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September 21 | Daily COVID-19 LST Report

Epidemiology

· A meta-analysis of 15 peer-reviewed articles found recurrent COVID-19 infections (confirmed via RT-PCR) were reported at a mean of 34 ± 10.5 days after full clinical recovery from an initial infection, but these patients also had persistent positive RT-PCR tests for a mean of 39 ± 9 days following their initial infection. Furthermore, a persistent positive test could be detected in patients without clinical relapse for 54 ± 24 days following initial infection.

Understanding the Pathology

· Investigators describe post-mortem neuropathological findings in 2 patients with COVID-19 and neurological decompensation. Case 1 showed widespread multi-focal cortical infarcts, and case 2 showed brainstem encephalitis. Since viral RNA was not detected in the post mortem brain tissue in either case, these pathologies may not be a direct consequence of viral invasion.

Transmission & Prevention

· Researchers argue that hurricane protection measures, such as evacuation and sheltering, cause people to gather together and is the paramount reason for the 3.7x increase in COVID-19 cases between May 1 and July 24, 2020. They suggest that during hurricanes, 1) people at risk should social distance, 2) officials should provide better communications for guidance on safe evacuation and sheltering, and that 3) we should "learn from each 2020 storm and refine operations."

Adjusting Practice During COVID-19

· Pharmacists and epidemiologists in Denmark conducted a population-based cohort study of 9,236 patients who tested positive for SARS-CoV-2 via PCR and found no significant difference between NSAID users (n=248) and non-NSAID users (n=8,988) regarding 30-day mortality, hospitalization, ICU admission, mechanical ventilation, or renal replacement therapy. Authors suggest NSAID use during COVID-19 infection may have minimal effect on risk of mortality or adverse outcomes.

· A survey of 414 interventional cardiologists and cardiac catheterization laboratory (CCL) directors in the United States found a 55% decrease in percutaneous coronary interventions (PCI) and a 64% decrease in transcatheter aortic valve replacements during March 15 to April 15, 2020 compared to 2019. Additionally, procedure deferral for angiogram/PCI for unstable angina, NSTEMI, and STEMI increased with greater inpatient COVID-19 burden and 40% of CCL directors reported increased cases of late presenting STEMIs. These findings suggest that patient fears due to the pandemic may be influencing their decisions to delay seeking urgent cardiac care.

R&D: Diagnosis & Treatments

· Editors from the New England Journal of Medicine had an audio discussion to discuss guidelines for deployment of a COVID-19 vaccine and discussed:

• The recent pause of testing for one vaccine due to a participant contracting transverse myelitis shows that the safety protocols in place for vaccine development are functioning as planned.

• The public does not need to apply causality hastily in these situations where an adverse effect comes to light in a trial.

• Deployment guidelines, including prioritized groups, is not COVID-19 exceptionalism but standard for medical practice worldwide.

• Public trust should be gained by transparency and honesty about vaccine development.


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