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October 27 | Daily COVID-19 LST Report

Understanding the Pathology

· Association of ABO blood group with indices of disease severity and multiorgan dysfunction in COVID-19 were evaluated in one study by looking at the potential protective effect of anti-A antibodies in SARS-CoV-2 infection on consecutively admitted ICU patients across 6 metropolitan Vancouver hospitals. While national and provincial ABO blood group distributions did not differ from the cohort analyzed, higher proportions of COVID-19 patients with blood group A or AB needed mechanical ventilation, continuous renal replacement therapy (CRRT), and a longer ICU stay compared to patients with blood types O or B. This correlation remained significant after adjusting for sex, age, and presence of one or more co-morbidities. These findings suggest that A or AB blood group is associated with higher disease severity in patients with severe COVID-19, though there is no known mechanism by which this may occur.

· Proteins associated with neutrophil degranulation are upregulated in nasopharyngeal swabs from SARS-CoV-2 patients according to 15 SARS-CoV-2 positive and 15 negative naso-oropharyngeal samples, specifically 17 significantly altered proteins were found in the positive samples. Notable proteins include neutrophil elastase (ELANE), azurocidin (AZU1), myeloperoxidase (MPO), myeloblastin (PRTN3), cathepsin G (CTSG), and transcobalamine-1 (TCN1). Presence of these altered proteins in the positive samples suggest their importance in the host immune response to SARS-CoV-2, particularly for their roles in neutrophil degranulation and NETosis. The authors recommend further research into these proteins as prognostic markers and targets for therapeutics.

Transmission & Prevention

· SARS-CoV-2 presence was found in the saliva, tears, and cerumen of COVID-19 patients according to analyzed samples from 38 patients with RT-PCR confirmed SARS-CoV-2 within 72 hours of the first positive result. 76.3% of saliva samples, 55.3% of tear samples, and 39.5% of cerumen samples tested positive for SARS-CoV-2 RNA. Notably, half of the samples from asymptomatic patients (n=2/4) contained SARS-CoV-2 RNA. Authors suggest that SARS-CoV-2 viral RNA can be found in different bodily secretions and that personal protective equipment should be utilized when contact with patient saliva, tears, or cerumen is possible.

R&D: Diagnosis & Treatments

· Effect of tocilizumab vs usual care in 131 adults hospitalized with COVID-19 and moderate or severe pneumonia was investigated in a randomized-controlled trial with 63 receiving Tocilizumab (TCZ) and 67 receiving usual care (UC). Authors found the TCZ cohort did not have improved WHO-clinical progression scores (CPS) by day 4 compared to the UC cohort, and there was no significant difference in deaths between the groups at day 28 despite ventilation rates being lower in TCZ group at day 14. These results suggest marginal benefit from TCZ treatment in moderate to severe COVID-19 pneumonia, but authors acknowledged a need for further research to determine its effect on clinical outcomes.

Mental Health & Resilience Needs

· Psychological impact of mass quarantine on population during pandemics were seen based on a cross-sectional survey study conducted during the 2nd and 3rd weeks of strict quarantine in India showing prevalence of depression, anxiety, and stress to be 30.5%, 22.4%, and 10.8%, respectively, with significantly higher incidence in the 3rd week compared to the 2nd. This data showed an 8-10 fold increase in depression and anxiety compared to baseline statistics in the Indian population as a result of the quarantine period, suggesting a detrimental psychological impact, which authors hope can assist in future consideration of coping strategies for those required to quarantine for prolonged periods of time.

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