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The COVID-19 LST Report

The COVID-19 LST Report

By COVID19LST

The COVID-19 Literature Surveillance Team is a group of physicians, medical students, PhDs and others that are keeping up with the latest research on SARS-CoV-2. We find the newest articles, read them and grade their level of evidence to bring you the bottom line.

Visit COVID19LST.org for full daily report with links to articles.
Contact us at: contact@covid19lst.org

Producers: Sarah Taylor
Writers: Thamanna Nishath, Sangeetha Thevuthasan
Host: Jasmine Rah, Will Smith

© 2020 | COVID19LST.org
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Week of February 15th, 2021

The COVID-19 LST ReportFeb 24, 2021

00:00
12:41
Week of February 15th, 2021

Week of February 15th, 2021

In today's episode we discuss:

—Climate: Infectious Disease Society of America (IDSA) made 4 strong recommendations for preventing COVID-19 infection in health care personnel. A pulmonologist and interventional cardiologist from the Cleveland Clinic and Emory University critique recently published IDSA guidelines for preventing COVID-19 infection in healthcare workers. They argue the recommendation to use either respirators or surgical masks conflicts with Centers for Disease Control guidance to use respirators, and believe the guidelines are missing recommendations on proper gloving strategies, which are crucial to avoid self-contamination. The authors suggest the IDSA must clarify these points to alleviate confusion for healthcare workers who are inundated with recommendations from multiple organizations.

—Transmission & Prevention: A retrospective observational study conducted by physicians at the Military Instruction Hospital during April 2020 found that among 1,739 crew members aboard a French aircraft carrier in April 2020, 64% tested positive for COVID-19 via real-time polymerase chain reaction (RT-PCR), with there being significant variations in symptomatic presentation and antibody development. This article suggests viral circulation in local outbreaks requires further testing and analysis.

—Management: Remdesivir for adults with COVID-19 may decrease time on mechanical ventilation. A multi-specialty team from Minnesota and Oregon conducted a systematic review of 5 randomized-controlled trials evaluating remdesivir as a treatment for adults with COVID-19. They found that a 10-day course of remdesivir may reduce the proportion of patients receiving mechanical ventilation (RR: 0.71 [CI, 0.56 to 0.90]; 3 RCTs), but was associated with a statistically insignificant decrease in mortality (RR: 0.93 [95% CI, 0.82 to 1.06]; 4 RCTs) compared to control groups. Authors suggest that remdesivir use probably confers little to no mortality benefit, but may improve recovery by reducing time on mechanical ventilation.

—Adjusting Practice During COVID-19: Methodological quality has been lower in some COVID-19 clinical research. As part of a systemic review of COVID-19 research quality, a team of molecular biologists, physicians, and statisticians from the University of Ottawa compared the quality of 686 research articles published during the COVID-19 pandemic to 593 historical controls matched for journal and study design published pre-pandemic. COVID-19 publications had a shorter time to acceptance (13.0 vs. 110 days, p

—R&D: Diagnosis & Treatments: SARS-CoV-2 lethal infected with K18-hACE2 transgenic mice may offer post-exposure protection. Researchers from the Israel Institute for Biological Research in Ness-Ziona, Israel analyzed the efficacy of monoclonal MD65 antibodies in K18-hACE2 transgenic mice with SARS-CoV-2 infection, finding a greater survival rate compared to mice without MD65 antibodies, in the setting of both prophylactic and post-exposure administration, as well as decreased viral load in lung tissue. 

Feb 24, 202112:41
COVID-19 LST Trailer

COVID-19 LST Trailer

We are an affiliated group of medical students, PhDs, and physicians keeping up with the latest research on SARS-CoV-2 / COVID-19. We find the newest articles, read them, grade their level of evidence, and bring you the bottom line. Our goal is to empower you to take the best care of yourself and those in your care. 

Our Story:

What did University of Washington third-year medical student Jasmine Rah do when her training program was suspended due to COVID-19? She teamed up with her mentor, Dr. Will Smith, an ER Doctor on the front lines of fighting COVID-19 who is also a UW clinical professor and Col. with the US Army Reserves, to launch the daily COVID-19 Literature Surveillance Team.

In just the first five months of 2020, more than ten thousand papers have been published regarding COVID-19. This is more than twice the number of publications on influenza or malaria for the entire year of 2019.  Many of these articles were just researchers desperate to share the findings in the hopes of helping others. However, many articles covered the same topic and many were of poor quality, highlighting the need for assistance in parsing through data, especially during the time of crisis in order to develop situational awareness.

The 50+ strong group of physicians, medical students, and other experts review every COVID-19 related study that is published each day, grades its level of evidence (aka scientific integrity) based on the Center for Oxford scheme, and summarizes delivering the BLUF- Bottom Line Up Front (it's a reporters dream come true!).

Their concept is to enable providers to "Stay Informed. Read Less. Do More." This effort is 100% volunteer, free, and open access. With the need to share information quickly to combat COVID-19 many leading medical journals have suspended peer review, which means more people have access to more information more quickly- but it also means there is a lot of noise. The COVID-19 LST cuts through this noise to get doctors and health care workers on the front lines the scientifically-sound information they need, quickly, to save lives.

Though it was initially created to guide clinical decision making, it grew to also guide policymakers, various agencies of Government, researchers, students and laypersons.  Through COVID-19 LST, we now understand the very important role of screening/summarizing evidence in an unbiased manner and the critical role of a literature surveillance team.  Critical members of COVID-19 LST were then invited to join in founding the non-profit, the Literature Surveillance Team or theLST.org. The next step is now to continue our process for other topics with clinical significance in the future.

Feb 09, 202101:51
Week of February 1st, 2021

Week of February 1st, 2021

In today's episode we discuss:

—Epidemiology

· What does the literature say about face mask usage against COVID-19? A large international, interdisciplinary group summarize the evidence supporting mask wearing to mitigate the spread of COVID-19. They reviewed direct epidemiological evidence, population-level impacts, transmission characteristics, laboratory-based source control experiments, personal protective equipment efficacy research, sociological considerations, and implementation policies. Authors conclude all evidence indicates mask wearing effectively reduces viral droplet transmission and should be encouraged by officials to help minimize the spread of COVID-19.

—Understanding the Pathology: ABO blood group showed minimal differences in SARS-CoV-2 antibody response but blood group B had higher neutralizing antibody titers. A multicenter prospective cohort study conducted by Johns Hopkins University, Mississippi Valley Regional Blood Center in Springfield, IL, Washington University School of Medicine in St. Louis, MO, Mayo Clinic in Rochester, MN, and National Institute of Health in Baltimore, MD involved 202 individuals who were eligible to donate COVID-19 convalescent plasma at the beginning of the pandemic. They found there was no difference in anti-SARS-CoV-2 spike IgA or IgG between ABO groups, but significantly higher neutralizing antibody (nAb) titers were present in blood group B (44%) compared to blood groups A (25%), O (20%) and AB (0%). These findings suggest blood group B may have higher nAb titers after recovery from COVID-19 infection and thus greater protection against future infection with SARS-CoV-2, however further studies correlating ABO blood groups and disease severity are needed to further support these findings.

—Transmission & Prevention: Further robust research is necessary to deduce the link, if any between COVID-19 vaccination efficacy and obesity. Researchers from Harvard Medical School, Massachusetts General Hospital and ConscienHealth in Pittsburgh refute previous speculations that obesity could be associated with reduced efficacy of the COVID-19 vaccines. Data from Phase 3 vaccine trial results show Pfizer-BioNTech has 95.4% efficacy (CI: 86.0 - 99.1%) in people with obesity compared to 94.8% (CI: 87.4-98.3%) in people without obesity and Moderna efficacy of 91.2% (CI:32.0-98.9%) in people with severe obesity and 94.8% (CI: 89.3-96.8%) overall. Since obesity is one of the most significant risk factors for severe outcomes from COVID-19, these authors suggest that ongoing placebo-controlled vaccine trials designed with necessary power for detecting differences among classes of obesity are important for post-vaccine risk stratification and public health strategy. 

 · A nanomechanical study found SARS-CoV-2 to survive best on polystyrene compared to other tested inanimate surfaces. A nanomechanical study by researchers in Alberta, Canada and Changsha, Shenzhen, and Guangdong, China tested SARS-CoV-2 survival on four different surfaces and found that the spike protein on the outer surface of the SARS-CoV-2 virion, which is responsible for transmission via fomites, survived the best on polystyrene, then stainless steel, then gold, and then on glass, suggesting that fomite transmission of SARS-CoV-2 is prevalent and that more surfaces need to be tested to get a better understanding for both prevention and tracking transmission of the virus.

The rest of the reports can be found here: https://www.covid19lst.org/reports 

Feb 09, 202115:25
January 18, 2021 & January 19, 2021

January 18, 2021 & January 19, 2021

In today's episode we discuss:

—Epidemiology: Seroprevalence of SARS-CoV-2 antibodies in over 6000 healthcare workers show increased occupational risk. Physicians and laboratory scientists from Spain conducted a cross-sectional study of 6,038 healthcare workers (HCW) across 4 regions in Spain to assess the seroprevalence of IgG anti-SARS-CoV-2 antibodies. They found 11% of HCW (n=662) had IgG against SARS-CoV-2, with those with high (OR: 2.06; 95%CI: 1.63-2.62) and moderate (OR: 1.77; 95%CI: 1.32-2.37) risk exposures more likely to have antibodies. Because this rate of seropositivity is slightly higher than in the general Spanish population, authors suggest their data confirm the occupational risk of SARS-CoV-2 infection among HCW with working in a clinical environment.

—Adjusting Practice During COVID-19: There was an effect of the COVID-19 pandemic process on STEMI patients’ timeline? An interdisciplinary group of cardiology researchers from hospitals in Samsun and Sivas, Turkey, performed a combined observational analysis as well as chart review to assess the effects that the COVID-19 pandemic has had on the management of ST elevation myocardial infarction (STEMI) patients. They concluded that there was a delayed time to first medical contact (61 minutes in non-pandemic times versus 190 minutes during the pandemic), as well as a delayed time for patients to leave their house after their onset of symptoms (30 minutes in non-pandemic times versus 165 minutes during the pandemic). While this implies that there may need to be widespread analysis of medical responses to patients experiencing STEMI, the authors do comment on the fact that the COVID-19 burden in areas studied was relatively small when compared to hotspots around the world. Further investigation is required in areas that can represent a patient population more severely burdened by COVID-19, however these results suggest an opportunity for quality improvement changes to more efficiently manage patients with STEMI during the pandemic and improve outcomes.

—R&D: Diagnosis & Treatments: Fluvoxamine when compared to placebo can decrease clinical deterioration in outpatients with symptomatic COVID-19. A double-blind randomized clinical trial, conducted by physicians from Washington University in St. Louis, analyzed the efficacy of fluvoxamine (100 mg 3 times daily for 15 days) against a placebo to decrease clinical deterioration of COVID-19 in non-hospitalized patients with confirmed SARS-CoV-2 infection within 7 days and oxygen saturation 92% or greater. Clinical deterioration (defined as development of both 1) shortness of breath or hospitalization for shortness of breath or pneumonia and 2) oxygen saturation less than 92% on room air or need for supplemental oxygen to achieve oxygen saturation of 92% or greater) occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group without a significant increase in adverse events. 

—Transmission & Prevention: Genomic evidence of points to in-flight transmission of SARS-CoV-2 despite predeparture testing. A study by the New Zealand Ministry of Health looking at the points of infection and transmission of SARS-CoV-2 in 86 people returning to New Zealand through an international flight from Dubai, UAE. Passengers were placed in managed isolation and quarantine and tested for SARS-CoV-2 on their third and twelfth day after their return; 7 passengers subsequently tested positive for COVID-19.


Jan 26, 202107:48
January 11, 2021

January 11, 2021

In today's episode we discuss:

—Epidemiology: Do we need routine COVID-19 testing of Emergency Department staff? A study from the University of Washington uses a mathematical model based on the Diamond Princess cruise ship data to predict detection of SARS-CoV-2 in asymptomatic health care workers (HCWs) in the emergency department in regions with high COVID-19 rates. Results revealed that within six months, weekly testing in asymptomatic HCWs would reduce infection rates by 3 to 5.9% when the transmission constant is 1.219e-4 new infections/person^2, while a transmission constant of 3.660e-4 new infections/person^2 would result in reduction of infections by 11 to 23%. The authors urge more frequent testing in asymptomatic HCWs to help reduce the rate of SARS-CoV-2 infection.

—Understanding the Pathology: Dynamic changes are witnessed in anti-SARS-CoV-2 antibodies during SARS-CoV-2 infection and recovery in a retrospective analysis by bioinformatics and global health specialists in Jiangsu, China where 1,850 hospitalized patients with COVID-19 were analyzed and those with mild or moderate disease were found to develop IgG antibodies one week earlier than patients with severe disease. While spike protein and receptor-binding domain specific IgG levels were 1.5- and 2-fold higher in critically ill hospitalized patients and SARS-CoV-2 RNA-negative recovered patients, respectively, compared to those who are remained RNA-positive. These data suggest earlier development of antibodies may be protective against developing severe disease; however, those who recover from more severe disease may also have higher levels of antibodies and a shorter duration of viral shedding.

—Management: Coronary calcium scoring was found to be a predictor for outcome in COVID-19. A retrospective cohort study conducted at the University of Munich by a team of internal medicine and radiology specialists found the coronary artery calcification (CAC) score to be a significant prognostic indicator based on 109 SARS-CoV-2-infected patients. Authors found the median CAC to be 140 [IQR 1–1165] in patients with critical COVID-19, and 160 [IQR: 88–562] in patients with fatal outcome. Authors note limitations due to retrospective design and small sample size, however, these findings suggest that coronary artery disease is significantly associated with an adverse clinical outcome in COVID-19.

—Adjusting Practice During COVID-19: There is a high prevalence of deep venous thrombosis in non-severe COVID-19 patients hospitalized for a neurovascular disease. This prospective study from Strasbourg University Hospital, France evaluates 13 patients with non-severe COVID-19 and concurrent neurovascular disease for deep venous thrombosis (DVT) via doppler ultrasound scanning (DUS) of the lower limbs. Results showed that despite thromboprophylaxis, the prevalence of asymptomatic DVT was 38.5%. The authors thus advocate for the use of bedside DUS to identify DVT in patients with COVID-19 given that D-dimer, the classic marker of DVT, has been shown to correlate with COVID-19 severity and may be elevated in this population regardless of coagulable state.

Jan 15, 202106:58
January 8, 2021

January 8, 2021

In today's episode we discuss:

—Epidemiology: The authors present a case report of a 29-year-old SARS-CoV-2 positive woman with minimal, mild symptoms who underwent an uncomplicated and successful vaginal delivery to a healthy baby boy at the University of Missouri Women and Children’s Hospital in April 2020. After birth, the patient’s placenta was subsequently analyzed using hematoxylin-and-eosin (H&E) staining, which revealed evidence of general placental vascular malperfusion possibly due to hypertrophic arteriolopathy along with immunohistochemistry (IHC) staining which revealed the presence of SARS-CoV-2 in chorionic villi endothelial cells. Current literature on COVID-19 in pregnant patients is somewhat conflicting regarding morbidity, miscarriage rates, susceptibility, and the possibility of vertical transmission; the authors posit that this case is the first report of placental SARS-CoV-2 in the setting of mild COVID-19 disease, where the patient had only symptoms of mild myalgias.

—R&D: Diagnosis & Treatments: A prospective study conducted at a Malaysian COVID-19 quarantine center of 217 asymptomatic adult males, where 160 tested positive, found a far greater SARS-CoV-2 detection rate using morning salivary samples (93.1%) when compared to nasopharyngeal swabs (52.5%) (p

Jan 15, 202102:09
January 7, 2021

January 7, 2021

In today's episode we discuss:

—Adjusting Practice During COVID-19: A team of cardiologists and pharmacists from hospitals in Shanghai and Wuhan, China assessed the association between mortality in hospitalized COVID-19 patients (n=535) and low molecular weight heparin (LMWH) use between January 26-March 26, 2020. They found overall adjusted odds ratio for mortality was lower in the LMWH-users vs non-users (0.20; 95% CI, 0.09-0.46), specifically in severe (0.08; 95% CI, 0.01–0.62) and critically ill cases (0.32; 95% CI ,0.10–0.996). Authors suggest LMWH appears correlated with a survival benefit in hospitalized COVID-19 patients, especially those severely and critically ill.

Jan 15, 202101:16
January 6, 2021

January 6, 2021

In today's episode we discuss:

—Climate: American physicians from Yale and the University of Maryland argue that the US government should mandate vaccination of migrant detainees against COVID-19. They assert the crowded and inadequate sanitary conditions in these facilities create epicenters for disease proliferation and that without federal mandates, states will fail to vaccinate this vulnerable population. Authors suggest such policy is both sound medical practice and a moral imperative.

—Epidemiology: A team of Spanish physicians conducted a retrospective cohort-study using the SEMI-COVID-19 Registry of 12,170 COVID-19 patients from 150 hospitals in Spain to investigate impact of arterial stiffness on mortality. They found arterial stiffness (pulse pressure greater than or equal to 60 mmHg) and systolic blood pressure (SBP) less than 120 mmHg on admission significantly and independently predicted all-cause in-hospital mortality (ORadj: 1.27, p=.0001; ORadj: 1.48, p=.0001, respectively). Authors concluded SBP and pulse pressure values on admission are independent predictors of mortality in COVID-19 patients.

—Management: A single-center retrospective cohort study of 157 hospitalized COVID-19 patients in Wuhan, China analyzed 43 demographic, clinical, and laboratory parameters and found an association between higher systolic blood pressure (SBP) on admission and increased mortality. They also utilized regression models to predict mortality and survivability based of available data and they suggest utilizing these models for risk stratification and appropriate triaging of patients to improve outcomes.

Jan 15, 202102:35
January 5, 2021

January 5, 2021

In today's episode we discuss:

—Climate: More transparency is needed for emergency use authorizations (EUA), including drugs and vaccines for COVID-19, according to a journalist writing for the Journal of the American Medical Association reporting on a recent US Government Accountability Office (GAO) report. The report calls on the Food and Drug Administration (FDA) to publicly share safety and efficacy data related to EUAs to improve public confidence during this unprecedented time.

—Epidemiology: Persistence of SARS-CoV-2 in a first trimester placenta may have led to transplacental transmission and fetal demise from an asymptomatic mother. An interdisciplinary group of researchers at Model Hospital in Mumbai, India describe a case of hydrops fetalis detected at 13 weeks gestation in an asymptomatic carrier of the SARS-CoV-2 virus. The patient tested posted for COVID-19 at 7.6 weeks of gestation and then was subsequently found to have detectable SARS-CoV2 in the amniotic fluid and placental cells at 13 weeks gestation. These findings suggest possible transplacental SARS-CoV-2 transmission and viral replication within the placenta. While there was evidence of robust placental inflammation, fetal tissue was unavailable for biopsy and therefore infection of the fetus itself is unable to be determined.

—Understanding the Pathology: Immunometabolism may be useful for inflammaging, immunosenescence, and autoimmunity in COVID-19. In this review, an interdisciplinary group of French researchers propose that inflammaging, which is chronic low-grade inflammation that occurs with aging, may be the common factor predisposing individuals with certain comorbidities to more severe COVID-19. They discuss how the underlying mechanisms of immunosenescence and chronic inflammation seen in diseases such as diabetes, hypertension, metabolic syndrome, systemic lupus erythematosus, and rheumatoid arthritis seem to predispose COVID-19 patients to the immune dysfunction and cytokine storm observed in severe disease. Thus, authors propose an immunometabolism-mediated treatment paradigm that includes metformin, rapamycin, and dimethyl fumarate.

—Transmission & Prevention: Intrauterine transmission of SARS-CoV-2 from COVID-19 infected pregnant women is a potential complication according to one review. Members of the Pakistan Health Research Council reviewed 16 articles (498 COVID-19 infected pregnant women) on vertical transmission of SARS-CoV-2 and found vertical transmission occurred in 4.883% of SARs-CoV-2 infected mothers (23/471), and in the 17 cases where outcomes were reported, 4 infants developed COVID-19 pneumonia, 8 required care in the neonatal intensive care unit, 4 received mechanical ventilation, and none died. Authors suggest vertical transmission is possible and that because severe neonatal complications can occur, recommend neonatal screening for infants born to mothers with SARS-CoV-2.

—Management: Do care bundles improve outcomes in patients with COVID-19 or related conditions in intensive care? A systematic review by authors from Ireland and Australia examined the literature on ICU care bundles used in the management of COVID-19 and other acute respiratory pathogens and identified 21 studies encompassing 8 countries, with care bundles most commonly including guidance on ventilator setting, restrictive fluid management, sedation, and prone positioning.

Jan 13, 202107:14
January 4, 2021

January 4, 2021

In today's episode we discuss:

—Climate: A systematic review by an international team of researchers highlights the significant underrepresentation of geriatric patients in published COVID-19 randomized control trials (RCTs). In the 12 RCTs included in the review, patients had mean age of 56.3 years, and were on average 20 years younger than patients from large observational trials. One explanation for this discrepancy is the strict exclusion criteria used for RCTs, which commonly exclude patients with cognitive impairment and multiple comorbidities frequently seen in the elderly population. The authors strongly advocate for future RCTs to include this vulnerable population that has been disproportionately affected by the COVID-19 pandemic.

—Epidemiology: Pediatric ischemic stroke is an infrequent complication of SARS-CoV-2. Physician members of the International Pediatric Stroke Study Group surveyed 61 international sites to assess the prevalence of SARS-CoV-2 infection in pediatric stroke patients. They found 3.6% (6/166) of pediatric arterial ischemic stroke, 0.9% (1/108) of neonatal arterial ischemic stroke, 1.9% (1/54) of pediatric cerebral sinovenous thrombosis, and zero (0/33) neonatal cerebral sinovenous thrombosis patients were positive for SARS-CoV-2. Authors suggest these results indicate that SARS-CoV-2 does not appear to increase the risk of stroke in neonatal and pediatric populations but acknowledge that more robust testing is needed to determine any role the virus has in pediatric stroke.

—Transmission & Prevention: Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators. Internists and microbiologists from University of New Mexico assessed whether dry heat incubation could decontaminate N95 respirators and found SARS-CoV-2 was not inactivated when N95 coupons inoculated with the virus were heated to 60-75 degrees Celsius for either 30 or 60 minutes when placed on parchment paper but was inactivated when placed on tissue culture plates. When intact 3M 1860 N95 respirators were incubated at 70-75 degrees Celsius for 60 minutes, SARS-CoV-2 was not inactivated. Authors suggests that dry heat incubation is not a consistently effective method for deactivating SARS-CoV-2 on N95 respirators.

—R&D: Diagnosis & Treatments: Efficacy of lopinavir/ritonavir in the treatment of COVID-19 was not found to be considerable according to a systematic review. An international research team from Nested Knowledge, Inc conducted a systematic review of 16 studies assessing the effectiveness and safety of lopinavir/ritonavir (LPV/r) in the treatment of COVID-19 and found the majority of included studies showed no significant improvement in clinical outcomes (RT-PCR negativity, chest-CT findings, mortality, adverse events) following LPV/r treatment, though they could not perform meta-analysis due to the high heterogeneity of the comparison groups. Though their review suggests little survival or clinical benefit of LPV/r in COVID-19, authors recommend larger clinical trials are needed to more definitively explore its potential benefits due to the limitations of currently available data.

—Mental Health & Resilience Needs: Experiences of New Zealand registered nurses of Chinese ethnicity during the COVID-19 pandemic are brought to light in one study. 

Jan 09, 202107:38
December 30, 2020

December 30, 2020

In today's episode we discuss:

—Climate: The US Centers for Disease Control COVID-19 Response Team used data from three online CARAVAN omnibus surveys (n=858) conducted to assess parental attitudes and concerns about schools reopening during the COVID-19 pandemic and found more white families were in favor of in-person school (62.3%) compared to Hispanic families (50.2%, p=0.014) and Black families (46.0%, p=0.007), while non-white parents were more concerned about schools opening safely (98.8% very or somewhat concerned) than were white families (86.0%, p=0.012). Authors suggest socioeconomic differences and structural inequities may drive these differing attitudes and recommend school districts consider each community's unique needs when devising school reopening plans.

—Epidemiology: In a retrospective cohort study evaluating albumin levels in correlation with disease severity and inflammatory markers (CRP, d-dimer, and IL-6), investigators in Milan, Italy analyzed data from 207 COVID-19 patients admitted to Fatebenefratelli-Sacco Hospital and found 50.7% patients had hypoalbuminemia (serum albumin albumin levels were significantly inversely correlated with increased severity of disease and worse outcomes at day 30, as well as inversely correlated with inflammatory markers. The results suggest hypoalbuminemia and urinary protein wasting may be useful biomarkers on admission to determine disease severity.

—Understanding the Pathology: Microbiologists and infectious disease specialists from Anhui Medical University and the Anhui and Fuyang Centers for Disease Control in China analyzed SARS-CoV-2 IgM and IgG antibody responses using indirect ELISA in serum from 165 patients and found spike protein IgM and IgG was detectable in 12.5% of hospitalized patients on day 1 of infection, IgM peaked at 22-28 days and was undetectable in 30% and 79% of patients at three and seven months, respectively, and IgG peaked at four months and declined rapidly at seven months. Authors suggest their analysis can help guide SARS-CoV-2 diagnosis and vaccine development via an improved understanding of the human humoral response in COVID-19.

—Transmission & Prevention: A review of current data on COVID-19 transmission and vaccine efficacy by otolaryngologists from Harvard Medical School and Johns Hopkins School of Medicine illustrates how COVID-19 mRNA vaccines generate immunogenicity by creating IgG antibodies against the SARS-CoV-2 virus, however IgG antibodies, while preventing patients from clinically getting sick with COVID-19, do not stop the virus from replicating in the upper airway -- as this requires secretory IgA antibodies -- suggesting that transmission precautions should still be widely practiced even after vaccination.

—Management: A multicenter retrospective study conducted by French physicians at the Cochin Hospital utilized demographic data, clinical symptomatology, and results of lab tests from 605 patients with clinical suspicion of COVID-19 to create a pre-test probability score of SARS-CoV-2 infection (the PARIS score) and found that fever, myalgias, lymphopenia, and elevated CRP had the highest positive predictive value, though no clinical variable was individually significant. The high-probability PARIS score had a positive predictive value of 93%, while the low-probability score had a negative predictive value of 98%. 

Jan 05, 202108:18
December 29, 2020

December 29, 2020

In today's episode we discuss:

—Understanding the Pathology: SARS-CoV-2 Infection likely triggers an autoimmune response. A case control study from Northern Italy found elevated inflammatory markers and autoantibodies (ANA, ASCA, IgG and anti-Cardiolipin) in 40 hospitalized COVID-19 patients compared to healthy controls. These results add to the growing body of evidence suggesting the association of COVID-19 with autoimmune disease and inflammatory dysfunction. The authors suggest utilizing these antibodies as prognostic indicators, especially when considering treatment with plasma therapy.

—Management: Is there an effect of artificial liver blood purification treatment on the survival of critically ill COVID-19 patients? A prospective study by multiple infectious disease centers in China to investigated the efficacy of liver blood purification treatment on the survival of severe/critical COVID-19 patients with serum inflammatory factors greater than or equal to five times the upper limit. A total of 101 critical COVID-19 patients were enrolled in the study and divided into either the treatment group or the control group. The authors demonstrated that artificial liver therapy clears inflammatory mediators through blocking the cytokine storm thus preventing theses cases from worsening any further and improving the survival rate.  

—Mental Health & Resilience Needs: Mental health continues to take a toll approximately 35 days after hospitalization for COVID-19 infection. Investigators from Hackensack Meridian School of Medicine and Hospital in New Jersey conducted a single center prospective cohort study of 183 COVID-19 patients admitted to Hackensack Meridian Hospital in order to identify persistent physical symptoms, psychological health, social relationships, and activities of daily living all pertaining to their self-reported quality of life 35 ± 5 days after hospital discharge. The results revealed 16.9% of participants reported their mental health as poor or fair, impairing their daily living, physical and mental health, and quality of life, suggesting the importance of early intervention for both physical and mental symptoms, along with social support, as an essential part of full recovery from COVID-19.

Jan 05, 202102:46
December 22, 2020

December 22, 2020

In today's episode we discuss:

—Climate: Board members of the International Society of Vaccine (ISV) summarize their organization's recent efforts to provide information and resources about COVID-19 vaccines to members worldwide: they provide links to their recent virtual lecture series on COVID-19 vaccines and suggest their organization is a global leader on vaccine development that can provide balanced information to a variety of stakeholders. The authors encourage new researchers and developers to join the ISV at www.isv-online.org.

Dec 31, 202001:08
December 21, 2020

December 21, 2020

In today's episode we discuss:

—Epidemiology: What was the SARS-CoV-2-specific neutralizing antibody response in Norwegian healthcare workers after the first wave of COVID-19 pandemic? A multicenter prospective survey study of 607 healthcare workers (HCW) by a researcher at the Influenza Centre at the University of Bergen in Norway found 5% of participants (32/607) were seropositive for SARS-CoV-2 (spike-specific IgG, IgM, and IgA antibodies), including 21 who were positive at baseline and 11 who seroconverted during follow-up. 77% of the infected HCWs, in high-risk departments were young nurses aged 23-31. Results also showed that HCW were 11.6 times more likely to contact COVID-19 patients when compared to low-risk HCW or community members, while HCW with partial PPE were at a 2.5 fold higher risk. Authors highlight the importance of protecting high-risk frontline HCW and suggest prioritization of this group during vaccine distribution.

—Understanding the Pathology: Could there be an association of salivary content alteration and early ageusia symptoms in COVID-19 infections? Dental specialists in Saudi Arabia reviewed 36 studies on chemical and inflammatory changes that occur in SARS-CoV-2 infected salivary glands and propose a chemosensory mechanism to explain alterations in taste and smell found commonly seen in COVID-19. In patients reporting aguesia, they found changes in salivary hormones, inorganic compounds, pH, enzymes, and salivary flow rate, which are all involved in normal taste perception. Authors suggest with better understanding and characterization of these changes, we may be able to prevent or treat changes in smell or taste seen among COVID-19 patients.

—Transmission & Prevention: Specific occupations and risk of severe COVID-19 are positively correlated. In this large-scale prospective cohort study, authors from various public health institutes in Glasgow, UK, Limerick, Ireland, and Syracuse, NY, analyzed data from the UK Biobank, involving 120,075 participants aged 40-69 registered with the National Health Service (NHS) in England, Wales or Scotland, and grouped them into occupational groups with concomitant serious COVID-19 infection (having to be hospitalized), in order to asses risk of infection across essential occupations.

—Management: There may be a high prevalence of pulmonary sequelae at 3 months after hospital discharge in mechanically ventilated COVID-19 survivors. In this letter to the editor, Dutch researchers share their clinical data from 48 critically-ill COVID-19 patients who underwent follow-up screening three months after discharge that included pulmonary function testing (PFT), high resolution chest CT (HRCT), and 6-minute walk test (6-MWT).

—R&D: Diagnosis & Treatments: There is some data suggesting usage of smartwatch tracking data to detect COVID-19 cases early. An article reviews a study conducted by researchers at Scripps Research Translational Institute who compared the smartwatch data between 333 participants, 54 of which ended up reporting positive for COVID-19, and found that symptom tracking plus smartwatch biometric data collecting yielded more predictive results of COVID-19 positive test probability than symptom tracking alone.This study was conducted earlier this year and used a smartphone/smartwatch app called DETECT.

Dec 31, 202005:19
December 17, 2020

December 17, 2020

In today's episode we discuss:

—Climate: Operations officers from several international biomedical manufacturing companies discuss the ability of manufacturers to reduce distribution of counterfeit vaccines in light of counterfeit SARS-CoV-2 vaccines being found in Russia and Ecuador in 2020. Authors recommend using various tracking methods such as a GS1 2D DataMatrix barcode, QR code and matrix code, or Automatic Identification and Data Capture (AIDC) flow to scan and identify vaccines, trace them from the factory to delivery, and upload that data into an easily accessible system. They suggest such a tracing system is necessary to ensure the delivery of safe and authentic vaccines from factories to the public.

—Epidemiology: A team from Johns Hopkins University and Brown University conducted a systematic review and meta-analysis of 77 studies (38906 hospitalized patients) and found the overall prevalence of death from COVID-19 among hospitalized patients was 23% (19–27%) in the US and Europe versus 11% (7–16%) in China. Risk factors for death included age 60 or older (sRR = 3.6; 95% CI: 3.0–4.4; I^2 77%), male gender (sRR=1.3; 1.2–1.4; I^2 18%), smoking history (sRR=1.3; 1.1–1.6; I^2 68%), COPD (sRR=1.7; 1.4–2.0; I^2 66%), diabetes (sRR=1.5; 1.4–1.7; I^2 58%), heart disease (sRR=2.1; 1.8– 2.4; I^2 69%), CKD (sRR =2.5; 2.1–3.0; I^2 72%). They observed similar risk factors for severe disease (respiratory rate>30, oxygen saturation50% within 24–48 hours).

—Transmission & Prevention: Researchers from England studying COVID-19 transmission in the education system found that the overall risk of SARS-CoV2 infection among children and school staff was low: there was minimal evidence of transmission from student to student or student to faculty member, and infected children most commonly acquired SARS-CoV-2 from family members at home. Data suggests that the rate of transmission in schools was directly correlated with regional COVID-19 prevalence, suggesting that re-opening schools may not significantly increase infection rates among children or school staff unless this is during a surge or in high prevalence areas.

· Members of the US Centers for Disease Control COVID-19 Response Team summarize their recommended public health strategies for mitigation of community SARS-CoV-2 transmission: they recommend the use of face masks, maintaining physical distancing, prompt case investigation, avoiding crowded situations, increasing protection for persons at highest risk for severe COVID-19, adequately protecting healthcare workers, improved hygiene practices, avoiding unnecessary travel, and widespread use of safe vaccines. Authors suggest following such evidence-based measures will substantially contribute to combating transmission of COVID-19.

Dec 23, 202004:49
December 16, 2020

December 16, 2020

In today's episode we discuss:

—Understanding the Pathology: Researchers from the Department of Health & Exercise Science at Appalachian State University analyze the vascular impact of SARS-CoV-2 on 20 healthy young adults 3-4 weeks post-infection by doppler ultrasound of arterial blood flow in the upper and lower extremities (markers of vascular function) and pulse wave velocity (indicator of arterial stiffness). Results demonstrated that brachial artery flow-mediated dilation (FMD) was 6% lower after COVID-19 infection, which is clinically significant because each 1% decrease in FMD is associated with a 13% higher risk of cardiovascular events, suggesting that systemic vascular dysfunction and arterial stiffness may be a potential mechanism of COVID-19 vasculopathy.

—Management: A single-center observational cohort study from Turin, Italy analyzed coagulopathy in 36 hospitalized pediatric patients (ages birth to 21 years) with COVID-19 (n=30) and Multisystem Inflammatory Syndrome in Children (MIS-C) (n=6) and found that D-dimer values were not useful in predicting disease severity. Significant differences between D-dimer and CRP values were observed between COVID-19 and MIS-C patients, however there was no difference in coagulopathy incidence in these groups (as measured by fibrinogen levels). They recommend against universal pharmacologic prophylaxis in pediatric COVID-19 patients except in cases of multiple concurrent pro-thrombotic risk factors such as obesity, active malignancy, and sickle cell disease.

Dec 23, 202002:23
December 15, 2020

December 15, 2020

In today's episode we discuss:

—Climate: What are the COVID-19 vaccine trial ethics once we have efficacious vaccines? An expert opinion penned by bioethicists from the National Institutes of Health and Fogarty International Center in Bethesda, MD explore the ethics of continuing blinded, placebo-controlled trials for COVID-19 vaccines in the wake of a safe and efficacious vaccine being approved for widespread use. Authors argue it is ethical to continue trials if participants consent and the risk-benefit profile of the trial remains acceptable, because continuing trials could lead to the discovery of longer lasting vaccines, better immunity, or greater efficacy in subpopulations. However, the authors emphasize trial participants in blinded, placebo-controlled trials should be informed of the availability of the vaccine and allowed to leave the trial if they desire.

—Understanding the Pathology: The L37F mutation may be critical to asymptomatic COVID-19 infection and transmission. Computer scientists from the University of Illinois analyzed 75,775 SARS-CoV-2 complete genome isolates to explore virological characteristics in asymptomatic COVID-19. They found patients with asymptomatic COVID-19 were significantly more likely to have the SARS-CoV-2 single nucleotide mutation 11083G>T-(L37F) on Non-Structural Protein 6 (NSP 6)(r=0.61, p=5.42×10^-56) and countries with the highest L37F mutation ratio had lower death ratio. Artificial intelligence (AI), topological data analysis (TDA), and network analysis revealed L37F destabilized NSP6's structure in a way that impeded viral assembly and replication. Authors suggest L37F mutation as a possible explanation for asymptomatic COVID-19 and encourage further research on therapies targeting NSP6.

—Transmission & Prevention: Transmissibility of COVID-19 depends on the viral load around onset in adult and symptomatic patients. Infectious disease specialists and microbiologists from the Toyama University Graduate School of Medicine and Pharmaceutical Sciences in Japan conducted a case-control study comparing patients with 14 COVID-19 who did ("index patients") and 14 who did not transmit SARS-CoV-2 to another patient. They found index patients showed higher viral loads at onset compared to non-index patients (6.6 [5.2 to 8.2] log copies/μL vs. 3.1 [1.5 to 4.8]) and that, in general, symptomatic patients had a higher initial viral load (2.8 log copies/μL) than asymptomatic patients (0.9 log copies/μL, p

· Peripheral oxygen saturation does not decrease in older persons wearing nonmedical face masks in community settings. Internists from McMaster University in Canada conducted a crossover study of 25 retirement home residents older than 65 to monitor self-measured peripheral oxygen saturation (SpO2) with use of a three-layer disposable nonmedical face mask. They found pooled mean SpO2 was 96.1%, 96.5%, 96.3% in the hour prior to use, during one hour of use, and one hour after wearing the masks, respectively.Authors suggest despite some public concerns about mask safety, the use of nonmedical face masks is not associated with a decrease in SpO2 in older populations.

Dec 23, 202004:32
December 11, 2020

December 11, 2020

In today's episode we discuss:

—Climate: The editorial team at JAMA explains their decision to publish the Lenze et al study "Fluvoxamine vs placebo and clinical deterioration in outpatients with symptomatic COVID-19: a randomized clinical trial." While it is a preliminary study with limitations, authors argue it warranted publication due to its design as a placebo-controlled, double-blind randomized clinical trial and the authors' methodological adjustments to conduct study activities without physical contact, such as arranging oxygen and medications deliveries for self-quarantining patients and obtaining consent virtually. The team suggests that the Lenze et al pilot study provides an excellent example of pandemic-appropriate research methods and lays the groundwork for research into preventing outpatients with COVID-19 from deteriorating into a more severe disease status.

—Epidemiology: A retrospective cohort study that analyzed pediatric electronic health record data from PEDSnet (n=135,794 patients 4% of patients were infected with SARS-CoV-2 (n=5,374), while Kawasaki Disease prevalence decreased in 2020 compared to 2018 or 2019*. Risk factors for SARS-CoV-2 infection included preexisting chronic disease and increased age. Additionally, subjects of Hispanic, Black, or Asian race/ethnicity had a higher likelihood of positive test result compared to White race/ethnicity, though they received fewer tests per population. These results provide large-scale data on pediatric risk factors, which authors hope will add to the growing knowledge on SARS-CoV-2 and host biology in pediatric populations.

· Leaders in the United Kingdom's Department of Health conducted a systematic review and narrative synthesis of literature on SARS-CoV-2 infection in children published through March 9, 2020 (24 articles) and found that children under age 10 had similar infection rates to adults, but the observed rate of infection in children was perceived as lower since children often had undetected milder infections, and transmission usually occurred within familial clusters when children were exposed to an infected adult. Authors suggest further data collection is necessary to understand child to child transmission of SARS-CoV-2 and to detail the clinical course of COVID-19 in children.

—Understanding the Pathology: A cohort-control study by pediatric infectious disease specialist in Ankara, Turkey evaluated cytokine and chemokine levels from serum samples of 60 COVID-19 positive patients (30 pediatric, 30 adult) and found that COVID-19 patients had higher levels of IP10 and MIP-3B compared to 30 healthy controls (15 pediatric, 15 adult; p

Dec 15, 202003:37
December 9, 2020

December 9, 2020

In today's episode we discuss:

—Epidemiology: A systematic review of 39 articles (30 retrospective and 9 prospective) on venous thromboembolic events (VTE) in COVID-19 by a team of cardiologists and molecular biologists from the Central South University in Hunan, China found that D-dimer, fibrinogen, and APTT may be useful in predicting thromboembolic events in patients with severe COVID-19.

—Understanding the Pathology: Physicians at the Icahn School of Medicine used enzyme-linked immunosorbent assay (ELISA) to screen patients (n=72,401) at Mount Sinai Health System for the SARS-CoV-2 spike protein antibody and found that 30,082 patients tested positive (titer 1:80 or higher) with quantitative microneutralization assay demonstrating that spike protein titer level positively correlated to neutralization titer (Spearman r: 0.87, p

—Management: Infectious disease physicians at the Imperial College London reviewed publications about bacterial and fungal coinfection with human coronaviruses and found that in the nine studies, 62/806 patients (8%) experienced coinfections during hospital admission. Because most patients across all studies received broad spectrum antibiotics (1450/2010; 72%), authors suggest the seemingly low occurrence of coinfection may be attributable to empiric antibiotic use and recommend conducting prospective studies to inform antibiotic stewardship during the COVID-19 pandemic.

· Members of the World Association of Perinatal Medicine propose consensus statements regarding SARS-CoV-2 infection in pregnant patients based on their review of the literature. They comment on diagnosis, screening in laboring patients, maternal and fetal complications, vertical transmission, delivery mode, breastfeeding, appropriate setting of care, and use of antiviral medications.

Dec 15, 202002:55
December 8, 2020

December 8, 2020

In today's episode we discuss:

—Climate: No-fault compensation for vaccine injury. Are we looking at the other side of equitable access to Covid-19 vaccines? An opinion piece on COVID-19 vaccination explains that though there are 79 higher-income countries ready to pay for vaccine distribution in 92 lower-income countries, there is not yet an established method for injury compensation if an adverse vaccine event takes place. This suggests the need for an injury compensation plan in these lower-income countries by incorporating existing systems in wealthier countries, some World Health Organization programs, and the COVAX Facility, an international partnership to help support vaccine access in lower-income countries.

—Epidemiology: One study estimated SARS-CoV-2 seroprevalence in the US as of September 2020. This cross-sectional study, conducted primarily by US Centers for Disease Control and Prevention (Atlanta, Georgia), sampled 177,919 residual serum specimens from across all 50 United States, the District of Columbia, and Puerto Rico during 4 collection periods between July and September, 2020. They found that less than 10% of participants in 42 of 49 jurisdictions had detectable SARS-CoV-2 antibodies, with estimates of seropositivity projected in a given jurisdiction to range between fewer than 1% to 23%. This finding suggests a large variation in SARS-CoV-2 seroprevalence across jurisdictions and that most individuals do not exhibit SARS-CoV-2 antibodies from prior infection, highlighting the need for ongoing preventative practices (face masks, social distancing, etc.) and continued nationwide sera testing to inform SARS-CoV-2 epidemiology in the US.

—Understanding the Pathology: SARS-CoV-2 antibody and COVID-19 severity may vary with multisystem inflammatory syndrome in children (MIS-C). A group associated with Perelman School of Medicine at the University of Pennsylvania compared the antibody response to SARS-CoV-2 in 29 children with minimal (n=10) or severe COVID-19 (n=9) to those with MIS-C (n=10). They discovered that children with MIS-C have higher titers of IgG antibody than children with severe COVID-19 that effectively neutralize SARS-CoV-2 and may be due to longer time since onset of infection. This study is one of the first to study this immunological process in children in hopes of identifying pathophysiological pathways to investigate further.

Dec 15, 202002:58
December 7, 2020

December 7, 2020

In today's episode we discuss:

—Understanding the Pathology: Critical illness is associated with cerebral microbleeds for patients with severe COVID-19. A retrospective cohort study conducted at University Hospitals of Strasbourg, France compared 19 severe COVID-19 patients with MRI evidence of microhemorrhage to 18 COVID-19 patients with normal MRI and found more pronounced respiratory failure, higher D-dimer increases, and more frequent need for dialysis in the microhemorrhage group. The researchers hypothesize that blood-brain barrier dysfunction due to hypoxemia and levels of uremic toxins may be a key mechanism of COVID-19-related cerebral microhemorrhage, which clinicians should consider during severe COVID-19 patient management.

—Transmission & Prevention: A pooled surveillance testing program for asymptomatic SARS-CoV-2 infections was implemented on a college campus. This observational cohort study conducted by an interdisciplinary team at Duke University in North Carolina implemented mandatory masking, social distancing, and entry-and-surveillance SARS-CoV-2 testing with five-to-one pooled quantitative RT-PCR. Large-scale testing of 10,265 students (n=68,913 total tests) yielded 84 positive results (43 asymptomatic). Authors suggest pooled testing allows for high sensitivity and rapid results, while decreasing supply-chain disruptions by using fewer resources, which could be more successful in limiting transmission than testing only symptomatic individuals.

—Adjusting Practice During COVID-19: Decline in SARS-CoV-2 antibodies after mild infection was noted among frontline health care personnel. The CDC COVID-19 Response Team and IVY Network conducted an analysis of 3,284 frontline healthcare personnel, from 13 different hospitals across 12 states and found 194 had SARS-CoV-2 antibodies at initial baseline testing using ELISA assay (96% sensitivity and 99% specificity). About 60 days later, 156 returned for follow up testing, of which 93.6% had a decline in antibody response, and 108 reported COVID-19 symptoms. Additionally, among the cohort who initially tested positive, seroreversion was observed in 19.4% of those that reported symptoms, and 47.9% of those without symptoms. These results suggest antibodies to SARS-CoV-2 decline over time and negative serologic results do not exclude previous infection, highlighting there may be significant differences in interpretation on serological studies regarding COVID-19 epidemiology.

Dec 15, 202003:14
December 3, 2020

December 3, 2020

In today's episode we discuss:

—Management: A systematic review analyzed a set of 45 studies (n= 4,203 patients) published between November 1, 2019 and March 15, 2020 and found that elevated leukocyte count, alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), and procalcitonin levels predicted ICU admission in patients with COVID-19. Acute respiratory distress syndrome (ARDS) was predicted by elevated LDH, while mortality was predicted by increased leukocyte count and elevated LDH. Treatment with lopinavir-ritonavir showed no significant benefit across mortality and ARDS rates, while corticosteroids were associated with a higher rate of ARDS. These findings suggest that elevated levels of LDH, leukocytosis, procalcitonin, AST, and ALT may be important early signs of disease severity, though early antiviral and steroid treatments do not appear to offer much clinical benefit.

· Members of the Department of Geriatrics at Peking University First Hospital in China conducted a systematic review and meta-analysis of 25 articles assessing coagulation parameters in 3952 SARS-CoV-2 positive patients published between December 1, 2019 and May 1, 2020 and  found significantly higher D-dimer (standardized mean difference [SMD] 0.83, I^2=56.9%), prothrombin time (SMD 0.39, I^2=79.4%), and fibrinogen (SMD 0.35, I^2=42.4%) in patients with more severe COVID-19 compared to those with less severe disease, suggesting that hypercoagulability is associated with severity of COVID-19 and coagulation parameters should be assessed in these patients to monitor progression.

—Silver Linings: A literature review by investigators at McGill University of vaccine trials for 23 different viral infectious diseases from January 2005 through March 2020 showed that these trials historically have a 10% chance of moving from phase 2 through Food and Drug Administration (FDA) licensure within 10 years, and the average timeline from phase 2 to approval was 4.4 years, suggesting an unparalleled achievement if COVID-19 vaccine is approved within 18 months of the start of the pandemic.

Dec 15, 202002:44
December 4, 2020
Dec 12, 202001:27
December 2, 2020

December 2, 2020

In today's episode we discuss:

—Climate: A review by pediatric specialists with The Ruth & Bruce Rappaport Faculty of Medicine in Haifa, Israel discusses the phenomenon known as “vaccine hesitancy” (continued deferment of vaccines despite proven effectiveness and extremely rare adverse effects), and the barrier it could create for eventual adoption of a COVID-19 vaccine, and suggest patient education on vaccine contraindications and lack of evidence supporting adverse reactions or autoimmune disease associations may reduce vaccine hesitancy. Additionally, they suggest thorough vaccine research and multimedia educational campaigning will be needed for the coming COVID-19 vaccines.

—Epidemiology: Physician scientists from Universidad Nacional de Cuyo in Mendoza, Argentina created a Susceptible-Exposed-Infected-Recovered (SEIR) model to explore COVID-19 management policies and found detection and isolation of just 50% of asymptomatic patients infected with SARS-CoV-2 could significantly reduce hospital bed usage and deaths, suggesting that massive screening initiatives including asymptomatic people will facilitate detection and isolation of all SARS-CoV-2 infected people, allowing for pandemic control in lieu of a complete regional shutdown.

· Computer scientists from Greece and Scotland analyzed the ability of Google Trends (COVID-19 related search terms) to predict the trajectory of the COVID-19 outbreak at the state and national level and found a statistically significant correlation between Google Trends data and COVID-19 cases and deaths by Pearson and Kendall correlation analysis, while prediction analysis by quantile regression predicted the early spread of COVID-19 in several regions. The authors suggest Google Trends can aid epidemic forecasting and allow health care systems to prepare for local outbreaks.

—Transmission & Prevention: Italian immunologists review the challenges of SARS-CoV-2 vaccine development in the elderly populations at high risk for COVID-19: elderly populations have relatively poor immune responses due to immunosenescence, comorbidities, and pharmacologic treatments; and increased pro-inflammatory cytokines (IL-6, 8, TNF-alpha) worsen both SARS-CoV-2 prognosis and vaccine efficacy. A systems biology approach considering clinical, socio-economic, immunological factors alongside advanced technologies, adjuvants, and vectors are necessary to develop an effective SARS-CoV-2 vaccine for the elderly.

—Mental Health & Resilience Needs: An international group of psychiatrists summarized guidelines provided by the International Academy of Suicide Research (IASR) on the reported increase in mental health concerns and suicide attempts after pandemics and they hypothesize that the COVID-19 pandemic might also be followed by similar issues due to several factors, with at-risk populations including the elderly, socially isolated individuals, healthcare professionals, and young children. Recommendations include: videoconferencing for suicide risk assessment rather than teleconferencing, careful attention toward elderly patients in isolation, and increased awareness of mental health concerns during and following the COVID-19 pandemic.

Dec 12, 202004:46
December 1, 2020

December 1, 2020

In today's episode we discuss:

—Epidemiology: Is there SARS-CoV-2 persistence and non-protective immunity in infected haematological patients? Greek infectious disease physicians present a case of 35-year-old with a history of acute lymphoblastic leukemia 14 days status-post chemotherapy with R-hyper-CVAD who presented on April 8, 2020 with pneumonia after positive RT-PCR for SARS-CoV-2 on March 26. The patient eventually recovered after a seven-week hospitalization and developed antibodies suggestive of immunologic memory but was later readmitted on July 22 with severe COVID-19 pneumonia despite serologic testing with continued adequate IgG. Authors suggest defective innate and adaptive immunity in immunocompromised patients may facilitate SARS-CoV-2 infection (i.e. antibodies may be non-neutralizing following chemotherapy) and allow persistence or viral reactivation.

—Understanding the Pathology: There may be postmortem findings of diaphragm pathology related to critically ill patients with COVID-19. Critical care physicians conducted a case-control study using autopsies of 26 deceased critically ill COVID-19 patients from 3 medical centers in the Netherlands to analyze the extent of diaphragm involvement. Findings show increased ACE-2 expression and SARS-CoV-2 viral infiltration in the diaphragm of patients who died of severe COVID-19 compared to control specimens from 8 deceased ICU patients without COVID-19, suggesting that diaphragm fibrosis could be a source of respiratory distress in COVID-19 patients.

—Management: Early short-course corticosteroids have beneficial outcomes in hospitalized patients with COVID-19. A quasi-experimental study, conducted by the Henry Ford COVID-19 Management Task Force at multiple hospitals in Michigan, evaluated the effect of early corticosteroid therapy in 132 hospitalized patients with severe to moderate COVID-19 versus 81 COVID-19 patients on standard care treatment. They found that early corticosteroid group (median time to initiation 2 days, IQR 1-3, range 0-8) had less transfers to the ICU (34.9% vs 54.3%, p=0.005), decreased ARDS occurrences (26.6% vs 38.3%, p=0.04), and spent less days in the hospital (5 vs 8 days, p less than 0.001) compared with the standard of care group. These findings suggest that early methylprednisolone therapy in patients with moderate/severe COVID-19 may help curb the inflammatory response elicited by SARS-CoV-2 and thus lead to better outcomes.

—R&D: Diagnosis & Treatments: What is the role of immunoglobulin G and IgM antibodies against SARS-CoV-2? Investigators from the National Clinical Research Center for Infectious Diseases in Shenzhen, China analyzed 347 serum samples from 41 RT-PCR confirmed COVID-19 patients (15 with mild-moderate symptoms, 16 with severe, and 10 with critical) admitted to The Third People’s Hospital of Shenzhen.Results revealed 39% of COVID-19 patients had seroconversion of IgG antibodies against SARS-CoV-2 nucleocapsid (N) protein and spike (S) glycoprotein in an average of 11 days after onset of symptoms, and 51.2% with seroconversion to IgM antibodies in an average of 14 days. Further, critical patients were found to have a delayed, but more robust IgG and IgM response. This understanding of antibody kinetics against SARS-CoV-2 may assist in clinical diagnosis, specifically in utilizing immunoassays as a testing tool during the pandemic.

Dec 12, 202004:07
November 30, 2020

November 30, 2020

In today's episode we discuss:

—Epidemiology: There is higher prevalence of pulmonary macrothrombi in SARS-CoV-2 than in influenza A. A comparative analysis by pathologists at University Hospital Zurich in Switzerland assessed pulmonary macrothrombi autopsy findings in 411 patients who died from the Influenza A pandemic in 1918/1919, 12 from Influenza A in 2009-2020, and 75 for COVID-19. They found COVID-19 patients had significantly higher occurrences of grossly visible pulmonary thrombosis despite empiric thrombophylaxis due to in situ clot formation associated with SARS-CoV-2. Authors suggest a specific COVID-19 coagulopathy may be linked to higher mortality rate seen in COVID-19 compared to the seasonal flu.

—Understanding the Pathology: In vivo demonstration of microvascular thrombosis in severe COVID-19 was found in one study where researchers in the Department of Internal Medicine, Ribeirão Preto School of Medicine in Brazil conducted imaging via video capillaroscopy of 13 severe COVID-19 positive patients requiring mechanical ventilation to assess sublingual microcirculation for evidence of microthrombi. They found microthrombi in 11/13 (85%) of patients and acute thromboembolic occlusion in 5/13 (38%) of patients. This evidence suggests that microvascular thrombosis could be considered a hallmark of COVID-19 and that these microvascular thrombotic events occur systemically, affecting many organ systems.  

—Management: Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients were explored by investigators in Stockholm, Sweden. They analyzed thromboprophylaxis and 28-day mortality among 156 patients with COVID-19-associated respiratory failure admitted to 2 local ICUs. Dosing was dependent on changes in regional guidelines over time and not patient severity. Results illustrated the following:  - 67 patients on low-dose thromboprophylaxis had a mortality rate of 38.8%  - 48 patients on medium-dose thromboprophylaxis had a mortality rate of 25%  - 37 patients on high-dose thromboprophylaxis had the lowest mortality rate of 13.5%  These findings suggest that starting critically ill patients on high-dose thromboprophylaxis maybe a beneficial strategy in reducing thromboembolic events and mortality.

· Point-of-Care Ultrasound (POCUS) can be useful in managing ICU Patients with COVID-19. 

—Adjusting Practice During COVID-19: ewer motor vehicle collisions and higher alcohol involvement were seen in COVID-19 Pandemic trauma presentations in one trauma center. Medical students and physicians from the Medical College of Georgia compared trauma activations at their level 1 trauma center between March 1 and June 15, 2020 to trauma activations from the same time frame in the previous 5 years (2015-2019). While there was no difference in the number and distribution of trauma cases, they found fewer motor vehicle collisions (MVCs)(p=0.009704), higher incidence of alcohol involvement in traumas (p=2.26 × 10^-7), and longer average length of hospital stay (3.87 vs 5.39; p=8.488 × 10^-6) in 2020 compared to pre-pandemic years. Authors suggest the decreased number of MVCs is attributable to fewer drivers during pandemic-related lockdowns but recommend further investigation into factors influencing the observed increase in alcohol related trauma and longer hospital stays to better identify areas of potential preventative interventions.

Dec 12, 202004:34
November 25, 2020

November 25, 2020

In today's episode we discuss: 

—Transmission & Prevention: A review by biomedical engineers in Canada discusses the possibility of using animal models including rhesus macaques, hamsters, and ferrets to help guide research on COVID-19 vaccine development. They also describe 8 current vaccine platforms, including 139 vaccine candidates in pre-clinical evaluation and 26 in clinical evaluation, and highlight the importance of introducing an effective COVID-19 vaccine to return to pre-pandemic life.

—Management: Emergency Medicine and Cardiovascular physicians from Mayo Clinic conduct a review reporting an increased risk of cardiac involvement in athletes with COVID-19: they discuss how 10-27.8% of all hospitalized COVID-19 patients have evidence of myocardial injury, of these 78% have arrhythmias, and note that myocarditis accounts for up to 22% of cardiac deaths in young athletes (

—Mental Health & Resilience Needs: Mental health experts performed a systematic review of 44 studies (54,231 participants across 13 countries) assessing the prevalence of sleep problems during the pandemic and found pooled prevalence of sleep problems was 35.7%, with COVID-19 patients being most affected (74.8%), followed by healthcare workers (36%), and the general public (32.3%), suggesting that sleep problems are common during the pandemic, particularly among COVID-19 patients, and encourage implementing strategies to mitigate adverse effects in these populations.

Dec 07, 202002:28
November 24, 2020

November 24, 2020

In today's episode we discuss: 

—Epidemiology: Body Mass Index is correlated with Risk for Intubation or Death in SARS-CoV-2 Infection according to a retrospective cohort study. The study, conducted at Columbia University Irving Medical Center, investigated the association between body mass index (BMI) and risk for intubation or death, inflammation, cardiac injury, or fibrinolysis from SARS-CoV-2 infection in 2,466 hospitalized COVID-19-positive adults. Compared to overweight patients, patients with class 3 obesity had the highest risk of intubation or death (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]), though these effects were most clear in patients less than 65 years old. BMI was not associated with admission levels of biomarkers for inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiac injury (troponin level), or fibrinolysis (D-dimer level). These results support previous studies showing increased risk of severe complications in overweight individuals, though this study also shows that other clinical correlates may demonstrate this increased risk upon admission.

—Management: Association of SARS-CoV-2 genomic load trends with clinical status in COVID-19 were found in a study of 42 COVID-19 patients with associated pneumonia admitted to NYU Langone Medical Center. Investigators analyzed each patients' genetic load of SARS-CoV-2 Cycle threshold (Ct) by rapid RT-PCR versus their Sequential Organ Failure Assessment (SOFA) score and found a statistically significant inverse correlation between the change in Ct value and change in clinical SOFA score. These findings suggest that a “decrease in viral load over time was associated with clinical improvement," highlighting the potential use of SARS-CoV-2 genomic load as a potential predictive value in disease outcome.

—Adjusting Practice During COVID-19: There may be increased susceptibility to SARS-CoV-2 infection in patients with reduced left ventricular ejection fraction. Cardiovascular and regenerative medicine researchers at the Université de Strasbourg in France followed-up via telephone interviews with 889 acute coronary syndrome patients who received percutaneous coronary intervention. They found that the incidence of COVID-19-associated hospitalization or mortality was significantly greater in patients with reduced left ventricular ejection fraction (LVEF, n=91) versus patients with moderately reduced and preserved LVEF (n=798; 9% versus 1%, P 60; 0.001). Further, they observed that reduced LVEF was an independent predictor of COVID-19 hospitalization or mortality via multivariate logistic regression (OR: 6.91; 95% CI: 2.60-18.35, P 60; 0.001), suggesting that COVID-19 testing and treatment plans should be considered for patients with reduced cardiac function.

Dec 07, 202003:12
November 23, 2020

November 23, 2020

In today's episode we discuss: 

—Understanding the Pathology: Truncation of orf3b in the circulating SARS-CoV-2 strains has been shown in one study. Microbiologists and Infectious Disease researchers from the University of Hong Kong analyze the genome of SAR-CoV-2 with a particular focus on the orf3b gene, which was found to antagonize type-I interferon activation. Using the sequence data from the GISAID depository, they report a steady increase and persistence of the truncated form of the orf3b gene in SARS-CoV-2 strains worldwide, particularly in countries with the highest confirmed number of COVID-19 cases. The authors note that further research on orf3b's truncation in context with COVID-19's transmissibility and infectivity could be beneficial for guiding future therapeutic and diagnostic developments.

—R&D: Diagnosis & Treatments: Convalescent plasma anti-SARS-CoV-2 spike protein ectodomain and receptor-binding domain IgG correlate with virus neutralization. Researchers primarily at Houston Methodist Hospital analyzed samples of plasma from 68 recovered COVID-19 patients, 2,814 asymptomatic patients, and 10 naive human plasma specimens to investigate the relationship between different neutralizing antibodies and possible ways to screen plasma samples for a virus neutralization (VN) titer ≥ 160.

· There is lack of efficacy of standard doses of ivermectin in severe COVID-19 patients according to a retrospective controlled cohort study. Specialists in global health and infectious disease from Hospital Clinic-Universitat de Barcelona, Spain evaluated efficacy of standard doses of ivermectin in 13 patients with severe COVID-19 against 13 controls without ivermectin. They found no significant differences in clinical or microbiological outcomes between the two groups after 8-11 days of treatment (p >0.999). Authors acknowledge the small sample size in this study, but suggest their results warrant further research involving high-dose ivermectin to better evaluate its efficacy in patients with severe COVID-19.

Dec 07, 202003:16
November 20, 2020

November 20, 2020

In today's episode we discuss:

—Epidemiology: A retrospective case series conducted by radiologists from Zucker School of Medicine at Hofstra/Northwell in Manhasset, NY evaluated imaging features of six patients (all >65 years old) who presented to the emergency department with PCR-confirmed moderate-to-severe SARS-CoV-2 infection that was complicated by thromboembolic events. These authors suggest a hyper-inflammatory state secondary to SARS-CoV-2 infection may increase susceptibility to systemic thrombosis and recommend venous thromboembolism (VTE) prophylaxis in severe COVID-19 cases.

—Understanding the Pathology: Australian pulmonologists respond to recently published data by Mo et al, 2020 that showed diffusion capacity of carbon monoxide (DLCO) and carbon monoxide transfer coefficient (KCO) in COVID-19 patients reduced by 50% and 25% after recovery, respectively. They caution against interpreting these findings as attributable only to reduced alveolar volume and instead propose that lung fibrosis in COVID-19 associated acute respiratory distress syndrome (ARDS) may lead to loss of alveolar units and disrupt the alveolar-capillary barrier. Since pulmonary vascular abnormalities (i.e. vascular pruning, reduced blood flow) may alter DLCO, authors recommend further studies using more specific measures (i.e. combined DLCO and DLNO measurements or advanced imaging techniques) to clarify the pathophysiology underlying reduced gas exchange.

—Management: Emergency Medicine and Critical Care physicians in Saudi Arabia conducted a prospective observational analysis using a point-of-care ultrasound (POCUS) with the Riyadh Residual Lung Injury in COVID-19 (RELIC) scale to predict the evolution of lung injury in 171 severe COVID-19 patients and found that the combination of the two modalities were able to predict evolving interstitial lung disease with a sensitivity of 0.82 (95% CI: 0.76–0.89) and specificity of 0.91 (95% CI: 0.94–0.95).

Dec 07, 202001:34
November 18, 2020

November 18, 2020

In today's episode we discuss:

—Epidemiology: Pediatric cardiologists from the Association for European Pediatric and Congenital Cardiology's COVID-19 Rapid Response Team evaluated 286 children with symptoms of multisystem inflammatory syndrome in children (MIS-C) and found 65% had laboratory evidence of current or past COVID-19 infection, 93% had cardiac involvement, and all had elevated inflammatory markers, suggesting pediatric patients with MIS-C should be monitored for cardiovascular complications and rising biomarkers.

· A literature review conducted by an international panel of pediatric dermatologists describes documented skin manifestations of COVID-19 in children including chilblain-like lesions, erythema multiforme, urticaria (10-20% of cutaneous manifestation reports), vesicular exanthema, and Kawasaki disease-like inflammatory syndrome (pediatric inflammatory multisystem syndrome with nonspecific skin symptoms and cardiovascular involvement).

—Understanding the Pathology: A retrospective cohort study by cardiac pathologists from the Mayo Clinic of post-mortem reviews of 15 patients with COVID-19, six patients with influenza, and six patients with no viral pathology found patients with COVID-19 were significantly more likely to have fibrin microthrombi (12/12 [100%] of COVID-19 vs 2/6 [33%] of influenza and control patients; p=0.006) and that these were found in a higher proportion of arterioles (p=0.003). One-third (33%) of COVID-19 patients had evidence of myocarditis and 26.7% evidence of amyloidosis.

· Investigators mainly from the Institute of Physiology in Berlin compared the respective plasma disruption to the lung epithelium between the plasma of 19 patients with severe COVID-19 (requiring intubation), 14 patients with moderate COVID-19 (requiring hospitalization but not intubation), and 15 healthy controls and found that addition of plasma from COVID-19 patients to healthy endothelial monolayers correlated with "significant endothelial gap formation and loss of junctional VE-cadherin". Additionally, when compared to the heathy control plasma, the plasma from COVID-19 patients not only resulted in increased severity of endothelial permeability but also rapid (within 1-2 hours) and long lasting (over 6 hours) effects, suggesting that endothelial-barrier-stabilizing adjunctive therapies administered to patients exhibiting signs of moderate to severe COVID-19 may delay progression to acute respiratory distress syndrome.

—Management: Neurosurgeons at the Laboratory of Experimental Neurosurgery and Cell Therapy in Milan, Italy compared blood samples from 47 healthy patients to samples from 111 SARS-CoV-2 positive patients and found sphingosine-1-phosphate (S1P) and apolipoprotein M (apoM; a carrier of S1P) levels were significantly decreased in COVID-19 patients compared to healthy patients (p

Nov 20, 202004:34
November 17, 2020

November 17, 2020

In today's episode we discuss:

—Epidemiology: Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection according to one study. Immunologists and infectious disease specialists at St. James’s Hospital in Dublin, Ireland examined prevalence of post-COVID-19 fatigue in 128 patients who had recovered from COVID-19 using the Chalder Fatigue Score (CFQ-11). They found 52.3% (67/128) of participants met the criteria for fatigue at a median of 10 weeks following initial symptoms and fatigue was associated with female gender and preexisting depression/anxiety, but data showed no association between total CFQ-11 score and age, disease course, or laboratory measures of inflammation. These results suggest post-COVID-19 fatigue may be more prevalent than previously understood, and authors advocate for further research among those with previous SARS-CoV-2 infection.

· An Outbreak of COVID-19 on an Aircraft Carrier Spreads Fast. Public Health experts affiliated with the U.S. Navy conducted an epidemiologic investigation of the COVID-19 outbreak on the U.S.S. Theodore Roosevelt. Results showed that of the 26.6% of crew (1271) who tested positive for SARS-CoV-2 via RT-PCR, nearly half were asymptomatic, more than 30% of symptomatic cases initially reported having cough and headache, and among 1331 suspected or confirmed cases, 23 were hospitalized, 4 received intensive care, and 1 died. The authors suggest that the confined and densely populated areas, as well as the relatively high number of asymptomatic cases, may have contributed to the fast spread of the COVID-19 cases on the Aircraft Carrier.

· Ultrasound Imaging Findings of Acute Testicular Infection in Patients With COVID-19 were explored by a team from the Department of Ultrasound Imaging at Wuhan University Renmin Hospital. It was a retrospective study of 142 male patients hospitalized with COVID-19 who underwent bedside scrotal ultrasound. They found 32 patients (22.5%) presented with findings of acute testicular inflammation: 10 with acute orchitis, 7 with acute epididymitis, 15 with epididymo-orchitis. There was a higher frequency in men >80 years-old  (p=0.003) and in the severe COVID-19 group (p=0.002). Authors suggest SARS-CoV-2 may infect the testicles and/or epididymis and recommend clinicians be aware of these genitourinary manifestations.

—Transmission & Prevention: United Kingdom’s definitions of vitamin D sufficiency and recommended supplement dose are set too low. UK  physicians in Infectious Disease, Endocrinology, Respiratory, and Gerontology conclude that the original threshold goal for vitamin D sufficiency, 25nmol/L, is too low and not evidence-based, suggesting that it should instead be set at 50 nmol/L and recommend supplementation with 800 IU per day. They speculate vitamin D deficiency as a risk factor for COVID-19 and advocate for an increase in the recommended Vitamin D supplement dose.

—Silver Linings: What was the impact of non-COVID-19 deaths after social distancing in Norway? American public health experts analyzed the effect of social distancing in Norway on non-COVID-19 deaths during March 16-May 18, 2020 using the Human Mortality Database’s Short-term Mortality Fluctuations data series.

Nov 20, 202004:32
November 16, 2020

November 16, 2020

In today's episode we discuss:

—Climate: The International COVID-19 Parental Attitude Study (COVIPAS) group conducted a cross-sectional survey of 1541 caregivers from six countries and found that 65% of caregivers were willing to vaccinate their child against COVID-19 whenever a vaccine became available, and that 52% of those refusing vaccination reported that the newness of the vaccine was a deciding factor. Authors suggest these findings demonstrate the need for effective public health education efforts regarding the safety, efficacy, and utility of any available COVID-19 vaccine

—Epidemiology: Massive dissemination of a SARS-CoV-2 Spike Y839 variant in Portugal was found. Bioinformatic and surveillance specialists from Portugal reviewed geotemporal spread of SARS-CoV-2 Spike 839Y variant, introduced from Italy to Portugal in February 2020, using 1,516 SARS-CoV-2 genome sequences collected as part of national surveillance. They found relative frequency increased at a rate of 12.1% every three days, and the Spike 839Y variant was associated with 24.8% of confirmed cases by the end of April. This variant has since been detected in 12 other countries, so authors suggest ongoing surveillance of SARS-CoV-2 genetic diversity and epidemiological monitoring of potentially significant variants.

· A retrospective study of 192 COVID-19 patients hospitalized at “Beato Matteo” (Hospital Group San Donato) conducted by internal and emergency medicine specialists in Vigevano, Italy found no significant association between having lupus anticoagulant (95/192, 49.5%) and mortality (47.7% of 130 survivors and 53.2% of 62 non-survivors; p=0.4745) or need for mechanical ventilation. However, worse outcomes were seen in patients with obesity, low oxygen saturation, and high troponin level. Authors suggest lupus anticoagulant is not a strong prognostic marker in COVID-19 patients and it may be a side effect of rather than a cause for thromboembolism.

—Management: What are the SARS-CoV-2 risks in first trimester pregnancy? A cohort study, conducted at Copenhagen University Hospital, examined potential risk caused by SARS-CoV-2 infection for first trimester pregnancies by analyzing double tests, which are blood samples for pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (β-hCG), of 1,019 pregnant women for SARS-CoV-2 antibodies. Results indicated SARS-CoV-2 infection early in pregnancy as 18 (1.8%) of the 1,019 pregnant women were positive for SARS-CoV-2 antibodies in their serum. However, there was not a significant correlation with nuchal translucency thickness nor increased risk of pregnancy loss between the women testing positive versus those testing negative for SARS-CoV-2 antibodies. While these results may be limited by sample size, population type, and severity of COVID-19 infection, this study demonstrates no increased risk of low-severity COVID-19 infections during the first trimester of pregnancy.

Nov 20, 202003:41
November 13, 2020
Nov 20, 202001:07
November 12, 2020

November 12, 2020

In today's episode we discuss:

—Epidemiology: A retrospective cohort study by physicians in Wuhan, China found no significant difference in levels of testosterone, follicle-stimulating hormone, or luteinizing hormone between 39 male patients with SARS-CoV-2 and 22 control patients without SARS-CoV-2 (p50 days of viral shedding  had elevated estradiol levels compared to those with shorter shedding duration (p

—Transmission & Prevention: An international group of vaccine development experts from the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) Working Group conducted a review of available literature regarding vaccine-associated enhanced disease and determined that the risk of COVID-19 VAED is similar to the risk associated with any other viral vaccine and acknowledge that the human experience of COVID-19 may differ from animal or in-vitro studies, recommending rigorous surveillance and phase 3 trials to evaluate safety and efficacy of any COVID-19 vaccine.

—Management: A retrospective cohort study by pediatricians in Florence, Italy of central precocious puberty (CPP) in girls presenting to their clinic during and after the Italian COVID-19 lockdown (March-July 2020) compared to the same period in 2015-2019 found more new cases of CPP in 2020 compared to previous years (37 vs. 16-19, p

—Adjusting Practice During COVID-19: A letter to the editor by The Netherlands Comprehensive Cancer Organization discusses derailed oncological care due to COVID-19 and subsequent reprioritization of health care services and determined that healthcare changes resulting from COVID-19 contributed to fewer breast and colorectal cancer diagnoses among age groups eligible for cancer screening, with slow return to expected rates following gradual restarts of cancer screenings. More information is needed to determine the long term clinical outcomes of decreased cancer screening and diagnoses, particularly whether these findings may represent decreased "overdiagnosis of particular early-stage cancers," but believe the trend warrants further investigation.

—R&D: Diagnosis & Treatments: Spanish immunologists investigated immunogenicity of cysteine-like protease (Mpro, a non-structural SARS-CoV-2 protein) by comparing samples from 36 COVID-19 patients diagnosed via RT-PCR versus 33 negative controls and, using ELISA (Mpro sensitivity 97% and specificity 100%), found high titers of IgG, IgM, and IgA against Mpro in serum and detected Mpro antibodies in all saliva samples collected from patients with the highest serum antibody titers, suggesting that detection of Mpro antibodies could be used to distinguish infected from non-infected individuals and that saliva tests could be used as a reliable, non-invasive test for seropositivity.

Nov 14, 202006:54
November 11, 2020

November 11, 2020

In today's episode we discuss:

—Epidemiology: An observation-based modeling study conducted at Columbia University analyzed reproductive numbers of COVID-19 in the United States and found a significant and rapid drop following social distancing and other control measures. Based on changes expected from such control measures in counterfactual models, a substantial number of cases and deaths could have been avoided if control measures were implemented 1 to 2 weeks earlier.

· An optimization model by mathematicians and data scientists using daily travel surveys, census data, and USPS building locations across various states estimated that >94% of Americans would travel to a nearby USPS facility (, suggesting that while high cost and additional precautions to protect USPS employees need to be considered, the USPS network has potential to provide greater ease of access to COVID-19 testing for a majority of Americans.

—R&D: Diagnosis & Treatments: A systematic review of 22 reports of rapid COVID-19 tests (n=3,198 total samples with 1,755 RT-PCR confirmed positive SARS-CoV-2 samples) published before May 25, 2020 revealed that antigen tests have variable sensitivity (average = 56.2%), while specificity was 99.5%; rapid molecular assays had a sensitivity of 95.2% and a specificity 98.9%; and calculated pooled results for individual tests revealed that Xpert Xpress assay had a summary sensitivity of 99.4% and specificity of 96.8%, while ID NOW assay had a summary sensitivity of 76.8% and a specificity of 99.6%.

Nov 14, 202002:31
November 10, 2020

November 10, 2020

In today's episode we discuss:

—Transmission & Prevention: Pediatricians published best practices for breastfeeding mothers who were positive for or exposed to COVID-19 in JAMA Pediatrics. The authors express that while the literature is uncertain on risk of COVID-19 transmission through breastmilk, this route of transmission seems unlikely, and protective antibodies are likely to be the only SARS-CoV-2 related material to be transmitted. They believe their proposed practices for breastfeeding while infected with COVID-19 will promote safe breastfeeding, although they note these suggestions may change overtime.

· Is there an association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19? Investigators on the STOP-COVID (Study of the Treatment and Outcomes in Critically Ill Patients With COVID-19) team retrospectively analyzed data of 3,924 COVID-19 patients from 68 US hospitals admitted to the ICU. They compared estimated 30-day mortality rates of patients that received tocilizumab (an IL-6 inhibitor) in the first 2 days of ICU admission verses those who did not. The researchers performed inverse probability weighting to ensure that baseline and severity of illness factors were balanced between the study groups. The results revealed an estimated 30-day mortality of 27.5% in patients treated with tocilizumab, compared to 37.1% in patients without tocilizumab, suggesting the drug's benefit in treatment of critically ill COVID-19 patients.    · Investigators affiliated with Yale School of Medicine performed a systematic review of 86 studies worldwide (n=2560 patients) on dermatologic manifestations in COVID-19 patients and found associations with chilblains/pernio like lesions at 51.5%, erythematous maculopapular rashes at 13.3%, and viral exanthem at 7.7%. Average time of skin lesion onset was 7.9 days after upper respiratory infection symptoms in adults and 1.5 days in children. These findings suggest that dermatologic manifestations may be another way to identify COVID-19 and better manage the spread of disease.    

—R&D: Diagnosis & Treatments: At what times during infection is SARS-CoV-2 detectable and no longer detectable using RT-PCR-based tests? A systematic review of 32 longitudinal studies examined the accuracy, temporal sensitivity, and optimal sampling sites and strategies for SARS-CoV-2. The authors reported on a total of 1,023 COVID-19 RT-PCR confirmed participants and 1,619 test results for 11 different sampling sites at various times during SARS-CoV-2 infection. They found that the highest rate of virus detection was within 4 days of symptom onset at 89%, which fell to 54% between 10 and 14 days. The authors discuss that the accuracy of RT-PCR is limited, early testing minimizes false negative results, and lower respiratory tract or fecal testing may be preferred sampling sites when testing more than a few days post symptom onset.

· There is clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections according to a cohort study conducted at Taipei Medical University Hospital (Taiwan), that analyzed potential biomarkers of SARS-CoV-2 infection in 174 patients (9 with nasal swab RT-PCR confirmed COVID-19, 24 with influenza confirmed via rapid-test, and 141 determined to have common URIs).

Nov 14, 202005:44
November 6, 2020

November 6, 2020

In today's episode we discuss:

—Epidemiology: How effective are public health measures, such as quarantine, in decreasing viral spread? An extended Susceptible–Infected–Recovered (SIR) model to estimate the case rate mortality (CFR) of COVID-19 in Wuhan and the rates of infection, recovery, and death globally revealed an estimated CFR of 4.4% and an estimated quarantine effect against transmission of 99.3%, highlighting the importance of adherence to public health quarantine policies in decreasing viral spread during the pandemic.

—Understanding the Pathology: What is the duration of SARS-CoV-2 antibodies in plasma after symptom onset? Infectious Disease researchers from China studied the prevalence of anti-SARS-CoV-2 specific antibodies in 52 convalescent COVID-19 patients (159 blood samples) from 1 to 6 months after symptom onset and found a positive rate of IgG (92.3%) and IgM (90.4%) antibodies in the first month, and continuously high IgG but downtrending IgM antibodies throughout the convalescent phase, suggesting retainment of anti-SARS-CoV-2 IgG antibodies up to at least 6 months post-infection.

—Adjusting Practice During COVID-19: Are patients receptive to at-home rehabilitation services? Cardiac rehabilitation specialists in Providence, RI conducted a retrospective study after initiating a transitional home-based cardiac, pulmonary, or vascular rehabilitation treatment plan for 129 patients between April 6, 2020, to May 27, 2020 (the time of temporary closure of in-person rehabilitation services) and found that about 90% of patients were receptive to participating in at-home rehabilitation services and 70% were responsive to follow-up progress tracking by telephone, suggesting that a home-based treatment is a viable option for treatment centers restricting in-person treatments during the COVID-19 pandemic.

Nov 12, 202002:35
November 5, 2020

November 5, 2020

In today's episode we discuss:

—Understanding the Pathology: Do childhood vaccines help protect against SARS-CoV-2? A team of Egyptian virologists inoculated mice with common childhood vaccines (BCG, Pneumococcal, Rotavirus, Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenzae, Meningococcal, Measles, Mumps, and Rubella) and found no evidence of cross-reacting antibodies against SARS-CoV-2 in serum up to seven weeks post-vaccination, suggesting that if childhood vaccines provide protection against SARS-CoV-2, it may not be antibody mediated.

—Transmission & Prevention: How often are discharged patients re-testing positive for SARS-CoV-2? A review of 62 studies evaluating recurrence of SARS-CoV-2 viral RNA in discharged COVID-19 patients found that the proportion of patients with re-positive RT-PCR ranged from 2.4% to 69.2% across studies, occurring from 1-38 days after discharge, which was attributed to false-negative tests prior to discharge, false positive tests following discharge, reinfection, reactivation, and intermittent viral shedding.

—Adjusting Practice During COVID-19: What treatment options should physicians consider for patients with psoriasis? Following a literature review, dermatologists from Tehran, Iran recommend not starting immunosuppressive drugs for psoriatic patients due to an increased risk of acquiring COVID-19 and instead encourage initiating and continuing low-risk immunomodulating drugs as a safer modality.

—R&D: Diagnosis & Treatments: Is there a correlation between vitamin D levels and COVID-19 severity? A retrospective study conducted by various medical institutions in Tehran, Iran investigated 73 subjects with confirmed COVID-19 and found mean serum vitamin D (25[OH]D) concentrations were significantly lower in the deceased compared to discharged patients, and higher 25(OH)D levels were associated with less extensive lung involvement, suggesting a potential correlation between vitamin D status and clinical course, extent of lung involvement, and patient outcome in COVID-19.

Nov 12, 202003:43
November 4, 2020

November 4, 2020

In today's episode we discuss:

—Understanding the Pathology: Should we be testing for more than SARS-CoV-2 antibodies? Microbiologists, pathologists, and public health experts associated with Mount Sinai Hospital analyzed 3277 blood specimens from recovered COVID-19 patients and found that neutralizing antibody level is the highest 31-35 days post symptom onset, even though general SARS-CoV-2 antibody levels had been high (well above the 160 titer range cutoff) long before this, suggesting the importance of also testing for neutralizing antibodies.

—Transmission & Prevention: How do close contact and aerosol transmission risks compare? Swiss environmental engineers applied a Quantitative Microbial Risk Assessment (QMRA) to evaluate SARS-CoV-2 infection risk via aerosol transmission and close indoor contact using dose-response mice models and infection risk data from meta-analyses and found lower infection transmission risk via aerosol exposure within one hour (10^-6 to 10^-4) compared to close contact (10^-1; 12.8% risk within 1m) in a typically ventilated room (10-400 square-meters) with one infected person. Close contact may pose higher infection risk than aerosol transmission, but suggest real-life circumstances (i.e. prolonged exposure, higher density) could heighten risk of aerosol transmission not accounted for in this analysis.

—R&D: Diagnosis & Treatments: Polyester or foam nasal swabs: which is better? A comparative analysis investigated sensitivity of polyester and foam nasal swabs stored in viral transport media (VTM), saline, or dry tubes from 126 convalescent COVID-19 patients and found polyester and foam swabs had sensitivities of 87.3% versus 94.5% in VTM, 87.5% versus 93.8% in saline, and 75.0% versus 90.6% in dry tubes, respectively. Polyester swabs had higher cycle threshold values and decreased performance compared to foam swabs when viral loads were near detection threshold, but because estimated sensitivity above 87% was deemed sufficient for times of public health emergency, polyester swabs stored in VTM or saline may suffice in settings where swab shortages exist.

—Mental Health & Resilience Needs: How do science literacy and neurological mechanisms contribute to false beliefs? A Behavioral Neurologist from University of California, San Francisco describes that the neural mechanism behind false beliefs in COVID-19 conspiracy theories and science denial in healthy individuals is similar to those that have Lewy body dementia or Fronto-temporal dementia, concluding that “developing frontal circuitry to support the process of reasoning is part of education and science literacy and stands at the core of a healthy democracy.” Establishing this is the responsibility of the medical and scientific community through changes in the education system and working with political officials.

Nov 08, 202004:23
November 3, 2020

November 3, 2020

In today's episode we discuss:

—Climate: Hospital Volumes during the COVID-19 Pandemic in 2 US Medical Centers, Stanford University Medical Center and New York-Presbyterian/Weill Cornell Medical Center,  were explored with the incidence of 5 medical emergencies: acute MI, ischemic stroke, nontraumatic subarachnoid hemorrhage, ectopic pregnancy, and appendicitis. Authors found decreased incidence of acute myocardial infarction, non-traumatic subarachnoid hemorrhage, and ischemic stroke cases in both centers, a decrease in appendicitis cases in New York, and no changes in ectopic pregnancy cases at either center. They implicate that deferring seeking care for acute conditions due to the fear of contracting COVID-19 could be leading to the higher rates of at-home death of patients during the pandemic.

—Transmission & Prevention: Operation Warp Speed's Strategy and Approach are outlined by an affiliated physician scientist. It is a partnership of the Department of Health and Human Services, Department of Defense, and the private sector. Their goal is to advance “development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics” to establish control over the COVID-19 pandemic. The initiative set objectives of delivering ~300 million doses of the SARS-COV-2 vaccine by mid-2021 with strict criteria by which companies have to comply in order to be accepted. Currently there are “eight vaccines in [their] portfolio which include “Moderna and Pfizer/BioNTech (both mRNA), AstraZeneca and Janssen (both replication-defective live-vector), and Novavax and Sanofi/GSK (both recombinant-subunit-adjuvanted protein).

Management: Among 89 COVID -19 ICU Patients at Newark Beth Israel Medical Center one study found 8.9% (n=8) developed nosocomial candidemia over an average ICU stay of 25 days. Compared to the control, they found that COVID-19 ICU patients with higher BMI, prolonged mechanical ventilation, and superimposed bacterial infections were associated with concomitant candidemia, but in-hospital mortality was not significantly changed. Authors suggest that providers be aware of systemic fungal infections as a potential complication in COVID-19 ICU patients.    

—R&D: Diagnosis & Treatments: The efficacy and safety of SARS-CoV-2 Neutralizing Antibody LY-CoV555, an antispike neutralizing monoclonal antibody,  were analyzed in a randomized, double-blind, controlled trial. The investigators examined the antibody's effect on viral load, symptom scores, and clinical outcome of 452 patients across 41 centers in the United States receiving one of three doses (700 mg, 2800 mg, or 7000 mg) or a placebo. Although the authors acknowledge the need for further studies, the trial so far indicates possible reduction in symptom severity and a reduction in viral load with higher doses of LY-CoV555, suggesting that LY-CoV555 could become a useful treatment for patients with a recent diagnosis of COVID-19.    

—Mental Health & Resilience Needs: Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic were examined in a survey of 248 adolescents in the urban areas of New South Wales, Australia.

Nov 08, 202004:42
November 2, 2020

November 2, 2020

In today's episode we discuss:

—Climate: No-Fault Compensation for Vaccine Injury and Equitable Access to Covid-19 Vaccines are explored by Public Health experts associated with Yale University. They discuss the concept of Vaccine Nationalism, the creation of the COVAX facility, and the plight of low- and middle-income countries during the COVID-19 pandemic. To address the concerns regarding the benefits and risks of the COVID-19 vaccine as well as vaccine manufacturers protection and liability, the authors suggest utilizing a no-fault compensation for vaccine injury.

—Epidemiology:  A compromised specific humoral immune response against the SARS-CoV-2 receptor-binding domain is related to viral persistence and periodic shedding in the gastrointestinal tract according to a cohort study conducted by various medical institutions in Shenzhen and Guangzhou, China. They found 21/289 Chinese patients with COVID-19 were readmitted due to persistent SARS-CoV-2 positivity. Among them, anal viral detection was positive in 15/21 (71.4%) patients and there was replication in the GI tract in 3/16 (18.7%) patients, with no respiratory tract replication. They hypothesize there is viral rebound due to decreased levels of IgA and IgG antibodies to the viral receptor-binding domain (RBD) and thus, a lack of protective humoral immune response suggesting this leads to persistence of SARS-CoV-2 in the GI tract along with active viral shedding.

—Transmission & Prevention: Climatic influence on the magnitude of COVID-19 outbreak was explored via a stochastic model-based global analysis. Researchers evaluated the effect of climates on COVID-19 transmission in 228 cities across 3 climatic zones. They found that the temperature and humidity may be major contributors to COVID-19 transmission. Average temperatures and relative humidity were the primary contributors in Europe, diurnal temperatures were most important for India, and temperature seasonality was most important for Brazil. These findings highlight the relationship between climates and COVID-19 spread and provide more insight into COVID-19 transmission.

—R&D: Diagnosis & Treatments: Two sample pooling strategies for SARS-CoV-2 RNA detection for efficient screening of COVID-19 were compared. Using 23 pools each containing 1 positive sample and either 5 or 9 negatives, authors demonstrated a similar diagnostic sensitivity to individual tests (p

Nov 04, 202004:44
October 29, 2020

October 29, 2020

In today's episode we discuss:

—Epidemiology: An online survey of 1777 pregnant and postpartum women conducted in Japan found high prevalence of prenatal anhedonia, depression, and anxiety (17%; evaluated via Edinburgh Postnatal Depression Scale [EDPS]), which was positively correlated with perceived risk of contracting COVID-19, concerns regarding financial effects of the pandemic, and lack of social support during the COVID-19 pandemic.

—Understanding the Pathology: A prospective observational study conducted at Infanta Leonor University Hospital in Madrid, Spain from analyzed 26 COVID-19 positive patients with pulmonary embolisms (PE) who were screened for deep vein thrombosis (DVT) via compression ultrasound and found just 2 had evidence of DVT on compression ultrasound, one in their left popliteal vein and the other in their left femoral vein.

—Transmission & Prevention: Researchers from Brazil analyzed results of 4,353 RT-PCR SARS-CoV-2 tests and 2,275 SARS-CoV-2 antibody tests of patients with known blood types collected before June 22, 2020 and found an insignificantly higher infection rate in individuals with type A blood compared to type O blood, indicating that ABO blood types may have a less direct effect on rates of SARS-CoV-2 infections than previously predicted and that altered rates of infection may be mediated by other qualities of the population being studied.

—Management: A prospective observational study conducted in Spain examined the complete blood count (CBC) and cell population data (CPD), via XN20 analyser, of 153 COVID-19 patients and 72 bacterial infection patients and found neutrophil-to-lymphocyte ratio (NLR) values helped distinguish COVID-19 and bacterial infections (positive predictive value 74.1%, negative predictive value 97.1%), suggesting that NLR, along with other CBC and CPD values, may assist in accurately differentiating infectious etiologies during the COVID-19 pandemic.

Nov 04, 202003:01
October 26, 2020

October 26, 2020

In today's episode we discuss: 

—Climate: Navigating through health care data showed disruption by the COVID-19 pandemic and was found to be variable and potentially unreliable due to the pandemic's effects on health-seeking, patient triage, and overall outcomes. Authors note that analytic methods for many study designs rely on the assumption that these factors are constant over time. They suggest that researchers should be cognizant of this disruption when planning studies and performing analyses in order to prevent potential confounding biases in future research studies.

—Management: Longitudinal profile of laboratory parameters and their application in the prediction for fatal outcome among 642 hospitalized patients infected with SARS-CoV-2 were evaluated and authors found that abnormal lactate dehydrogenase, urea, lymphocyte count, and procalcitonin levels were predictors of death during the acute phase (days 1-9), in addition to abnormal procalcitonin, lactate dehydrogenase, lymphocyte count, monocyte percentage, and cholinesterase being predictors of death in the critical phase (days 10-15). This study suggests that these labs should be followed as markers for prognosis and aggressive care should be considered should abnormalities in these markers arise.

—Adjusting Practice During COVID-19: Powered air purifying respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among healthcare workers during the COVID-19 outbreak according to a study evaluating cerebral hemodynamic changes using Transcranial Doppler (TCD) of the middle cerebral artery (MCA) flow among 154 COVID-19 healthcare workers, of whom 123/154 developed de-novo headache due to N95 use (38/154 had preexisting migraine co-morbidity). Wearing an N95 increased Mean Flow Velocity (MFV) and ET-CO2, while Pulsatility Index (PI) decreased (p

—Mental Health & Resilience Needs: Mental health disorders may be related to COVID-19-related deaths based on a commentary by psychiatrists. The authors cite the Center for Disease Control and Prevention (CDC) June 2020 survey with 40.9% of participants reporting “at least one adverse mental or behavioral health condition," which is 3-4 times higher than one year ago. Health disparities and a distressed healthcare workforce are additional areas of concern. The authors recommend screening (e.g. trauma, grieving, depression, anxiety) by primary care physicians and mental health professionals as well as broad supportive public health strategies (e.g. online resources for grieving families) in an effort to identify and aid those in need of assistance.

Oct 28, 202003:46
October 23, 2020
Oct 28, 202001:38
October 21, 2020

October 21, 2020

In today's episode we discuss:

—Epidemiology: A 3-patient case series highlights the potential association between COVID-19 and pancreatitis in pediatric patients. The authors report this association based on temporal observations, asserting that clinicians should be aware of COVID-19 as a potential diagnosis in patients with extra-pulmonary presentations such as pancreatitis.

—Understanding the Pathology: A prospective cohort study of PCR-proven or presumed SARS-CoV-2 infected patients at a tertiary care hospital in the Netherlands found that complement factors C3a, C3c and the terminal complement complex (TCC) were elevated in COVID-19 patients sent to the ICU (n=75) compared to non-ICU COVID-19 patients (n=115; p

—R&D: Diagnosis & Treatments: A randomized controlled trial of patients hospitalized with COVID-19 pneumonia (n=126) conducted across 24 hospitals in Italy compared treatment with tocilizumab versus standard therapy and found 28.3% of patients who received tocilizumab worsened in clinical condition within 14 days compared to 27.0% who received standard of care, 3.3% in the tocilizumab group died versus 1.6% in the standard therapy group, and those who received tocilizumab had a higher incidence of adverse events overall than those who received standard therapy.

· A physician from the Division of Infectious Diseases at University of North Carolina at Chapel Hill examined studies on tocilizumab as a treatment for COVID-19 and found two randomized control trials (RTCs) met predefined efficacy thresholds via reduction of mechanical ventilation or death (EMPACTA, 28 day threshold; CORIMUNO-19, 14 day threshold), suggesting that observational studies have demonstrated a mortality benefit but current RCT data do not adequately support efficacy of tocilizumab in COVID-19 treatment and would recommend against routine use.

Oct 23, 202002:51
October 20, 2020

October 20, 2020

In today's episode we discuss:

—Epidemiology: Clinical features and outcomes of adults with COVID-19 admitted to the hospital based on a systematic review and pooled analysis of the literature

—Understanding the Pathology: Endotheliopathy is induced by plasma from critically-ill patients and associated with organ failure in severe COVID-19 based on a retrospective cohort study at Lille University Hospital assessing cytotoxicity of plasma from 28 patients (12 ICU and 16 non-ICU) hospitalized with COVID-19. Samples from COVID-19 patients had significantly decreased human pulmonary microvascular endothelial cells (HPMVEC) viability (p

—Transmission & Prevention: Regeneration Processes for Filtering Facepiece Respirators (FFRs) in Terms of the Bacteria Inactivation Efficiency and Influences on Filtration Performance were investigated through the ability of microwave irradiation (MWI), UV irradiation (UVI), MWI + UVI, steam, and ethanol. Authors found ethanol unacceptably reduced filtration efficiency while steam and MWI effectively decontaminated FFRs (100% inactivation in 90 min and 30 min, respectively) without sacrificing filtration, though long exposure to MWI did damage fiber morphology. While UVI successfully inactivated surface bacteria, efficiency decreased from outer to inner layers and authors suggest that a combination of UVI and short-duration MWI can best decontaminate used FFRs while maintaining filtration performance.

—Management: Anti-androgens may protect against severe COVID-19 outcomes based on results from a prospective cohort study of 77 hospitalized men.  The authors found patients taking anti-androgens (dutasteride [n=9], finasteride [n=2], spironolactone [n=1]) were significantly less likely to be admitted to the ICU than men not taking anti-androgens (p=0.0002), even after stratifying for age (p=0.018). Given the reduced risk of experiencing severe COVID-19 (RR: 0.14, 95% CI: 0.02-0.94), they suggest anti-androgens could be utilized therapeutically to improve COVID-19 disease course in men.

—Adjusting Practice During COVID-19: Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal Anti-VEGF Injections and transmission of COVID-19 were constructed by ophthalmologists in New Zealand through statistical model that weighed risks and benefits of performing anti-VEGF intraocular injections in patients with neovascular age-related macular degeneration (nAMD) during the COVID-19 pandemic. 

—R&D: Diagnosis & Treatments: Sensitivity of nasopharyngeal, oropharyngeal, and nasal wash specimens for SARS-CoV-2 detection in the setting of sampling device shortage was explored though a cross-sectional study comparing sensitivities of different samples for detection of ORF1 and E-protein genes via RT-PCR in 29 SARS-CoV-2 positive patients.


Oct 23, 202008:40
October 19, 2020

October 19, 2020

In today's episode we discuss:

—Epidemiology: Sex differential in COVID-19 mortality varies markedly by age  according to collated data from the National Institute for Demographic Studies of pooled aggregate rates of infection and mortality of almost 400 million COVID-19 patients in Europe and Korea. Mortality risk ratio was found to be higher in men (overall RR: 1.35, no measure of significance provided). This risk was increased between the ages of 40-79 (RR: 1.87, no measure of significance provided). Authors suggest their findings corroborate prior data reporting equivalent rates of SARS-CoV-2 infection between men and women but higher rates of mortality in men, and hypothesize that both social and genetic factors contribute to this disparity.

—Transmission & Prevention: COVID-19 Precautions Helped Limit Cases Linked to Milwaukee Primary. A Centers for Disease control case report described preventative measures enacted for the primary election in Milwaukee, Wisconsin which suggested that preventative measures such as mail-in ballots (69% of votes), early voting, social distancing, PPE for poll-workers, and frequent disinfection at polling sites (which were crowded due to reduction of polling sites from 181 to 5) resulted in no substantial increase in COVID-19 cases after the event.    

—Management: Anaemia is associated with severe illness in COVID-19 according to a retrospective cohort study (n total=222, n anemic=79). Authors found anemic patients developed more severe cases of COVID-19 compared to non-anemic patients (17.7% vs 8.1%, P=0.001; OR 3.77, 95%CI:1.33-10.71, P=0.013), though results were limited by sample size. Anemic patients also had demonstrably elevated inflammatory markers (CRP, ESR, PCT, lymphocyte count), increased incidence of coagulopathies, and greater magnitude of organ damage, though no level of significance was provided for these measures. Based on this, the authors posit anemia as an independent risk factor for progression to the severe form of COVID-19, and urge close attention to hemoglobin levels in confirmed COVID-19 patients.    

—Adjusting Practice During COVID-19: Outcomes of COVID-19 in 198 chronic lymphocytic leukemia (CLL) patients with CLL from 43 cancer care centers internationally yielded 90% hospitalized and an overall survival (OS) of 71% and 63% at 14 and 28 days, respectively. OS was not affected by whether patients were receiving CLL directed therapy (hazard ratio [HR], 0.77; 95% CI: 0.47-1.26; p = 0.30) or were on a "watch-and-wait" plan (HR, 0.83; 95% CI, 0.51-1.36; p = 0.47). Rather, age and CIRS score provided the largest impact on OS. Authors suggest that CLL patients are at greater risk for death from COVID-19, but different treatment plans for CLL have no effect on overall survival.

Oct 23, 202005:10
October 16, 2020

October 16, 2020

In today's episode we discuss:

—Climate: Decreased air pollution reported during the global shutdown due to the COVID-19 pandemic was "a brief respite" from the impacts of climate change, but in light of the global recession, governments and individuals will likely prioritize the economy and their health rather than the environment (decreased use of public transportation, more fossil fuel consumption, increased use of single use plastics), suggesting these behaviors will contribute to even worse air quality moving forward.

—Epidemiology: Italian sports medicine physicians conducted a cohort study of 30 male professional soccer players, all of whom were negative for acute SARS-CoV-2 infection via RT-PCR and reported histories of either no or mild symptoms of COVID-19, however 18 (60%) were positive for SARS-CoV-2 IgG and demonstrated a statistically significant decrease in spirometry parameters (p

—Transmission & Prevention: A retrospective cohort study of 2888 residents in a Guangzhou community with RT-PCR and genome sequencing of samples collected from the environment and residents found that working in waste management (RR=13, 95% CI: 2.3-180), failing to change into clean shoes at home (RR=7.4, 95% CIexact: 1.8-34), and coming home and cleaning shoes daily (RR=6.3, 95% CIexact: 1.4-30) were significantly associated with SARS-CoV-2 infection.

—Adjusting Practice During COVID-19: An international consortium of multidisciplinary cancer care experts from the European Society for Medical Oncology presents a set of statements encompassing 28 committee-approved guidelines for cancer care best practices during the SARS-CoV-2 pandemic that encompass 10 categories (patient management and follow-up, infection prevention, use of specific therapies [GC-SF, thromboembolism prophylaxis, targeted TKI, chemotherapy, radiation], immunotherapy utilization, COVID-19 testing, and clinical trial activity) and suggest that their guidelines offer the best strategy for providing high quality care to cancer patients during the COVID-19 pandemic while minimizing potential harm.

Oct 23, 202002:50
October 14, 2020

October 14, 2020

In today's episode we discuss:

—Epidemiology: Outcomes of COVID-19 in living donor liver transplant (LDLT) recipients are studied by hepatologists and leading liver transplant surgeons from the Institute of Liver Transplantation & Regenerative Medicine in Gurugram, India through a case series of 12 living donor liver transplant patients who tested positive for SARS-CoV-2 via RT-PCR. Most were symptomatic (n=11, 91.7%) with evidence of pneumonia on radiologic imaging (n=9, 75%) and with median duration of detectable virus of 12 days. While the majority (n=10, 83.3%) were on tacrolimus-based immunosuppression, all but one patient (n=11, 91.7%) survived with only supportive care. Because the patient who died had multiple other risk factors for severe COVID-19 (quadruple immunosuppression, hypertension, metabolic syndrome, diabetes), these authors suggest that liver transplant patients as a whole are not at particularly increased risk for mortality from COVID-19.

· Hematological manifestations of SARS-CoV-2 in children  are explored in a review of 15 articles meeting study criteria and found children with SARS-CoV-2 were less likely to be lymphopenic compared to adults, with the most common abnormalities being leukopenia in older children and lymphocytosis in infants/neonates. Thrombotic complications and platelets and erythrocytes abnormalities were relatively uncommon and more likely in children with multisystem inflammatory syndrome. Authors suggest these findings, which contrast hematologic changes observed in adults, may be a result of pediatric patients' immature ACE-2 expression and immune systems.

—Understanding the Pathology: Mechanisms by Which SARS-CoV-2 May Impact Male Fertility are discussed in a letter to the editor based on Dutta and Sengupta’s article "SARS-CoV-2 and male infertility: possible multifaceted pathology." They propose viral binding to angiotensin-converting enzyme 2 receptors on spermatogonia, Leydig cells, and Sertoli cells may cause overactivation and negatively impact spermatogenesis. Additionally, they urge further studies on SARS-CoV-2's ability to disrupt sperm formation and function because SARS-CoV-2 seems to disproportionately impact males in some studies.    

—R&D: Diagnosis & Treatments: REGN-COV2 antibodies prevent and treat SARS-CoV-2 infection in certain species based on virologists from Regeneron Pharmaceuticals results from an in vivo study of their proprietary therapeutic cocktail REGN-COV2's (human antibodies REGN10933, REGN10987) ability to reduce viral load via SARS-CoV-2 spike protein binding in resus macaques and golden hamsters. They found a 50 mg/kg dose significantly reduced SARS-CoV-2 gRNA (p

Oct 20, 202003:59