe cases of COVID-19 compared to non-anemic patients (17.7% vs 8.1%, P=0.001; OR 3.77, 95%CI:1.33-10.71, P=0.013), though results were limited by sample size. Anemic patients also had demonstrably elevated inflammatory markers (CRP, ESR, PCT, lymphocyte count), increased incidence of coagulopathies, and greater magnitude of organ damage, though no level of significance was provided for these measures. Based on this, the authors posit anemia as an independent risk factor for progression to the severe form of COVID-19, and urge close attention to hemoglobin levels in confirmed COVID-19 patients. Adjusting Practice During COVID-19

· Outcomes of COVID-19 in 198 chronic lymphocytic leukemia (CLL) patients with CLL from 43 cancer care centers internationally yielded 90% hospitalized and an overall survival (OS) of 71% and 63% at 14 and 28 days, respectively. OS was not affected by whether patients were receiving CLL directed therapy (hazard ratio [HR], 0.77; 95% CI: 0.47-1.26; p = 0.30) or were on a "watch-and-wait" plan (HR, 0.83; 95% CI, 0.51-1.36; p = 0.47). Rather, age and CIRS score provided the largest impact on OS. Authors suggest that CLL patients are at greater risk for death from COVID-19, but different treatment plans for CLL have no effect on overall survival. · Musculoskeletal injuries secondary to exercise during confinement by the pandemic COVID-19 was found through an 11 question survey of a convenience sample on Twitter in Spain. 12% of 1902 respondents reported MSK injuries during lockdown, with 35% reporting more physical activity than usual and 45% engaging in high intensity exercises. Based on this, they suggest there is a need for public education on safe exercise to decrease MSK injuries in the absence of supervision by trainers or coaches.

R&D: Diagnosis & Treatments

· Detection and quantification of SARS-CoV-2 by droplet digital PCR (ddPCR) in real-time PCR negative nasopharyngeal swabs from 55 suspected COVID-19 patients found 19 samples (35%) had detectable levels of SARS-CoV-2 by ddPCR (median viral load: 1128 copies/mL), of which 12 had multiple RT-PCR negative results (median number of negative swabs=3). They suggest ddPCR can detect SARS-CoV-2 at low copy numbers in symptomatic cases, which could improve sensitivity of testing where current RT-PCR assays are lacking and allow providers to correctly manage COVID-19 patients.

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