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October 20 | Daily COVID-19 LST Report

Epidemiology

· Clinical features and outcomes of adults with COVID-19 admitted to the hospital based on a systematic review and pooled analysis of the literature of 45 studies (n = 14,358) found the following: • the most common symptoms included fever (81.2%), cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%;) • the most common comorbidities were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%) • 27.7% of patients had abnormal chest x-rays; 63% had ground-glass opacities on chest CT • Acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%) were the most common adverse outcomes • death occurred in 8.2% of patients, 16.3% needed intensive care admission and 11.7% had mechanical ventilation • bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock These findings reveal the heterogeneous manifestations of COVID-19, although the authors note that these findings may not be generalizable to a wider population and are limited by differences in follow-up.

Understanding the Pathology

· Endotheliopathy is induced by plasma from critically-ill patients and associated with organ failure in severe COVID-19 based on a retrospective cohort study at Lille University Hospital assessing cytotoxicity of plasma from 28 patients (12 ICU and 16 non-ICU) hospitalized with COVID-19. Samples from COVID-19 patients had significantly decreased human pulmonary microvascular endothelial cells (HPMVEC) viability (p<0.01) and increased cytotoxicity compared to plasma from 8 healthy donors. The authors suggest their findings bolster the growing body of evidence indicating SARS-CoV-2 induces endothelial damage that contributes to organ dysfunction, respiratory failure, and thrombosis.

Transmission & Prevention

· Regeneration Processes for Filtering Facepiece Respirators (FFRs) in Terms of the Bacteria Inactivation Efficiency and Influences on Filtration Performance were investigated through the ability of microwave irradiation (MWI), UV irradiation (UVI), MWI + UVI, steam, and ethanol. Authors found ethanol unacceptably reduced filtration efficiency while steam and MWI effectively decontaminated FFRs (100% inactivation in 90 min and 30 min, respectively) without sacrificing filtration, though long exposure to MWI did damage fiber morphology. While UVI successfully inactivated surface bacteria, efficiency decreased from outer to inner layers and authors suggest that a combination of UVI and short-duration MWI can best decontaminate used FFRs while maintaining filtration performance. · Leveraging on the genomics and immunopathology of SARS-CoV-2 for vaccines development has its prospects and challenges according to a literature review covering current data related to genomic organization, genetic mutations, pathophysiology, immune response to SARS-CoV-2, potential vaccine targets (particularly components of the S-protein and ACE-2 receptors), current vaccine trials, and potential animal models for vaccine testing (rhesus macaques, ferrets, mice, and Syrian hamsters). Authors suggest enough promising data exists to synthesize a COVID-19 vaccine in the near future but additional funding is needed to extend trials globally to ensure high performance across diverse population and create a centralized evaluation system to assess safety, efficacy, accessibility, and potency. · Political partisanship influences behavioral responses to governors' recommendations for COVID-19 prevention in the United States. A team including physicians and communications experts from the University of Pennsylvania used mobility statistics from Safegraph (estimates for time at home), Google search data, and tweets from gubernatorial accounts to evaluate COVID-19 prevention behaviors in 3140 United States counties. Authors found democratic governors tweeted stay-at-home messages earlier than republicans (median 6-7 days before official order vs. 1 day). Additionally, governors' stay-at-home tweets correlated with increased median time spent at home by 3.4% (10.4 minutes/day; p<0.01), and democratic counties spent more time at home (4.1% increase vs. 3.1%, p<0.01)(Table 2,3), suggesting that political partisanship and governor recommendations had significant impacts on citizens' mobility during the early COVID-19 pandemic.

· With regards to community health workers (CHW) and Covid-19 population health experts from NYU Grossman School of Medicine discuss how CHWs, who are trusted community members also familiar with local health systems, have supported marginalized communities in New York impacted by the COVID-19 pandemic. They review CHWs’ various roles (health systems/social services navigators, ability to conduct home visits, health educators, and community advocates, among others). Because CHWs in New York have performed thousands of services since March 2020 (9600 telephone wellness checks, 600 health coaching sessions, and 3400 enrollments in online patient portals) they argue that investing in such programs could help alleviate the burden of disease in communities disproportionately impacted by COVID-19.

Management

· Anti-androgens may protect against severe COVID-19 outcomes based on results from a prospective cohort study of 77 hospitalized men. The authors found patients taking anti-androgens (dutasteride [n=9], finasteride [n=2], spironolactone [n=1]) were significantly less likely to be admitted to the ICU than men not taking anti-androgens (p=0.0002), even after stratifying for age (p=0.018). Given the reduced risk of experiencing severe COVID-19 (RR: 0.14, 95% CI: 0.02-0.94), they suggest anti-androgens could be utilized therapeutically to improve COVID-19 disease course in men. · High prevalence of acquired thrombophilia did not have prognosis value in Covid-19 patients based on a prospective cohort study of 89 patients with COVID-19. They found acquired thrombophilia was not significantly associated with increased risk of severe disease (p=0.89), DVT (p=0.71), or mortality (p=0.89). Most (71.9%) patients had antiphospholipid antibodies, and 20.2 % had protein S deficiency, therefore authors suggest thrombophilia does not significantly influence disease course and its presence should not impact management of COVID-19 patients.

Adjusting Practice During COVID-19

· Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal Anti-VEGF Injections and transmission of COVID-19 were constructed by ophthalmologists in New Zealand through statistical model that weighed risks and benefits of performing anti-VEGF intraocular injections in patients with neovascular age-related macular degeneration (nAMD) during the COVID-19 pandemic. Using health-adjusted life years (HALYs) lost to compare expected disease burden from COVID-19 to visual impairment secondary to nAMD in a variety of theoretical scenarios, authors found expected burden from visual impairment outweighed that from COVID-19 unless the latter's prevalence was very high and suggest continuing anti-VEGF injections during the pandemic minimizes overall HALYs lost. R&D: Diagnosis & Treatments

· Sensitivity of nasopharyngeal, oropharyngeal, and nasal wash specimens for SARS-CoV-2 detection in the setting of sampling device shortage was explored though a cross-sectional study comparing sensitivities of different samples for detection of ORF1 and E-protein genes via RT-PCR in 29 SARS-CoV-2 positive patients. They found oropharyngeal washes (mean rRT-PCR delta cycle threshold[Ct]:1.24 for ORF1, 1.32 for E-protein; Pearson r: 0.88) and nasal washes (mean delta Ct: 1.77 ORF1,1.73 E-protein; Pearson r: 0.75) demonstrated similar levels of sensitivity compared to nasopharyngeal swabs (current standard of care). They also validated a cell culture medium (Dulbecco’s modified Eagle medium) for sample transport (mean delta Ct of 0.67 for E-gene and 0.53 for ORF-1), suggesting that these alternative methods for sample collection can be reliably used in the setting of testing supply shortages.

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