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September 3 | Daily COVID-19 LST Report

Epidemiology

· Systematic review and meta-analysis of 42 studies including 23,353 COVID-19 positive patients estimated random prevalence of olfactory dysfunction to be 38.5%, taste dysfunction 30.4%, and overall chemosensory dysfunction 50.2% among these patients with Caucasians having a 3-6 times higher prevalence of chemosensory deficits (43.2%) than East Asians (15.1%). These results suggest that chemosensory dysfunction is a relatively common effect of COVID, though inter-study variability was high for this analysis.

· A retrospective observational study conducted in Wuhan, China found that among 126 patients with confirmed COVID-19 infection, 3 patients had a re-detected COVID-19 positive result via RT-PCR when tested 11-20 days after being discharged, but remained asymptomatic following discharge. This study suggests that while the reactivation rate is low, the window for COVID-19 viral shedding and virus reactivation may be longer than previously indicated and should be studied more thoroughly in order to guide public health measures.

· In a letter to the editor, dermatologists from Belgium present updated data regarding a recent case series of patients with chilblains (23 new cases for a total of 54), of whom more than half had flu-like symptoms a few days prior to lesion appearance. Only 1/47 patients tested for COVID-19 via RT-PCR, 2/54 patients with serological testing showed presence of SARS-CoV-2 IgG and IgM, and 0/39 repeat serological tests 3 weeks afterward showed any late seroconversion, leading the authors to believe that, contrary to previous reports, there is no causal association between chilblains and COVID-19.

· A cross-sectional study at Wuhan's Children Hospital of 216 COVID-19-positive pediatric patients (ages 2-12) found that 22.7% of these patients had ocular findings. The most common ocular manifestations included conjunctival discharge (55.1%), eye rubbing (38.8%), and conjunctival congestion (10.2%). Additionally, 9 children had ocular manifestations as their initial presenting symptom, although fever and cough remained the most common COVID-19 manifestations.

Understanding the Pathology

· A group of international interdisciplinary researchers performed real time polymerase chain reaction (RT-PCR) on 461 viral samples of 12 severely ill and 11 mildly ill COVID-19 patients and found:

· IgM response in mildly ill patients is lower than that of the severely ill.

· Antibodies preferentially recognized the spike protein S2 fragment,

· Neutralizing antibodies were found in 73.9% of patients 3 weeks post disease onset, with higher titers in the severely ill group.

· Activity of neutralization was correlated with SARS-CoV-2 antibody response to S and N proteins.

Management

· Researchers performed a retrospective clinical analysis on 50 critical and 73 non-critical COVID-19-positive and found that lower lymphocyte count, high neutrophil to lymphocyte ratio, high platelet to lymphocyte ratio, elevated IL‐6 and C-reactive peptide, increased chest CT score, need for nutritional support and electrolyte imbalance may be used as prognostic markers of critical COVID-19 positive patients.

Mental Health & Resilience Needs

· Psychologists, pharmacists, and toxicologists in Canada surveyed a group of 320 participants to assess home, work and psychological factors and how they relate to alcohol use to cope with the COVID-19 pandemic. They found that having a child under 18-years-old was associated, higher levels of depression and lower levels of social connectedness showed increased coping tendencies to drink, and loss of income had a positive association with prior 30-day alcohol use, though no association was found between COVID-19 anxiety and drinking to cope.



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