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September 23 | Daily COVID-19 LST Report

Climate

· An expert opinion from individuals affiliated with University of North Carolina and Boston University schools of medicine expose socioeconomic disparities and health inequities in US populations, with higher COVID-19 mortality present among Black, Latinx, and Indigenous populations when compared to Whites. They recommend new policies that include a monthly universal food income to all US households, unemployment insurance reform, and community development investment policies. Such policies may promote improvement of health inequity among Americans.

Epidemiology

· To assess environmental prevalence of SARS-CoV-2, microbiologists collected and analyzed 57 samples from 13 households, 9 public venues, and the wastewater sewage system of Horcajo de los Montes village in Spain (883 inhabitants). They found 12% of samples from clothing, fridge and oven handles, doors knobs, keyboards, and other items were SARS-CoV-2 positive via RT-PCR. Although 6% of villagers had COVID-19, most known cases had resolved prior to sample collection, suggesting there may be a significant incidence and persistence of SARS-CoV-2 in the environment even after recovery within the population.

· Physicians from Brigham and Women's Hospital in Boston, Massachusetts extracted data from the Premier Healthcare Database to explore outcomes and clinical profiles of 3,222 young adults (ages 18-34) hospitalized with COVID-19 and found 21% of patients required intensive care, 10% required mechanical ventilation, and 2.7% died. Also, there was increased risk of adverse outcomes in patients with morbid obesity, hypertension, or diabetes. Authors suggest young adults hospitalized for COVID-19 may experience significant adverse outcomes, emphasizing the importance of prevention among this age group.

· A case study conducted in Nice, France involved a 63 year-old female presenting with asthenia, fever, dry cough, and headache with chest CT showing evidence of COVID-19 pneumonia. Day 26 following onset, during the non-inflammatory timeline of infection, she noticed lower limb purpura without PT, aPTT, fibrinogen abnormalities, and consistent with immune thrombocytopenia, which resolved following IVIg therapy. This case indicates physicians need to be cautious of bleeding, thrombosis, and septic risks in COVID-19 patients and should consider IVIg therapy as a reasonable treatment for ITP.

Management

· A cohort-control study conducted by pathologists at University Women’s Hospital Basel in Switzerland investigated 5 COVID-19 positive pregnant women (three mildly symptomatic and two asymptomatic) and 10 controls for the potential of vertical transmission of SARS-CoV-2. All 5 mothers and 2/5 fetuses has malperfusion, including 1 fetus having small thrombi. One patient, who was the only one symptomatic at childbirth, had placental pathological findings of lymphohistiocytic villitis and intervillositis, as well as viral RNA present in both the placenta and umbilical cord. The authors concluded that SARS-CoV2 infection displays potential for increased risk of fetal malperfusion through an increased coagulative state and and may result in placental infection. Adjusting Practice During COVID-19

· A review of studies by surgeons in India assessed the efficacy of chest computed tomography (CT) as a preoperative COVID-19 diagnostic tool for patients undergoing elective surgeries and found early studies indicated chest CT as an effective screening tool, but further evaluation of subsequent studies showed low predictive value and potentially unnecessary surgery delay. Authors suggest chest CT is not practical in settings where RT-PCR is readily available, recommending its use only for symptomatic patients with high post-operative complication risk or pulmonary sequelae after COVID-19.


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