Investigators affiliated with the Laboratorio de Investigacao Medica em Envelhecimento at Universidade de Sao Paulo performed a longitudinal, observational study on 707 COVID-19 patients admitted to a tertiary university hospital in Sao Paulo, Brazil and found that 33% (n=234) of patients had descriptors of delirium (confusional state, disorientation, hallucinations, etc;). Additionally, delirium was independently associated with length of hospital stay, ICU admission, and in-hospital deaths in adults older than the age of 50. Based on these findings, the authors suggest that healthcare workers should assess for delirium among COVID-19 patients, which may help monitor the severity and prognosis of these patients.
Transmission & Prevention
Authors affiliated with several institutions in China performed a cross-sectional study on the daily COVID-19 cases, air quality, and meteorological factors in 33 locations in China. Among their findings, the authors note an association between relative risk of COVID-19 spread and air quality index (AQI) that was greater between 10 degrees Celsius and 20 degrees Celsius and a possibly stronger AQI impact on confirmed COVID-19 cases between the range of 10% to 20% relative humidity, respectively, suggesting that AQI may play a role in COVID-19 transmission in both low temperatures and low humidity, although further investigation is needed.
An opinion piece by Lancet Infectious Diseases discusses the changes made to airline travel to mitigate the transmission of SARS-CoV-2 such as closing international borders, mandating masks, reducing passenger numbers, and increasing cleaning efforts. This article suggests that in the future, airlines may permanently increase preventative measures such as utilizing touchless technology, requiring masks and vaccines, improving cleaning, and reducing services to prevent transmission, similar to the increases in airline security seen following the September 11th, 2001 terrorist attacks.
A literature review was conducted by pharmacists from Yale, Cleveland Clinic, and University of Pittsburgh regarding alternative drugs for managing analgesia, sedation, and paralysis in COVID-19 patients requiring mechanical ventilation in the event of drug shortages, as detailed in the summary section below. These conservative and alternative management strategies for mechanically ventilated ICU patients can ensure sustainability of optimum critical care in the near future as the COVID-19 pandemic wears on.
Adjusting Practice During COVID-19
A cohort study by oncologists from the Tata Memorial Centre in Mumbai, India including 262 asymptomatic preoperative cancer patients found the following: 21/262 patients (8%) tested positive for COVID-19 during preoperative screening, one patient eventually developed symptoms after testing positive, and of the 16 patients with major post-operative complications, none were attributable to COVID-19. Patients who tested positive were quarantined for 14 days before retesting, and at the time of writing, 13 re-tested as negative and 12 patients followed through with surgery. These findings suggest the utility and importance of screening for COVID-19 in asymptomatic preoperative cancer patients and that this strategy may help in mitigating post-operative COVID-19 complications.
R&D: Diagnosis & Treatments
A case-control validation study including 50 SARS-CoV-2 positive specimens and 300 SARS-CoV-2 negative specimens combined into various sized pooled samples was conducted in South Korea by physicians and infectious disease researchers, and found that less than or equal to 6 specimens was the ideal specimen number for a pooled testing strategy to avoid decreasing sensitivity. Limitations of the study were as follows: the cutoff cycle threshold (Ct) number in the PCR kit was Ct value <35 within 40 amplification cycles, in addition to cost effectiveness not being analyzed. These findings help inform the upper limit threshold of number of specimens to process for COVID-19 pooled testing strategies to ensure high sensitivity.