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September 22 | Daily COVID-19 LST Report

Climate

· Authors from the Department of Environmental Health at George Washington University and Harvard University highlight the need for governmental interventions regarding workplace safety, specifically through the Occupational Safety and Health Administration (OSHA), to protect workers reentering the workforce during the COVID-19 pandemic. Businesses are beginning to return to a normal work schedule, and they argue there needs to be an infection control protocol—PPE, symptom screening processes, hand sanitizer stations—to prevent further COVID-19 transmission. The authors ultimately advocate for OSHA to implement an Emergency Temporary Standard (ETS) to facilitate the safe reopening of businesses.

· A professional opinion piece by internal medicine physicians from the Medical College of Wisconsin, Milwaukee (U.S.) found that structural racism, the systems through which inequalities are reinforced, has been an overlooked piece of public health for years and has played a part in higher rates of hospitalization and death among black individuals and other minority groups during the COVID-19 pandemic. The authors hope that this manifestation of inequality will lead to policies, targeted interventions, and actions that decrease structural racism in American society in order to promote public health for affected individuals during the COVID-19 pandemic and beyond.

Understanding the Pathology

· Investigators at David Geffen School of Medicine at University California, Los Angeles performed serial measurements on the IgG levels of plasma from 34 mildly symptomatic participants with confirmed or suspected COVID-19. Based on these serial measurements (first measurement: mean 37 days after symptom onset; last measurement: mean 86 days after onset), the estimated mean change of anti-SARS-CoV-2 IgG was −0.0083 log10 ng/mL per day with an estimated half-life of 36 days (95% CI: 26 to 60 days), suggesting a short lifespan of humoral immunity against SARS-CoV-2 in mild cases. Transmission & Prevention

· A commentary by a multidisciplinary team of vaccine experts discusses the possibility of a second wave of COVID-19 cases near the end of 2020 and warns against the potential for co-occurrence with seasonal influenza. The authors advocate for public health authorities to prioritize influenza vaccination production and usage this year, especially among vulnerable populations (e.g.—pregnant women, the elderly, patients with multiple co-morbidities) and health care providers. The goal is to prevent severe complications caused by contraction of both COVID-19 and the influenza virus. Management

· A professional opinion piece by physicians at Holbael University Hospital (Denmark) suggest that cases of COVID-19 with acute respiratory distress syndrome (ARDS) resemble the low compliance seen in neonatal respiratory distress syndrome (NRDS). They discuss that SARS-CoV-2 replicates in alveolar type II cells, impacting the production and turnover of surfactant, and causes alveolar inflammation and collapse. The authors propose that severe COVID-19 cases should be evaluated for surfactant levels (for which a point of care test for babies has been developed), and individuals with low surfactant could be given surfactant treatment to possibly improve patient outcomes. R&D: Diagnosis & Treatments

· A special report by members of the National Institutes of Health (NIH) briefly describes the various COVID-19 diagnostic tests currently available and the new NIH Rapid Acceleration of Diagnostics (RADx) initiative, which is aimed at rapidly increasing COVID-19 diagnostic capabilities in the US. Challenges this program will encounter include: digital connectivity, manufacturing, and distribution. The authors highlight how the RADx initiative will provide diagnostic testing solutions on a larger scale, promote entrepreneurship, and help address inequities in healthcare.

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