Up-to-date information on hearth health, respiratory & COVID-19.

The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

International Journal of Cardiology, September 25, 2020

There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus. We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients. MultivariatQe analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27–1.03; p = 0.06). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60–70, 70–80 and > 80 years vs < 60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1–3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21–0.62; p < 0.0001).


Heart rhythm in COVID-19 patients receiving short term treatment with hydroxychloroquine

European Society of Cardiology, September 25, 2020

[Press Release] Short-term hydroxychloroquine treatment is not associated with lethal heart rhythms in patients with COVID-19 who are risk assessed prior to receiving the drug. That’s the finding of research published today in EP Europace, a journal of the European Society of Cardiology (ESC). “This was the largest study to assess the risk of dangerous heart rhythms (arrhythmias) in COVID-19 patients treated with hydroxychloroquine,” said study author Dr. Alessio Gasperetti of Monzino Cardiology Centre, Milan, Italy and University Hospital Zurich, Switzerland. “In our cohort, there was a low rate of arrhythmias and none were associated with hydroxychloroquine.” The study began when there was very little experience using hydroxychloroquine to treat patients with COVID-19. Current evidence suggests that it is ineffective in patients with advanced disease but there is debate around its effectiveness in the early phase. This study was not designed to test the effectiveness of hydroxychloroquine in COVID-19 but rather to examine cardiac safety.


Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study

European Heart Journal, September 24, 2020

Coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been associated with cardiovascular features of myocardial involvement including elevated serum troponin levels and acute heart failure with reduced ejection fraction. The cardiac pathological changes in these patients with COVID-19 have yet to be well described. In this international multicentre study, cardiac tissue from the autopsies of 21 consecutive COVID-19 patients was assessed by cardiovascular pathologists. The presence of myocarditis, as defined by the presence of multiple foci of inflammation with associated myocyte injury, was determined, and the inflammatory cell composition analysed by immunohistochemistry. Other forms of acute myocyte injury and inflammation were also described, as well as coronary artery, endocardium, and pericardium involvement. Lymphocytic myocarditis was present in 3 (14%) of the cases. In two of these cases, the T lymphocytes were CD4 predominant and in one case the T lymphocytes were CD8 predominant. Increased interstitial macrophage infiltration was present in 18 (86%) of the cases. A mild pericarditis was present in four cases. Acute myocyte injury in the right ventricle, most probably due to strain/overload, was present in four cases. There was a non-significant trend toward higher serum troponin levels in the patients with myocarditis compared with those without myocarditis.


Training and Education: New Strategies For New Times

Cardiology, September 24, 2020

Much has changed this year, but one thing that remains the same is the need for training and ongoing education. Our task as physicians is to stay up to date and learn and collaborate to deliver the best patient care, and using our phones, tablets and personal computers we can do all that. While we all miss the in-person scientific meetings, there are many resources available to help us learn new techniques, innovations, devices and medications that will help our patients. Virtual education activities have evolved allowing us to continue to learn from experts in the field, and not disrupt our workflow. Here are some of the ways I’m keeping up by M. Chadi Alraies, MD, FACC, director of interventional cardiology research at Detroit Medical Center in Michigan.


Stroke occurs frequently in COVID-19, leads to ‘devastating consequences’ for patients

Helio | Neurology, September 23, 2020

Respiratory symptom severity served as the most significant indicator of in-hospital mortality among patients with COVID-19 who had a stroke, according to a systematic review published in Neurology. Older age and a greater number of cardiovascular comorbidities also correlated with in-hospital mortality in this patient population, study findings demonstrated. “To date, relatively little is known about the frequency, clinical characteristics and outcomes of acute cerebrovascular events in patients with COVID-19,” the researchers wrote. “We hypothesized that stroke is a frequent complication among COVID-19 patients, that in-hospital mortality is higher in patients with stroke and COVID-19 compared to historical non-COVID-19 cohorts, and that young patients would show a higher mortality due to a higher incidence of large vessel occlusion (LVO).” The researchers added that the burden on the health care system and other factors related to the pandemic have led the frequency of stroke events to be underestimated. The intended outcomes of the review were to estimate the proportion of COVID-19 patients who experience stroke; analyze their comorbidities, clinical characteristics and outcomes; determine clinical phenotypes; and compare in-hospital mortality between those clinical phenotypes.


Pharmacological and cardiovascular perspectives on the treatment of COVID-19 with chloroquine derivatives\

Acta Pharmacologica Sinica, September 23, 2020

Curative drugs specific for COVID-19 are currently lacking. Chloroquine phosphate and its derivative hydroxychloroquine, which have been used in the treatment and prevention of malaria and autoimmune diseases for decades, were found to inhibit SARS-CoV-2 infection with high potency in vitro and have shown clinical and virologic benefits in COVID-19 patients. Therefore, chloroquine phosphate was first used in the treatment of COVID-19 in China. Later, under a limited emergency-use authorization from the FDA, hydroxychloroquine in combination with azithromycin was used to treat COVID-19 patients in the USA, although the mechanisms of the anti-COVID-19 effects remain unclear. Preliminary outcomes from clinical trials in several countries have generated controversial results. Here, we provide pharmacological and cardiovascular perspectives on the application of chloroquine derivatives in the treatment of COVID-19. Systematic evaluations of their efficacy and safety, especially of the potential cardiovascular toxicity of chloroquine and hydroxychloroquine and combination therapies with other drugs in the treatment of COVID-19, and genetic variability in the metabolism of these drugs in patients are required to prevent lethal cardiovascular adverse events.


Routine blood test may predict mortality risk in patients with COVID-19

Helio | Primary Care, September 23, 2020

A standard test that evaluates blood cells can help identify patients hospitalized with COVID-19 who are at an elevated risk for death, according to research published in JAMA Network Open. “We were surprised to find that one standard test that quantifies the variation in size of red blood cells — called red cell distribution width, or RDW — was highly correlated with patient mortality, and the correlation persisted when controlling for other identified risk factors like patient age, some other lab tests, and some pre-existing illnesses,” Jonathan Carlson, MD, PhD, an instructor in medicine at Massachusetts General Hospital, said in a press release. In their cohort study, Carlson and colleagues retrospectively analyzed adult patients with SARS-CoV-2 infection who were admitted to one of four participating hospitals in the Boston area from March 4 through April 28. As part of standard critical care, all patients had their RDW, absolute lymphocyte count and dimerized plasmin fragment D levels collected daily. According to the researchers, RDW reflects cellular volume variation, and elevated RDW (more than 14.5%) has previously been associated with an increased risk for morbidity and mortality in a variety of diseases, including heart disease, pulmonary diseases, influenza, cancer and sepsis. A total of 1,641 patients were included in the analyses. The final discharge among these patients was June 26, and there were no COVID-19-related readmissions through July 25.


COVID Death Toll Hits 200,000 in the U.S.

WebMD, September 22, 2020

Just over 6 months after the World Health Organization declared COVID-19 a pandemic, the United States has reached a grim milestone: the novel coronavirus death toll has climbed to a staggering 200,000. “It’s sobering. It’s a large number, and clearly it tells us that everything we’re doing right now to contain it needs to continue,” says Erica Shenoy, MD, associate chief of the Infection Control Unit at Massachusetts General Hospital. “Especially heading into the fall, where we don’t know if there will be a second surge, or if this will be compounded by other respiratory illnesses.” Doctors and scientists say the number sends a clear message: Although people are itching to return to pre-pandemic life, Americans should continue to wear masks, practice hand-washing hygiene, and keep physical distance from others. While the high death toll is a bleak glimpse into how severe the illness is, there are two silver linings: The numbers seem to be trending in the right direction, and researchers have had time to discover more about a virus that at first baffled even the world’s leading scientists.


Cardiology and COVID-19

Journal of the American Medical Association, September 22, 2020

The initial reports on the epidemiology of coronavirus disease 2019 (COVID-19) emanating from Wuhan, China, offered an ominous forewarning of the risks of severe complications in elderly patients and those with underlying cardiovascular disease, including the development of acute respiratory distress syndrome, cardiogenic shock, thromboembolic events, and death. These observations have been confirmed subsequently in numerous reports from around the globe, including studies from Europe and the US. The mechanisms responsible for this vulnerability have not been fully elucidated, but there are several possibilities. In the brief timeline of the current pandemic, numerous publications highlighting the constellation of observed cardiovascular consequences have emphasized certain distinctions that appear unique to COVID-19. Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gains entry via the upper respiratory tract, its affinity and selective binding to the angiotensin-converting enzyme 2 (ACE2) receptor, which is abundant in the endothelium of arteries and veins as well as in the respiratory tract epithelium, create a scenario in which COVID-19 is as much a vascular infection as it is a respiratory infection with the potential for serious vascular-related complications.


COVID vs Head, Heart, and Heparin—Recent developments of interest in cardiovascular medicine

MedPage Today, September 22, 2020

  • Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and “potently” blocks the virus, which could open up therapy options. (Cell)
  • The heightened focus on post-viral effects is what’s really novel about lingering heart damage after COVID-19, a piece in The Atlantic suggests.
  • Nearly 2% of COVID-19 patients sustain a stroke, with “exceedingly high” 34% in-hospital mortality, a meta-analysis showed. (Neurology)
  • Johns Hopkins Hospital turned its interactive gaming room for stroke rehabilitation into a staff decompression space during the COVID-19 lockdown.

COVID-19 mortality rates higher among men than women

Science Daily, September 22, 2020

A new review article from Beth Israel Deaconess Medical Center (BIDMC) shows people who are biologically male are dying from COVID-19 at a higher rate than people who are biologically female. In a review published in Frontiers in Immunology, researcher-clinicians at BIDMC explore the sex-based physiological differences that may affect risk and susceptibility to COVID-19, the course and clinical outcomes of the disease and response to vaccines. “The COVID-19 pandemic has revealed a striking gender bias with increased mortality rates in men compared with women across the lifespan,” said corresponding author Vaishali R. Moulton, MD, PhD, an assistant professor of medicine in the Division of Rheumatology and Clinical Immunology at BIDMC. “Apart from behavioral and lifestyle factors that differ between men and women, sex chromosome-linked genes, sex hormones and the microbiome control aspects of the immune responses to infection and are potentially important biological contributors to the sex-based differences we’re seeing in men and women in the context of COVID-19.”


ACIP Mulls Priority Groups for COVID-19 Vaccines

MedPage Today, September 22, 2020

Members of the CDC’s Advisory Committee on Immunization Practices (ACIP) meeting Tuesday appeared to agree that healthcare workers should be first in line to receive a COVID-19 vaccine when one is approved, followed by some combination of essential workers, those with high-risk medical conditions, and older adults. However, with no formal vote taken — that won’t happen until one or more vaccines are authorized or approved by the FDA for clinical use — it’s not yet official policy, and not much was settled about priorities for later rounds of immunizations. ACIP chair José Romero, MD, said once data is available from phase III clinical trials, an ACIP work group will conduct an independent review of its safety and efficacy. “If and when the FDA authorizes or approves vaccines, ACIP will have an emergency meeting and then vote on recommendations and populations for use,” he said.


Viral heart damage under scrutiny

Science, September 18, 2020

Fears that COVID-19 can cause the cardiac inflammation called myocarditis have grown, as doctors report seeing previously healthy people whose COVID-19 experience is trailed by myocarditis-induced heart failure. Mohiddin recently treated 42-year-old Abul Kashem, who had typical COVID-19 symptoms in April, including loss of smell and mild shortness of breath. A month later, he fell critically ill from severe myocarditis. “I’m just grateful to be alive,” says Kashem, who spent more than 2 weeks in an intensive care unit. Why did this happen? How the virus might damage heart muscle is just one question researchers are now probing. Other studies are following people during and after acute illness to learn how common heart inflammation is after COVID-19, how long it lingers, and whether it responds to specific treatments. Researchers also want to know whether patients fare similarly to those with myocarditis from other causes, which can include chemotherapy and other viruses. In more than half of virus-induced cases, the inflammation resolves without incident. But some cases lead to arrhythmia and impaired heart function, or, rarely, the need for a heart transplant. Because millions are now contracting the coronavirus, even a small proportion who suffer severe myocarditis would amount to a lot of people. “Are we going to have an increase of patients with heart failure secondary to this?” asks Peter Liu, a cardiologist and chief scientific officer of the University of Ottawa Heart Institute.


Virtual medical education during the COVID-19 pandemic: how to make it work

European Heart Journal, September 18, 2020

The emergence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the cause of the COVID-19 pandemic, has brought many new challenges to healthcare workers around the globe. The number of COVID-19 patients started rising in the USA after the first reported case in January 2020. Physicians in training, an essential part of the healthcare system, have found themselves to be in critical positions as a direct result of the pandemic as they continue to care for patients and work to expand their medical knowledge and skills beyond books during this uncertain time. The Centers for Disease Control and Prevention (CDC) recommended sanitary and social distancing guidelines to be followed by individuals as a measure to contain the spread of COVID-19 in the USA. These guidelines include proper handwashing techniques and maintaining at least 6 feet distance from others in social and work settings whenever possible. Therefore, many medical facilities, institutions, and societies recognized the need to cancel most of the in-person lectures and conferences to ensure compliance with the CDC and minimize the risk of exposure of medical personnel. The CDC’s social distancing guidelines have given rise to innovative ways of continuing work and study productivity via virtual meetings using online platforms including, but not limited to, Microsoft Teams, Zoom, and WebEx. In this new normal, virtual meetings have provided a solution for physicians to continue receiving education, training, and communications. Though virtual meetings attempt to resemble in-person meetings as closely as possible, these have a different dynamic as the presenter and attendees find themselves speaking to a camera rather than to a physical audience. This virtual environment takes away from the human element of immediate feedback through non-verbal cues, but in return it provides benefit of remote attendance to keep attendees safe from contagion.


Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction

The American Journal of Emergency Medicine, September 17, 2020

The objective was to explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF), the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), Kaplan-Meier survival curves during the 28 days after the operation. The times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05).


Flu, COVID-19 or Both? Don’t Overlook Co-Infection, CDC Urges

MedPage Today, September 17, 2020

With overlapping signs and symptoms, surveillance, testing more important than ever. When a patient presents with acute respiratory symptoms this fall, clinicians should consider three options: influenza, COVID-19, or co-infection, CDC experts said. And given the likelihood that influenza and SARS-CoV-2 will be co-circulating in the community, clinicians should pay special attention to local surveillance data about each virus. On a CDC Clinician Outreach and Communication Activity call, CDC officials reminded clinicians that not only do influenza and COVID-19 have overlapping signs and symptoms, but co-infection with both has been documented in both case reports and case series. Co-infection, or even distinguishing SARS-CoV-2 from influenza, is particularly important because of the implications of treatment. For example, Uyeki noted that dexamethasone is recommended for severe COVID-19 infection in hospitalized patients, but corticosteroids actually prolong viral replication in influenza. Testing then becomes key in distinguishing the viruses, and Uyeki said that, as noted by Department of Health and Human Services officials, there are several kinds of “multiplex” assays that received FDA emergency use authorization (EUA), including some that received EUAs “this week,” he added.


Promising effects of exercise on the cardiovascular, metabolic and immune system during COVID-19 period

Journal of Human Hypertension, September 17, 2020
With 4 billion people in lockdown in the world, COVID-19 outbreak may result in excessive sedentary time, especially in the population of vulnerable and disabled subjects. In many chronic disorders and diseases including type 2 diabetes mellitus and hypertension, cardiovascular and immune beneficial effects of exercise interventions should be reminded. Direct metabolic and endocrine link between type 2 diabetes mellitus (T2DM), hypertension, and coronavirus SARS-CoV-2 disease (COVID-19) was recently reported. It is also important to note that with 4 billion people in lockdown in the world, COVID-19 outbreak may result in excessive sedentary time, especially in the population of vulnerable and disabled subjects. Indeed, this population is very dependent on the caregivers in charge of their rehabilitation, since the trip to the patients’ homes may be made more difficult during the outbreak. In many chronic disorders and diseases including T2DM and hypertension, cardiovascular, metabolic and immune, beneficial effects of exercise interventions have been reported. The intensity, volume, and mode of exercise may exert different activation of the hypothalamic-pituitary-adrenal axis, of the autonomous nervous system and of the resulting immunoregulatory hormones that influence immune response. Exercise interventions may affect susceptibility to infection, as they were shown to modify monocytes and lymphocytes distribution, phenotype and cytokine production.


Fabry Disease Patients Have An Increased Risk Of Stroke In The COVID-19 ERA. A Hypothesis

] Medical Hypotheses, September 17, 2020

Stroke is a severe and frequent complication of Fabry disease (FD), affecting both males and females. Cerebrovascular complications are the end result of multiple and complex pathophysiology mechanisms involving endothelial dysfunction and activation, development of chronic inflammatory cascades leading to a prothrombotic state in addition to cardioembolic stroke due to cardiomyopathy and arrhythmias. The recent coronavirus disease 2019 outbreak share many overlapping deleterious pathogenic mechanisms with those of FD and therefore we analyze the available information regarding the pathophysiology mechanisms of both disorders and hypothesize that there is a markedly increased risk of ischemic and hemorrhagic cerebrovascular complications in Fabry patients suffering from concomitant SARS-CoV-2 infections. There are 4 different pathophysiology mechanisms enhancing the risk of stroke in COVID-19 patients that overlap with those of FD including: renin angiotensin aldosterone imbalance, vasculopathy, thromboinflammation and cardiac damage.


HHS Outlines COVID Vax Distribution Strategy

MedPage Today, September 17, 2020

The Health and Human Services (HHS) department on Wednesday unveiled general outlines for how the first COVID-19 vaccine doses will be shipped and administered. Developed with the Department of Defense (DOD), the four-part strategy addresses engagement with state and local partners and other stakeholders; distribution under a “phased allocation methodology” still to be developed; safe vaccine administration and availability of auxiliary supplies; and data gathering via information technology to track distribution and administration. The strategy gives January 2021 as the target to begin distribution of an FDA-approved or authorized vaccine. Also released Wednesday was a COVID-19 Vaccination Program Interim Playbook from the CDC to assist local, state, tribal and territorial partners in rolling out their COVID-19 vaccination programs. The playbook identifies healthcare personnel and other essential workers as among the “critical populations,” although final decisions remain to be made by the CDC’s Advisory Committee on Immunization Practices.


Statin use prior to hospital admission benefits COVID-19 patients

Cardiovascular Business, September 17, 2020

Hospitalized COVID-19 patients are less likely to experience severe symptoms if they were taking statins prior to being admitted, according to a new observational study published in the American Journal of Cardiology. Statin use prior to admission was also associated with a faster time to recovery. Individuals with underlying cardiovascular disease (CVD), hypertension, and diabetes have been identified as groups at particularly high risk for developing severe COVID-19,” wrote lead author Lori B. Daniels, MD, UC San Diego Health in La Jolla, California, and colleagues. “Because a large proportion of patients with these conditions are on statins and either angiotensin-converting enzyme (ACE) inhibitors or angiotensinogen II receptor blockers (ARBs), there has been speculation about whether these cardiovascular medications may influence COVID-19 risk.” The authors tracked data from more than 5,000 patients hospitalized at a single healthcare facility from Feb. 10 to June 17, 2020. The cohort included 170 patients hospitalized for COVID-19, with all other patients serving as COVID-negative controls. Among the patients hospitalized for COVID-19, 56% were obese, 44% had a history of hypertension, 21% had CVD, 20% had diabetes, 18% had chronic kidney disease and 14% had cancer. Also, 27% of hospitalized COVID-19 patients were actively taking statins when first admitted, 21% were taking an ACE inhibitor and 12% were taking an ARB.


Efforts to prevent COVID-19 led to global decline in flu

Infectious Disease News, September 17, 2020

Interventions to prevent SARS-CoV-2 transmission have led to a global decline in influenza during the COVID-19 pandemic, researchers reported in MMWR. In addition to causing a significant drop in the percentage of respiratory specimens that tested positive for influenza in the early days of the pandemic in the United States, measures such as mask wearing, social distancing, school closures and telework have kept positive tests at “historically low interseasonal levels,” the researchers said. The Southern Hemisphere has experienced a similar effect. If the measures continue through the fall, the influenza season in the U.S. “might be blunted or delayed,” according to the report. “The global decline in influenza virus circulation appears to be real and concurrent with the COVID-19 pandemic and its associated community mitigation measures,” Sonja J. Olsen, PhD, an epidemiologist in the CDC’s Influenza Division, and colleagues wrote. Olsen and colleagues reviewed data from around 300 U.S. laboratories in all 50 states, Puerto Rico, Guam and the District of Columbia. They also analyzed influenza laboratory data from surveillance platforms in Australia, Chile and South Africa to determine viral activity in the Southern Hemisphere.


Post-COVID Heart Scans Without Symptoms: Not a Good Idea

MedPage Today, September 15, 2020

Cardiac MRI (CMR) might be able to find abnormalities suggestive of myocarditis after COVID-19 recovery — or to rule them out — but it shouldn’t be used that way in the absence of symptoms, a group of cardiologists, radiologists, and others argued. “We wish to emphasize that the prevalence, clinical significance and long-term implications of CMR surrogates of myocardial injury on morbidity and mortality are unknown,” they wrote in an open letter signed by some 50 medical professionals from a range of disciplines. Until there’s better evidence, “testing asymptomatic members of the general public after COVID-19 is not indicated outside of carefully planned and approved research studies with appropriate control groups,” the group argued. The letter called on the 18 professional societies to which it was sent, including the American College of Cardiology (ACC), American Heart Association, American College of Radiology, and the Society for Cardiovascular Magnetic Resonance (SCMR) to put out clear guidance to stop people seeking CMR screening for that purpose. SCMR responded to the open letter on Tuesday, agreeing that routine CMR in asymptomatic patients after COVID-19 “is currently not justified…and it should not be encouraged.” The statement did not specifically address athletes.


Convalescent plasma treatment of severe COVID-19: a propensity score–matched control study

Nature Medicine, September 15, 2020

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed. This retrospective, propensity score–matched case–control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score–matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75–0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13–0.89; chi-square test P = 0.027).


Hypertension, Obesity, and COVID-19

Journal of the American Medical Association, September 14, 2020

[Podcast] New data show unfavorable US trends in hypertension and obesity, with communities of color doing worse. Join Howard Bauchner, MD, Editor in Chief of JAMA, as he interviews National Institute of Diabetes and Digestive and Kidney Diseases Director Griffin P. Rodgers, MD, and National Heart, Lung, and Blood Institute Director Gary H. Gibbons, MD, to discuss the implications for COVID-19 outcomes and public health.


How COVID-19 can damage the brain

Nature, September 15, 2020

In the early months of the COVID-19 pandemic, doctors struggled to keep patients breathing, and focused mainly on treating damage to the lungs and circulatory system. But even then, evidence for neurological effects was accumulating. Some people hospitalized with COVID-19 were experiencing delirium: they were confused, disorientated and agitated. In April, a group in Japan published the first report of someone with COVID-19 who had swelling and inflammation in brain tissues. Another report described a patient with deterioration of myelin, a fatty coating that protects neurons and is irreversibly damaged in neurodegenerative diseases such as multiple sclerosis. “The neurological symptoms are only becoming more and more scary,” says Alysson Muotri, a neuroscientist at the University of California, San Diego, in La Jolla. The list now includes stroke, brain haemorrhage and memory loss. It is not unheard of for serious diseases to cause such effects, but the scale of the COVID-19 pandemic means that thousands or even tens of thousands of people could already have these symptoms, and some might be facing lifelong problems as a result. Yet researchers are struggling to answer key questions — including basic ones, such as how many people have these conditions, and who is at risk. Most importantly, they want to know why these particular symptoms are showing up.


Type I IFN deficiency: an immunological characteristic of severe COVID-19 patients

Signal Transduction and Targeted Therapy, September 14, 2020

Recently, a paper published in Science by Hadjadj et al. reported that type I interferon (IFN) deficiency, could be a hallmark of severe coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe COVID-19 was also associated with a lymphocytopenia, persistent blood viral load, and an exacerbated inflammatory response. These findings provide insights into the treatment of severe COVID-19 patients with type I IFN. The immunological features and mechanisms involved in COVID-19 severity are unclear. In order to test whether the severity disease can be caused by SARS-CoV-2 viral infection and hyperinflammation, Hadjadj et al. conducted a comprehensive immune analysis of grouped 50 COVID-19 patients with different disease severity. First, to identify whether the severe disease induced lymphocytopenia, Hadjadj et al. compared the peripheral blood leukocytes density of variously severe patients by combining mass cytometry with visualization of high-dimensional single-cell data based on t-distributed stochastic neighbor embedding. There is a significantly decreased density of NK cells and CD3+ T cells in severe and critical patients, while the density of B cells and monocytes was increased. The authors determined the functional status of specific T-cell subsets (CD4+/CD8+) and NK cells based on the expression of activation (CD38, HLA-DR) and exhaustion (PD-1, Tim-3) markers. They observed that the activated NK and CD4+/CD8+ T cells were increased in all infected patients, while the exhausted CD4+/CD8+ T cells and NK cells were increased in only severity patients. This result supported lymphocytopenia correlates with disease severity.


A reminder about choosing the proper code for a telehealth visit

Helio | Infectious Diseases in Children, September 14, 2020

Telehealth has helped immensely during the COVID-19 crisis. Insurance companies, although slow to approve payments, joined in to allow us to aid and interact with our patients and their families. How long this arrangement will last and how long they will waive coinsurance payments is a moving target. The AAP continues to discuss these matters with insurers. Rules have changed, confusion over which modifiers to use have been resolved and by now we are all familiar with telephone-only CPT codes 99441-3 and our old friends 99212-5 that we used for our “sick visits.” One thing has not changed, though — our fear to use 99214 and 99215, particularly when we cannot actually physically examine our patients. However, we can still use time as the main factor in choosing the proper code — 10 minutes for 99212, 15 minutes for 99213, 25 minutes for 99214 and 40 minutes for 99215. Remember, you must write down the time: For example, either 9:00 to 9:25, or 25 minutes (99214). On the other hand, do not forget that until Jan. 1, 2021, if you fulfill two-thirds of the key factors — history, physical examination and medical decision-making — you can still use 99214 with proper documentation.


The lasting misery of coronavirus long-haulers

Nature, September 14, 2020
Months after infection with SARS-CoV-2, some people are still battling crushing fatigue, lung damage and other symptoms of ‘long COVID’. People with more severe infections might experience long-term damage not just in their lungs, but in their heart, immune system, brain and elsewhere. Evidence from previous coronavirus outbreaks, especially the severe acute respiratory syndrome (SARS) epidemic, suggests that these effects can last for years. And although in some cases the most severe infections also cause the worst long-term impacts, even mild cases can have life-changing effects — notably a lingering malaise similar to chronic fatigue syndrome. Many researchers are now launching follow-up studies of people who had been infected with SARS-CoV-2, the virus that causes COVID-19. Several of these focus on damage to specific organs or systems; others plan to track a range of effects. In the United Kingdom, the Post-Hospitalisation COVID-19 Study (PHOSP-COVID) aims to follow 10,000 patients for a year, analysing clinical factors such as blood tests and scans, and collecting data on biomarkers. A similar study of hundreds of people over 2 years launched in the United States at the end of July. What they find will be crucial in treating those with lasting symptoms and trying to prevent new infections from lingering.


Home BP Monitoring Can Make Inroads During the Pandemic

MedPage Today, September 12, 2020

The rapid expansion of telemedicine due to COVID-19 presents an opportunity for home blood pressure (BP) monitoring to stake a place as a component of routine clinical practice — provided that policymakers recognize the changes needed to facilitate greater access to healthcare, according to a discussion by hypertension experts. There is increasing recognition of the importance of out-of-office confirmation of BP elevation even when white coat hypertension isn’t strongly suspected, said J. Brian Byrd, MD, of University of Michigan Medical School in Ann Arbor. It may be the right time to push for home BP measurement — a more practical alternative to ambulatory monitoring — as a standard part of patient care, several suggested during a session of the virtual Hypertension conference, hosted by the American Heart Association (AHA). In-office screening for hypertension in adults with confirmation outside of the clinical setting was tentatively given a grade A recommendation by the U.S. Preventive Services Task Force in June. Around the same time, a joint policy statement from the AHA and American Medical Association affirmed that self-measured blood pressure at home is a validated, cost-effective addition to office monitoring. “The pre-COVID status quo of the cost of care for hypertension is not sustainable. Increased utilization of telehealth has the potential to reduce the economic burden from costly hospital care attributed to poor hypertension control,” said Gbenga Ogedegbe, MD, MPH, of NYU Grossman School of Medicine in New York City.


Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery, September 12, 2020

Past history of stroke has been associated with an increased risk of a new ischemic stroke. Several studies have indicated increased prevalence of strokes among coronavirus patients. However, the role of past history of stroke in COVID19 patients is still unclear. The purpose of this systematic review is to evaluate and summarize the level of evidence on past history of stroke in COVID19 patients. A systematic review was performed according to the PRISMA guidelines was performed in PubMed, Embase, EBSCO Host, Scopus, Science Direct, Medline, and LILACS. Eligibility criteria: We evaluated studies including patients with diagnosis of COVID 19 and a past history of stroke. Risk of bias: was evaluated with the Newcastle- Ottawa Scale (NOS) and experimental studies were evaluated using the ROBINS-I scale. Seven articles out of the total 213 articles were evaluated and included, involving 3244 patients with SARS VOC 2 Disease (COVID19) of which 198 had a history of cerebrovascular disease. Meta-analysis of the data was performed, observing an increase in mortality in patients with a history of cerebrovascular disease compared to those with different comorbidities or those without underlying pathology (OR 2.78 95% CI [1.42- 5.46] p = 0.007; I 2 = 49%) showing adequate heterogeneity.


COVID-19 Storms: Bradykinin In, Cytokine Out?

MedPage Today, September 11, 2020

In the last week, questions have been raised about whether cytokine storm is indeed a culprit in severe COVID-19, while a paper from a government lab has made an intriguing and much-discussed case for a new mechanism, bradykinin storm. While the concepts are not necessarily mutually exclusive, scientists trying to understand how COVID-19 wreaks its damage on the human body have been buzzing about the new possibilities. The theory connects many of the disparate symptoms of COVID-19, from a loss of sense of smell and taste, to a gel-like substance forming in the lungs, and abnormal coagulation. It posits that SARS-CoV-2 disrupts both the renin-angiotensin system (RAS) and the kinin-kallikrein pathways, sending bradykinin — a peptide that dilates blood vessels and makes them leaky — out of whack. The process impedes the transfer of oxygen from the lung to the blood and subsequently to all other tissues, a common abnormality in COVID-19 patients. They found the COVID-19 cases had extremely high levels (increased nearly 200-fold) of angiotensin-converting enzyme 2 (ACE2), the surface protein used by the coronavirus to enter the cell. When the virus interacts with ACE2, it triggers an abnormal response in the bradykinin pathway, Jacobson said. At the same time, levels of angiotensin-converting enzyme, which is involved in the breakdown of bradykinin, were lower in COVID-19 patients than in controls.


A big update: COVID-19 patients with hypotension may need to stop taking blood pressure medications

Cardiovascular Business, September 11, 2020

COVID-19 patients may need to stop taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) if they develop hypotension, according to new findings presented during the American Heart Association’s Hypertension 2020 Scientific Sessions. “Our study suggests low blood pressure in a person with a history of high blood pressure is an important and independent signal that someone with COVID-19 is developing or has acute kidney injury,” study author Paolo Manunta, MD, PhD, chair of nephrology at San Raffaele University in Milan, Italy, said in a prepared statement. “This also suggests that people with high blood pressure should carefully monitor it at home, and their kidney function should be measured when they’re first diagnosed with COVID-19. If they or their doctors notice blood pressure levels going down to the hypotensive range, their doctors may consider reducing or stopping their blood pressure medications to prevent kidney damage and possibly even death.” The role of ACE inhibitors and ARBs in the treatment of COVID-19 has been a key topic for researchers since the pandemic began. While there was an initial push from some parties for patients to stop taking antihypertensive medications if they were diagnosed with COVID-19, cardiovascular specialists pushed back, emphasizing their continued importance. For example, the AHA, Heart Failure Society of America, and American College of Cardiology released a joint statement in March that highlighted why patients should remain on ACE inhibitors and ARBs.


Ageing and atherosclerosis: vascular intrinsic and extrinsic factors and potential role of IL-6

Nature Reviews Cardiology, September 11, 2020

The number of old people (aged >65 years) is rising worldwide, and cardiovascular diseases are the largest contributor to morbidity and mortality in this population. Changes in diet and lifestyle contribute to the high cardiovascular morbidity and mortality in old individuals, but many biological processes that are altered with ageing also contribute to this increased cardiovascular risk. As a result, therapies for cardiovascular disease that are effective in young and middle-aged people might be less effective in older people. Additionally, novel therapies might be required to improve disease management specifically in old people. Deciphering the mechanisms by which ageing promotes atherosclerotic cardiovascular disease will be fundamental for the development of novel therapies to reduce the burden of atherosclerosis with ageing. The development of new therapies is especially relevant with the coronavirus disease 2019 (COVID-19) pandemic, because old people and particularly those with cardiovascular diseases are at a substantially higher risk of morbidity and death.


Molecular interaction and inhibition of SARS-CoV-2 binding to the ACE2 receptor

Nature Communications, September 11, 2020

Study of the interactions established between the viral glycoproteins and their host receptors is of critical importance for a better understanding of virus entry into cells. The novel coronavirus SARS-CoV-2 entry into host cells is mediated by its spike glycoprotein (S-glycoprotein), and the angiotensin-converting enzyme 2 (ACE2) has been identified as a cellular receptor. Here, we use atomic force microscopy to investigate the mechanisms by which the S-glycoprotein binds to the ACE2 receptor. We demonstrate, both on model surfaces and on living cells, that the receptor binding domain (RBD) serves as the binding interface within the S-glycoprotein with the ACE2 receptor and extract the kinetic and thermodynamic properties of this binding pocket. Altogether, these results provide a picture of the established interaction on living cells. Finally, we test several binding inhibitor peptides targeting the virus early attachment stages, offering new perspectives in the treatment of the SARS-CoV-2 infection.


New Recovery Programs Target COVID Long-Haulers

MedPage Today, September 10, 2020

Pulmonologists, cardiologists, neurologists, psychiatrists, and more join to get patients on their feet for good. Zijian Chen, MD, leads Mount Sinai’s COVID-19 recovery program, which is currently treating about 400 patients. At their first visit, patients are evaluated by a primary care physician for symptoms and referred to the appropriate specialists, Chen said. “Right now, we have almost every medical specialty working with the program,” Chen told MedPage Today. “We’re looking at a broad spectrum of disease. Some may have permanent lung fibrosis … that may last for the rest of their lives. Others have reactive airway or inflammatory problems that will subside over time. It’s unpredictable. It’s the same for cardiac symptoms and neurological symptoms.” At Hackensack Meridian’s COVID Recovery Center, primary care physicians develop a customized care plan and connect patients with specialists. Pulmonologists there have been treating patients with shortness of breath and exertional fatigue; cardiologists are treating heart function and rhythm disorders, and neurologists are treating comorbidities arising from strokes and clotting disorders, as well as neuropathy and cognitive impairment, according to program chair Laurie Jacobs, MD.


Single-cell transcriptomic atlas of primate cardiopulmonary aging

Cell Research, September 10, 2020

Aging is a major risk factor for many diseases, especially in highly prevalent cardiopulmonary comorbidities and infectious diseases including Coronavirus Disease 2019 (COVID-19). Resolving cellular and molecular mechanisms associated with aging in higher mammals is therefore urgently needed. Here, we created young and old non-human primate single-nucleus/cell transcriptomic atlases of lung, heart and artery, the top tissues targeted by SARS-CoV-2. Analysis of cell type-specific aging-associated transcriptional changes revealed increased systemic inflammation and compromised virus defense as a hallmark of cardiopulmonary aging. With age, expression of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) was increased in the pulmonary alveolar epithelial barrier, cardiomyocytes, and vascular endothelial cells. We found that interleukin 7 (IL7) accumulated in aged cardiopulmonary tissues and induced ACE2 expression in human vascular endothelial cells in an NF-κB-dependent manner. Furthermore, treatment with vitamin C blocked IL7-induced ACE2 expression. Altogether, our findings depict the first transcriptomic atlas of the aged primate cardiopulmonary system and provide vital insights into age-linked susceptibility to SARS-CoV-2, suggesting that geroprotective strategies may reduce COVID-19 severity in the elderly.


Aldeyra to undertake phase 2 trial of ADX-629 in patients hospitalized with COVID-19

Helio | Ocular Surgery News, September 10, 2020

Aldeyra Therapeutics has received a “study may proceed” letter from the FDA for a phase 2 clinical trial evaluating ADX-629 as a treatment for adult patients hospitalized with COVID-19, according to a press release. “What’s exciting about ADX-629 is its potential to act like a dimmer switch to modulate the aggressive immune response that is a hallmark of SARS-CoV-2, the virus that causes COVID-19,” Todd C. Brady, MD, PhD, president and CEO of Aldeyra, told Healio/OSN. “We’re still in the early innings in terms of clinical testing, but in animal models, ADX-629 has demonstrated a broad and highly statistically significant reduction in cytokine levels, which are critical mediators of inflammation in COVID-19. As a first-in-class, orally available inhibitor of RASP, ADX-629 has the potential to be clinically relevant not only for treating COVID-19 but also an array of inflammatory diseases that are not being adequately addressed by currently available therapies.” The trial will enroll about 30 patients with COVID-19. Enrollment will occur upon hospitalization, and patients will be treated for up to 28 days with orally administered ADX-629 or placebo twice daily. The trial’s key endpoints will include the National Institute of Allergy and Infectious Diseases COVID-19 scale, in addition to levels of cytokines and RASP.


AstraZeneca halts COVID-19 vaccine trial following adverse reaction in UK participant

Helio | Infectious Disease News, September 9, 2020

AstraZeneca’s phase 3 trial of a COVID-19 vaccine candidate has been put on hold because of a “suspected serious adverse reaction” in a participant from the United Kingdom, according to a report by STAT. AstraZeneca began the phase 3 trial in the United States on August 17. According to information available on clinicaltrials.gov, the trial is being held at 62 sites across the U.S., although not all locations have started enrolling participants. According to STAT, the trials were halted at all locations after a participant in the U.K. trial developed a suspected serious adverse reaction during the trial. In a statement from AstraZeneca issued to STAT, representatives said this is a “routine action” that happens whenever an unexplained illness occurs during a trial. “We are working to expedite the review of the single event to minimize any potential impact on the trial timeline,” they wrote. “We are committed to the safety of our participants and the highest standards of conduct in our trials.”


Obesity and Hypertension in the Time of COVID-19

Journal of the American Medical Association, September 9, 2020

[Editorial] In this issue of JAMA, 2 reports present cross-sectional data on the prevalence and trends for obesity and controlled hypertension from 1999 through 2018 based on data from the National Health and Nutrition Examination Survey, a federal program of nationally representative surveys designed to monitor the health and nutrition of adults and children in the US. At first glance, these 2 studies may appear to be addressing different issues. Ogden et al describe the seemingly inexorable increase in obesity prevalence among both children and adults, a condition that has few preventive strategies that have proven effective on a population basis despite recognition of its adverse effect on health. Muntner et al2 document a substantial decrease in the successful control of hypertension among US adults, a disease for which effective medical treatments exist. Hypertension increases the risk for heart disease, stroke, and chronic kidney disease, which are 3 leading causes of death for US residents, and effective treatment of hypertension can reduce the risk of these diseases. In addition to its contribution to cardiovascular and kidney diseases, obesity increases the risk for diseases affecting almost every organ system, including type 2 diabetes, nonalcoholic fatty liver disease, and certain types of cancer. The prevalence of both obesity and uncontrolled hypertension remains disturbingly high. As documented in both studies, these health indicators are moving in the wrong direction in all populations but occur disproportionately in racial and ethnic minority groups.


Abnormal Respiratory Vital Signs, ECG Findings May Predict Early Deterioration in COVID-19

Pulmonology Advisor, September 9, 2020

Abnormal respiratory vital signs coupled with electrocardiogram (ECG) findings of atrial fibrillation (AF)/flutter, right ventricular (RV) strain, or ST-segment abnormalities were found to predict early deterioration in patients with coronavirus disease 2019 (COVID-19), according to a study published in the Mayo Clinic Proceedings. Early triage is crucial for hospitalized patients with COVID-19 who require a higher level of care. In this study, researchers examined medical record data from 3 hospitals in New York City, New York to determine whether early data at emergency department presentation could predict the composite outcome of mechanical ventilation or death within the next 48 hours. The data of 1258 adults with COVID-19 (mean age, 61.6 years) who were hospitalized in March and April 2020 were examined. Electrophysiologists systematically read each patient’s ECG recordings conducted at presentation. A model adjusted for demographics, comorbidities, and vital signs was used to assess the prognostic value of ECG abnormalities. The most common comorbidities in this cohort included hypertension (57%), diabetes (37%), obesity (34%), primary lung disease (17%), and chronic kidney disease (16%). In this cohort, 73 patients (6%) died within 48 hours of presentation, and 14% of patients (n=174) were still alive at this time but were receiving mechanical ventilation. Another 277 patients (22%) died by 30 days. A total of 53% of all intubations occurred within 48 hours of presentation.


Pediatric COVID-19 cases surpass half-million

Infectious Diseases in Children, September 9, 2020

The AAP announced that a total of 513,415 pediatric cases of COVID-19 have been reported, according to an analysis of state-level data. The report found 70,630 new pediatric cases from August 20 to September 3 — a 16% increase from the total case count of 442,785 that was reported on August 19. “These numbers are a chilling reminder of why we need to take this virus seriously,” AAP President Sally Goza, MD, FAAP, said in a statement. “While much remains unknown about COVID-19, we do know that the spread among children reflects what is happening in the broader communities. A disproportionate number of cases are reported in Black and Hispanic children and in places where there is high poverty. We must work harder to address societal inequities that contribute to these disparities.” As of September 3, the total number of pediatric COVID-19 cases represents 9.8% of all reported cases.


Multimodality Imaging in Cardiovascular Complications of COVID-19

American College of Cardiology, September 9, 2020

Standard evaluation and management of the patient with suspected or proven cardiovascular complications of coronavirus disease-2019 (COVID-19), the disease caused by severe acute respiratory syndrome related-coronavirus-2 (SARS-CoV-2), is challenging. Routine history, physical examination, laboratory testing, electrocardiography, and plain x-ray imaging may often suffice for such patients, but given overlap between COVID-19 and typical cardiovascular diagnoses such as heart failure and acute myocardial infarction, need frequently arises for advanced imaging techniques to assist in differential diagnosis and management. This document provides guidance in several common scenarios among patients with confirmed or suspected COVID-19 infection and possible cardiovascular involvement, including chest discomfort with electrocardiographic changes, acute hemodynamic instability, newly recognized left ventricular dysfunction, as well as imaging during the subacute/chronic phase of COVID-19. For each, the authors consider the role of biomarker testing to guide imaging decision-making, provide differential diagnostic considerations, and offer general suggestions regarding application of various advanced imaging techniques.


The Real Reason Post-COVID Myocarditis Is a Worry

MedPage Today, September 8, 2020

It’s not often that myocarditis trends on Twitter, but cardiac MRI findings after recovery from acute COVID-19 symptoms have rocketed to public attention for their impact on decisions being made about sports. One (as yet unpublished) study found myocarditis in 15% of college athletes who tested positive, largely after mild or no symptoms. A more alarming statement by Penn State football’s team doctor put that rate at 30% to 35%, but that claim has since been walked back. Before that was a German cardiac MRI study in non-athletes that turned up lingering myocardial inflammation and other cardiac abnormalities in 78 of 100 people. While the study was subsequently corrected, the message remained the same: even a mild course of COVID-19 in relatively healthy people could leave a mark on the heart. That study, too, received an enormous amount of attention due, in part, to its use by colleges and sports programs to determine the future of the fall athletics season.


The American College of Cardiology Roundtable on Research in the Era of COVID-19

Journal of the American College of Cardiology, September 8, 2020

The onset of the SARS-CoV-2 pandemic (coronavirus disease-2019 [COVID-19]) has had a profound effect on research. It has created an impetus for change, presented a wide range of challenges, and sparked an array of initiatives. In doing so, the pandemic has revealed threats to old models of knowledge generation and openings for new approaches. It is clear there is an unprecedented need for action. To address the research challenges created by the pandemic, the American College of Cardiology (ACC) conducted a Heart House Roundtable on clinical research in the COVID-19 era. The ACC invited a range of experts to discuss the changing landscape and to identify opportunities to provide rapid research to support efforts to prevent, diagnose, and treat COVID-19 infection; to produce actionable insights about the effects of the pandemic on non–COVID-19 cardiovascular disease; and to address the need to continue and accelerate cardiovascular clinical research that remains urgently needed but that has encountered obstacles during the pandemic. The goal was to generate discussion, share insights, and produce recommendations.


The coronaviruhttps://www.nature.com/articles/d41586-020-02544-6s is mutating — does it matter?

Nature, September 8, 2020

When COVID-19 spread around the globe this year, David Montefiori wondered how the deadly virus behind the pandemic might be changing as it passed from person to person. Montefiori is a virologist who has spent much of his career studying how chance mutations in HIV help it to evade the immune system. The same thing might happen with SARS-CoV-2, he thought. In March, Montefiori, who directs an AIDS-vaccine research laboratory at Duke University in Durham, North Carolina, contacted Bette Korber, an expert in HIV evolution and a long-time collaborator. Korber, a computational biologist at the Los Alamos National Laboratory (LANL) in Sante Fe, New Mexico, had already started scouring thousands of coronavirus genetic sequences for mutations that might have changed the virus’s properties as it made its way around the world. Compared with HIV, SARS-CoV-2 is changing much more slowly as it spreads. But one mutation stood out to Korber. It was in the gene encoding the spike protein, which helps virus particles to penetrate cells. Korber saw the mutation appearing again and again in samples from people with COVID-19. At the 614th amino-acid position of the spike protein, the amino acid aspartate (D, in biochemical shorthand) was regularly being replaced by glycine (G) because of a copying fault that altered a single nucleotide in the virus’s 29,903-letter RNA code. Virologists were calling it the D614G mutation.


Developing a COVID-19 mortality risk prediction model when individual-level data are not available

Nature Communications, September 7, 2020

At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a post-processing method to calibrate the predictions to reported COVID-19 case-fatality rates. With the accumulation of a COVID-19 patient cohort, this predictor is validated to have good discrimination (area under the receiver-operating characteristics curve of 0.943) and calibration (markedly improved compared to that of the baseline predictor). At a 5% risk threshold, 15% of patients are marked as high-risk, achieving a sensitivity of 88%. We thus demonstrate that even at the onset of a pandemic, shrouded in epidemiologic fog of war, it is possible to provide a useful risk predictor, now widely used in a large healthcare organization.


T cells in COVID-19 — united in diversity

Nature Immunology, September 7, 2020

Comprehensive mapping reveals that functional CD4+ and CD8+ T cells targeting multiple regions of SARS-CoV-2 are maintained in the resolution phase of both mild and severe COVID-19, and their magnitude correlates with the antibody response. CD4+ and CD8+ T cells work with other constituents of a coordinated immune response to first resolve acute viral infections and then to provide protection against reinfection. Careful delineation of the frequency, specificity, functionality and durability of T cells during COVID-19 is vital to understanding how to use them as biomarkers and targets for immunotherapies or vaccines. In this issue of Nature Immunology, Peng et al. take a comprehensive approach to characterizing circulating SARS-CoV-2-specific CD4+ and CD8+ T cells following resolution of COVID-19. They report a robust and diverse T cell response targeting multiple structural and non-structural regions of SARS-CoV-2 in most resolved cases, irrespective of whether the individual had mild or severe infection. While the most frequent responses were against peptides spanning spike, membrane and nucleoprotein antigens, all eight regions tested were recognized by multiple individuals, with a maximum of 23 reactive pools in two individuals. Such multispecific T cell responses are well suited to providing a failsafe form of multilayered protection, mitigating against viral escape by mechanisms such as mutation or variable antigen presentation.


Coronavirus in Context: Can a Cholesterol Drug Fight COVID?

WebMD, September 7, 2020

[Video] Dr. John Whyte, chief medical officer at WebMD has spent a lot of episodes talking about different drug treatments for COVID-19. Watch as he interviews Dr. Yaakov Nahmias, professor of bioengineering at the Hebrew University of Jerusalem, to discuss an interesting study about the role of lipid metabolism and a strategy for some cholesterol-lowering medicines in the treatment of COVID-19.


PICS: A Serious Issue for COVID-19 Survivors

MedPage Today, September 6, 2020

Even healthcare professionals may not be aware of and prepared for a condition called post-intensive care unit (ICU) syndrome (PICS) that can occur in the aftermath of COVID-19. What about those who were hospitalized for COVID-19, treated in the ICU, and are unaware of the possible long-term impact and rehabilitation phase? There is a tendency to think that once the patient is discharged from the hospital, has tested negative, and looks well, the problem is resolved. However, the struggle of COVID-19 survivors and family members or caregivers may not end there. PICS is an ongoing challenge that may potentially present a public health crisis. PICS is a term used to describe the group of impairments faced by ICU survivors. It can persist for months or years. PICS encompasses a combination of physical, neurological, social, and psychological decline. The physical impairments include intensive care-acquired weakness, classified as critical illness myopathy, neuropathy, and neuromyopathy. Cognitive and psychological impairments involve impaired memory, language, delirium, depression, anxiety, and post-traumatic stress disorder (PTSD). During the COVID-19 pandemic, critically ill clients are considered the most vulnerable to PICS. Among these, 30% suffer from depression and 70% experience anxiety and PTSD after ICU discharge. Moreover, survivors can experience additional stress as a result of isolation and limited contact with loved ones and reduced contact with staff due to precautionary measures such as personal protective equipment.


COVID-19 and hypertension – is the HSP60 culprit for the severe course and worse outcome?

The American Journal of Physiology Heart and Circulatory Physiology, September 4, 2020

The 60 kDa heat shock protein (HSP60) is a chaperone essential for mitochondrial proteostasis ensuring thus sufficient aerobic energy production. In pathological conditions, HSP60 can be translocated from the mitochondria and excreted from the cell. In turn, the extracellular HSP60 has a strong ability to trigger and enhance inflammatory response with marked pro-inflammatory cytokine induction, which is mainly mediated by toll-like receptors binding. Previous studies have found increased circulating levels of HSP60 in hypertensive patients, as well as enhanced HSP60 expression and membrane translocation in the hypertrophic myocardium. These observations are of particular interest as they could provide a possible pathophysiological explanation of the severe course and worse outcome of SARS-CoV-2 infection in hypertensive patients, repeatedly reported during recent COVID-19 pandemic, and related to hyperinflammatory response and cytokine storm development during the third phase of the disease. In this regard, pharmacological inhibition of HSP60 could attract attention to potentially ameliorate inappropriate inflammatory reaction in severe COVID-19 patients.


CDC: Weekly COVID-19 Deaths Down, but Still Above Epidemic Threshold

Infectious Disease Special Edition, September 4, 2020

As of Sept 4, almost 190,000 people in the United States have died from COVID-19, according to the Johns Hopkins COVID-19 Dashboard, but the weekly numbers appear to be slowing. The deaths attributed to COVID-19 during the last week of August are down, but the percentage still exceeds the epidemic threshold, according to the National Center for Health Statistics (NCHS) database. Provisional data from across the United States show that based on death certificates available on Aug. 27, the percentage of deaths attributed to COVID-19, pneumonia or influenza for week 34 was 7.9%. During week 33, it was 23.3%. In addition, the statistics show that only 6% of deaths listed just COVID-19 as a cause of death. Most certificates list comorbid conditions, such as respiratory and cardiovascular conditions, as contributors to the deaths. “In 94% of deaths with COVID-19, other conditions are listed in addition to COVID-19,” the NCHS told Infectious Disease Special Edition. “These causes may include chronic conditions like diabetes or hypertension. They may also include acute conditions that occurred as a result of COVID-19, such as pneumonia or respiratory failure.”


Heart, COVID‐19, and echocardiography

Echocardiography, September 4, 2020

Although clinical manifestations of coronavirus disease of 2019 (COVID‐19) mainly consist of respiratory symptoms, a severe cardiovascular damage may occur. Moreover, previous studies reported a correlation of cardiovascular metabolic diseases with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and actually, many COVID‐19 patients show comorbidities (systemic hypertension, cardio‐cerebrovascular disease, and diabetes) and have a raised risk of death. The purpose of this review is to focus the cardiovascular effects of 2019‐nCoV on the base of the most recent specific literature and previous learnings from SARS and MERS and analyze the potential role of echocardiography during the current critical period and short‐ and long‐term follow‐up.


Invasive fungal disease common among critically ill COVID-19 patients, study finds

Helio | Infectious Disease News, September 4, 2020

Invasive fungal disease occurs often in critically ill patients with COVID-19 on mechanical ventilation, according to a study published in Clinical Infectious Diseases. “With the COVID-19 pandemic far from over, it is paramount that our understanding of the risk from associated invasive fungal disease is enhanced,” P. Lewis White, PhD, FECMM, FRCPath, consultant clinical scientist and head of the mycology reference laboratory for Public Health Wales, told Healio. White and colleagues screened 135 patients with COVID-19 for invasive fungal disease to evaluate an enhanced testing strategy. The patients were from a national, multicenter cohort in Wales. The incidence of invasive fungal disease was 26.7% — 14.1% aspergillosis and 12.6% yeast infections. The overall mortality rate was 38%, including 53% in patients with fungal disease and 31% in patients without it (P = .0387). The overall mortality rate declined when antifungal therapy was used. It was 38.5% in patients who received antifungal therapy vs. 90% in patients who did not (P = .008). White said they did not expect the high rate of invasive yeast infections.


Will Labor Day Weekend Bring Another Holiday COVID Surge?

Kaiser Health News, September 4, 2020

Hopefully, summer won’t end the way it began. Memorial Day celebrations helped set off a wave of coronavirus infections across much of the South and West. Gatherings around the Fourth of July seemed to keep those hot spots aflame. And now Labor Day arrives as those regions are cooling off from COVID-19. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned Wednesday that Americans should be cautious to avoid another surge in infection rates. But travelers are also weary of staying home — and tourist destinations are starved for cash. “Just getting away for an hour up the street and staying at a hotel is like a vacation, for real,” says Kimberly Michaels, who works for NASA in Huntsville, Alabama, and traveled to Nashville, Tennessee, with her boyfriend to celebrate his birthday last weekend. In time for the tail end of summer, many local governments are lifting restrictions to resuscitate tourism activity and rescue small businesses.


COVID-19 impact on treatment for chronic illness revealed

UN News, September 4, 2020

The four most common NCDs are cardiovascular disease, cancer, diabetes and chronic respiratory diseases; together, they contribute to more than 40 million deaths a year, said Dr Bente Mikkelsen, Director, WHO Division of Noncommunicable Diseases. “The most recent study shows that there is a disruption in healthcare services including NCD diagnosis and treatments in 69 per cent of cases”, she said. “In cancer, there are the highest numbers, with 55 per cent of people living with cancer (having) their health services disrupted.” Dr Mikkelsen noted that those living with one or more NCDs were among the most likely to become severely ill and die from the new coronavirus. Studies from several countries had indicated this, she said, highlighting how data on indigenous communities in Mexico, showed that diabetes was the most commonly found disease among COVID-19 fatalities. Research also found that in Italy, of those who succumbed to COVID-19 in hospital, 67 per cent suffered from hypertension and 31 per cent had type 2 diabetes.


Subtle Cardiac Troubles in MIS-C Paint a ‘Myocarditis-Like Picture’

MedPage Today, September 3, 2020

Multisystem inflammatory syndrome in children (MIS-C) caused by SARS-CoV-2 infection was often accompanied by subtle changes in myocardial function that differ from what is seen in classic Kawasaki disease, one center reported. Various strain parameters on echocardiography showed that left ventricular (LV) systolic and diastolic function were worse in MIS-C compared with Kawasaki disease and healthy controls. Myocardial injury was a common finding, in 17 out of 28 MIS-C patients, and affected patients performed particularly badly on these functional parameters, according to Anirban Banerjee, MD, of Children’s Hospital of Philadelphia (CHOP), and colleagues. Only one out of 28 MIS-C patients had coronary artery dilatation in the acute phase, which resolved over approximately 5 days, the authors reported in their study online in the Journal of the American College of Cardiology. On the other hand, four of the 20 kids with classic Kawasaki disease had coronary abnormalities (including two with aneurysms detected). “The major finding during the acute phase of MIS-C is a myocarditis-like picture, that may remain subtle and sub-clinical, particularly in the preserved EF [ejection fraction] cohort. Even in the presence of normal EF, the latter group showed distinct dysfunction in systolic and diastolic deformation parameters,” the researchers wrote. MIS-C is characterized as a hyperinflammatory syndrome with multi-organ dysfunction. The observed LV dysfunction in the study may be the result of subclinical myocarditis, which was suspected in 61% of the MIS-C group based on brain natriuretic peptide and troponin elevations, the team explained.


FDA Could Issue EUA for COVID-19 Vaccine Before Clinical Trials Are Completed

Pulmonology Advisor, September 3, 2020

Emergency use authorization (EUA) or approval for a COVID-19 vaccine before phase 3 clinical trials are complete could be considered by the U.S. Food and Drug Administration, according to the agency’s commissioner, Stephen Hahn, M.D. “It is up to the sponsor [vaccine developer] to apply for authorization or approval, and we make an adjudication of their application,” he told the Financial Times, CNN reported. “If they do that before the end of phase 3, we may find that appropriate. We may find that inappropriate, we will make a determination.” An EUA is not the same as full-fledged approval, Hahn noted. “Our emergency use authorization is not the same as a full approval,” he said. “The legal, medical, and scientific standard for that is that the benefit outweighs the risk in a public health emergency.” Two vaccines are currently in phase 3 trials in the United States and two more are expected to begin phase 3 trials by mid-September, CNN reported.


Barriers to remote care ‘unmasked at wider scale’ due to COVID-19

Helio | Cardiology Today, September 3, 2020

An interview with Khaldoun G. Tarakji, MD, MPH, a Cardiology Today Next Gen Innovator, about the data he presented at the virtual Heart Rhythm Society Annual Scientific Sessions. Tarakji, who serves as associate section head of cardiac electrophysiology and director of the Center for Digital Health at the Heart and Vascular Institute at Cleveland Clinic, also highlighted other abstracts presented at the virtual Heart Rhythm Society Annual Scientific Sessions (HRS) that gave insight into the “digital health” of patients with arrhythmias. At Heart Rhythm Society Annual Scientific Sessions (HRS), Tarakji explained about the use of virtual visits, “While there are many advantages for using virtual visits, we never thought about a pandemic as one of them. Our study was one of its kind as it provided insight about both patient experience with using this modality prior to COVID-19. Interestingly the issues highlighted in our studies as barriers were unmasked at wider scale during the pandemic. With the unprecedented demand for telemedicine, many platforms could not keep up and the technical difficulties became a major obstacle. The government was thankfully quick to respond with swift actions that included reimbursement for these visits and also allowing caregivers to use other video conferencing secured platforms at the time of the crisis. While these rules are temporary, virtual visits are here to stay, and for the right patient coupled with the right tools, they can provide effective and high-quality care.”


Technology Aids Fight Against COVID-19 — Nine innovations in health tech that help to manage the pandemic

MedPage Today, September 3, 2020

As the COVID-19 cases continue to rise across the globe, companies are working hard to develop innovative solutions to fight the coronavirus pandemic. Chinese companies such as Alibaba have led the way using artificial intelligence, data science, and technology. Startups are teaming up with clinicians, engineers, and government entities to reduce the spread of COVID-19. As we continue our fight in the management and eventual eradication of the virus, read about nine innovative ways companies are helping on the front lines.


Understanding the Association Between COVID-19, Thromboembolism, and Therapeutic Anticoagulation

Pulmonology Advisor, September 2, 2020

Among hospitalized patients with coronavirus disease 2019 (COVID-19), those who receive anticoagulation treatment have lower adjusted risk of mortality and intubation compared with in-hospital patients who do not receive anticoagulation, according to study results published in the Journal of the American College of Cardiology. A team of investigators at Icahn School of Medicine at Mount Sinai in New York, New York, expanded on previous findings that suggested an association between in-hospital anticoagulation and reduced mortality. In the present investigation, the researchers compared the effects of therapeutic and prophylactic anticoagulation treatment with the absence of such treatment. Choice of agent, survival outcomes, intubation, and major bleeding were also analyzed. In addition, the study authors also reviewed the first consecutive autopsies performed at their institution to characterize the premortem management of this patient population as it relates to anticoagulation therapy. The primary outcome was in-hospital mortality, and secondary outcomes included intubation and major bleeding. Participants were all older than 18 years, had clinically confirmed severe acute respiratory syndrome coronavirus 2 infection between March 1, 2020, and April 30, 2020, and were admitted to 1 of 5 New York City hospitals included in the study.


Kevzara fails to meet endpoints in ex-US phase 3 trial for severe COVID-19

Helio | Rheumatology, September 2, 2020

Sanofi announced that its IL-6 inhibitor Kevzara failed to meet primary and secondary endpoints in a phase 3 trial of patients outside the United States hospitalized with severe COVID-19. “Although this trial did not yield the results we hoped for, we are proud of the work that was achieved by the team to further our understanding of the potential use of Kevzara for the treatment of COVID-19,” John Reed, MD, PhD, global head of research and development at Sanofi, said in a company press release. The randomized trial included 420 patients who were severely or critically ill with COVID-19, recruited from hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia and Spain. Among the participants, 161 received 200 mg of Kevzara (sarilumab), 173 were treated with 400 mg and 86 received a placebo. According to the press release, although not statistically significant, the researchers observed numerical trends toward a decrease in hospital stay duration as well as faster time to better clinical outcomes, defined as a two-point improvement on a seven-point scale. In addition, the researchers noted a trend toward reduced mortality in the critical patient group, but not in the severe group. Lastly, the time to discharge was reduced by 2 to 3 days among patients who received sarilumab within the first 2 weeks of treatment, although, again, this was not statistically significant.


Mount Sinai identifies drugs that could prevent COVID-19 replication

Modern Healthcare, September 2, 2020

Researchers from the Icahn School of Medicine at Mount Sinai Health System in New York have developed a computational method to identify drugs that could be combat COVID-19. Unlike other research to repurpose drugs to treat infection, this effort focused on inhibiting viral uptake of SARS-CoV-2 in the first place. In a preprint paper posted to BioRxiv, the researchers explored viral sequences using PCR analysis, RNA sequencing, and bioinformatics. They identified four compounds that could block replication of the novel coronavirus, namely amlodipine, loperamide, terfenadine, and berbamine. They then validated these findings in multiple assays using primate Vero cells infected with SARS-CoV-2, A549 cells, and in human organoids. According to the paper, these compounds were found to potently reduce viral load despite having no impact on viral entry or modulation of the host antiviral response in the absence of virus. “You have a bunch of drugs that are blocking the virus in cell culture,” said lead researcher Avi Ma’ayan, director of the Mount Sinai Center for Bioinformatics and principal investigator with the academic health system’s LymeMIND team of other research into other potential COVID-19 treatments. “But this particular paper is showing a lot of details about why and which drug and … is beginning to understand the molecular mechanism.” The researchers used a collection of gene expression profiles from the National Institutes of Health’s Library of Integrated Network-based Cellular Signatures (LINCS) database that has previously been applied to identify drugs that attenuate the Ebola virus. With SARS-CoV-2, the Mount Sinai team was able to spot transcriptional irregularities by comparing changes in gene expression before and after infection or drug treatment. In this new work, the Mount Sinai team studied 50 genes that were downregulated by the virus or 50 upregulated by certain drugs. They also looked at the 100 genes most commonly coexpressed by ACE2, known to be the receptor of SARS-CoV-2.


No clinical benefit of ACE inhibitor, ARB suspension in mild to moderate COVID-19

Helio | Cardiology Today, September 1, 2020

In patients hospitalized with mild or moderate COVID-19, suspending ACE inhibitors and angiotensin receptor blockers for 30 days, compared with continued treatment, did not impact the number of days alive and out of hospital. BRACE CORONA provides the first randomized controlled trial data on continuing vs. suspending ACE inhibitors and angiotensin receptor blockers in this patient population. “Because these data indicate that there is no clinical benefit from routinely suspending these medications in hospitalized patients with mild to moderate COVID-19, they should be generally continued for those with an indication,” Renato D. Lopes, MD, MHS, PhD, professor of medicine at Duke University School of Medicine and member of the Duke Clinical Research Institute, said while presenting results of the BRACE CORONA trial at the virtual European Society of Cardiology Congress.


COVID Hypoxemia: Finally, an Explanation

MedPage Today, September 1, 2020

In the early days of the pandemic in New York City, physicians were having serious debates about whether COVID-19 patients developed typical acute respiratory distress syndrome (ARDS), or if they were suffering from a different phenomenon entirely. The main discrepancy was that patients with severe hypoxemia often had well preserved lung compliance; their lungs weren’t “stiff,” as is seen in typical ARDS. Now, a team at Mount Sinai Hospital thinks they may have an explanation for that disconnect — and it was a completely serendipitous finding, according to Alexandra Reynolds, MD, and Hooman Poor, MD, who published their findings in a letter in the American Journal of Respiratory & Critical Care Medicine. Reynolds, a neurointensivist, wondered whether her COVID-19 patients were having frequent strokes, given rising concerns about clotting being a significant feature of the disease. So she used transcranial Doppler ultrasound to assess blood flow in the brain. A robotic version of NovaSignal’s TCD system enabled the researchers to attach the scanner and leave the patient room for analysis, which was helpful during COVID quarantine, she said. “I was expecting to see microemboli given the reports of clotting, but I saw zero emboli in the patients I scanned,” Reynolds told MedPage Today.


Link found between metabolic syndrome and worse COVID-19 outcomes

Medical News Today, September 1, 2020

A new study has found that people with metabolic syndrome, which refers to a cluster of conditions that increase a person’s risk of cardiovascular issues, are more likely to have worse COVID-19 outcomes — including requiring ventilation and death. The research, which appears in the journal Diabetes Care, provides further information on the underlying risk factors that affect the severity of COVID-19. Since its emergence in Wuhan, China, in December 2019, COVID-19 has spread rapidly across the world. However, its effects are not equal. As journals started publishing the results of observational studies drawing on data from the first wave of the pandemic, it became clear that some underlying medical conditions were associated with a greater chance of a person developing severe COVID-19. According to the Centers for Disease Control and Prevention (CDC), some groups most at risk of severe disease include older adults and those with certain underlying medical conditions, such as cardiovascular diseases, obesity, and type 2 diabetes. The new research highlights that obesity, hypertension, and diabetes, in particular, are more common in people who die from COVID-19 than heart or lung conditions.


The Role of Critical Care Cardiology During the COVID-19 Pandemic

American College of Cardiology, September 1, 2020

As of August 3rd 2020, the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2), responsible for the disease COVID-19 (coronavirus disease 2019), had infected more than 18 million people worldwide and caused nearly 700,000 deaths. After an initial wave that predominantly affected the northeastern United States, there has recently been a resurgence in cases across many states. The clinical spectrum of COVID-19 is wide, ranging from asymptomatic infection and mild upper respiratory tract illness to acute respiratory distress syndrome (ARDS), shock, and death. Critically ill patients frequently have extra-pulmonary manifestations, including myocardial injury, with elevated biomarkers, electrocardiographic changes, or echocardiographic abnormalities. Herein, we outline the central role for critical care cardiologists during this pandemic, changes to pre-pandemic practices in the cardiac intensive care unit (CICU), and the need for change at an institutional, regional, and national level in response to a surge in CICU COVID-19 patients.


Natural Flavonoids as Potential Angiotensin-Converting Enzyme 2 Inhibitors for Anti-SARS-CoV-2

Molecules, September 1, 2020

Over the years, coronaviruses (CoV) have posed a severe public health threat, causing an increase in mortality and morbidity rates throughout the world. The recent outbreak of a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the current Coronavirus Disease 2019 (COVID-19) pandemic that affected more than 215 countries with over 23 million cases and 800,000 deaths as of today. The situation is critical, especially with the absence of specific medicines or vaccines; hence, efforts toward the development of anti-COVID-19 medicines are being intensively undertaken. One of the potential therapeutic targets of anti-COVID-19 drugs is the angiotensin-converting enzyme 2 (ACE2). ACE2 was identified as a key functional receptor for CoV associated with COVID-19. ACE2, which is located on the surface of the host cells, binds effectively to the spike protein of CoV, thus enabling the virus to infect the epithelial cells of the host. Previous studies showed that certain flavonoids exhibit angiotensin-converting enzyme inhibition activity, which plays a crucial role in the regulation of arterial blood pressure. Thus, it is being postulated that these flavonoids might also interact with ACE2. This postulation might be of interest because these compounds also show antiviral activity in vitro. This article summarizes the natural flavonoids with potential efficacy against COVID-19 through ACE2 receptor inhibition.


COVID-19 pandemic leads to more people with high blood pressure, research suggests

Mobi Health News, August 31, 2020

More people experienced high blood pressure in response to the COVID-19 pandemic compared to before, according to new research from chronic care management company Livongo. The study looked at the proportion of Livongo members who had high blood pressure before and during the pandemic, specifically covering the time between mid-September of 2019 and mid-August of 2020. The data does not support a direct cause-and-effect relationship between specific events related to the COVID-19 pandemic and an increased proportion of people with high blood pressure, but a correlation does exist, according to Livongo. As the pandemic progressed in the U.S., so did the percentage of Livongo members with high blood pressure, the results show. Up until January of this year, the average percentage of members with high blood pressure was 62%. However, by the end of January, when the first confirmed case of COVID-19 was announced in the U.S. and quarantining began in Wuhan, China, the average percentage of members with high blood pressure increased to 67%. By March 23, the median date of lockdown orders in the U.S., 64% of members had high blood pressure. In early April, the percentage reached a peak of 68%, which correlates with the April 3 release of COVID-19-related unemployment figures and the first time that the Centers for Disease Control and Prevention recommended that everyone wear masks in public.


Coronavirus in Context: Do Antibodies Provide Protection?

WebMD, August 31, 2020

[Video] What’s the role of antibodies against coronavirus infection? It’s one of the biggest questions over the past six months. WebMD’s Chief Medical Officer, Dr. John Whyte, speaks with Alexander Greninger, MD, PhD, Assistant Director of the UW Medicine Clinical Virology Laboratory, University of Washington, about the effectives of antibodies for COVID-19 immunity and transmission.


1st U.S. COVID-19 Reinfection Reported in Nevada Patient

WebMD, August 31, 2020

The first U.S. case of a confirmed coronavirus reinfection looks to be a patient in Nevada. The U.S. case comes a few days after the first reinfection in the world was announced in Hong Kong. The Nevada case is detailed in a new paper published in The Lancet on an online preprint server. The study has not yet been reviewed by peers. Reinfection is rare, researchers said, but people should still be cautious. “If you’ve had it, you can’t necessarily be considered invulnerable to the infection,” Mark Pandori, one of the authors and director of the Nevada State Public Health Laboratory, told NBC. According to the report, the 25-year-old man from Reno, Nevada, first tested positive for COVID-19 in mid-April after experiencing a sore throat, cough, headache, nausea, and diarrhea. He recovered but got sick again in late May, marking 48 days between two positive tests after two negative tests in between the infections. During the second round, his illness was more severe, and he was hospitalized with pneumonia. Researchers found that the genetic sequencing of the virus varied, and the patient was infected with slightly different strains of the coronavirus. They aren’t sure why he was reinfected, which could be related to the virus itself or the patient’s immune system.


Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience

Interactive CardioVascular and Thoracic Surgery, August 31, 2020

Pneumothorax, a major and potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. The rate of pneumothorax in such patients has not yet been quantified. However, previous experience from the SARS outbreak, also caused by a coronavirus, suggests a high incidence (20–34%) of pneumothorax in mechanically ventilated SARS patients. Mechanical ventilation is the most common cause of iatrogenic pneumothoraces in the ICU setting; however, it is a rare occurrence in intubated patients who have relatively normal lung parenchyma. Most pneumothoraces related to mechanical ventilation are associated with a combination of high ventilation pressures and underlying chronic lung pathology such as emphysema. Previous studies have suggested that high inspiratory airway pressures and positive end-expiratory pressure were correlated with increased incidence of barotrauma. Currently, there is limited literature on how to manage pneumothoraces in mechanically ventilated COVID-19 patients. We present a case series (nine patients) and a suggested protocol for how to manage and treat pneumothoraces in COVID-19 patients in an ICU setting.


Leaders in Cardiovascular Research: Filippo Crea

Cardiovascular Research, August 31, 2020

[Video or Article] Join Cardiovascular Research Editor-in-Chief as he interviews Professor Filippo Crea, Catholic University, Rome. Prof. He trained in Pisa Medical School in Cardiology and in Pulmonary Diseases. Crea has been a Senior Lecturer in Cardiology at RPMS-Hammersmith Hospital in London. Since 2008, he is Professor of Cardiology, Director of the Department of Cardiovascular Sciences, Director of the Postgraduate School in Cardiology, and Coordinator of the PhD programme in Cellular and Molecular Cardiology at the Catholic University in Rome. As of August 2020, he is the new Editor-in-Chief of the European Heart Journal of the European Society of Cardiology.


Fad or future? Telehealth expansion eyed beyond pandemic

Modern Healthcare, August 30, 2020

Consultations via tablets, laptops and phones linked patients and doctors when society shut down in early spring. Telehealth visits dropped with the reopening, but they’re still far more common than before and now there’s a push to make them widely available in the future. Permanently expanding access will involve striking a balance between costs and quality, dealing with privacy concerns and potential fraud, and figuring out how telehealth can reach marginalized patients, including people with mental health problems. “I don’t think it is ever going to replace in-person visits, because sometimes a doctor needs to put hands on a patient,” said CMS Administrator Seema Verma, the Trump administration’s leading advocate for telehealth. Caveats aside, “it’s almost a modern-day house call,” she added. “It’s fair to say that telemedicine was in its infancy prior to the pandemic, but it’s come of age this year,” said Murray Aitken of the data firm IQVIA, which tracks the impact. In the depths of the coronavirus shutdown, telehealth accounted for more than 40% of primary care visits for patients with traditional Medicare, up from a tiny 0.1% sliver before the public health emergency. As the government’s flagship health care program, Medicare covers more than 60 million people, including those age 65 and older, and younger disabled people.


Findings from a probability-based survey of U.S. households about prevention measures based on race, ethnicity, and age in response to SARS-CoV-2

Journal of Infectious Diseases, August 29, 2020

There are 21.7 million reported cases of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and over 776,000 deaths due to the coronavirus disease 2019 (COVID-19) worldwide through August 17, 2020. Over one-fourth of cases are in the U.S., with African American and Latinos being disproportionately impacted in case counts and death rates. Prevention control messages and efforts, such as sheltering in place and quarantining, may not have been as successful among African Americans and Latinos for numerous reasons, such as needing to work outside of the home, living in large households in close quarters, and including the effects of structural racism (i.e., access to health insurance and care, limited health literacy). Little is known about individual prevention measures that were taken in response to COVID-19 or how people may engage with surveillance/reporting strategies as we enter phase two of the pandemic. We investigated individual behaviors taken by White, African American, and Latino U.S. households in response to SARS-CoV-2, and likelihood of using digital tools for symptom surveillance/reporting. We analyzed cross-sectional week one data (April 2020) of the COVID Impact Survey in a large, nationally-representative sample of U.S. adults. In general, all groups engaged in the same prevention behaviors, but Whites reported being more likely to use digital tools to report/act on symptoms and seek testing, versus African Americans and Latinos.


Fauci on ‘Highly Specific, Direct’ Therapy for COVID-19

MedPage, August 28, 2020

Monoclonal antibodies could hold promise in COVID-19 treatment and prevention if the results bear out in clinical trials for efficacy, the nation’s leading infectious diseases expert told MedPage Today. “There’s a lot of activity and it’s a highly concentrated, highly specific, direct antiviral approach to a number of diseases. The success in Ebola was very encouraging,” said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD. Most recently thrust into the spotlight as effective treatments for Ebola, monoclonal antibodies are currently being researched as a potential treatment for HIV, as well as COVID-19. This month, the NIH highlighted trials of monoclonal antibodies being conducted among several different COVID-19 patient populations: outpatients with COVID-19, patients hospitalized with the disease, and even a trial in household contacts of confirmed cases, where the therapy was used as prophylaxis. Fauci explained how the mechanism of monoclonal antibodies “is really one of a direct antiviral. It’s like getting a neutralizing antibody that’s highly, highly concentrated and highly, highly specific. So, the mechanism involved is blocking of the virus from essentially entering its target cell in the body and essentially interrupting the course of infection,” he said.


Sudden Cardiac Arrest in a Patient with Myxedema Coma and COVID-19

Journal of the Endocrine Society, August 28, 2020

SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of COVID-19. We present the first case of myxedema coma in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multi-organ damage and sudden cardiac arrest in our patient. A 69-year-old female with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyroid stimulating hormone, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died two days later from multi-organ failure. This is the first report of SARS-CoV-2 infection with myxedema coma. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and myxedema coma – all of which were associated with the patient’s SARS-CoV-2 infection.


The coronavirus is most deadly if you are older and male — new data reveal the risks

Nature, August 28, 2020

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19. Trends in coronavirus deaths by age have been clear since early in the pandemic. Research teams looking at the presence of antibodies against SARS-CoV-2 in people in the general population — in Spain, England, Italy and Geneva in Switzerland — have now quantified that risk, says Marm Kilpatrick, an infectious-disease researcher at the University of California, Santa Cruz. The studies reveal that age is by far the strongest predictor of an infected person’s risk of dying — a metric known as the infection fatality ratio (IFR), which is the proportion of people infected with the virus, including those who didn’t get tested or show symptoms, who will die as a result. “COVID-19 is not just hazardous for elderly people, it is extremely dangerous for people in their mid-fifties, sixties and seventies,” says Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire, who has estimated that getting COVID-19 is more than 50 times more likely to be fatal for a 60-year-old than is driving a car. But “age cannot explain everything”, says Henrik Salje, an infectious-disease epidemiologist at the University of Cambridge, UK. Gender is also a strong risk factor, with men almost twice more likely to die from the coronavirus than women.


Heparin may neutralize virus that causes COVID-19

Helio | HemOnc Today, August 28, 2020

The COVID-19 pandemic has prompted a flurry of scientific studies of various potential treatments and vaccines for the novel coronavirus. One such study, conducted by researchers at Rensselaer Polytechnic Institute and published in Antiviral Research, showed the FDA-approved anticoagulant heparin may neutralize SARS-CoV-2, the virus that causes COVID-19. SARS-CoV-2 uses a surface spike protein to attach to human cells and infect them, according to the study background. However, because heparin binds tightly with the surface spike protein, it potentially could serve as a decoy and prevent infection from occurring. “We’ve known for quite some time that heparin possesses the ability to be antiviral; it has the ability to bind to very specific proteins on the surfaces of viruses,” Jonathan S. Dordick, PhD, the Howard P. Isermann Professor of Chemical and Biological Engineering at Rensselaer and one of the study authors, said in an interview with Healio. “So that wasn’t really a surprise. The other reason we studied heparin had nothing to do with its antiviral properties.”


ANMCO POSITION PAPER: Network Organization for the Treatment of Acute Coronary Syndrome Patients during the Emergency COVID-19 Pandemic

European Heart Journal Supplements, August 27, 2020

Among the risk factors associated with increased mortality from COVID-19—besides male gender and age—the following are to be considered risk factors: hypertension, diabetes mellitus, a history of cardiovascular, and cerebrovascular events. The mortality rate for acute myocardial infarction during SARS by coronavirus was 2.6%, on an overall mortality rate linked to the infection of 6.6%. In consideration of the epidemiological framework described, we have to consider all the patients that we examine for acute coronary syndrome (ACS) as potential COVID-19. This aspect is particularly important for the safety of the other hospitalized patients, of our hospitals and of our healthcare professionals (physicians, nurses, residents, social healthcare workers, and radiology technicians) who are directly involved in the management of the patient. Therefore, the cardiologist must be ready to manage any cardiac emergency by guaranteeing the adequate therapy but at the same time, must protect the healthcare professionals from the risk of infection and optimize the available individual protection resources. In a patient presenting with ST-elevation (STEMI) myocardial infarction or ‘STEMI-like’, if positive to COVID-19, the reperfusion therapeutic strategy depends on the local organization and on the possibility to access without delay a Coronary Angioplasty (PCI) COVID Center, on the basis, obviously, of the risk/benefit assessment of the individual case. However, we advise to try pursuing, in the first instance, the mechanical revascularization strategy, according to the available local possibilities.


Cardiovascular System in COVID-19: Simply a Viewer or a Leading Actor?

Life, August 27, 2020

Several studies have observed a relationship between coronavirus disease (COVID-19) infection and the cardiovascular system with the appearance of myocardial damage, myocarditis, pericarditis, heart failure and various arrhythmic manifestations, as well as an increase in thromboembolic risk. COVID-19 causes cardiovascular complications, including diffuse thrombosis, pulmonary thromboembolism, disseminated intravascular coagulation (DIC), myocarditis, pericardial effusion, both hypokinetic and hyperkinetic arrhythmias, but also cardiogenic shock. In addition, drugs currently in use for the treatment of COVID-19, such as hydroxychloroquine, azithromycin and protease inhibitors, can affect the cardiac conduction system leading to an extension of the QT interval, which in turn can predispose the onset of ventricular arrhythmias, in particular torsades de pointes. This review examines the cardiovascular involvement, direct and indirect, associated with SARS CoV-2 infection in order to manage the cardiovascular complications in the clinical practice.


Blood pressure control and adverse outcomes of COVID-19 infection in patients with concomitant hypertension in Wuhan, China

Hypertension Research, August 27, 2020

Early investigations on the clinical characteristics of patients with COVID-19 infection have found that comorbidities significantly increase the risk of severe clinical outcomes, such as mortality, ICU admission, and mechanical ventilation. One of the most common comorbidities among COVID-19 patients is hypertension, with a prevalence ranging from 16.9 to 31.2% in hospitalized patients in China. Hypertension was also the most common comorbidity in ICU patients in Lombardy, Italy (49%) and hospitalized COVID-19 patients in New York, USA (56.6%). The mechanism of exacerbation associated with underlying conditions remains unclear, and experts worldwide have called for in-depth analysis of blood pressure (BP) control in hypertension patients during the clinical course of COVID-19. The mechanisms of exacerbation of underlying cardiovascular conditions after COVID-19 infection remain unclear. One of the most cited hypotheses is the overexpression of angiotensin converting enzyme II (ACE2) in arterial endothelial and smooth muscle cells. In this retrospective cohort study, the anonymized individual medical records from February 4 (admission of the first patient) to March 31, 2020 were retrieved from the electronic database of Huoshenshan Hospital, an acute field hospital built in Wuhan in response to the COVID-19 outbreak.


The Transformational Effects of COVID-19 on Medical Education

JAMA Network, August 26, 2020

[Podcast] The onset of the COVID-19 pandemic and the public health response required to minimize the catastrophic spread of the disease required an immediate change in the traditional approach to medical education and clearly amplified the need for expanding the competencies of the US physician workforce. Medical educators responded at the local and national levels to outline concerns and offer guiding principles so that academic health systems could support a robust public health response while ensuring that physician graduates are prepared to contribute to addressing current and future threats to the health of communities. While each school approached their response somewhat differently, several common themes have emerged. Join Howard Bauchner, MD, Editor in Chief of JAMA, as he interviews Catherine Lucey, MD, FACP, Department of Medicine, University of California San Francisco School of Medicine and author of The Transformational Effects of COVID-19 on Medical Education.


Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019 – Results of a Multicenter Study

JAMA Cardiology, August 26, 2020

Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates. The objective of this study was to evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19. This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values.


Blood Thinners Again Linked to COVID-19 Survival in Hospital

MedPage Today, August 26, 2020

Anticoagulation for patients hospitalized with COVID-19 was associated with lower risk of death or intubation in an observational study from New York City’s pandemic peak. In-hospital mortality risk was a relative 50% lower with standard prophylactic dosing and 47% lower with higher therapeutic-level dosing after adjustment for other factors, both statistically significant when compared with COVID-19 patients in Mount Sinai hospitals not given an anticoagulant (mortality rates of 21.6%, 28.6%, and 25.6%, respectively). Intubation was less likely for anticoagulant-treated COVID-19 patients as well (adjusted HR 0.69 with prophylactic dosing, 95% CI 0.51-0.94, and aHR 0.72 with therapeutic dosing, 95% CI 0.58-0.89), reported Anuradha Lala, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in the Journal of the American College of Cardiology. Major bleeding events adjudicated by clinician chart review turned up a “low” rate of 1.7% (33 of 1,959) on prophylactic anticoagulation and 3% (27 of 900) on therapeutic anticoagulation compared with 1.9% (29 of 1,530) on no anticoagulant during hospitalization.


Hello? This Is Your Cardiologist

JAMA Cardiology, August 26, 2020

Read how physician Neha Yadav, MBBS, Cook County Hospital in Chicago, Illinois, was able to connect with a patient while transitioning from in-person work to telemedicine during the coronavirus disease 2019 pandemic.


Sex differences in immune responses that underlie COVID-19 disease outcomes

Nature, August 26, 2020

A growing body of evidence reveals that male sex is a risk factor for a more severe disease, including death. Globally, ~60% of deaths from COVID-19 are reported in men, and a cohort study of 17 million adults in England reported a strong association between male sex and risk of death from COVID-19 (hazard ratio 1.59, 95% confidence interval 1.53-1.65. .53-1.65). Past studies have demonstrated that sex has a significant impact on the outcome of infections and has been associated with underlying differences in immune response to infection. For example, prevalence of hepatitis A and tuberculosis are significantly higher in men compared with women. Viral loads are consistently higher in male patients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Conversely, women mount a more robust immune response to vaccines. However, the mechanism by which SARS-CoV-2 causes more severe disease in male patients than in female patients remains unknown. To elucidate the immune responses against SARS-CoV-2 infection in men and women, we performed detailed analysis on the sex differences in immune phenotype via the assessment of viral loads, SARS-CoV-2 specific antibody levels, plasma cytokines/chemokines, and blood cell phenotypes.


Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report

BMC Cardiovascular Disorders, August 26, 2020

Fulminant (life-threatening) COVID-19 can be associated with acute respiratory failure (ARF), multi-system organ failure and cytokine release syndrome (CRS). We present a rare case of fulminant COVID-19 associated with reverse-takotsubo-cardiomyopathy (RTCC) that improved with therapeutic plasma exchange (TPE). This is a case report of a 40 year old previous healthy male presented in the emergency room with 4 days of dry cough, chest pain, myalgias and fatigue. He progressed to ARF requiring high-flow-nasal-cannula (flow: 60 L/minute, fraction of inspired oxygen: 40%). Real-Time-Polymerase-Chain-Reaction (RT-PCR) assay confirmed COVID-19 and chest X-ray showed interstitial infiltrates. Biochemistry suggested CRS: increased C-reactive protein, lactate dehydrogenase, ferritin and interleukin-6. Renal function was normal but lactate levels were elevated. Electrocardiogram demonstrated non-specific changes and troponin-I levels were slightly elevated. Echocardiography revealed left ventricular (LV) basal and midventricular akinesia with apex sparing (LV ejection fraction: 30%) and depressed cardiac output (2.8 L/min) consistent with a rare variant of stress-related cardiomyopathy: RTCC. His ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen was < 120. He was admitted to the intensive care unit (ICU) for mechanical ventilation and vasopressors, plus antivirals (lopinavir/ritonavir), and prophylactic anticoagulation.


Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (Covid-19)

International Journal of Environmental Research and Public Health, August 26, 2020

Healthcare workers (HCWs) facing COVID-19 pandemic represented an at-risk population for new psychosocial COVID-19 strain and consequent mental health symptoms. The aim of the present study was to identify the possible impact of working contextual and personal variables (age, gender, working position, years of experience, proximity to infected patients) on professional quality of life, represented by compassion satisfaction (CS), burnout, and secondary traumatization (ST), in HCWs facing COVID-19 emergency. Further, two multivariable linear regression analyses were fitted to explore the association of mental health selected outcomes, anxiety and depression, with some personal and working characteristics that are COVID-19-related. A sample of 265 HCWs of a major university hospital in central Italy was consecutively recruited at the outpatient service of the Occupational Health Department during the acute phase of COVID-19 pandemic. HCWs were assessed by Professional Quality of Life-5 (ProQOL-5), the Nine-Item Patient Health Questionnaire (PHQ-9), and the Seven-Item Generalized Anxiety Disorder scale (GAD-7) to evaluate, respectively, CS, burnout, ST, and symptoms of depression and anxiety. Females showed higher ST than males, while frontline staff and healthcare assistants reported higher CS rather than second-line staff and physicians, respectively. Burnout and ST, besides some work or personal variables, were associated to depressive or anxiety scores.


After Care of Survivors of COVID-19—Challenges and a Call to Action

JAMA Health Forum, August 26, 2020

For most patients with severe illness requiring hospitalization, COVID-19 has been a frightening and life-changing experience. At the peak of the pandemic, the attention of health care teams was focused on saving lives and protecting health services from being overwhelmed. Those who survived were often discharged without a robust process of follow-up. The prevalence of post–COVID-19 complications is not yet fully known and may only become apparent in the months and years to come. Data from previous coronavirus (severe acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]) outbreaks indicate that between 20% and 40% of survivors experience long-term complications. In a recent report of 143 patients with COVID-19 who were evaluated a mean of 2 months after hospital discharge at a follow-up clinic in Rome, Italy, many patients reported persistent fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%), and chest pain (21.7%). Drawing on these experiences, respiratory, cardiovascular, neurologic, metabolic, and psychosocial complications may be important long-term sequelae of COVID-19. It is therefore essential that systems are in place for timely and thorough identification of such sequelae followed by appropriate interventions. We discuss the challenges we have addressed in establishing a multidisciplinary COVID-19 follow-up clinic in a secondary care setting at the University Hospital of Birmingham, England.


Malignant Ventricular Arrhythmias in Patients with Severe Acute Respiratory Distress Syndrome Due to COVID-19 without Significant Structural Heart Disease

Heart Rhythm Case Reports, August 25, 2020

Since December 2019, the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in a pandemic of novel coronavirus (COVID-19) infections. Although predominantly a respiratory illness that can cause acute respiratory distress syndrome (ARDS), data suggest cardiovascular involvement contributes significantly to the disease’s mortality. Data from Wuhan, China demonstrated patients with pre-existing cardiovascular disease and elevated troponin levels had 69.44% mortality. ARDS is defined by acute hypoxemic respiratory failure of non-cardiac etiology, bilateral pulmonary infiltrates, and a decreased PaO2/FIO2 ratio with mortality rates reaching 40%. After decades of ARDS research, little has been described about any associated ventricular arrhythmias despite the potential interplay between pulmonary pathology, treatments, and malignant arrhythmias. We present a series of COVID-19 infected patients with preserved cardiac function who developed ARDS and refractory ventricular arrhythmias.


AstraZeneca starts trial of COVID-19 antibody treatment

Reuters, August 25, 2020

British drugmaker AstraZeneca has begun testing an antibody-based cocktail for the prevention and treatment of COVID-19, adding to recent signs of progress on possible medical solutions to the disease caused by the novel coronavirus. The London-listed firm, already among the leading players in the global race to develop a successful vaccine, said the study would evaluate if AZD7442, a combination of two monoclonal antibodies (mAbs), was safe and tolerable in up to 48 healthy participants between the ages of 18 and 55 years. If the UK-based early-stage trial, which has dosed its participants, shows AZD7442 is safe, AstraZeneca said it would proceed to test it as both a preventative treatment for COVID-19 and a medicine for patients who have it, in larger, mid-to-late-stage studies. Development of mAbs to target the virus, an approach already being tested by Regeneron, Eli Lilly, Roche and Molecular Partners, has been endorsed by leading scientists. mAbs mimic natural antibodies generated in the body to fight off infection and can be synthesised in the laboratory to treat diseases in patients. Current uses include treatment of some types of cancers.


Medicure Announces AGGRASTAT Shows Promise in Treating Thrombotic Complications Due to COVID-19 in Early Clinical Reports

BioSpace, August 24, 2020

Medicure, Inc., a pharmaceutical company, is reporting that early investigator sponsored clinical reports evaluating the efficacy of AGGRASTAT® (tirofiban hydrochloride) show promise for preventing and treating thrombotic complications due to COVID-19. AGGRASTAT® is not currently indicated for use in patients with COVID-19. Notably, a non-randomized, case-controlled, investigator sponsored proof of concept study (n=10) evaluating AGGRASTAT® in combination with standard of care in patients with severe COVID-19 and hypercoagulability found that enhanced platelet inhibition improves hypoxemia. Treated patients experienced a mean reduction in alveolar-arterial oxygen gradient and an increase in PaO2/FiO2 at 24h, 48h and 7 days after treatment. Seven other small clinical reports have recently been published exploring the clinical efficacy of AGGRASTAT® in patients with COVID-19. Medicure is evaluating sponsorship of further US-based randomized clinical studies to rapidly assess the efficacy and safety of using AGGRASTAT® for preventing thrombotic complications due to COVID-19. “These initial results are sufficiently positive to warrant further investigation to more clearly understand the potential role of AGGRASTAT® to reduce thrombotic effects which are observed in many COVID-19 patients”, commented Medicure’s CEO, Dr. Albert D. Friesen. “We believe there is reason to sponsor this type of clinical research due to the emerging understanding of the role of thrombosis in the pathophysiology of COVID-19.”


Outcomes of Acute Myocardial Infarction Hospitalizations During the COVID-19 Pandemic

American College of Cardiology, August 24, 2020

While hospitalization rates related to COVID-19 infection have surged, there is clear evidence that patients in the United States and around the world have less commonly sought medical attention for a number medical emergencies such as acute myocardial infarction (AMI) than they were prior to the pandemic.6 The characteristics of patients most affected by this phenomenon and its impact on complication rates and patient outcomes are yet to be elucidated. In order to examine the impact of the epidemic on patients with AMI, Dr. Gluckman and colleagues evaluated case rates and in-hospital outcomes for patients presenting with AMI to any of the 49 hospitals in the Providence St. Joseph Health (PSJH) system spread across six states. This study evaluated over 15,000 hospitalizations involving more than 14,700 patients and confirmed the concerning trends of prior studies in AMI hospitalization: case rates of AMI hospitalization across PSJH decreased during the period early in the pandemic at a rate of -19.0 (95% CI, -29.0 to -9.0) cases per week, with increasing cases at a rate of +10.5 (95% CI, +4.6 to +16.5) during the period later in the pandemic. However, case rates had not returned to baseline by the last week of the study period.


Scientists say Hong Kong man got coronavirus a second time

Modern Healthcare, August 24, 2020

University of Hong Kong scientists claim to have the first evidence of someone being reinfected with the virus that causes COVID-19. Genetic tests revealed that a 33-year-old man returning to Hong Kong from a trip to Spain in mid-August had a different strain of the coronavirus than the one he’d previously been infected with in March, said Dr. Kelvin Kai-Wang To, the microbiologist who led the work. The man had mild symptoms the first time and none the second time; his more recent infection was detected through screening and testing at the Hong Kong airport. “It shows that some people do not have lifelong immunity” to the virus if they’ve already had it, To said. “We don’t know how many people can get reinfected. There are probably more out there.” Whether people who have had COVID-19 are immune to new infections and for how long are key questions that have implications for vaccine development and decisions about returning to work, school and social activities.


Online searches for ‘chest pain’ rise, emergency visits for heart attack drop amid COVID

Newswise, August 24, 2020

A study of search engine queries addressed the question of whether online searches for chest pain symptoms correlated to reports of fewer people going to the emergency department with acute heart problems during the COVID-19 pandemic. Mayo Clinic researchers looked at Google Trends data for Italy, Spain, the U.K. and the U.S., reviewing search terms such as “chest pain” and “myocardial infarction” (heart attack). The study spanned June 1, 2019 to May 31. Prior to the pandemic, those searches had relatively similar volumes to each other. The expectation would be that the frequency of heart attacks would stay the same or even rise in this setting. However, at the onset of the COVID-19 pandemic, searches for “myocardial infarction” dropped, while searches for “chest pain” rose at least 34%. Conor Senecal, M.D., a Mayo Clinic cardiology fellow in Rochester, is first author on the study, which is published in JMIR Cardio. “Interestingly, searches for ‘heart attack’ dropped during the same period of reported reduced heart attack admissions, but surprisingly, searches for ‘chest pain’ rose,” says Dr. Senecal. “This raises concern that people may have either misconstrued chest pain as an infectious symptom or actively avoided getting care due to COVID-19 concerns.”


Not just antibodies: B cells and T cells mediate immunity to COVID-19

Nature Reviews Immunology, August 24, 2020

Recent reports that antibodies to SARS-CoV-2 are not maintained in the serum following recovery from the virus have caused alarm. However, the absence of specific antibodies in the serum does not necessarily mean an absence of immune memory. Here, we discuss our current understanding of the relative contribution of B cells and T cells to immunity to SARS-CoV-2 and the implications for the development of effective treatments and vaccines for COVID-19. The induction of SARS-CoV-2-specific memory T cells and B cells (as opposed to circulating antibodies) is important for long-term protection. In particular, T follicular helper (TFH) cells indicate maturation of the humoral immune response and the establishment of a pool of specific memory B cells ready to rapidly respond to possible reinfection. SARS-CoV-2-specific T cells are recruited from a randomly formed and pre-constituted T cell pool capable of recognizing specific viral epitopes. Specific CD4+ T cells are important for eliciting potent B cell responses that result in antibody affinity maturation, and the levels of spike-specific T cells correlate with serum IgG and IgA titres.


Effect of Renin-Angiotensin-Aldosterone System inhibitors in patients with COVID-19: a systematic review and meta-analysis of 28,872 patients

Current Atherosclerosis Reports, August 24, 2020

The role of renin-angiotensin-aldosterone system (RAAS) inhibitors, notably angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), in the COVID-19 pandemic has not been fully evaluated. With an increasing number of COVID-19 cases worldwide, it is imperative to better understand the impact of RAAS inhibitors in hypertensive COVID patients. PubMed, Embase and the pre-print database Medrxiv were searched, and studies with data on patients on ACEi/ARB with COVID-19 were included. Random effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software. Recent Findings A total of 28,872 patients were included in this meta-analysis. The use of any RAAS inhibition for any conditions showed a trend to lower risk of death/critical events (OR 0.671, CI 0.435 to 1.034, p = 0.071). Within the hypertensive cohort, however, there was a significant lower association with deaths (OR 0.664, CI 0.458 to 0.964, p = 0.031) or the combination of death/critical outcomes (OR 0.670, CI 0.495 to 0.908, p = 0.010). There was no significant association of critical/death outcomes within ACEi vs non-ACEi (OR 1.008, CI 0.822 to 1.235, p = 0.941) and ARB vs non-ARB (OR 0.946, CI 0.735 to 1.218, p = 0.668).


An inflammatory cytokine signature predicts COVID-19 severity and survival

Nature Medicine, August 24, 2020

Several studies have revealed that the hyper-inflammatory response induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major cause of disease severity and death. However, predictive biomarkers of pathogenic inflammation to help guide targetable immune pathways are critically lacking. We implemented a rapid multiplex cytokine assay to measure serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α and IL-1β in hospitalized patients with coronavirus disease 2019 (COVID-19) upon admission to the Mount Sinai Health System in New York. Patients (n = 1,484) were followed up to 41 d after admission (median, 8 d), and clinical information, laboratory test results and patient outcomes were collected. We found that high serum IL-6, IL-8 and TNF-α levels at the time of hospitalization were strong and independent predictors of patient survival (P < 0.0001, P = 0.0205 and P = 0.0140, respectively). Notably, when adjusting for disease severity, common laboratory inflammation markers, hypoxia and other vitals, demographics, and a range of comorbidities, IL-6 and TNF-α serum levels remained independent and significant predictors of disease severity and death.


FDA Authorizes Convalescent Plasma for COVID-19 Patients

MedPage Today, August 24, 2020

Convalescent plasma shows promising efficacy in hospitalized patients with COVID-19, and the benefits outweigh the risks, the FDA said in announcing emergency use authorization (EUA) for such products on Sunday. The EUA was granted to the Office of Assistant Secretary for Preparedness and Response within the Department of Health and Human Services. It is not for any particular convalescent plasma product, but rather any such preparation “collected by FDA registered blood establishments from individuals whose plasma contains anti-SARS-CoV-2 antibodies, and who meet all donor eligibility requirements,” according to a fact sheet for healthcare providers. “Independent experts at the FDA who reviewed the totality of data” including more than a dozen published studies “concluded convalescent plasma is safe and shows promising efficacy, thereby meeting criteria for an emergency use authorization,” FDA commissioner Stephen Hahn, MD, said at a press conference on Sunday night.


Sex differences underlying preexisting cardiovascular disease and cardiovascular injury in COVID-19

Journal of Molecular and Cellular Cardiology, August 22, 2020

The novel 2019 coronavirus disease (COVID-19) results from severe acute respiratory syndrome coronarvirus-2 (SARS-CoV-2) infection and typically afflicts the lungs, with severe cases leading to acute respiratory distress syndrome. Although the respiratory system is the major organ system affected by SARS-CoV-2, cardiovascular complications should not be overlooked by healthcare workers and basic scientists. In particular, acute myocardial injury, cardiac arrhythmias and microvascular dysfunction and thrombosis are reported to contribute to a large proportion of COVID-19 deaths. While there is a robust body of evidence elucidating sex differences in CVD, sex disparities in COVID-19 are becoming more apparent as well. Interestingly, mounting data also indicate that individuals with higher risk of severe COVID-19 outcome due to preexisting CVD and COVID-19-related cardiovascular injury include a disproportionate number of males. In this review, we will discuss sex differences in the interplay between preexisting CVD, COVID-19 severity, and COVID-19-related cardiac injury by providing a basic science perspective based on the current literature in this rapidly evolving field.


DARE-19: Dapagliflozin could target key mechanisms activated in COVID-19

Helio | Endocrine Today, August 22, 2020

SGLT2 inhibitors could potentially target key mechanisms activated in COVID-19, increasing lipolysis, reducing glycolysis, inflammation and oxidative stress, and improving endothelial function to reduce organ damage, according to a speaker. “We know that favorable effects on mechanisms such as endothelial function, a key driver of adverse outcomes in COVID-19, can occur very quickly after treatment with SGLT2 inhibitors,” Mikhail Kosiborod, MD, FACC, FAHA, cardiologist at Saint Luke’s Mid America Heart Institute, professor of medicine at the University of Missouri-Kansas City School of Medicine, said during an online presentation during the virtual Heart in Diabetes conference. “If you think through these mechanisms and the fact that SGLT2 inhibitors can have a positive impact on many of them, what becomes clear is that testing SGLT2 inhibitors as potential agents for organ protection in COVID-19 may be one of the key hypotheses.” The concept is relatively simple, Kosiborod said. Viral replication and spread after COVID-19 infection trigger metabolic derangements that lead to inflammatory “overdrive,” endothelial injury and, ultimately, organ damage leading to complications and death. Data suggest antiviral treatments can work in the early phase of the disease; anti-inflammatory medications show promise during the mid-phase of the disease.


Cardiovascular Risk Factors, Comorbidity Linked to COVID-19 CV Complications

Pulmonology Advisor, August 21, 2020

For patients hospitalized with COVID-19, preexisting cardiovascular comorbidities or risk factors (RFs) are associated with cardiovascular complications, which contribute to mortality, according to a meta-analysis published online in PLOS ONE. Jolanda Sabatino, M.D., from “Magna Graecia” University in Catanzaro, Italy, and colleagues conducted a meta-analysis of observational studies assessing cardiovascular complications in hospitalized COVID-19 patients. Data were included for 77,317 hospitalized patients from 21 studies. The researchers found that 12.86 percent of the patients had cardiovascular comorbidities or RFs. During hospitalization, cardiovascular complications were registered in 14.09 percent of cases. Preexisting cardiovascular comorbidities or RFs were associated significantly with cardiovascular complications in COVID-19 patients in a meta-regression analysis. Significant interactions with death were seen for preexisting cardiovascular comorbidities or RFs, older age, and the development of cardiovascular complications during hospitalization. “The association between the novel coronavirus and cardiac complications needs further exploration and clinicians should be aware of the potential impact of cardiovascular conditions and complications in COVID-19 patients, which should require more extensive and frequent monitoring,” the authors write.


Clear Link Between Heart Disease and COVID-19, But Long-Term Implications Unknown, Researchers Find in Review of Published Studies

Newswise, August 21, 2020

One of the most harrowing effects of COVID-19 is severe damage to the lungs, which makes breathing hard or impossible for those who’re severely affected. However, evidence is mounting that COVID-19 also damages the heart, damage either caused by the virus itself, from inflammation triggered by the immune system’s response to the virus or a from increased clotting in heart vessels. There is now evidence that heart damage may persist even after the patient recovers and, in some cases, that damage may be long lasting. Experts just don’t know how often the heart damage will occur at this point or whether it might affect people with only mild symptoms. The worry is so grave that it was cited by some college football conferences as one of the reasons to postpone games for the year for fear that athletes who contract COVID-19 may suffer long-term cardiovascular problems. In a prospectus review published this week in the Journal of Molecular and Cellular Cardiology, Kirk U. Knowlton MD, from the Intermountain Healthcare Heart Institute in Salt Lake City, examined more than 100 published studies related to COVID-19 and its effects on the heart. While lung disease (severe acute respiratory distress syndrome, or ARDS) has been the most consistent problem with the virus, Dr. Knowlton found that many patients also suffer significant cardiovascular damage that might also persist after they have otherwise recovered.


Utility of D-dimers and intermediate-dose prophylaxis for venous thromboembolism in critically ill patients with COVID-19

Thrombosis Research, August 21, 2020

Increasing evidence indicates that hypercoagulability plays a significant role in the pathophysiology of severe coronavirus disease 2019 (COVID-19), contributing to macro- and microvascular thrombosis. It is of practical relevance to identify adequate diagnostic and prophylactic approaches to recognize and limit these complications. We report D-dimer performance in VTE-diagnosis and the comparison of intermediate-dose versus standard-of-care prophylactic anticoagulation in VTE-prevention among critically-ill COVID-19 patients. We performed a retrospective study at Lausanne University Hospital (CHUV). We included patients aged ≥18 years admitted to ICU for severe COVID-19 with microbiologically confirmed SARS-CoV-2 infection. Until 6 April 2020, internal guidelines recommended for ICU-patients with COVID-19, in absence of contraindications, a standard-of-care prophylactic anticoagulation [enoxaparin 40 mg (60 mg for patients >120 kg) q.d. or unfractionated heparin 5′000 UI bid for those with creatinine clearance <30 ml/min]. Internal guidelines implemented intermediate-dose prophylactic anticoagulation [enoxaparin 40 mg bid (60 mg bid if >120 kg) or unfractionated heparin IV 200 UI/kg/24 h in case of impaired renal function] on 7 April 2020. D-dimers were measured irregularly prior to 29 March 2020, afterwards every other day. Primary outcome was VTE [deep venous thrombosis (DVT) assessed by compression ultrasonography, and pulmonary embolism (PE) assessed by computer tomography (CT)].


SARS-CoV-2 in cardiac tissue of a child with COVID-19-related multisystem inflammatory syndrome

The Lancet | Child and Adolescent Health, August 20, 2020

We report the case of an 11-year-old child with multisystem inflammatory syndrome in children (MIS-C) related to COVID-19 who developed cardiac failure and died after 1 day of admission to hospital for treatment. An otherwise healthy female of African descent, the patient was admitted to the paediatric intensive care unit (ICU) with cardiovascular shock and persistent fever. Her initial symptoms were fever for 7 days, odynophagia, myalgia, and abdominal pain. On admission to the ICU, the patient presented with respiratory distress, comprising tachypnoea (respiratory rate 70 breaths per min) and hypoxia, and signs of congestive heart failure, including jugular vein distention, crackles at the base of the lungs, displaced liver, hypotension (blood pressure 80/36 mm Hg), tachycardia (134 beats per min [bpm]), and cold extremities with filiform pulses. Non-exudative conjunctivitis and cracked lips were present on physical examination. The patient was promptly intubated and antibiotic treatment was started with ceftriaxone and azithromycin. Peripheral epinephrine was initiated in the emergency room before the patient was moved to paediatric ICU.


COVID-19, the heart and returning to physical exercise

Occupational Medicine, August 20, 2020

COVID-19 infection may be complicated by cardiac arrhythmias, myocarditis and other cardiovascular complications, with potentially fatal outcomes. Early reports from China suggested that 12–30% of patients admitted to hospital with SARS-CoV-2 had a raised troponin above the 99th percentile. The pathophysiological mechanisms of cardiac injury are not yet fully understood, but may include augmented metabolic demand, hypoxaemia, right ventricular pressure overload, T-cell- and cytokine-mediated hyperinflammatory reaction or direct myocardial cell infection. Cardiac involvement is likely to be potentiated by a high level of expression of angiotensin-converting enzyme 2 (ACE2). Cardiac involvement should be considered in patients presenting with a history of new-onset chest pain/pressure, palpitations, breathlessness, or exercise-induced dizziness or syncope—even in the absence of fever and other respiratory symptoms. There is concern that even ‘recovered’ patients may be at risk of adverse cardiac events.


Annual Heart in Diabetes conference offers all-virtual sessions on cardiometabolic health

Helio | Endocrine Today, August 20, 2020

Organizers behind this year’s Heart in Diabetes conference are preparing to launch a free, all-virtual platform of sessions spanning all aspects of cardiometabolic health, along with a new emphasis on the impact of the COVID-19 pandemic. Leading experts from a range of specialties will once again come together — this time online — to address the relationship between type 2 diabetes, cardiovascular and renal disease along with the latest research demonstrating their interconnectedness, according conference co-chair Yehuda Handelsman, MD, FACP, FNLA, FASCP, MACE. The now 4-day CME conference, described as where the heart, kidney and diabetes meet in clinical practice, will take place Friday through Monday. The agenda includes sessions that span the subspecialties from cardiology, lipidology and endocrinology to nephrology, hepatology and primary care, with an emphasis on the latest guidelines and data from important CV outcomes trials.


Evidence mounts for ECMO in patients with severe COVID-19 respiratory failure

Helio | Pulmonology, August 20, 2020

Two recently published studies report success with extracorporeal membrane oxygenation support in patients with acute respiratory distress syndrome associated with COVID-19. In a retrospective cohort study published in The Lancet Respiratory Medicine, researchers analyzed clinical characteristics and outcomes of 492 patients treated with ECMO for COVID-19-associated ARDS at five ICUs within the Paris-Sorbonne University Hospital Network from March 8 to May 2. The researchers reported complete day-60 follow-up for 83 patients (median age, 49 years; 73% men) who received ECMO. Before ECMO, 94% of patients were prone positioned (median driving pressure, 18 cm H2O; ratio of arterial oxygen partial pressure to fractional inspired oxygen, 60 mm Hg). Sixty days after initiation of ECMO, the researchers’ estimated probability of death was 31% and the probability of being alive and out of the ICU was 45%.


Circulating Endothelial Cells as a Marker of Endothelial Injury in Severe COVID -19

Journal of Infectious Diseases, August 19, 2020

The vascular endothelium is a dynamic organ that plays key roles in vascular homeostasis, such as maintaining vascular tone, permeability and inflammatory response, preserving the hemostatic balance. Any endothelial injury, including infections, impairs regulatory functions of the endothelium with subsequent vasoconstriction, ischemia, inflammation and activation of the coagulation cascade, ultimately leading to vessels denudation and exposure of the thrombogenic subendothelium. Circulating endothelial cells (CEC) are stressed cells detached from injured vessels. They are detectable at very low levels in healthy conditions. Increased CEC counts have been reported in various diseases of inflammatory, infectious or ischemic origin, where they evidence a profound vascular insult and are indicative of disease severity. The objective of the present study was to measure CEC in the blood of patients with COVID-19, in relation to systemic inflammation and disease severity.


Ex-CDC director Tom Frieden provides strategies for protecting HCWs amid COVID-19

Helio | Primary Care, August 19, 2020

Former CDC director Tom Frieden, MD, MPH, recently described a hierarchy of controls — elimination, substitution, engineering, administration and personal protective equipment — that may help prevent COVID-19 among health care workers. His remarks came during the National Medical Association’s Annual Meeting, held virtually due to the pandemic. Frieden said the “most effective” step is eliminating the hazard or infection. This can be accomplished by not allowing people who are ill to enter nursing homes and other congregate facilities. It can also be accomplished by ensuring that all hospitals and nursing home staffs have paid sick leave, so that there is no economic incentive to work while ill. If patients with COVID-19 cannot be separated from other patients and staff by engineering and substitution, PPE becomes necessary, Frieden said. When PPE is necessary, supply has to be ensured.


The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19

Journal of Antimicrobial Chemotherapy, August 19, 2020

Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19. Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT–PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality. Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04–0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1–12.1, P < 0.01).


As U.S. schools reopen, concerns grow that kids spread coronavirus

Reuters, August 19, 2020

U.S. students are returning to school in person and online in the middle of a pandemic, and the stakes for educators and families are rising in the face of emerging research that shows children could be a risk for spreading the new coronavirus. Several large studies have shown that the vast majority of children who contract COVID-19, the disease caused by the virus, have milder illness than adults. And early reports did not find strong evidence of children as major contributors to the deadly virus that has killed more than 780,000 people globally. But more recent studies are starting to show how contagious infected children, even those with no symptoms, might be. “Contrary to what we believed, based on the epidemiological data, kids are not spared from this pandemic,” said Dr. Alessio Fasano, director of the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital and author of a new study.


The Physicians Foundation 2020 Physician Survey

Physicians Foundation, August 18, 2020

The Physicians Foundation’s 2020 Survey of America’s Physicians finds that the majority of physicians believe COVID-19 won’t be under control until January 2021, with nearly half not seeing the virus being under control until after June 1, 2021. Furthermore, a majority of physicians believe that the virus will severely impact patient health outcomes due to delayed routine care during the pandemic. Read and download the findings. The survey, conducted in July with more than 3,500 respondents, asked physicians how the pandemic is affecting their practices and patients. Nearly three-quarters of those surveyed said COVID-19 would have serious consequences for health in their communities because many are delaying needed care. Health insurance is another problem; 76% cited changes in employment and insurance status is a primary cause of harm to patients caused by COVID-19. But 59% believed opening schools, businesses and other public places posed a greater risk to their patients than continued social isolation. “The data reveals a near-consensus among America’s physicians about COVID-19’s immediate and lasting impact on our healthcare system,” said Dr. Gary Price, president of The Physicians Foundation, in a prepared statement.


FDA flags accuracy issue with widely used coronavirus test

Associated Press, August 18, 2020

Potential accuracy issues with a widely used coronavirus test could lead to false results for patients, U.S. health officials warned. The Food and Drug Administration issued the alert Monday to doctors and laboratory technicians using Thermo Fisher’s TaqPath genetic test. Regulators said issues related to laboratory equipment and software used to run the test could lead to inaccuracies. The agency advised technicians to follow updated instructions and software developed by the company to ensure accurate results. The warning comes nearly a month after Connecticut public health officials first reported that at least 90 people had received false positive results for the coronavirus. Most of those receiving the false results were residents of nursing homes or assisted living facilities. A spokeswoman for Thermo Fisher said the company was working with FDA “to make sure that laboratory personnel understand the need for strict adherence to the instructions for use.” She added that company data shows most users “follow our workflow properly and obtain accurate results.”


Cardiac Involvement, Ongoing Myocardial Inflammation Observed After Recent COVID-19 Recovery

Pulmonology Today, August 17, 2020

A large percentage of patients who recently recover from coronavirus disease 2019 (COVID-19) were found to have cardiac involvement and ongoing myocardial inflammation, according to a study published in JAMA Cardiology. The prospective observational study included 100 patients (median age, 49 years) in the University Hospital Frankfurt COVID-19 Registry in Germany who were diagnosed with and recovered from the severe acute respiratory syndrome coronavirus 2 and identified between April and June 2020. In this cohort, cardiac magnetic resonance imaging (MRI) was performed, and levels of cardiac blood markers, including high-sensitivity C-reactive protein (CRP), high-sensitivity troponin T (hsTnT), and N-terminal pro–b-type natriuretic peptide (NT-proBNP) were measured. Data from patients recovered from COVID-19 and age- and sex-matched control normotensive healthy volunteers (n=50) and risk factor–matched patients (n=57) were compared. The overall median duration between the COVID-19 diagnosis and the performance of a cardiac MRI was 71 days. A total of 67% of the study population recovered from COVID-19 at home, and the remaining 33% of patients required hospitalization.


Assessment of COVID-19 Hospitalizations by Race/Ethnicity in 12 States

JAMA Internal Medicine, August 17, 2020

Given the reported health disparities in coronavirus disease 2019 (COVID-19) infection and mortality by race/ethnicity, there is an immediate need for increased assessment of the prevalence of COVID-19 across racial/ethnic subgroups of the population in the US. We examined the racial/ethnic prevalence of cumulative COVID-19 hospitalizations in the 12 states that report such data and compared how this prevalence differs from the racial/ethnic composition of each state’s population. Using data extracted from the University of Minnesota COVID-19 Hospitalization Tracking Project, we identified the 12 states that reported the race/ethnicity of individuals hospitalized with COVID-19 between April 30 and June 24, 2020. We calculated the percentage of cumulative hospitalizations by racial/ethnic categories averaged over the study period and then calculated the difference between the percentage of cumulative hospitalizations for each subgroup and the corresponding percentage of the state’s population for each racial/ethnic subgroup as reported in the US Census. The race/ethnicity categories included were White, Black, American Indian and/or Alaskan Native, Asian, and Hispanic. Descriptive statistical analyses were conducted using Stata/MP, version 14 (Stata Corp). The University of Minnesota Institutional Review Board reviewed the study data and deemed it exempt from review and informed consent requirements because the study was not human subjects research. This analysis of COVID-19 hospitalizations in 12 US states during nearly a 2-month period represented a total of 48 788 cumulative hospitalizations among a total population of 66 796 666 individuals in 12 US states.


Cardiac Arrest Tracked Stages of Lockdown

MedPage Today, August 17, 2020

The recent uptick in out-of-hospital cardiac arrests (OHCAs) could be a consequence of heart attack patients avoiding hospitals during COVID-19, one Denver group suggested. There were significantly more OHCAs in the first 2 weeks of the local shelter-in-place order compared with the period before COVID or the early COVID period between the declaration of emergency and the statewide shelter-in-place order (46 vs 26 and 27 per week, respectively, P=0.001 and P=0.004). Despite the increase in OHCAs, there were progressively fewer average ambulance activations per week across time (P=0.007):

  •  2,218 in the pre-mandate period from Jan. 1 to March 7
  • 2,129 in the peri-mandate period from March 8 to 28
  • 1,921 in the post-mandate period from March 29 to April 11

The report by Brian Stauffer, MD, of Denver Health Medical Center, and colleagues was published in the Aug. 24 issue of JACC: Cardiovascular Interventions. “A review at the patient level is essential to obtain a more granular understanding of these data. However, in the interim, providers should consider the unintended consequence of the pandemic response in the context of chronic and emergent cardiovascular disease,” Stauffer’s group urged. “One possibility suggested by our data is that patients with acute coronary syndromes are not presenting for care, resulting in an increase in OHCA,” they said.


AANP National Survey Reveals Progress, Challenges as Nurse Practitioners (NPs) Combat COVID-19

Cision, August 17, 2020

The findings of a second, nationwide trend survey of NPs assessing COVID-19’s impacts on NP professional practice demonstrate both significant progress and lingering challenges as health care providers work to stem the tide of the pandemic in communities nationwide. More than 80% of the profession reports their practices are better prepared to manage COVID-19 patients than at the start of the pandemic, with 35% indicating they are ready for a surge in COVID-19 cases. Despite marked progress in practice readiness and improving supplies of PPE, the number of NPs now testing positive for COVID-19 has increased three-fold since the early days of the pandemic. While acknowledging improvements in access, NPs identify testing as the most significant barrier to combatting COVID-19 in their communities, with one-third of NPs reporting patients being turned away from centralized testing sites for failure to meet pre-determined criteria, and 78% of NPs citing significant delays in receiving patients’ viral test results. Test result delays range from a low-end range of seven to 10 business days to a high-end of up to 20 days. This is the second national survey fielded by the American Association of Nurse Practitioners® (AANP), the largest national association of NPs of all specialties, aimed at understanding how COVID-19 is affecting the clinical practice of NPs across settings, specialties, and geographic location.


Highly sensitive quantification of plasma SARS-CoV-2 RNA shelds [sic] light on its potential clinical value

Clinical Infectious Diseases, August 17, 2020

Coronavirus disease 2019 (COVID-19) is a global public health problem that has already caused more than 662,000 deaths worldwide. Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients present other severe damage such as cardiovascular, renal and liver injury or/and multiple organ failure, suggesting a spread of the SARS-CoV-2 in blood. Recent ultrasensitive polymerase chain reaction (PCR) technology now allows absolute quantification of nucleic acids in plasma. We herein intended to use the droplet-based digital PCR technology to obtain sensitive detection and precise quantification of plasma SARS-CoV-2 viral load (SARS-CoV-2 RNAaemia) in hospitalized COVID-19 patients. Fifty-eight consecutive COVID-19 patients with pneumonia 8 to 12 days after onset of symptoms and 12 healthy controls were analyzed. Disease severity was categorized as mild-to-moderate in 17 patients, severe in 16 patients and critical in 26 patients. Plasma SARS-CoV-2 RNAaemia was quantified by droplet digital Crystal Digital PCR™ next-generation technology. Overall, SARS-CoV-2 RNAaemia was detected in 43 (74.1%) patients. Prevalence of positive SARS-CoV-2 RNAaemia correlated with disease severity, ranging from 53% in mild-to-moderate patients to 88% in critically ill patients (p=0.036). Levels of SARS-CoV-2 RNAaemia were associated with severity (p=0.035).


CDC: Sorry, People Do Not Have COVID-19 ‘Immunity’ for 3 Months

MedPage Today, August 17, 2020

People infected with COVID-19 do not necessarily have immunity to reinfection for three months, the CDC said late Friday night, trying to squelch speculation the agency had inadvertently stimulated. While people can continue to test positive for SARS-CoV-2 for up to three months after diagnosis and not be infectious to others, that does not imply that infection confers immunity for that period, the agency said. The confusion stemmed from an August 3 update to CDC’s isolation guidance, which stated: Who needs to quarantine? People who have been in close contact with someone who has COVID-19 — excluding people who have had COVID-19 within the past 3 months. People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms. These statements could be read as suggesting that those recovering from COVID-19 will likely be safe from reinfection for three months even with close exposure to infected people. Media reports took this as a tacit acknowledgment of immunity from the agency.


Household Transmission of SARS-CoV-2 in the United States

Clinical Infectious Diseases, August 16, 2020

Although many viral respiratory illnesses are transmitted within households, the evidence base for SARS-CoV-2 is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. We recruited laboratory-confirmed COVID-19 patients and their household contacts in Utah and Wisconsin during March 22–April 25, 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 rRT-PCR and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (OR) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Thirty-two (55%) of 58 households had evidence of secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI]: 23–36%) overall, 42% among children (<18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions had increased odds of infection (OR: 15.9, 95% CI: 2.4–106.9). Household contacts who themselves had diabetes mellitus had increased odds of infection (OR: 7.1, 95% CI: 1.2–42.5).


The cardiac threat coronavirus poses to athletes

Axios, August 15, 2020

Cardiologists are increasingly concerned that coronavirus infections could cause heart complications that lead to sudden cardiac death in athletes. Why it matters: Even if just a tiny percentage of COVID-19 cases lead to major cardiac conditions, the sheer scope of the pandemic raises the risk for those who regularly conduct the toughest physical activity — including amateurs who might be less aware of the danger. Driving the news: Both the Big 10 and Pac-12 conferences announced this week that they wouldn’t play college football in the fall because of health concerns about the COVID-19 pandemic. According to ESPN, a major factor driving those decisions has been fear that COVID-19 could lead to a rise in myocarditis among athletes. Myocarditis is an inflammation of the heart caused by viral infections that can lead to rapid or abnormal heart rhythms and even sudden cardiac death. Myocarditis causes about 75 deaths per year in young athletes between the ages of 13 and 25, often without any warning. The 27-year-0lld Boston Celtics star Reggie Lewis collapsed at a practice and soon died from myocarditis in 1993. While research is still in its infancy, a July study of 100 adult patients in Germany had recovered from COVID-19 found that 60% had findings of ongoing myocardial inflammation.


Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization to Yale School of Public Health for SalivaDirect, Which Uses a New Method of Saliva Sample Processing

U.S. Food & Drug Administration, August 15, 2020

Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) to Yale School of Public Health for its SalivaDirect COVID-19 diagnostic test, which uses a new method of processing saliva samples when testing for COVID-19 infection. “The SalivaDirect test for rapid detection of SARS-CoV-2 is yet another testing innovation game changer that will reduce the demand for scarce testing resources,” said Assistant Secretary for Health and COVID-19 Testing Coordinator Admiral Brett P. Giroir, M.D. “Our current national expansion of COVID-19 testing is only possible because of FDA’s technical expertise and reduction of regulatory barriers, coupled with the private sector’s ability to innovate and their high motivation to answer complex challenges posed by this pandemic.” “Providing this type of flexibility for processing saliva samples to test for COVID-19 infection is groundbreaking in terms of efficiency and avoiding shortages of crucial test components like reagents,” said FDA Commissioner Stephen M. Hahn, M.D. “Today’s authorization is another example of the FDA working with test developers to bring the most innovative technology to market in an effort to ensure access to testing for all people in America. The FDA encourages test developers to work with the agency to create innovative, effective products to help address the COVID-19 pandemic and to increase capacity and efficiency in testing.” SalivaDirect does not require any special type of swab or collection device; a saliva sample can be collected in any sterile container. This test is also unique because it does not require a separate nucleic acid extraction step. This is significant because the extraction kits used for this step in other tests have been prone to shortages in the past. Being able to perform a test without these kits enhances the capacity for increased testing, while reducing the strain on available resources.


The Intersection Between Flu and COVID-19

Journal of the American Medical Association, August 14, 2020

[Audio Clinical Review] As the COVID-19 pandemic continues to spread throughout the world, flu season is almost upon us. This is concerning because there will be an overlap between flu and COVID-19 and patients could get both diseases. Daniel Solomon, MD, from the Division of Infectious Diseases at the Brigham and Women’s Hospital of the Harvard Medical School in Boston, discusses COVID-19 and how the flu might pan out this year.


Severe COVID-19 associated with heart issues; much yet to discover

American Heart Association, August 14, 2020

The number of people coronavirus disease 2019 (COVID-19) is rising with more cases in the U.S. (5M according to the Centers for Disease Control and Prevention, CDC) than any other country (20M confirmed cases worldwide, according to the World Health Organization, WHO). Initially thought to be an infection causing disease of the lungs, inflammation of the vascular system and injury to the heart appear to be common features of this novel coronavirus, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. The risk of death from COVID-19-related heart damage appears to be as or more important than other well-described risk factors for COVID-related mortality, such as age, diabetes mellitus, chronic pulmonary disease or prior history of cardiovascular disease. “Much remains to be learned about COVID-19 infection and the heart. Although we think of the lungs being the primary target, there are frequent biomarker elevations noted in infected patients that are usually associated with acute heart injury. Moreover, several devastating complications of COVID-19 are cardiac in nature and may result in lingering cardiac dysfunction beyond the course of the viral illness itself,” said Mitchell S. V. Elkind, M.D., MS, FAHA, FAAN, president of the American Heart Association, the world’s leading voluntary organization focused on heart and brain health and research, and attending neurologist at New York-Presbyterian/Columbia University Irving Medical Center. “The need for additional research remains critical. We simply don’t have enough information to provide the definitive answers people want and need.”


Arrhythmia management during COVID-19 incorporates remote monitoring, virtual visits

Cardiology Today, August 14, 2020

Since the COVID-19 pandemic started, we have learned about how it affects certain patient populations and how it can lead to complications such as arrhythmias. In a study published in JAMA in February, 44.4% of patients assessed from Wuhan, China, were treated in the ICU due to complications related to arrhythmias. Arrhythmias may also be aggravated by severe systemic inflammatory conditions associated with COVID-19. The pandemic has also affected arrhythmia management, with focus shifting to telehealth. “The pandemic and need to conduct medical care remotely at a distance supercharged the implementation of these technologies,” Jonathan P. Piccini, MD, MHS, FHRS, associate professor of medicine and director of cardiac electrophysiology at Duke University Medical Center, told Healio. “For, example in our [electrophysiology] clinic at Duke, before the pandemic, telehealth visits accounted for far less than 5% of visits. Two weeks into COVID, more than 90% of our clinic visits were telehealth encounters.”


Defining heart disease risk for death in COVID-19 infection

QJM: An International Journal of Medicine, August 13, 2020

Cardiovascular disease (CVD) was in common in Coronavirus Disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of SARS-CoV-2-infected patients with or without CVD. Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People’s Hospital, Wuhan, China. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD. Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 years vs 52 years) and had higher proportion of men (52.5% vs 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs 8.1%), malignant arrhythmias (3.7% vs 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy (7.9% vs 1.8%), and acute kidney injury (11.6% vs 3.4%). The rate of glucocorticoid therapy (36.7% vs 25.5%), Vitamin C (23.3% vs 11.8%), mechanical ventilation (21.9% vs 7.6%), intensive care unit admission (12.6% vs 3.7%) and mortality (16.7% vs 4.7%) were higher in patients with CVD (both p < 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722-5.817) and patients with CVD (HR 2.166, 95% CI 1.189-3.948) were independent risk factors for death.


The Impact of COVID-19 on Pulmonary Hypertension

American College of Cardiology, August 13, 2020

COVID-19 has had a significant impact on all aspects of PH, from diagnosis and management to observing an increased risk of death in patients with PAH. In addition, because of the vulnerable nature of this population, the pandemic has impacted the very manner in which care is delivered in PH. The risks associated with COVID-19 in patients with PH are significant. In a US survey of 77 PAH Comprehensive Care Centers, the incidence of COVID-19 infection was 2.1 cases per 1,000 patients with PAH, which is similar to the incidence of COVID-19 infection in the general US population. But although COVID-19 did not seem to be more prevalent in patients with PAH, the mortality did appear to be higher at 12%. In addition, 33% of patients with PAH who were infected with COVID-19 ended up being hospitalized. With the outbreak of COVID-19, it became necessary to revisit the manner in which patients receive care to decrease risk of contracting the virus.


Preparing for and responding to Covid-19’s ‘second hit’

Healthcare, August 13, 2020

While already sobering, Covid-19 mortality projections only account for a portion of morbidity and mortality we should expect from the current outbreak – patients directly affected by Covid-19. Largely missing from current discussions is the indirect impact on a much broader set of patients affected the epidemic – patients who will experience greater morbidity and mortality from a wide range of clinical conditions due to disruptions in the provision of health care and other essential services – what we are describing here as the ‘second hit’ of Covid-19. Current estimates of the human health toll from the ongoing outbreak of the respiratory disease Coronavirus Disease 2019 (Covid-19) are staggering. As of July 13, 2020, there have been over 13,000,000 cases and 500,000 deaths globally, and most experts agree that the epidemic is just beginning. The second hit of Covid-19 is already well underway in the U.S. and globally, as efforts on social distancing, mitigating spread, and increasing surge capacity in hospitals are being put in place. Experts predict that health facilities will be overwhelmed for sustained periods of time, and that it is likely that social distancing measures will need to be reintroduced in subsequent epidemic waves. While necessary to mitigate Covid-19, these changes have widespread ramifications on system’s ability to manage acute, chronic, and preventive care. There are a number of major shifts happening now that can help the health system understand which parts of the system and what segments of the population will be most affected.


Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes – Interim Analysis of 2 Randomized Clinical Trials

Journal of the American Medical Association, August 13, 2020

What are the safety and immunogenicity of an inactivated vaccine against coronavirus disease 2019 (COVID-19)? This was an interim analysis of 2 randomized placebo-controlled trials. In 96 healthy adults in a phase 1 trial of patients randomized to aluminum hydroxide (alum) only and low, medium, and high vaccine doses on days 0, 28, and 56, 7-day adverse reactions occurred in 12.5%, 20.8%, 16.7%, and 25.0%, respectively; geometric mean titers of neutralizing antibodies at day 14 after the third injection were 316, 206 and 297 in the low-, medium-, and high-dose groups, respectively. In 224 healthy adults randomized to the medium dose, 7-day adverse reactions occurred in 6.0% and 14.3% of the participants who received injections on days 0 and 14 vs alum only, and 19.0% and 17.9% who received injections on days 0 and 21 vs alum only, respectively; geometric mean titers of neutralizing antibodies in the vaccine groups at day 14 after the second injection were 121 vs 247, respectively.


Researchers Strive to Recruit Hard-Hit Minorities Into COVID-19 Vaccine Trials

Journal of the American Medical Association, August 13, 2020

Seldom does a vaccine researcher’s job include calling city hall, big-box stores like Walmart and Target, and the US Postal Service. But Ann Falsey, MD, had those tasks on her to-do list in June as she prepared to recruit volunteers to test potential vaccines for coronavirus disease 2019 (COVID-19). Falsey, of the University of Rochester School of Medicine, hoped large employers in her area would publicize vaccine trials to their essential workers, many of whom are Black or Hispanic. “We are thinking very hard about not only how to get a diverse population that reflects the US population but also people at high risk—postal workers, home health workers, you name it,” she said. COVID-19’s startling toll on minorities has drawn widespread attention to the need for diversity in large-scale phase 3 vaccine trials. Two 30 000-person trials, led by Moderna and a joint effort of Pfizer and BioNTech, began on July 27. AstraZeneca was expected to start US recruitment to test its vaccine, developed with Oxford University, in August, followed by Johnson & Johnson in September and Novavax later this fall.


In-hospital Use of ACEI/ARB is associated with lower Risk of Mortality and Critic Illness in COVID-19 Patients with Hypertension: ACEI/ARB protect COVID-19 patients

Journal of Infection, August 12, 2020

[Letter to the Editor] We read with great interest the recent article published by Macro Zuin, et al. in this journal suggested the prevalence of hypertension and its contribution to increased mortality risk in COVID-19 patients. RAAS inhibitors is one of the commonly used medication for hypertension management. However, since the culprits of COVID-19, SARS-COV-2, takes advantage of membrane-bound angiotensin-converting enzyme 2 (ACE2) to infect host cells, and which were reported to be upregulated in result of treatment of RAAS inhibitors, concerns of using RAAS inhibitors in COVID-19 patients with hypertension were aroused. Nonetheless, in animal models of acute lung injury and other influenza virus infection, ACEI and ARB are protective by inhibiting the downregulation of ACE2 and further limit disease progression. Thus, RAAS inhibitors might be theoretically protective in patient with COVID-19. Despite various studies showed that RAAS inhibits were not harmful in COVID-19, more clinical data and evidence are needed for clarifying this controversial issue and developing better treatment plans for patients suffering COVID-19. Here, we present a retrospective study, analyzing use of different antihypertensive drugs and its association with various outcomes of COVID-19 patients with hypertension.


A SARS-CoV-2 Prediction Model from Standard Laboratory Tests

Clinical Infectious Diseases, August 12, 2020

With the limited availability of testing for the presence of the SARS-CoV-2 virus and concerns surrounding the accuracy of existing methods, other means of identifying patients are urgently needed. Previous studies showing a correlation between certain laboratory tests and diagnosis suggest an alternative method based on an ensemble of tests. Here, a machine learning model was trained to analyze the correlation between SARS-CoV-2 test results and 20 routine laboratory tests collected within a 2-day period around the SARS-CoV-2 test date. We used the model to compare SARS-CoV-2 positive and negative patients. In a cohort of 75,991 veteran inpatients and outpatients who tested for SARS-CoV-2 in the months of March through July, 2020, 7,335 of whom were positive by RT-PCR or antigen testing, and who had at least 15 of 20 lab results within the window period, our model predicted the results of the SARS-CoV-2 test with a specificity of 86.8%, a sensitivity of 82.4%, and an overall accuracy of 86.4% (with a 95% confidence interval of [86.0%, 86.9%]). While molecular-based and antibody tests remain the reference standard method for confirming a SARS-CoV-2 diagnosis, their clinical sensitivity is not well known. The model described herein may provide a complementary method of determining SARS-CoV-2 infection status, based on a fully independent set of indicators, that can help confirm results from other tests as well as identify positive cases missed by molecular testing.


Previous cardiovascular surgery significantly increases the risk of developing critical illness in patients with COVID-19

Journal of Infection, August 12, 2020

We read with great interest the article by Dr. Galloway JB and colleagues recently published in the Journal of Infection entitled “A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study.” Early identification of patients with high-risk of poor prognosis may facilitate the provision of timely supportive treatment in advance and reduce the mortality of patients. In this study, the authors identified several comorbidities as risk factors of worse outcomes of COVID-19 patients, including diabetes, hypertension, and chronic lung disease. However, little is known about the impact of previous surgery on COVID-19. Herein, we evaluated whether COVID-19 patients with previous surgery are at high-risk of critical illness. We conducted a multicenter study focusing on the clinical characteristics of COVID-19 patients with previous surgery in six designated hospitals in the Hubei and Guangdong provinces, China. COVID-19 was diagnosed according to the WHO interim guidance. 461 patients with COVID-19 that hospitalized from January 1 to March 31, 2020 were enrolled. We collected demographics, comorbidities, laboratory variables, and chest CT images from medical records. We defined the severity of COVID-19 according to the newest COVID-19 guidelines of China and the guidelines of American Thoracic Society for community-acquired pneumonia. Critical illness is defined as meeting at least one of the following criteria: respiratory failure requiring mechanical ventilation, shock, intensive care unit (ICU) admission, or death.


Global COVID-19 Cases Top 20 Million

WebMD, August 12, 2020

The total of number of confirmed COVID-19 cases worldwide went over the 20 million mark on Tuesday, the Johns Hopkins Coronavirus Resource Center reported. The number of us cases has grown exponentially since the virus was first reported in China about 6-and-a-half months ago. Total cases hit the 1 million mark on April 2, CNN reported. Ten million cases were recorded in late June. It took less than 6 weeks to double that figure as case counts surged in the United States and Latin America. The number of cases is probably much higher because of testing limitations and a high number of infected people who show no symptoms. Deaths have also gone up. More than 737,000 have people died worldwide, Johns Hopkins said. The nations with the most cases are the United States (almost 5.1 million with more than 163,000 deaths), Brazil (3 million cases and 101,000 deaths), India (2.2 million cases and 45,000 deaths), Russia (895,000 cases and 15,000 deaths), and South Africa (563,000 cases and 10,600 deaths). Africa recorded its 1 millionth case last week. The 7-day average of new cases has been more than 250,000 for two weeks, CNN said.


Annals On Call – Diagnosing SARS-CoV-2 Infection: Symptoms or No Symptoms?

Annals of Internal Medicine, August 12, 2020

[Podcast] In this episode of Annals On Call, Dr. Centor discusses challenges to diagnosing COVID-19 with Dr. Jeanne Marrazzo. Annals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.


COVID-19 surge moves to Midwest, as young people fuel US case rise

Center for Infectious Disease Research and Policy, August 12, 2020

Many states initially spared from the COVID-19 pandemic is March, April, and May, are now reporting increasing transmission rates in non-metropolitan counties fueled by community spread. According to the Wall Street Journal, in Ohio, Missouri, Wisconsin, and Illinois, the weekly change in COVID-19 cases has been higher in rural regions compared to metro areas, and outbreaks are linked to social events, rather than workplace exposure or congregate living situations. A summer of waning social distancing restrictions has made bars and restaurants common COVID-19 outbreak sites, on par with nursing homes and prisons states across the country. In Louisiana, the New York Times reports bars and restaurants are linked to 25% of the state’s cases, and in Maryland, that percentage was 12%. Fueling these outbreaks are the twin forces of a national “quarantine fatigue” and young adults, who are more likely than older, more at-risk Americans, to be both patrons and employees in dining and drinking establishments. Young adults are driving outbreaks in many states, and experts worry those with mild or asymptomatic cases are spreading the disease to more vulnerable household members.


This Fall Could Be ‘Worst’ We’ve Seen

icon name=”pencil” class=”” unprefixed_class=””] WebMD, August 12, 2020

We are in a war against COVID-19, and this fall could be one of the worst from a public health standpoint that the U.S. has ever faced, says CDC Director Robert Redfield, MD. The surging coronavirus pandemic, paired with the flu season, could create the “worst fall” that “we’ve ever had,” he said during an interview on “Coronavirus in Context,” a video series hosted by John Whyte, MD, WebMD’s chief medical officer. Redfield also said the agency’s efforts to understand the virus were hampered by a lack of cooperation from China. He reached out to China CDC Director George Gao on Jan. 3 to see if the agency could work with health officials in Wuhan to better understand the outbreak. But he never received an invitation, Redfield said. “I think if we had been able to get in at that time, we probably would have learned quicker than we learned here,” Redfield said.


Having Coronavirus Disease 2019 (COVID-19): Perspective from an ICU Doc

JAMA Cardiology, August 12, 2020

Janet Shapiro, MD, an ICU physician at Mount Sinai Morningside Hospital in New York City, had just come back to work after a relatively mild course of COVID-19. She had lost her sense of smell and taste, and for a few days had a low-grade temperature and cough. But as she was rounding, she noticed she still wasn’t feeling right. She was short of breath and her heart was often pounding. She didn’t have underlying heart disease. The experience reinforced recent reports that call attention to the disease’s impact on the heart, which in many cases may be silent. Last month, two German studies published found evidence of long-lasting cardiac effects, even in patients who never developed overt cardiac disease during their infection. One, an autopsy study, found viral infection in the hearts of deceased COVID-19 patients who were never diagnosed with myocarditis during their illness. The other study found that most patients who had recovered from COVID showed abnormal cardiac MRI findings consistent with active inflammation more than 2 months after diagnosis.


Exclusive: Over 900 health workers have died of COVID-19. And the toll is rising

News Medical, August 11, 2020

More than 900 front-line health care workers have died of COVID-19, according to an interactive database unveiled Wednesday by The Guardian and KHN. Lost on the Frontline is a partnership between the two newsrooms that aims to count, verify and memorialize every U.S. health care worker who dies during the pandemic. KHN and The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened in their final days. It is the most comprehensive accounting of U.S. health care workers’ deaths in the country. As coronavirus cases surge — and dire shortages of lifesaving protective gear like N95 masks, gowns and gloves persist — the nation’s health care workers are again facing life-threatening conditions in Southern and Western states. A team of more than 50 journalists from the Guardian, KHN and journalism schools have spent months investigating individual deaths to make certain that they died of COVID-19, and that they were indeed working on the front lines in contact with COVID patients or working in places where they were being treated. Thus far, we have independently confirmed 167 deaths and published their names, data and stories about their lives and how they will be remembered. The tally includes doctors, nurses and paramedics, as well as crucial support staff such as hospital custodians, administrators and nursing home workers, who put their own lives at risk during the pandemic to care for others.


Cardiac surgery Enhanced Recovery Programs modified for COVID-19: key steps to preserve resources, manage caseload backlog, and improve patient outcomes

Journal of Cardiothoracic and Vascular Anesthesia, August 10, 2020

SARS-CoV-2 and the COVID-19 pandemic have turned healthcare systems worldwide upside-down, and hospitals are adjusting volume of non-urgent surgical cases according to local COVID-19 prevalence rates. In the face of active disease surges or resurgences, many hospitals are postponing all non-emergent cardiac operations to redirect scarce resources to the care of patients with severe viral illness. This includes rationing personal protective equipment (PPE), establishing additional ICU capacity often in novel spaces, sequestering ventilators, and redeploying personnel. Hospitals are at risk of being overwhelmed as demand for care exceeds available resources. In locations where infection rates are lower, the throughput of elective and semi-urgent procedures may nevertheless be maintained at a lower level in the effort to preserve reserve capacity in the event of an acute surge. In a recent survey of cardiac-surgery centers, the median reduction in case volume was between 50 to 75% over the first months of the pandemic. The forced deferral of necessary care has resulted in a backlog of patients, leading to new potential risks of increased morbidity and mortality secondary to longer wait times.


A Great Unknown: When Flu Season and COVID Collide

WebMD, August 10, 2020

For months scientists have urged the public to wear masks, wash their hands and socially distance. And as the flu season approaches, those practices have never been more crucial. Depending on whether people heed this advice, the U.S. could either see a record drop in flu cases or a dangerous viral storm, doctors say. “We just have no idea what’s going to happen. Are we going to get a second surge [of coronavirus]?” says Peter Chai, MD, an emergency physician at the Brigham and Women’s Hospital in Boston. “Hopefully, knock on wood, that won’t happen.” To get an idea of how the flu season might go, public health officials in the U.S. often look to Australia and other countries in the southern hemisphere, where they are in the winter flu season. The World Health organization reports few cases worldwide. But only time will tell whether the U.S. will follow suit. If not, the consequences could be dire, leaving people even more vulnerable to COVID-19 and potentially overwhelming hospitals, says Aubree Gordon, associate professor of epidemiology at the University of Michigan School of Public Health.


Case Rates and Outcomes in Acute MI During COVID-19 Pandemic

American College of Cardiology, August 10, 2020

The investigators conducted a retrospective cross-sectional study and analyzed AMI hospitalizations that occurred between December 30, 2018, and May 16, 2020, in 1 of the 49 hospitals in the Providence St Joseph Health system located in six states (Alaska, Washington, Montana, Oregon, California, and Texas). The cohort included patients aged ≥18 years who had a principal discharge diagnosis of AMI (ST-segment elevation myocardial infarction [STEMI] or non–STEMI [NSTEMI]). Segmented regression analysis was performed to assess changes in weekly case volumes. Cases were grouped into one of three periods: before coronavirus disease 2019 (COVID-19) (December 30, 2018-February 22, 2020), early COVID-19 (February 23-March 28, 2020), and later COVID-19 (March 29-May 16, 2020). In-hospital mortality was risk-adjusted using an observed to expected (O/E) ratio and covariate-adjusted multivariable model. The primary outcome was the weekly rate of AMI (STEMI or NSTEMI) hospitalizations. The secondary outcomes were patient characteristics, treatment approaches, and in-hospital outcomes of this patient population. Trends among the three COVID-19 periods were compared using univariate χ2, Fisher exact, or Kruskal-Wallis tests, as appropriate, for each variable.


Additional $400,000 awarded for research projects focused on cardiovascular impact of COVID-19

News Medical, August 10, 2020

The American Heart Association has awarded an additional $400,000 in research grants focused on the cardiovascular impact of COVID-19. The awards go to four more teams who submitted proposals for the COVID-19 and Its Cardiovascular Impact Rapid Response Grants during the original submission process in March. The new research projects include:
• Cleveland Clinic, led by Mina Chung, M.D., Professor of Medicine — Testing of SARS-CoV-2 Infectivity and Antiviral Drug Effects in Engineered Heart Tissue, Microglial Cell Models, and COVID-19 Patient Registries.
• Johns Hopkins University, led by Daniela Cihakova M.D., Ph.D., Associate Professor and Director of the Immune Disorders Laboratory — Pathogenesis of Cardiac Inflammation During COVID-19 Infection.
• Cedars-Sinai Board of Governors Regenerative Medicine Institute at the Cedars-Sinai Medical Center, co-led by Clive Svendsen, Ph.D., Director of the institute Kerry and Simone Vickar Family Foundation Distinguished Chair in Regenerative Medicine and Professor of Biomedical Sciences and Medicine, and by Arun Sharma, Ph.D., Senior Research Fellow — Human iPSCs and Organ Chips Model SARS-CoV-2-Induced Viral Myocarditis.
• New York-Presbyterian/Columbia University Irving Medical Center, led by Emily J. Tsai, M.D., Florence Irving Assistant Professor of Medicine — Elucidating the Pathogenesis of COVID-19 Cardiac Disease Through snRNA-Seq and Histopathological Analysis of Human Myocardium.


IV High-Dose Vitamin C Success Story in COVID-19

MedPage Today, August 10, 2020

A 74-year-old white woman presents to an emergency department in Flint, Michigan, after suffering with low-grade fever, dry cough, and shortness of breath for the previous 2 days. Her medical history for the week before includes elective surgery at an¬other hospital for total replacement of the right knee. She notes that she was healthy on admission and at discharge. She stayed in a private room, and had no contact with individuals who were ill or who had traveled recently. Lung auscultation reveals bilateral rhonchi with rales, and chest radiography shows patchy air space opacity in the right upper lobe suspicious for pneumonia. Concerns about community transmission of COVID-19 prompt a nasopharyngeal swab, which is sent to the state laboratory for detection of SARS-CoV-2. The patient is admitted to the airborne-isolation unit, maintaining compliance to the CDC recommendations for contact, droplet, and airborne precautions. Results of the nasopharyngeal swab are positive for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR). Clinicians start treatment with oral hydroxychloroquine 400 mg once and then 200 mg twice a day, along with intravenous azithromycin 500 mg once a day, zinc sulfate 220 mg three times a day, and oral vitamin C 1 g twice a day. When blood and sputum cultures are negative for any organisms, broad-spectrum antibiotics are discontinued. The patient’s dyspnea rapidly worsens, and oxygen requirements increase to 15 liters. She is drowsy, in moderate distress, and her airways remain unprotected. On day 7, the second day of mechanical ventilation, at the request of the family when the patient develops ARDS, she is started on a continuous intravenous infusion of high-dose vita¬min C (11 g /24 hours). Two days later, her clinical condition gradually begins to improve, and the clinicians discontinue supportive treatment with norepinephrine. On day 10, the fifth day of mechanical ventilation, another chest x-ray shows that both the pneumonia and interstitial edema have improved considerably. The patient responds well to a spontaneous breathing trial with continuous positive airway pressure/pressure support, with the settings of positive end-expiratory pressure (PEEP) of 7 mm Hg, pressure support above PEEP of 10 mm Hg, and a fraction of inspired oxygen of 40%.


No End in Sight as U.S. Cases Pass 5 Million

WebMD, August 9, 2020

The U.S. logged 5 million confirmed COVID-19 cases, hitting another grim milestone in the nearly 6-month long pandemic that has devastated the country. The U.S. tally is substantially larger than the next closest country, Brazil, which has logged roughly 3 million cases. It is roughly 2.5 times the size of the outbreak in India, though the total population in that country is more than 4 times as large. Experts say the number of cases underscores the failure of our national response. In July, newly reported cases in the U.S. topped 70,000 a day. “Seventy thousand was the number of cases that they had in Wuhan, China where this started, in total. So we were having a Wuhan a day in this country,” says Carlos Del Rio, MD, an infectious disease specialist and a professor of Global Health and Epidemiology at Emory University in Atlanta. “We’re doing a crappy job.” While cases have slowed slightly in recent days, they have been rapidly accelerating in the U.S. Since the introduction of the virus, it took the U.S. more than 12 weeks to reach its first 1 million cases, 7 weeks to amass 2 million cases, 3.5 weeks to reach 3 million, and 2.5 weeks to hit 4 million, and another 2.5 weeks to reach 5 million.


Coronavirus in Context: The Impact of COVID on Digital Health

WebMD, August 7, 2020

[Video] Dr. John Whyte, Chief Medical Officer at Web MD, discusses the future of healthcare right now during COVID and post-COVID? Dr. Whyte interviews Dr. Bertalan Mesko, a self-described “geek physician” with a PhD in genomics and a medical futurist.


Acute MI fatality rate higher than expected during COVID-19 pandemic

Helio | Cardiology Today, August 7, 2020

In a cross-sectional study of patients with acute MI, there were more observed fatalities than expected during the early period of the COVID-19 pandemic. In the later period of the pandemic, there were more observed fatalities than expected for patients with STEMI but not for the overall acute MI population, researchers reported. Cardiology Today Next Gen Innovator Ty J. Gluckman, MD, FACC, FAHA, medical director of the Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health in Portland, Oregon, and colleagues retrospectively analyzed 15,244 patients (mean age, 68 years; 66% men; 33% with STEMI) hospitalized for acute MI at one of 49 centers in six Western states between December 30, 2018 and May 16, 2020.


Potentially fatal severe brady arrythmias related to Lopinavir-Ritonavir in a COVID 19 patient

Journal of Microbiology, Immunology and Infection, August 6, 2020

The novel coronavirus (COVID-19) outbreak was declared a global pandemic, with over 6 million people infected, and 371166 deaths worldwide. Without proven treatments for severe COVID-19, physicians have resorted to experimental therapies like Lopinavir-Ritonavir. We report the first case of potentially fatal bradyarrhythmias with long sinus pauses due to Lopinavir-Ritonavir. The patient is a 67-year-old male with a history of hypertension and coronary artery disease. He tested positive for COVID-19 on day 5 of respiratory symptoms. On day 10, he deteriorated and Lopinavir 4mg/kg / Ritonavir 1mg/kg 12-hourly was initiated. His baseline electrocardiogram showed a heart rate of 84bpm, and QTc of 496ms.


COVID-19 Breakthrough: Scientists Identify Possible “Achilles’ Heel” of SARS-CoV-2 Virus

SciTechDaily, August 6, 2020

In the case of an infection, the SARS-CoV-2 virus must overcome various defense mechanisms of the human body, including its non-specific or innate immune defense. During this process, infected body cells release messenger substances known as type 1 interferons. These attract natural killer cells, which kill the infected cells. One of the reasons the SARS-CoV-2 virus is so successful — and thus dangerous — is that it can suppress the non-specific immune response. In addition, it lets the human cell produce the viral protein PLpro (papain-like protease). PLpro has two functions: It plays a role in the maturation and release of new viral particles, and it suppresses the development of type 1 interferons. The German and Dutch researchers have now been able to monitor these processes in cell culture experiments. Moreover, if they blocked PLpro, virus production was inhibited and the innate immune response of the human cells was strengthened at the same time. Professor Ivan Dikic, Director of the Institute of Biochemistry II at University Hospital Frankfurt and last author of the paper, explains: “We used the compound GRL-0617, a non-covalent inhibitor of PLpro, and examined its mode of action very closely in terms of biochemistry, structure and function. We concluded that inhibiting PLpro is a very promising double-hit therapeutic strategy against COVID-19. The further development of PLpro-inhibiting substance classes for use in clinical trials is now a key challenge for this therapeutic approach.”


Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea

JAMA Internal Medicine, August 6, 2020

Are there viral load differences between asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this study was to quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients. In this cohort study that included 303 patients with SARS-CoV-2 infection isolated in a community treatment center in the Republic of Korea, 110 (36.3%) were asymptomatic at the time of isolation and 21 of these (19.1%) developed symptoms during isolation. The cycle threshold values of reverse transcription–polymerase chain reaction for SARS-CoV-2 in asymptomatic patients were similar to those in symptomatic patients. Many individuals with SARS-CoV-2 infection remained asymptomatic for a prolonged period, and viral load was similar to that in symptomatic patients; therefore, isolation of infected persons should be performed.


Healthcare workers of color nearly twice as likely as whites to get COVID-19

Modern Healthcare, August 6, 2020

Healthcare workers of color were more likely to care for patients with suspected or confirmed COVID-19, more likely to report using inadequate or reused protective gear, and nearly twice as likely as white colleagues to test positive for the coronavirus, a new study found. The study from Harvard Medical School researchers also showed that healthcare workers are at least three times more likely than the general public to report a positive COVID test, with risks rising for workers treating COVID patients. Dr. Andrew Chan, a senior author and an epidemiologist at Massachusetts General Hospital, said the study further highlights the problem of structural racism, this time reflected in the front-line roles and personal protective equipment provided to people of color. “If you think to yourself, ‘healthcare workers should be on equal footing in the workplace,’ our study really showed that’s definitely not the case,” said Chan, who is also a professor at Harvard Medical School. The study was based on data from more than 2 million COVID Symptom Study app users in the U.S. and the United Kingdom from March 24 through April 23. The study, done with researchers from King’s College London, was published in the journal The Lancet Public Health.


How a Zoom forum is changing the way ICU doctors treat desperately ill Covid-19 patients

STAT, August 6, 2020

It was late April, near the height of the Covid-19 pandemic in the big cities in the northeastern U.S., and anesthesiologist Joseph Savino was puzzled. In two months, an unexpectedly high number of coronavirus patients had died in his intensive care unit at the Hospital of the University of Pennsylvania after a stroke caused by bleeding in the brain. All were among 15 Covid-19 patients at the Philadelphia hospital who had been on a life-support technology called ECMO that is a last resort for patients when mechanical ventilators fail to help their virus-ravaged lungs. ECMO, for extracorporeal membrane oxygenation — essentially an artificial lung — is high-risk, but still, the number of fatal brain bleeds seemed unusual, said Savino, a critical-care specialist. It was too low, however, “to draw any substantive conclusions” about cutting back the blood-thinning drugs they were giving other Covid-19 patients on ECMO, because blood clots, not bleeds, were seen as the major risk to survival. Swamped by overflowing ICUs and the myriad not-seen-before ways the novel coronavirus attacks the body, doctors caring for the pandemic’s sickest patients are scrambling to share their experiences with each other in real time, hoping to find ways to stanch Covid-19’s devastating toll. Some 200 physicians from several countries and dozens of states have participated in the Friday Zoom sessions.


The effects of COVID-19 on the office visit

MJH Life Sciences, August 6, 2020

[Infographic] In this State of Physician Survey, COVID-19’s effect on the office visit was the subject. With over 1,000 responses from a variety of specialties, physicians were candid about navigating a new normal with COVID-19 and the office visit. Accommodating safe distancing in the waiting room to patient compliance and education are top areas of concern highlighted on the infographic.


Association of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with risk of COVID ‐19, inflammation level, severity, and death in patients with COVID ‐19: A rapid systematic review and meta‐analysis

Clinical Cardiology, August 5, 2020

An association among the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) with the clinical outcomes of coronavirus disease 2019 (COVID-19) is unclear. PubMed, EMBASE, MedRxiv, and BioRxiv were searched for relevant studies that assessed the association between application of ACEI/ARB and risk of COVID-19, inflammation level, severity COVID-19 infection, and death in patients with COVID-19. Eleven studies were included with 33 483 patients. ACEI/ARB therapy might be associated with the reduced inflammatory factor (interleukin-6) and elevated immune cells counts (CD3, CD8). Meta-analysis showed no significant increase in the risk of COVID-19 infection (odds ratio [OR]: 0.95, 95%CI: 0.89-1.05) in patients receiving ACEI/ARB therapy, and ACEI/ARB therapy was associated with a decreased risk of severe COVID-19 (OR: 0.75, 95%CI: 0.59-0.96) and mortality (OR: 0.52, 95%CI: 0.35-0.79). Subgroup analyses showed among the general population, ACEI/ARB therapy was associated with reduced severe COVID-19 infection (OR: 0.79, 95%CI: 0.60-1.05) and all-cause mortality (OR: 0.31, 95%CI: 0.13-0.75), and COVID-19 infection (OR: 0.85, 95% CI: 0.66-1.08) were not increased. Among patients with hypertension, the use of an ACEI/ARB was associated with a lower severity of COVID-19 (OR: 0.73, 95%CI: 0.51-1.03) and lower mortality (OR: 0.57, 95%CI: 0.37-0.87), without evidence of an increased risk of COVID-19 infection (OR: 1.00). Our results need to be interpreted with caution considering the potential for residual confounders, and more well-designed studies that control the clinical confounders are necessary to confirm our findings.


Skin Rashes a Clue to COVID-19 Vascular Disease

MedPage Today, August 5, 2020

Certain types of rashes in severe COVID-19 patients may be “a clinical clue” to an underlying thrombotic state, researchers said. Four patients with severe illness at two New York City academic medical centers had livedoid and purpuric rashes, all associated with elevated D-dimer levels and suspected pulmonary emboli, reported Joanna Harp, MD, of NewYork-Presbyterian/Weill Cornell Medical College in New York City, and colleagues, writing in a research letter in JAMA Dermatology. All had been on prophylactic anticoagulation since admission and developed those “hallmark manifestations of cutaneous thrombosis” despite escalation to therapeutic dose anticoagulation for the suspected pulmonary embolism before the rash was noted. “Clinicians caring for patients with COVID-19 should be aware of livedoid and purpuric rashes as potential manifestations of an underlying hypercoagulable state,” Harp’s group wrote. Skin biopsy in each case showed pauci-inflammatory thrombogenic vasculopathy.


Efforts Needed to Get Minorities Into Clinical Trials, Experts Say

MedPage, August 4, 2020

More work needs to be done to enroll people of color in clinical trials, Freda Lewis-Hall, MD, chief patient officer and executive vice president at Pfizer, said Sunday at the annual meeting of the National Medical Association. “One of the really interesting things the data tell us about participation in clinical trials of Black and brown people is they are much less likely to be asked,” Lewis-Hall said during the plenary session of the meeting, which was held remotely. Lewis-Hall said investigator bias against Black and brown patients is reflected in statements such as “I don’t know if they can get here; adherence might be a problem; it may take too long,” and this needs to improve. One thing that would help is having more Black and brown physicians, she added. “The numbers are woefully lagging. We need to increase our pipeline of physicians and physician-investigators, because over and over we heard that the trust issue is critical,” and that “we need to educate patients around clinical trials and their relative safety.”


Coronavirus Q&A With Anthony Fauci

JAMA Live, August 3, 2020

[Video] Anthony Fauci, MD, White House Coronavirus Task Force member and Director of the National Institutes of Allergy and Infectious Diseases, discusses latest developments in the COVID-19 pandemic with Howard Bauchner, MD, Editor in Chief, JAMA.


The effect of sample site, illness duration and the presence of pneumonia on the detection of SARS-CoV-2 by real-time reverse-transcription PCR

Open Forum Infectious Diseases, August 3, 2020

The performance of rRT-PCR for SARS-CoV-2 varies with sampling site(s), illness stage and infection site were evaluated. Unilateral nasopharyngeal, nasal mid-turbinate, throat swabs, and saliva were simultaneously sampled for SARS-CoV-2 rRT-PCR from suspect or confirmed cases of COVID-19.True positives were defined as patients with at least one SARS-CoV-2 detected by rRT-PCR from any site on the evaluation day or at any time point thereafter, till discharge. Diagnostic performance was assessed and extrapolated for site combinations. We evaluated 105 patients; 73 had active SARS-CoV-2 infection. Overall, nasopharyngeal specimens had the highest clinical sensitivity at 85%, followed by throat, 80%, mid-turbinate, 62%, and saliva, 38-52%. Clinical sensitivity for nasopharyngeal, throat, mid-turbinate and saliva was 95%, 88%, 72%, and 44-56% if taken ≤7 days from onset of illness, and 70%, 67%, 47%, 28-44% if >7 days of illness. Comparing patients with URTI vs. pneumonia, clinical sensitivity for nasopharyngeal, throat, mid-turbinate and saliva was 92% vs 70%, 88% vs 61%, 70% vs 44%, 43-54% vs 26-45%. A combination of nasopharyngeal plus throat or mid-turbinate plus throat specimen afforded overall clinical sensitivities of 89-92%, this rose to 96% for persons with URTI and 98% for persons <7 days from illness onset.


Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

JAMA Internal Medicine, August 3, 2020

In this cross-sectional study of 24 emergency departments in 5 health care systems in Colorado, Connecticut, Massachusetts, New York, and North Carolina, decreases in emergency department visits ranged from 41.5% in Colorado to 63.5% in New York, with the most rapid rates of decrease in visits occurring in early March 2020. Rates of hospital admissions from the ED were stable until new COVID-19 case rates began to increase locally, at which point relative increases in hospital admission rates ranged from 22.0% to 149.0%. To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US. This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states’ COVID-19 case counts.


Longitudinal dynamics of the neutralizing antibody response to SARS-CoV-2 infection

Clinical Infectious Diseases, August 3, 2020

Coronavirus disease 2019 (COVID-19) is a global pandemic with no licensed vaccine or specific antiviral agents for therapy. Little is known about the longitudinal dynamics of SARS-CoV-2-specific neutralizing antibodies (NAbs) in COVID-19 patients. In this study, blood samples (n=173) were collected from 30 COVID-19 patients over a 3-month period after symptom onset and analyzed for SARS-CoV-2-specific NAbs, using the lentiviral pseudotype assay, coincident with the levels of IgG and proinflammatory cytokines. SARS-CoV-2-specific NAb titers were low for the first 7–10 d after symptom onset and increased after 2–3 weeks. The median peak time for NAbs was 33 d (IQR 24–59 d) after symptom onset. NAb titers in 93·3% (28/30) of the patients declined gradually over the 3-month study period, with a median decrease of 34·8% (IQR 19·6–42·4%). NAb titers increased over time in parallel with the rise in IgG antibody levels, correlating well at week 3 (r = 0·41, p & 0·05). The NAb titers also demonstrated a significant positive correlation with levels of plasma proinflammatory cytokines, including SCF, TRAIL, and M-CSF.


Presidential order signed expanding use of virtual doctors

The Hill, August 3, 2020

On Monday, the President signed an executive order seeking to expand the use of virtual doctors visits, as his administration looks to highlight achievements in health care. The administration waived certain regulatory barriers to video and phone calls with doctors, known as telehealth, when the coronavirus pandemic struck and many people were stuck at home. Now, the administration is looking to make some of those changes permanent, arguing the moves will provide another option for patients to talk to their doctors. The order calls on the secretary of Health and Human Services to issue rules within 60 days making some of the changes permanent.


RLF-100 (aviptadil) clinical trial showed rapid recovery from respiratory failure and inhibition of coronavirus replication in human lung cells

Cision, August 2, 2020

NeuroRx, Inc. and Relief Therapeutics Holdings AG (SIX:RLF, OTC:RLFTF) “Relief” today announced that RLF-100 (aviptadil) showed rapid recovery from respiratory failure in the most critically ill patients with COVID-19. At the same time, independent researchers have reported that aviptadil blocked replication of the SARS coronavirus in human lung cells and monocytes. RLF-100 has been granted Fast Track designation by FDA and is being developed as a Material Threat Medical Countermeasure in cooperation with the National Institutes of Health and other federal agencies. Further research will be conducted. The first report of rapid clinical recovery under emergency use IND was posted by doctors from Houston Methodist Hospital. The report describes a 54-year-old man who developed COVID-19 while being treated for rejection of a double lung transplant and who came off a ventilator within four days. Similar results were subsequently seen in more than 15 patients treated under emergency use IND and an FDA expanded access protocol which is open to patients too ill to be admitted to the ongoing Phase 2/3 FDA trial. Patients with Critical COVID-19 were seen to have a rapid clearing of classic pneumonitis findings on x-ray, accompanied by an improvement in blood oxygen and a 50% or greater average decrease in laboratory markers associated with COVID-19 inflammation.


Upping the Cardiovascular Health Game

Managed Healthcare Executive, August 1, 2020

Although it is a new disease, COVID-19 has a way of peeling back layers and bringing other medical issues to the surface. For example, research has shown that people with high blood pressure are more likely to become seriously ill. A study published in the April 22 issue of JAMA of 5,700 patients hospitalized with COVID-19 in the New York City area found that 56% had hypertension, making it the most common comorbidity. The death rate from cardiovascular disease has been declining, but it remains the leading cause of death in the United States. According to the CDC, 647,457 Americans died of heart disease and 146,383 of stroke in 2017. (Of course, this year COVID-19 has scrambled the usual list of the leading causes of death in this country.) “(Cardiovascular disease) has to be a priority of health systems and the government. We haven’t really attacked it as well as we should have,” says Martha Gulati, M.D., M.S., FACC, FAHA, division chief of cardiology at the University of Arizona College of Medicine in Phoenix and editor-in-chief at CardioSmart.org, a website run by the American College of Cardiology aimed at educating patients about heart disease. “The whole population has to be involved in this,” with a focus on preventing cardiovascular disease, Gulati says.


Stroke With COVID-19? Check the Large Vessels

MedPage, July 31, 2020

COVID-19’s excess stroke risk appeared to be largely related to large vessel strokes, an observational study showed. Among stroke code patients at one large health system in New York City during the pandemic surge there, 38.3% had COVID-19 (126 of 329 seen from March 16 to April 30, 2020). Large vessel occlusion (LVO) as a cause of the stroke was 2.4-fold more common with COVID-19 than without it after adjustment for race and ethnicity (P=0.011), Shingo Kihira, MD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in the American Journal of Roentgenology. Of the stroke cases, 31.7% of those in COVID-19 patients were LVOs compared with 15.3% in those without COVID-19 (P=0.001). But there was not much difference between groups for small vessel occlusions (SVOs), at 15.9% and 13.8%, respectively (P=0.632).


Women Physicians and the COVID-19 Pandemic

Journal of the American Medical Association, July 31, 2020

Before the magnifying glass of the COVID-19 pandemic caused physicians to look more closely at many aspects of their profession, there was awareness of the general culture of overwork that affect all physicians and the expectation by some that women physicians would make adjustments in their professional roles to accommodate their personal roles. These professional adjustments were made, including part-time status, despite the known limitations on professional progression, career advancement, and economic potential. These adjustments further propagate gender inequities and the persistent compensation gap women physicians’ experience. Women physicians have diverse personal characteristics. There is no appropriate stereotype for a woman physician. Some are just starting their professional careers. Some are older, nearing retirement. Some are partnered, others are solo. Some are childless, others are parents. Family care responsibilities vary with some caring for their children, their aging parents, or both. Practice parameters and settings vary, including business owners, health care executives, academic physicians, and employees of hospitals and group practices. For partnered women physicians, a small number are the principal source of income with a partner assuming the primary role for home and family care. The increasing number of women physicians is accompanied by a rise in the number of dual physician households. This diversity of personal situations highlights the reason to avoid broad assumptions when considering the life-work preferences or professional work adjustments related to the COVID-19 epidemic for individuals or groups of physicians, by gender.


From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists

Science, July 31, 2020

The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain. The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases. Researchers are now facing a familiar COVID-19 narrative: trying to make sense of a mystifying illness. Distinct features of the virus, including its propensity to cause widespread inflammation and blood clotting, could play a role in the assortment of concerns now surfacing. “We’re seeing a really complex group of ongoing symptoms,” says Rachael Evans, a pulmonologist at the University of Leicester.


Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

The Lancet | Public Health, July 31, 2020

Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. This prospective, observational cohort study was done in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33).


U.S. records over 25,000 coronavirus deaths in July

Reuters, July 31, 2020

U.S. coronavirus deaths rose by over 25,000 in July and cases doubled in 19 states during the month, according to a Reuters tally, dealing a crushing blow to hopes of quickly reopening the economy. The United States recorded 1.87 million new cases in July, bringing total infections to 4.5 million, for an increase of 69%. Deaths in July rose 20% to nearly 154,000 total. The biggest increases in July were in Florida, with over 310,000 new cases, followed by California and Texas with about 260,000 each. All three states saw cases double in June. Cases also more than doubled in Alabama, Alaska, Arizona, Arkansas, Georgia, Hawaii, Idaho, Mississippi, Missouri, Montana, Nevada, Oklahoma, Oregon, South Carolina, Tennessee and West Virginia, according to the tally. Connecticut, Massachusetts, New Jersey and New York had the lowest increases, with cases rising 8% or less.


Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 20

CDC Morbidity and Mortality Weekly Report, July 31, 2020

Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 (COVID-19). Characterizing return to baseline health among outpatients with milder COVID-19 illness is important for understanding the full spectrum of COVID-19–associated illness and tailoring public health messaging, interventions, and policy. During April 15–June 25, 2020, telephone interviews were conducted with a random sample of adults aged ≥18 years who had a first positive reverse transcription–polymerase chain reaction (RT-PCR) test for SARS-CoV-2, the virus that causes COVID-19, at an outpatient visit at one of 14 U.S. academic health care systems in 13 states. Interviews were conducted 14–21 days after the test date. Respondents were asked about demographic characteristics, baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview. Among 292 respondents, 94% (274) reported experiencing one or more symptoms at the time of testing; 35% of these symptomatic respondents reported not having returned to their usual state of health by the date of the interview (median = 16 days from testing date), including 26% among those aged 18–34 years, 32% among those aged 35–49 years, and 47% among those aged ≥50 years. Among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview.


2nd US virus surge hits plateau, but few experts celebrate

Associated Press, July 31, 2020

While deaths from the coronavirus in the U.S. are mounting rapidly, public health experts are seeing a flicker of good news: The second surge of confirmed cases appears to be leveling off. The virus has claimed over 150,000 lives in the U.S., by far the highest death toll in the world, plus more than a half-million others around the globe. Over the past week, the average number of COVID-19 deaths per day in the U.S. has climbed more than 25%, from 843 to 1,057. Florida on Thursday reported 253 more deaths, setting its third straight single-day record, while Texas had 322 new fatalities and California had 391. The number of confirmed infections nationwide has topped 4.4 million, which could be higher because of limits on testing and because some people are infected without feeling sick.


Coronary Calcium in COVID-19 Patients Linked to Worse Outcomes

tctMD, July 30, 2020

Elevated coronary artery calcium (CAC) is a marker for worse prognosis among patients hospitalized for COVID-19, according to a French analysis. “The severity of immune response, endothelial dysfunction, and myocardial stress due to COVID-19 could be exacerbated in patients with subclinical coronary atherosclerosis,” write Jean Guillaume Dillinger, MD, PhD (Lariboisiere Hospital, Paris, France), and colleagues. Although small, the study supports the practice of analyzing CAC in every COVID-19 patient, since it is a “freebie” that can help plan appropriate management, said Harvey Hecht, MD (Mount Sinai Medical Center, New York, NY), who was not involved in the study. “You’re getting a CT scan of the lungs on every COVID patient and that information is just there. You simply can’t miss it. So it takes virtually no additional time to do the measurements,” he told TCTMD, acknowledging that this information is not always reported on a routine basis despite guideline recommendations. In those patients with COVID-19 and elevated CAC, Hecht advised physicians to “follow that patient more carefully and perhaps be more aggressive at the first signs of worsening of their COVID status and their pneumonia. You should be more aggressive in treating that with all available tools.”


Treatment Options for COVID-19

Helio | Infectious Disease News, July 30, 2020

[Podcast] Research and data on potential treatment modalities continue to emerge at a rapid pace. This episode explores the IDSA and NIH guidelines for the treatment and management of COVID-19, as well as available evidence on antivirals, glucocorticoids and antibodies. Gitanjali Pai, MD, is an infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. She is a member of the Infectious Disease News Editorial Board and host of Healio’s podcast Unmasking COVID-19.


Systematic review of the role of renin-angiotensin system inhibitors in late studies on Covid-19: A new challenge overcome?

International Journal of Cardiology, July 30, 2020

A role for the renin-angiotensin-aldosterone-system in Severe Acute Respiratory Syndrome-Coronavirus-2 infection and in the development of COronaVIrus Disease-19 disease has generated remarkable concerns among physicians and patients. Even though a suggestive pathophysiological link between renin-angiotensin-aldosterone-system and the virus has been proposed, its pathogenic role remains very difficult to be defined. Although COronaVIrus Disease-19 targets preferentially older people with high prevalence of hypertension and extensive use of renin-angiotensin-aldosterone-system inhibitors, an independent role for hypertension and its therapies is not defined. In this article, we scrutinize evidence from the most representative available studies in which the potential role of renin-angiotensin system inhibitors, specifically angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, was evaluated in the COronaVIrus Disease-19 disease course, with regard to severity of the disease and mortality.


The toll that COVID-19 takes on the heart

NewsMedical, July 29, 2020

The coronavirus disease (COVID-19) has ravaged across the globe, with more than 16.95 million people infected. Early in the pandemic, the disease was described as a respiratory condition as it usually attacks the lungs first. As the disease progressed, other vital organs have been affected, including the heart and the kidneys. Now, two new studies describe the toll that COVID-19 takes on the heart, increasing the risk of long-term damage even after patients recover. These studies also show that heart damage can even occur in people who did not have severe illness that required hospitalization.


Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After COVID-19

Annals of Internal Medicine, July 29, 2020

Endotheliitis and microangiopathy have been identified as key features of the pathophysiology of severe coronavirus disease 2019 (COVID-19). In addition, a multisystem inflammatory syndrome (MIS) similar to Kawasaki disease has been increasingly reported in association with COVID-19 in children and young adults. Although vascular damage seems to be a component of both of these presentations, the pathologic features of MIS remain elusive. This report is meant to provide what we believe to be the first report on the pathologic findings of vasculitis of the small vessels of the heart, which likely represents MIS, leading to death in a young adult after presumed resolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was a 31-year-old African American woman with a body mass index of 36.1 kg/m2, hypertension controlled with lisinopril, and diabetes with poor adherence to metformin and glipizide (hemoglobin A1c level, 13.9%). She was admitted for fever, dry cough, and abdominal discomfort of 5 days. She was positive for SARS-CoV-2 by reverse transcriptase polymerase chain reaction testing of a nasopharyngeal swab specimen and was treated with a course of azithromycin and 2 days of hydroxychloroquine. At discharge, she was afebrile and her oxygen saturation was 95% on room air.


Phase 3 Trial of COVID-19 Vaccine Candidate mRNA-1273 Begins

Pulmonology Advisor, July 29, 2020

Moderna and the National Institutes of Allergy and Infectious Diseases have initiated a phase 3 trial evaluating the vaccine candidate mRNA-1273 against coronavirus disease 2019 (COVID-19). The trial, which is the first to be implemented under Operation Warp Speed, is expected to enroll around 30,000 adults and will be conducted at multiple clinical research sites across the US. In addition, the National Institutes of Health (NIH) Coronavirus Prevention Network will participate in conducting the trial. Testing sites in areas with emerging cases or high incidence rates will be prioritized for enrollment. Participants will be randomized to receive 2 intramuscular injections of either mRNA-1273 or saline placebo approximately 28 days apart. The study’s primary aim will be to assess whether the vaccine is able to prevent symptomatic COVID-19 after the administration of 2 doses; prevention after 1 dose will also be investigated as a secondary goal. Moreover, researchers will look at whether vaccination with mRNA-1273 prevents severe COVID-19 or laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with or without disease symptoms, as well as death.


Evaluation of Stress Cardiac Magnetic Resonance Imaging in Risk Reclassification of Patients With Suspected Coronary Artery Disease

JAMA Cardiology, July 29, 2020

The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline–recommended categories has not been established. In a multicenter cohort study of 1698 consecutive patients (median follow-up, 5.4 years) without a history of coronary artery disease, stress cardiac magnetic resonance imaging was performed for evaluation of suspected coronary artery disease. Stress cardiac magnetic resonance imaging significantly reclassified patient risk for cardiovascular death and myocardial infarction across American College of Cardiology/American Heart Association guideline–based risk categories. The findings of this study suggest that, in patients with suspected coronary artery disease, stress cardiac magnetic resonance imaging may provide incremental prognostic value for cardiovascular death and myocardial infarction and aid in clinical decision-making by reclassifying a substantial proportion of patients at intermediate risk.


U.S. records a coronavirus death every minute as total surpasses 150,000

Reuters, July 29, 2020

One person in the United States died about every minute from COVID-19 on Wednesday as the national death toll surpassed 150,000, the highest in the world. The United States recorded 1,461 new deaths on Wednesday, the highest one-day increase since 1,484 on May 27, according to a Reuters tally. U.S. coronavirus deaths are rising at their fastest rate in two months and have increased by 10,000 in the past 11 days. Nationally, COVID-19 deaths have risen for three weeks in a row while the number of new cases week-over-week recently fell for the first time since June. A spike in infections in Arizona, California, Florida and Texas this month has overwhelmed hospitals. The rise has forced states to make a U-turn on reopening economies that were restricted by lockdowns in March and April to slow the spread of the virus. Texas leads the nation with nearly 4,300 deaths so far this month, followed by Florida with 2,900 and California, the most populous state, with 2,700. The Texas figure includes a backlog of hundreds of deaths after the state changed the way it counted COVID-19 fatalities.


Eagle’s Eye View: COVID-19 Tip of the Week – Elevated Troponin Levels

American College of Cardiology, July 29, 2020

[Video] Watch Dr. Kim Eagle as he provides a weekly tip for clinicians on the front lines of the COVID-19 pandemic. This week, he discussed elevated troponin levels and outcomes in patients diagnosed with COVID-19. (See full article, Myocardial Injury in Patients Hospitalized With COVID-19, below.)


As pandemic rages, PPE supply remains a problem

Center for Infectious Disease Research and Policy, July 29, 2020

On top of being overwhelmed with severely ill people, healthcare workers are dealing with shortages of the personal protective equipment (PPE) that they need to keep from getting infected themselves. N95 respirators, surgical masks, gowns, and gloves were all were in short supply, forcing hospitals to ration them. At the root of the issue were several problems: a global surge in demand for protective gear that was outstripping supply, a lack of adequate supplies in the Strategic National Stockpile, which is intended to supplement state and local supplies during public health emergencies, and a response that lacked any federal coordination. A nationwide scrum for available PPE ensued, pitting state governments, healthcare systems, and individual hospitals against each other as they fought to outbid each other for adequate supplies for the pandemic response. Four months later, many hospitals have a better supply of PPE than they did in March and April. But with the dramatic nationwide rise in coronavirus cases that began in mid-June and shows no signs of slowing, concerns about PPE supplies remain. And demand is now coming not only from the hospitals that are treating COVID-19 patients, but also from nursing homes, primary care doctors who want to ensure a safe environment as they begin welcoming back patients for routine primary care, and other frontline healthcare workers.


Impact of Cardiac CT During COVID-19

Diagnostic and Interventional Cardiology, July 28, 2020

The use of cardiovascular computer tomography angiography (CCTA) is one of the areas that has seen a sudden increase in use and value since the start of the ongoing COVIF-19 pandemic. While SARS-CoV-2 has had significantly impacted cardiovascular care delivery, with a large reduction in elective diagnostic testing and face-to-face patient care, it also resulted a necessary re-examination of how cardiac care is delivered. Alternative approaches, beyond traditional, entrenched clinical practice for cardiac imaging are discussed in a recent paper published in Radiology: Cardiothoracic Imaging. “In many ways, the COVID crisis has been like a crucible,” the authors of the paper wrote. “Anything that is extraneous or unnecessary, anything that has gone on ‘just because’ gets melted away, leaving only that which is inherently of value and worth keeping.” The authors said telemedicine is showing cardiologists that not every patient needs to present in-person in order to have meaningful interactions for care. They said the same is true for an expanded clinical role of CCTA in ambulatory and acute care settings has been equally beneficial. However, they argue neither approach will be sustainable in the future unless the regulatory and reimbursement systems for care delivery can adapt to these innovative approaches.


Myocardial Injury in Patients Hospitalized With COVID-19

American College of Cardiology, July 27, 2020

Data were obtained retrospectively from the electronic medical record (EMR) of patients admitted with COVID-19 to one of five Mount Sinai Health System hospitals in New York City between February and April 2020. Patients with a troponin I drawn within 24 hours of admission were included. These levels were stratified into normal (0.00-0.03 ng/ml), mildly elevated (>0.03-0.09 ng/ml), and elevated (>0.09 ng/ml). Variables collected included demographics, laboratory values, and comorbidities based on International Classification of Diseases, Tenth Revision (ICD-10) billing codes. A CURB-65 score was computed on admission to reflect illness severity, reported as an integer between 0-5. The primary outcome was mortality, with a composite secondary outcome of mortality or mechanical ventilation. Of patients admitted with COVID-19, 2,736 (89.1%) of 3,069 had ≥1 troponin I measurement within 24 hours of admission. The median age was 66.4 years, 59.6% were male, and 40.7% of patients were ages >70 years; 27.6% of patients self-identified as African American, and 27.6% as Hispanic or Latino. Mean body mass index (BMI) was 29.8 ± 6 kg/m2. Cardiovascular disease (CVD), comprised of either coronary artery disease (CAD), atrial fibrillation (AF), or heart failure (HF) was present in 24% of patients. The risk factors of hypertension (HTN) and diabetes (DM) were present in another 25.8% of the cohort. Statins were used in 36% of patients and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) in 22%. Regarding troponin levels, 1,751 (64%) patients had an initial troponin in the normal range, while 455 (17%) had mild elevation and 530 (19%) had an elevated troponin; 173 (6.3%) patients had a troponin elevation over 1 ng/ml at any point during their hospital stay.


Cleaner data confirm severe COVID-19 link to diabetes, hypertension

The Hospitalist, July 27, 2020

Further refinement of data from patients hospitalized worldwide for COVID-19 disease showed a 12% prevalence rate of patients with diabetes in this population and a 17% prevalence rate for hypertension. These are lower rates than previously reported for COVID-19 patients with either of these two comorbidities, yet the findings still document important epidemiologic links between diabetes, hypertension, and COVID-19, said the study’s authors. A meta-analysis of data from 15,794 patients hospitalized because of COVID-19 disease that was drawn from 65 carefully curated reports published from December 1, 2019, to April 6, 2020, also showed that, among the hospitalized COVID-19 patients with diabetes (either type 1 or type 2), the rate of patients who required ICU admission was 96% higher than among those without diabetes and mortality was 2.78-fold higher, both statistically significant differences. The rate of ICU admissions among those hospitalized with COVID-19 who also had hypertension was 2.95-fold above those without hypertension, and mortality was 2.39-fold higher, also statistically significant differences, reported a team of researchers in the recently published report.


Longitudinal analyses reveal immunological misfiring in severe COVID-19

Nature, July 27, 2020

Recent studies have provided insights into the pathogenesis of coronavirus disease 2019 (COVID-19). Yet, longitudinal immunological correlates of disease outcome remain unclear. Here, we serially analysed immune responses in 113 COVID-19 patients with moderate (non-ICU) and severe (ICU) disease. Immune profiling revealed an overall increase in innate cell lineages with a concomitant reduction in T cell number. We identify an association between early, elevated cytokines and worse disease outcomes. Following an early increase in cytokines, COVID-19 patients with moderate disease displayed a progressive reduction in type-1 (antiviral) and type-3 (antifungal) responses. In contrast, patients with severe disease maintained these elevated responses throughout the course of disease. Moreover, severe disease was accompanied by an increase in multiple type 2 (anti-helminths) effectors including, IL-5, IL-13, IgE and eosinophils.


COVID-19 fears would keep most Hispanics with stroke, MI symptoms home

The Hospitalist, July 27, 2020

More than half of Hispanic adults would be afraid to go to a hospital for a possible heart attack or stroke because they might get infected with SARS-CoV-2, according to a new survey from the American Heart Association. Compared with Hispanic respondents, 55% of whom said they feared COVID-19, significantly fewer Blacks (45%) and Whites (40%) would be scared to go to the hospital if they thought they were having a heart attack or stroke, the AHA said based on the survey of 2,050 adults, which was conducted May 29 to June 2, 2020, by the Harris Poll. Hispanics also were significantly more likely to stay home if they thought they were experiencing a heart attack or stroke (41%), rather than risk getting infected at the hospital, than were Blacks (33%), who were significantly more likely than Whites (24%) to stay home, the AHA reported.


Covid-19 and the cardiovascular system: a comprehensive review

Journal of Human Hypertension, July 27, 2020

The main clinical manifestations of COVID-19 are respiratory, varying from a mild presentation to acute respiratory distress syndrome (ARDS), being potentially fatal. Moreover, as in other respiratory infections, pre-existing CV diseases and risk factors can increase the severity of COVID-19, leading to the aggravation and decompensation of chronic underlying cardiac pathologies as well as acute-onset of new cardiac complications [3], highlighting that myocardial injury can be present in approximately 12% of hospitalized patients with SARS-CoV-2 infection. Within the CV manifestations of COVID-19, we can highlight four different aspects: (a) CV risk factors and established CV disease is associated with a worse prognosis, (b) appearance of acute CV complications in previously healthy individuals, (c) promising therapies with antimalarials and antivirals present important CV side effects, and (d) questioning the safety of the use of renin–angiotensin–aldosterone system (RAAS) inhibitors regarding an increased risk of COVID-19. Thus, the need to elucidate the potential pathophysiological mechanisms caused by COVID-19 and its CV repercussions becomes evident.


Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

JAMA Cardiology, July 27, 2020

Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown. The objective of the study was to evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness. In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020. Exposure included recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription–polymerase chain reaction on swab test of the upper respiratory tract. Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor–matched patients (n = 57).


Ischemic Stroke Risk May Be Higher in COVID-19 vs Influenza

Pulmonary Advisor, July 27, 2020

Patients hospitalized with coronavirus disease 2019 (COVID-19) had higher rates of ischemic stroke those of patients with influenza, according to study results published in JAMA Neurology. The rates of ischemic stroke were compared between patients who presented to the emergency room or who were admitted to 2hospitals in New York City for either COVID-19 or influenza. Patients were aged ≥18 years with laboratory-confirmed influenza A/B or COVID-19 infection as confirmed by evidence of severe acute respiratory syndrome coronavirus 2 in the nasopharynx by polymerase chain reaction. Of the 3402 patients with either COVID-19 or influenza in the emergency room or admitted to the hospital, 1916 had COVID-19 while 1486 had influenza. The rates of ischemic stroke were 1.6% in patients with COVID-19, while ischemic stroke occurred in 0.2% of patients with influenza. After adjustment for age, sex, and race, the likelihood of stroke remained higher with COVID-19 infection than with influenza infection (odds ratio, 7.6; 95% CI, 2.3-25.2).


Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases

JAMA Cardiology, July 27, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be documented in various tissues, but the frequency of cardiac involvement as well as possible consequences are unknown. The objective of the study was to evaluate the presence of SARS-CoV-2 in the myocardial tissue from autopsy cases and to document a possible cardiac response to that infection. This cohort study used data from consecutive autopsy cases from Germany between April 8 and April 18, 2020. All patients had tested positive for SARS-CoV-2 in pharyngeal swab tests. Cardiac tissue from 39 consecutive autopsy cases were included. The median (interquartile range) age of patients was 85 (78-89) years, and 23 (59.0%) were women. SARS-CoV-2 could be documented in 24 of 39 patients (61.5%). Viral load above 1000 copies per μg RNA could be documented in 16 of 39 patients (41.0%). A cytokine response panel consisting of 6 proinflammatory genes was increased in those 16 patients compared with 15 patients without any SARS-CoV-2 in the heart. Comparison of 15 patients without cardiac infection with 16 patients with more than 1000 copies revealed no inflammatory cell infiltrates or differences in leukocyte numbers per high power field.


The Color of COVID: Will Vaccine Trials Reflect America’s Diversity?

Kaiser Health News, July 27, 2020

Black and Latino people have been three times as likely as white people to become infected with COVID-19 and twice as likely to die, according to federal data obtained via a lawsuit by The New York Times. Asian Americans appear to account for fewer cases but have higher rates of death. Eight out of 10 COVID deaths reported in the U.S. have been of people ages 65 and older. And the Centers for Disease Control and Prevention warns that chronic kidney disease is among the top risk factors for serious infection. Historically, however, those groups have been less likely to be included in clinical trials for disease treatment, despite federal rules requiring minority and elder participation and the ongoing efforts of patient advocates to diversify these crucial medical studies. In a summer dominated by COVID-19 and protests against racial injustice, there are growing demands that drugmakers and investigators ensure that vaccine trials reflect the entire community.


Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?

JAMA Cardiology, July 27, 2020

[Editorial] Multiple data sets now confirm the increased risk for morbid and mortal complications due to coronavirus disease 2019 (COVID-19) in individuals with preexisting cardiovascular diseases including hypertension, coronary artery disease, and heart failure. These salient observations have strengthened preventive strategies and undoubtedly have resulted in lives saved. Although episodes of clinical myocarditis have been suspected and a few cases have been reported in the literature, direct cardiac involvement due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been difficult to confirm. In this issue of JAMA Cardiology, Linder and colleagues report on 39 autopsy cases of patients with COVID-19 in whom pneumonia was the clinical cause of death in 35 of 39 (89.7%). While histopathologic evaluation did not meet criteria seen in acute myocarditis, there was evidence of virus present in the heart in 24 of 39 patients (61.5%) with a viral load more than 1000 copies per microgram of RNA in 16 of 24 patients (66.7%). Evidence of active viral replication was also noted. In situ hybridization suggested that the most likely localization of the viral infection was in interstitial cells or macrophages infiltrating the myocardial tissue rather than localization in the myocytes themselves. Further using a panel of 6 proinflammatory genes, the investigators demonstrated increased activity among hearts with evidence of viral infection compared with hearts with no SARS-CoV-2 viral infection detected. These new findings provide intriguing evidence that COVID-19 is associated with at least some component of myocardial injury, perhaps as the result of direct viral infection of the heart.


Florida records 9,300 new coronavirus cases, blows past New York

Reuters, July 26, 2020

Florida on Sunday became the second state after California to overtake New York, the worst-hit state at the start of the U.S. novel coronavirus outbreak, according to a Reuters tally. Total COVID-19 cases in the Sunshine State rose by 9,300 to 423,855 on Sunday, just one place behind California, which now leads the country with 448,497 cases. New York is in third place with 415,827 cases. Still, New York has recorded the most deaths of any U.S. state at more than 32,000 with Florida in eighth place with nearly 6,000 deaths. On average, Florida has added more than 10,000 cases a day in July while California has been adding 8,300 cases a day and New York has been adding 700 cases.


U.S .agency vows steps to address COVID-19 inequalities

Modern Healthcare, July 25, 2020

If Black, Hispanic and Native Americans are hospitalized and killed by the coronavirus at far higher rates than others, shouldn’t the government count them as high risk for serious illness? That seemingly simple question has been mulled by federal health officials for months. And so far the answer is no. But federal public health officials have released a new strategy that vows to improve data collection and take steps to address stark inequalities in how the disease is affecting Americans. Officials at the Centers for Disease Control and Prevention stress that the disproportionately high impact on certain minority groups is not driven by genetics. Rather, it’s social conditions that make people of color more likely to be exposed to the virus and — if they catch it — more likely to get seriously ill. “To just name racial and ethnic groups without contextualizing what contributes to the risk has the potential to be stigmatizing and victimizing,” said the CDC’s Leandris Liburd, who two months ago was named chief health equity officer in the agency’s coronavirus response. Outside experts agreed that there’s a lot of potential downside to labeling certain racial and ethnic groups as high risk.


US surpasses 1,000 COVID-19 deaths for fourth straight day

The Hill, July 25, 2020

The U.S. tallied over 1,000 coronavirus-related deaths Friday for the fourth straight day this week, yet another sign of the alarming spike in COVID-19 cases across the country. There were 1,178 new deaths Friday alone, according to the COVID Tracking project, compared with 1,038 Tuesday, 1,117 Wednesday, and 1,039 Thursday. Over 137,000 people have died in the U.S. and over 4 million people have contracted the virus in the country since the outbreak began. The alarming figures are largely driven by a surge in cases across the South and West, particularly in Arizona, California, Florida and Texas. The spikes have led to urgent calls from public health officials for Americans, particularly young people, to heed health guidance such as wearing masks and socially distancing.


COVID-19 pandemic may play critical role in increased CTA use

Cardiology Today, July 24, 2020

The COVID-19 pandemic poses several challenges for cardiac care but may be an opportunity for coronary CTA to be more widely used, according to presentations at the Society of Cardiovascular Computed Tomography Annual Scientific Meeting. The role of coronary CTA during the COVID-19 pandemic depends on the stage of disease. For the acute stage of the disease, clinicians will ask whether patients have ACS or myocardial injury. “This is an important question because 10% to 30% of patients with COVID who are admitted have elevated troponin markers,” Ron Blankstein, MD, MSCCT, FASNC, FACC, FASPC, director of cardiac computed tomography, associate director of the cardiovascular imaging program and associate physician of preventive cardiology at Brigham and Women’s Hospital, associate professor of medicine and radiology at Harvard Medical School and president of the Society of Cardiovascular Computed Tomography (SCCT), said during the presentation. In the chronic stage of the disease, coronary CTA may be used to evaluate patients who have chest pain, potentially new left ventricular dysfunction or new arrhythmias.


Cardiac CT may be safer vs. TEE during COVID-19 pandemic

Cardiology Today, July 23, 2020

Cardiac CT may be the ideal imaging technique during the COVID-19 pandemic compared with transesophageal echocardiography, according to a presentation at the Society of Cardiovascular Computed Tomography Annual Scientific Meeting. “The COVID-19 pandemic has affected and upended everything that we do in delivering cardiovascular care,” Andrew D. Choi, MD, FSCCT, co-director of cardiac CT and MRI, interventional echocardiographer and associate professor of medicine and radiology at George Washington University School of Medicine, said during the presentation.


Time to Address Race-Ethnic COVID Disparities in Seniors, Senate Panel Told

MedPage Today, July 23, 2020

Enhancing data collection, investing in research, and building trust can help mitigate the disparate impacts of the COVID-19 pandemic on Black and Latinx seniors, witnesses told members of the Senate Special Committee on Aging during a hearing on Tuesday. The pandemic’s impact on minority and ethnic groups appears most acute in young people and seems to taper off among community-dwelling older adults, Mercedes Carnethon, PhD, an epidemiologist and preventive medicine specialist at Northwestern University in Chicago, told the committee. Nevertheless, disparities persist for seniors living in congregate care settings such as nursing homes. In fact, nursing homes with a higher proportion of Black and Latinx residents have double the rates of COVID-19 infections than facilities with a greater share of non-Hispanic whites, Carnethon said. Current policies don’t require universal reporting of race or ethnicities of individuals affected by COVID-19, she said.


Association of Interleukin 7 Immunotherapy With Lymphocyte Counts Among Patients With Severe Coronavirus Disease 2019 (COVID-19)

JAMA Network Open, July 22, 2020

[Research Letter] Cytokine storm–mediated organ injury continues to dominate current thinking as the primary mechanism for coronavirus disease 2019 (COVID-19). Although there is an initial hyper-inflammatory phase, mounting evidence suggests that virus-induced defective host immunity may be the real cause of death in many patients. COVID-19 has been called a serial lymphocyte killer because profound and protracted lymphopenia is a near uniform finding among patients with severe COVID-19 and correlates with morbidity and mortality. Autopsies demonstrate a devastating depletion of lymphocytes in the spleen and other organs. CD4, CD8, and natural killer cells, which play important antiviral roles, are depleted and have reduced function, leading to immune collapse. Clinical and pathological findings in patients with COVID-19 indicate that immunosuppression is a critical determinant of outcomes.


Trends in US Heart Transplant Waitlist Activity and Volume During the Coronavirus Disease 2019 (COVID-19) Pandemic

JAMA Cardiology, July 22, 2020

How have heart transplant listings and volumes in the US changed during the coronavirus disease 2019 (COVID-19) pandemic? In this cross-sectional analysis of heart transplant data from the United Network for Organ Sharing and the US Centers for Disease Control and Prevention, compared with the pre–COVID-19 era, the total number of waitlist inactivations has increased while new waitlist additions, deceased donor recoveries, and heart transplants have decreased across the US. During the COVID-19 era, there was significant regional variation in these practices. Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT). The objective of the study was to describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19.


Financial Impact of COVID-19 on physicians and their practices

MJH Life Sciences, July 22, 2020

[Infographic] With over 1,600 responses from a variety of specialties, physicians weighed in on the financial impact of COVID-19 and how they are navigating the decrease in patient volume, telehealth reimbursements and financial relief. These results convey the challenges and concerns of physicians as they transition to the new normal with COVID-19. From anticipated loss in revenue to influence on headcount, the Financial Impact survey reveals the lasting repercussions COVID-19 will have practices for the remainder of 2020 and beyond.


Autopsies reveal surprising cardiac changes in COVID-19 patients

Medical Xpress, July 21, 2020

A series of autopsies conducted by LSU Health New Orleans pathologists shows the damage to the hearts of COVID-19 patients is not the expected typical inflammation of the heart muscle associated with myocarditis, but rather a unique pattern of cell death in scattered individual heart muscle cells. They report the findings of a detailed study of hearts from 22 deaths confirmed due to COVID-19 in a Research Letter published in Circulation, available here. “We identified key gross and microscopic changes that challenge the notion that typical myocarditis is present in severe SARS-CoV-2 infection,” says Richard Vander Heide, M.D., Ph.D., Professor and Director of Pathology Research at LSU Health New Orleans School of Medicine. “While the mechanism of cardiac injury in COVID-19 is unknown, we propose several theories that bear further investigation that will lead to greater understanding and potential treatment interventions.” The team of LSU Health pathologists led by Dr. Vander Heide, an experienced cardiovascular pathologist, also found that unlike the first SARS coronavirus, SARS-CoV-2 was not present in heart muscle cells. Nor were there occluding blood clots in the coronary arteries.


Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020

JAMA Internal Medicine, July 21, 2020

In this cross-sectional study of 16 025 residual clinical specimens, estimates of the proportion of persons with detectable SARS-CoV-2 antibodies ranged from 1.0% in the San Francisco Bay area (collected April 23-27) to 6.9% of persons in New York City (collected March 23-April 1). Six to 24 times more infections were estimated per site with seroprevalence than with coronavirus disease 2019 (COVID-19) case report data. For most sites, it is likely that greater than 10 times more SARS-CoV-2 infections occurred than the number of reported COVID-19 cases; most persons in each site, however, likely had no detectable SARS-CoV-2 antibodies.


Higher SARS-CoV-2 Viral Load Associated With Shorter Symptom Duration

Pulmonary Advisor, July 21, 2020

Viral load (VL) of severe acute respiratory syndrome coronavirus 2 is lower in hospitalized patients, and higher VL is associated with a shorter duration of symptoms and hospital stay, according to a study published online July 2 in The American Journal of Pathology. Kimon V. Argyropoulos, M.D., from NYU Langone Health in New York City, and colleagues examined the associations between VL and parameters such as symptom severity, disposition, length of hospitalization, and admission to the intensive care unit in a cohort of 205 patients from a tertiary care center. The researchers found that after adjustment for age, sex, race, body mass index, and comorbidities, diagnostic VL was significantly lower in hospitalized than nonhospitalized patients (log10 VL, 3.3 versus 4.0). In all patients and hospitalized patients only, higher VL was associated with a shorter duration of symptoms and shorter hospital stay. There was no significant association noted between VL, intensive care unit admission, length of oxygen support, and overall survival.


HHS Rolls Out New COVID-19 Data Dashboard

MedPage Today, July 21, 2020

The Department of Health and Human Services (HHS) debuted its new COVID-19 dashboard on Monday, and the department’s data chief said it will provide even more data than the CDC’s old one did. Called the Coronavirus Data Hub, the HHS dashboard replaces the CDC’s National Healthcare Safety Network (NHSN), to which states and hospitals had previously been submitting COVID-19 data such as intensive care unit capacity, ventilator use, personal protective equipment (PPE) levels, and staffing shortages. But in guidance to hospitals, updated July 10 and published with little fanfare, HHS ordered hospitals to stop submitting such data to the NHSN and instead submit it either to HHS or to their state health department, which would then submit it to HHS. The data would then be put on the dashboard via the department’s new HHS Protect data system. The dashboard’s public-facing side allows users to see the overall number of confirmed coronavirus cases in the U.S. as well as the overall number of reported deaths. It also includes data on inpatient and ICU bed utilization.


As Coronavirus Patients Skew Younger, Tracing Task Seems All But Impossible

Kaiser Health News, July 20, 2020

Younger people are less likely to be hospitalized or die of COVID-19 than their elders, but they circulate more freely while carrying the disease, and their cases are harder to trace. Together, these facts terrify California hospital officials. People under 50 make up 73% of those testing positive for the disease in the state since the beginning of June, compared with 52% before April 30. That shift isn’t comforting to Dr. Alan Williamson, chief medical officer of Eisenhower Health in Riverside County’s Coachella Valley. “It honestly worries me more because it means that this is now established in the community,” he said. As the virus spreads throughout the United States, figuring out how patients were exposed becomes increasingly difficult, which makes it nearly impossible to stop viral transmission. Younger people with COVID-19 are also less likely to pick up the phone when a contact tracer calls, health officials say.


Synairgen’s Inhaled COVID-19 Treatment Appears to Decrease Disease Risk by 79%

BioSpace, July 20, 2020

A small biotech company in Southampton, UK, Synairgen, announced positive results from a clinical trial of its wholly-owned inhaled formulation of interferon beta in COVID-19 patients. Company shares exploded 373% at the news. The company indicated its nebulizer treatment resulted in a 79% lower risk of patients developing severe disease compared to those receiving a placebo. And the patients receiving the treatment “were more than twice as likely to recover (defined as ‘no limitation of activities’ or ‘no clinical or virological evidence of infection’) over the course of the treatment period compared to those receiving placebo.” It’s worth noting that the p-value of the 79% figure was 0.046, which only provides a narrow margin for being statistically significant. P-value, or probability value, is a determination of statistical value.


As Coronavirus Patients Skew Younger, Tracing Task Seems All But Impossible

Kaiser Health News, July 20, 2020

Younger people are less likely to be hospitalized or die of COVID-19 than their elders, but they circulate more freely while carrying the disease, and their cases are harder to trace. Together, these facts terrify California hospital officials. People under 50 make up 73% of those testing positive for the disease in the state since the beginning of June, compared with 52% before April 30. That shift isn’t comforting to Dr. Alan Williamson, chief medical officer of Eisenhower Health in Riverside County’s Coachella Valley. “It honestly worries me more because it means that this is now established in the community,” he said. As the virus spreads throughout the United States, figuring out how patients were exposed becomes increasingly difficult, which makes it nearly impossible to stop viral transmission. Younger people with COVID-19 are also less likely to pick up the phone when a contact tracer calls, health officials say.


Key Points About Myocardial Injury and Cardiac Troponin in COVID-19

American College of Cardiology, July 17, 2020

The coronavirus disease 2019 (COVID-19) pandemic has affected >8 million patients and caused >400 thousand deaths to date.1 Recent reports indicate that myocardial injury is frequent among patients with COVID-19. Here we summarize 10 key points about myocardial injury and COVID-19.


Mavrilimumab Improves Clinical Outcomes in Severe COVID-19 Pneumonia

Pulmonology Advisor, July 17, 2020

Treatment with mavrilimumab is associated with improved clinical outcomes compared with standard care in non-mechanically ventilated patients with severe coronavirus disease 2019 (COVID-19) pneumonia and systemic hyperinflammation, according to the results of a single-center prospective cohort study published in The Lancet Rheumatology. Hyperinflammation, with its excessive cytokine production (known as a cytokine storm), has been identified as a key factor of poor prognosis in patients with COVID-19-related severe pneumonia, leading to high frequencies of respiratory failure and mortality. Therefore, researchers investigated whether mavrilimumab, an anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor-α monoclonal antibody, added to standard management, improves clinical outcomes in patients with COVID-19 pneumonia and systemic hyperinflammation.


Coronary Artery Calcification and Complications in COVID-19 Patients

American College of Cardiology, July 17, 2020

This cross-sectional study was conducted from March 15-May 3, 2020 in consecutive patients 40-80 years of age without cardiovascular disease (CVD) who were hospitalized with COVID-19 and had a noncontrast chest computed tomography (CT) on the day of admission. The presence or absence of CAC (CAC+ and CAC-, respectively) was defined as any area ≥1 mm2 with a density >130 Hounsfield units along the known coronary tract. There was no ECG gating. Primary outcome segmented by median age was the first occurrence of mechanical noninvasive or invasive ventilation, extracorporeal membrane oxygenation (ECMO), or death within 30 days of admission. The presence and extent of CAC is associated with a worse prognosis in hospitalized COVID-19 patients. The severity of immune response, endothelial dysfunction, and myocardial stress due to COVID-19 could be exacerbated in patients with subclinical coronary atherosclerosis.


WHO reports record total of new coronavirus cases worldwide

The Hill, July 17, 2020

The World Health Organization (WHO) on Friday reported a record number of daily coronavirus cases worldwide with the U.S. leading other nations in the spike. In a daily report, WHO reported 237,743 new COVID-19 cases in the last 24 hours, surpassing the previous single-day record of 230,370 on July 12. There were 5,682 more deaths in the past day. There have been more than 13.6 million confirmed coronavirus cases around the globe since the pandemic began. The U.S. had the highest number of new cases out of any other country with more than 67,000, almost doubling the nearly 35,000 new cases in India, which had the second-most cases in the last 24 hours. The record-breaking total comes as states across the U.S., particularly in the South and West, see alarming spikes in COVID-19 cases. Texas reported roughly 10,000 new cases Thursday for the third day in a row, while California tallied nearly 20,000 new cases over the last two days. Florida also saw nearly 14,000 new cases Thursday.


Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Centers for Disease Control and Prevention, July 17, 2020

Updates to the list of underlying medical conditions that put individuals at increased risk for severe illness from COVID-19 were based on published reports, articles in press, unreviewed pre-prints, and internal data available between December 1, 2019 and May 29, 2020. This list is a living document that will be periodically updated by CDC, and it could rapidly change as the science evolves. Severe illness from COVID-19 was defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death. The level of evidence for each condition was determined by CDC reviewers based on available information about COVID-19. Conditions were added to the list (if not already on the previous underlying medical conditions list [originally released in March 2020]) if evidence for an association with severe illness from COVID-19 met any of the criteria listed.


Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study

Radiology, July 16, 2020

Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. This study evaluated whether Non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission CXR compared with White/Non-Hispanic patients. This single-institution, retrospective cohort study was approved by the IRB. Patients hospitalized with confirmed COVID-19 infection (3/27/20-4/10/20) were identified using the electronic medical record (EMR) (n=326, mean age: 59 years (SD: 17 years), M:F (188:138). Primary outcome was severity of lung disease on admission CXR, measured by modified Radiographic Assessment of Lung Edema (mRALE) score. Secondary outcome was a composite adverse clinical outcome of intubation, ICU admission, or death. Primary exposure was racial/ethnic category: White/Non-Hispanic versus Non-White [i.e., Hispanic, Black, Asian, Other]. Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race/ethnicity. Read the results.


As Coronavirus Patients Skew Younger, Tracing Task Seems All But Impossible

Kaiser Health News, July 20, 2020

Younger people are less likely to be hospitalized or die of COVID-19 than their elders, but they circulate more freely while carrying the disease, and their cases are harder to trace. Together, these facts terrify California hospital officials. People under 50 make up 73% of those testing positive for the disease in the state since the beginning of June, compared with 52% before April 30. That shift isn’t comforting to Dr. Alan Williamson, chief medical officer of Eisenhower Health in Riverside County’s Coachella Valley. “It honestly worries me more because it means that this is now established in the community,” he said. As the virus spreads throughout the United States, figuring out how patients were exposed becomes increasingly difficult, which makes it nearly impossible to stop viral transmission. Younger people with COVID-19 are also less likely to pick up the phone when a contact tracer calls, health officials say.


SARS-CoV-2 and the cardiovascular system

Clinica Chimica Acta, July 19, 2020

The coronavirus disease COVID-19 is a public health emergency caused by a novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 infection uses the angiotensin-converting enzyme 2 (ACE2) receptor, and typically spreads through the respiratory tract. Invading viruses can elicit an exaggerated host immune response, frequently leading to a cytokine storm that may be fueling some COVID-19 death. This response contributes to multi-organ dysfunction. Accumulating data points to an increased cardiovascular disease morbidity, and mortality in COVID-19 patients. This brief review explores potential available evidence regarding the association between COVID-19, and cardiovascular complications.


Coagulopathy in COVID-19: Focus on vascular thrombotic events

Journal of Molecular and Cellular Cardiology, July 19, 2020

SARS-CoV-2 causes a phenotype of pneumonia with diverse manifestation, which is termed as coronavirus disease 2019 (COVID-19). An impressive high transmission rate allows COVID-19 conferring enormous challenge for clinicians worldwide, and developing to a pandemic level. Combined with a series of complications, a part of COVID-19 patients progress into severe cases, which critically contributes to the risk of fatality. To date, coagulopathy has been found as a prominent feature of COVID-19 and severe coagulation dysfunction may be associated with poor prognosis. Coagulopathy in COVID-19 may predispose patients to hypercoagulability-related disorders including thrombosis and even fatal vascular events. Inflammatory storm, uncontrolled inflammation-mediated endothelial injury and renin angiotensin system (RAS) dysregulation are the potential mechanisms. Ongoing efforts made to develop promising therapies provide several potential strategies for hypercoagulability in COVID-19. In this review, we introduce the clinical features of coagulation and the increased vascular thrombotic risk conferred by coagulopathy according to present reports about COVID-19. The potential underlying mechanisms and emerging therapeutic avenues are discussed, emphasizing an urgent need for effective interventions.


WHO reports record total of new coronavirus cases worldwide

The Hill, July 17, 2020

The World Health Organization (WHO) on Friday reported a record number of daily coronavirus cases worldwide with the U.S. leading other nations in the spike. In a daily report, WHO reported 237,743 new COVID-19 cases in the last 24 hours, surpassing the previous single-day record of 230,370 on July 12. There were 5,682 more deaths in the past day. There have been more than 13.6 million confirmed coronavirus cases around the globe since the pandemic began. The U.S. had the highest number of new cases out of any other country with more than 67,000, almost doubling the nearly 35,000 new cases in India, which had the second-most cases in the last 24 hours. The record-breaking total comes as states across the U.S., particularly in the South and West, see alarming spikes in COVID-19 cases. Texas reported roughly 10,000 new cases Thursday for the third day in a row, while California tallied nearly 20,000 new cases over the last two days. Florida also saw nearly 14,000 new cases Thursday.


Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Centers for Disease Control and Prevention, July 17, 2020

Updates to the list of underlying medical conditions that put individuals at increased risk for severe illness from COVID-19 were based on published reports, articles in press, unreviewed pre-prints, and internal data available between December 1, 2019 and May 29, 2020. This list is a living document that will be periodically updated by CDC, and it could rapidly change as the science evolves. Severe illness from COVID-19 was defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death. The level of evidence for each condition was determined by CDC reviewers based on available information about COVID-19. Conditions were added to the list (if not already on the previous underlying medical conditions list [originally released in March 2020]) if evidence for an association with severe illness from COVID-19 met any of the criteria listed.


Racial/Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed COVID-19: A Retrospective Cohort Study

Radiology, July 16, 2020

Disease severity on chest radiographs (CXR) has been associated with higher risk of disease progression and adverse outcomes from COVID-19. Few studies have evaluated COVID-19-related racial/ethnic disparities in radiology. This study evaluated whether Non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission CXR compared with White/Non-Hispanic patients. This single-institution, retrospective cohort study was approved by the IRB. Patients hospitalized with confirmed COVID-19 infection (3/27/20-4/10/20) were identified using the electronic medical record (EMR) (n=326, mean age: 59 years (SD: 17 years), M:F (188:138). Primary outcome was severity of lung disease on admission CXR, measured by modified Radiographic Assessment of Lung Edema (mRALE) score. Secondary outcome was a composite adverse clinical outcome of intubation, ICU admission, or death. Primary exposure was racial/ethnic category: White/Non-Hispanic versus Non-White [i.e., Hispanic, Black, Asian, Other]. Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race/ethnicity. Read the results.


COVID-19 and high blood pressure: Why hypertension patients can be severely affected by the disease

Firstpost, July 16, 2020

COVID-19 was first reported in Wuhan, Hubei Province, China on the 31 December 2019. Since then, much research has been done into establishing who is the most vulnerable to this new disease and how can the disease’s impact be reduced for these at-risk populations. COVID-19 patients who have other underlying conditions or comorbidities are one of the groups which are most vulnerable to having complications if they contract the infection. As per some reports, the most common comorbidities are hypertension (30 percent), diabetes (19 percent) and coronary heart disease (8 percent). About 99 percent of COVID-19 patients who died in Italy had either hypertension or other diseases like cancer, diabetes or other lung diseases. About 76 percent of these were patients who were suffering from high BP. What needs to be noted is that nearly two-thirds of the world population above the age of 60 have hypertension. Another possible reason why people with hypertension are at a higher risk is the drugs they use to treat the disease and not the disease itself. Hypertension and other cardiovascular diseases which are often found in COVID-19 patients are treated with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Both these drugs increase the level of ACE2 in the body and COVID-19 viruses attach themselves to this enzyme to infect the cells.


Among patients with stroke, outcomes worse in those with COVID-19

Helio | Cardiology Today, July 16, 2020

Ischemic stroke in patients with COVID-19 conferred greater mortality and worse functional outcomes than stroke in patients without COVID-19, according to a report published in Stroke. “The association between COVID-19 and severe stroke highlights the urgent need for studies aiming to uncover the underlying mechanisms and is relevant for prehospital stroke awareness and in-hospital acute stroke pathways during the current and future pandemics, since severe strokes have typically poor prognosis and can potentially be treated with recanalization techniques,” George Ntaios, MD, MSc, PhD, from the department of internal medicine of the School of Health Sciences at the University of Thessaly in Larissa, Greece, and colleagues wrote. For this analysis, researchers pooled consecutive patients hospitalized with COVID-19 and stroke from 28 sites in 16 countries (n = 174; median age, 71 years; 38% women) and performed a 1-to-1 propensity score matching analyses with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne project from 2003 to 2019. Researchers observed that the median NIH Stroke Scale score was higher in patients with COVID-19 (OR = 1.69; 95% CI, 1.08-2.65) compared with patients without COVID-19.


COVID-19 and the heart: Searching for the location of the SARS-CoV-2 receptor

Medical Xpress, July 15, 2020

Nearly 20% of all COVID-19-associated deaths are from cardiac complications, yet the mechanisms from which these complications arise have remained a topic of debate in the cardiology community. One hypothesis centers on the infection of the heart itself, but the understanding of which cells may be infected is unclear. To address this, MMRI Assistant Professor Dr. Nathan Tucker, in collaboration with the Broad Institute, the University of Pennsylvania, and Bayer US, report the distribution of the SARS-CoV-2 receptor in a manuscript titled, “Myocyte upregulation of ACE2 in cardiovascular disease” published in the journal, Circulation. COVID-19 (SARS-CoV-2) infects cells through a particular cellular molecule, termed ACE2. To assess levels of this molecule in different patient populations and in response to common hypertension medications (ACE inhibitors), the group applied state-of-the-art single nucleus sequencing technologies in human heart samples.


COVID19 and increased mortality in African Americans: socioeconomic differences or does the renin angiotensin system also contribute?

Journal of Human Hypertension, July 15, 2020

The dawn of the new decade is marked by the emergence of the novel coronavirus SARS-CoV-2, whose spread has resulted in the COVID-19 pandemic, having already affected millions of individuals and resulted in hundreds of thousands of deaths worldwide. While the pandemic situation is constantly evolving, alarming signals have arisen during the past few weeks from the United States of America, which now represents the world’s most affected country, as disproportionally higher infection and mortality rates in African–Americans compared to other races were reported in some states. After these initial reports that raised public awareness, most states gradually started sharing data regarding confirmed cases and deaths by race. Most of them have reported higher infection rates in African–Americans, although data regarding confirmed COVID-19 cases by race are largely incomplete. Furthermore, based on current estimates, it is calculated that overall African–Americans suffer from a 2.4 and 2.2 times higher mortality rate when compared to Whites and Asians or Latinos, respectively. The higher mortality rate in African–Americans raises questions about the underlying mechanisms behind these racial disparities. Several known mechanisms might be implicated, including increased comorbidities, inequalities in healthcare access, and socioeconomic factors. However, we propose that another mechanism might be also implicated: the renin-angiotensin system.


UTHealth physicians investigate blood pressure drug’s effect on improving COVID-19 outcomes

News Medical, July 14, 2020

An interventional therapy aimed at improving survival chances and reducing the need for critical care treatment due to COVID-19 is being investigated by physicians at The University of Texas Health Science Center at Houston (UTHealth). The clinical trial is underway at Memorial Hermann and Harris Health System’s Lyndon B. Johnson Hospital. The randomized, double-blind, placebo-controlled study is evaluating the effectiveness of the drug ramipril, an angiotensin-converting enzyme (ACE) inhibitor approved to treat high blood pressure, heart failure, and diabetic kidney disease. The yearlong trial aims to enroll up to 560 patients across the nation with COVID-19. A positive COVID-19 test is required before the medication is administered. Experts are investigating whether ACE inhibitors can reduce the severity of COVID-19 by ensuring the renin-angiotensin-aldosterone system (RAAS) functions properly. RAAS is the hormone system responsible for regulating blood pressure, electrolyte and fluid balance, and overall circulatory system flow.


FDA Fast-Tracks Two mRNA-Based COVID-19 Vaccine Candidates

Monthly Prescribing Reference, July 13, 2020

The Food and Drug Administration (FDA) has granted Fast Track designation to 2 of Pfizer and BioNTech’s vaccine candidates against coronavirus disease 2019 (COVID-19). The vaccine candidates, BNT162b1 and BNT162b2, are both nucleoside-modified messenger RNA (modRNA) vaccines. BNT162b1 encodes an optimized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein receptor binding domain (RBD) antigen, while BNT162b2 encodes an optimized SARS-CoV-2 full-length spike protein antigen. The Companies recently announced positive preliminary results from a phase 1/2 study evaluating BNT162b1. Initial findings from the US trial showed the vaccine candidate produced neutralizing antibody responses similar to those seen in convalescent human serology samples obtained from patients with confirmed SARS-CoV-2 infection. Data from a similar trial in Germany is expected to be released in July. If regulatory approval is granted, a phase 2b/3 trial, which may include upwards of 30,000 individuals, could begin this July after an appropriate dose level is determined.


Considerations on cardiac patients during Covid‐19 outbreak

Echocardiography, July 12, 2020

[Letter to the Editor] The ongoing coronavirus disease (Covid‐19) pandemic has challenged globalized society to cope with the adoption of revolutionary healthcare measures. The severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) not only causes viral pneumonia but also acute myocardial injury and chronic damage to the cardiovascular system. Currently, treating patients with cardiovascular disease (CVD) has become more challenging. A network of “hub ” and “spoke ” centers based on a system of specialized Covid‐19 referral hospitals has been organized, in order to guarantee optimal medical care for patients with cardiac and noncardiac emergencies. Indeed, in Lombardy, Italy (the epicenter of the European outbreak), the ST‐elevation myocardial infarction (STEMI) regional network has been rearranged, reducing by more than 75% the number of previous “hub ” centers with 24 hours a day—7 days a week capacity to perform primary percutaneous coronary interventions (PCI), with 13 hospitals acting as “hubs ” and other 42 acting as “spokes. ” The most vulnerable Covid‐19‐free subjects, such as patients with chronic cardiac disorders (ie, heart failure), have not routinely been followed‐up in the hospital facilities during the pandemic. A rapid reorganization of cardiac services and practical guidance on how to manage chronic patients are needed in the shortest time. Telemedicine and telecardiology, integrated with the traditional management, appear to be precious tools for this emergent medical model, focused on the interplay between social, economic, environmental, and clinical factors.


COVID-19, coagulopathy and venous thromboembolism: more questions than answers

Internal and Emergency Medicine, July 11, 2020

The acute respiratory illnesses caused by severe acquired respiratory syndrome corona Virus-2 (SARS-CoV-2) is a global health emergency, involving more than 8.6 million people worldwide with more than 450,000 deaths. Among the clinical manifestations of COVID-19, the disease that results from SARS-CoV-2 infection in humans, a prominent feature is a pro-thrombotic derangement of the hemostatic system, possibly representing a peculiar clinicopathologic manifestation of viral sepsis. The severity of the derangement of coagulation parameters in COVID-19 patients has been associated with a poor prognosis, and the use of low molecular weight heparin (LMWH) at doses registered for prevention of venous thromboembolism (VTE) has been endorsed by the World Health Organization and by Several Scientific societies. This review is particularly focused on four clinical questions: What is the incidence of VTE in COVID-19 patients? How do we frame the COVID-19 associated coagulopathy? Which role, if any, do antiphospolipid antibodies have? How do we tackle COVID-19 coagulopathy? In the complex scenario of an overwhelming pandemic, most everyday clinical decisions have to be taken without delay, although not yet supported by a sound scientific evidence.


SARS-CoV-2 a dagger to the aging heart

News Medical, July 9, 2020

Researchers in Europe have shown that genes involved in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are expressed to a higher degree in older heart muscle cells (cardiomyocytes) than they are in younger cardiomyocytes. The team found that genes encoding the proteins involved in host cell viral entry, including angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS2) were upregulated in aged cardiomyocytes compared to young adult cardiomyocytes. Risk factors for adverse outcomes following SARS-CoV-2 infection include age over 70 years and comorbidity, particularly cardiovascular disease. Anthony Davenport (University of Cambridge) and colleagues say their findings could inform studies investigating experimental or currently available compounds to understand further how the protein pathways in cardiomyocytes contribute to disease outcomes in older patients with coronavirus disease 2019 (COVID-19). NOTE: This report by bioRxiv is published as a preliminary scientific report that is not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.


Stroke risk higher in COVID-19 vs. influenza

Cardiology Today, July 9, 2020

Patients who visited the ED or were hospitalized for COVID-19 had a higher risk for ischemic stroke compared with those with ED visits or hospitalizations for influenza, researchers found. “We found that COVID-19 was associated with a far greater risk for stroke than the flu and stress the importance of combating this deadly disease,” Alexander E. Merkler, MD, assistant professor of neurology and neuroscience at Weill Cornell Medicine, told Healio. “Our findings highlight the fact that COVID is not the same as the flu. COVID is far more serious, as we found that COVID is associated with an almost eightfold higher risk for stroke than the flu.” In this retrospective cohort study published in JAMA Neurology, researchers analyzed data from 1,916 patients who visited the ED or were hospitalized for COVID-19 between March 4 and May 2. This group was compared with 1,486 patients who visited the ED or were hospitalized for influenza between January 2016 and May 2018.


U.S. sets one-day record with more than 60,500 COVID cases; Americans divided

Reuters, July 9, 2020
More than 60,500 new COVID-19 infections were reported across the United States on Thursday, according to a Reuters tally, setting a one-day record as weary Americans were told to take new precautions and the pandemic becomes increasingly politicized. The total represents a slight rise from Wednesday, when there were 60,000 new cases, and marks the largest one-day increase by any country since the pandemic emerged in China last year. As infections rose in 41 of the 50 states over the last two weeks, Americans have become increasingly divided on issues such as the reopening of schools and businesses. Orders by governors and local leaders mandating face masks have become particularly divisive. “It’s just disheartening because the selfishness of (not wearing a mask) versus the selflessness of my staff and the people in this hospital who are putting themselves at risk, and I got COVID from this,” said Dr. Andrew Pastewski, ICU medical director at Jackson South Medical Center in Miami.


Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic

JAMA Network Open, July 9, 2020

The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe psychological, social, and economic stress in people’s lives. It is not known whether the stress of the pandemic is associated with an increase in the incidence of stress cardiomyopathy. The objective of the study was to determine the incidence and outcomes of stress cardiomyopathy during the COVID-19 pandemic compared with before the pandemic. This retrospective cohort study at cardiac catheterization laboratories with primary percutaneous coronary intervention capability at 2 hospitals in the Cleveland Clinic health system in Northeast Ohio examined the incidence of stress cardiomyopathy (also known as Takotsubo syndrome) in patients presenting with acute coronary syndrome who underwent coronary arteriography. Patients presenting during the COVID-19 pandemic, between March 1 and April 30, 2020, were compared with 4 control groups of patients with acute coronary syndrome presenting prior to the pandemic across 4 distinct timelines: March to April 2018, January to February 2019, March to April 2019, and January to February 2020.


COVID‐19 and hypertension—evidence and practical management: Guidance from the HOPE Asia Network

The Journal of Clinical Hypertension, July 9, 2020

There are several risk factors for worse outcomes in patients with coronavirus 2019 disease (COVID‐19). Patients with hypertension appear to have a poor prognosis, but there is no direct evidence that hypertension increases the risk of new infection or adverse outcomes independent of age and other risk factors. There is also concern about use of renin‐angiotensin system (RAS) inhibitors due to a key role of angiotensin‐converting enzyme 2 receptors in the entry of the SARS‐CoV‐2 virus into cells. However, there is little evidence that use of RAS inhibitors increases the risk of SARS‐CoV‐2 virus infection or worsens the course of COVID‐19. Therefore, antihypertensive therapy with these agents should be continued. In addition to acute respiratory distress syndrome, patients with severe COVID‐19 can develop myocardial injury and cytokine storm, resulting in heart failure, arteriovenous thrombosis, and kidney injury. Troponin, N‐terminal pro‐B‐type natriuretic peptide, D‐dimer, and serum creatinine are biomarkers for these complications and can be used to monitor patients with COVID‐19 and for risk stratification. Other factors that need to be incorporated into patient management strategies during the pandemic include regular exercise to maintain good health status and monitoring of psychological well‐being.


Late Coronary Stent Thrombosis in a Patient With Coronavirus Disease 2019

JAMA Cardiology | Research Letter, July 8, 2020

The excessive inflammatory response and hypercoaguable state associated with coronavirus disease 2019 (COVID-19) might trigger acute coronary events or stent thrombosis. However, cases of stent thrombosis directly associated with COVID-19 have not been reported. We describe a patient with COVID-19 developing late drug-eluting stent thrombosis. Academic ethics committee approval was waived because this was a single-case report; written informed consent was obtained from the patient. An 81-year-old man with hypertension, coronary artery disease, and recent COVID-19 infection presented in April 2020 with an anterior ST-segment elevation myocardial infarction. Five years prior to admission, following a myocardial infarction, drug-eluting stents were implanted in his left main to left anterior descending coronary artery (LAD), circumflex coronary artery, and right coronary artery. Three months prior to admission, an exercise test with a positive result led to the implantation of a durable-polymer ridaforolimus drug-eluting stent (3 × 15 mm) in a de novo lesion in the proximal left anterior descending coronary artery, overlapping with the stent coming from the left main coronary artery. He was compliant with a dual antiplatelet regimen of aspirin and clopidogrel. Ten days prior to admission, he was admitted to another hospital for dyspnea and fever, with a final diagnosis of COVID-19 with bilateral pneumonia.


Cardiac Arrhythmias Seen in Critically Ill Patients With COVID-19

Pulmonary Advisor, July 8, 2020

Critically ill patients with COVID-19 are more likely to develop heart rhythm disorders than other hospitalized patients, according to a study published online June 22 in Heart Rhythm. Anjali Bhatla, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues reviewed the incidence of cardiac arrests, arrhythmias, and inpatient mortality among 700 COVID-19 patients (mean age 50 years; 45 percent male) admitted to one center over a nine-week period. The researchers found that 11 percent of patients received care in the intensive care unit (ICU), and there were nine cardiac arrests (all occurring in ICU patients), 25 incident atrial fibrillation (AF) events, nine clinically significant bradyarrhythmias, and 10 nonsustained ventricular tachycardias (NSVTs). Admission to the ICU was associated with incident AF (odds ratio, 4.68) and NSVT (odds ratio, 8.92) in adjusted analysis. There were also independent associations seen between age and incident AF (odds ratio, 1.05) and between prevalent heart failure and bradyarrhythmias (odds ratio, 9.75). In-hospital mortality was only associated with cardiac arrest.


Changes in Blood Platelets Triggered by COVID-19 Could Trigger Heart Attacks, Strokes

Journal of Invasive Cardiology, July 6, 2020

Changes in blood platelets triggered by COVID-19 could contribute to the onset of heart attacks, strokes, and other serious complications in some patients who have the disease, according to University of Utah Health scientists. The researchers found that inflammatory proteins produced during infection significantly alter the function of platelets, making them “hyperactive” and more prone to form dangerous and potentially deadly blood clots. They say better understanding the underlying causes of these changes could possibly lead to treatments that prevent them from happening in COVID-19 patients. Their report appears in Blood, an American Society of Hematology journal. “Our finding adds an important piece to the jigsaw puzzle that we call COVID-19,” says Robert A. Campbell, Ph.D., senior author of the study and an assistant professor in the Department of Internal Medicine. “We found that inflammation and systemic changes, due to the infection, are influencing how platelets function, leading them to aggregate faster, which could explain why we are seeing increased numbers of blood clots in COVID patients.”


Effect of hypertension on outcomes of adult inpatients with COVID-19 in Wuhan, China: a propensity score–matching analysis

Respiratory Research, July 6, 2020

Participants enrolled in this study were patients with COVID-19 who had been hospitalized at the Central Hospital of Wuhan, China. Chronic comorbidities and laboratory and radiological data were reviewed; patient outcomes and lengths of stay were obtained from discharge records. We used the Cox proportional-hazard model (CPHM) to analyze the effect of hypertension on these patients’ outcomes and PSM analysis to further validate the abovementioned effect. A total of 226 patients with COVID-19 were enrolled in this study, of whom 176 survived and 50 died. The proportion of patients with hypertension among non-survivors was higher than that among survivors (26.70% vs. 74.00%; P < 0.001). Results obtained via CPHM showed that hypertension could increase risk of mortality in COVID-19 patients (hazard ratio 3.317; 95% CI [1.709–6.440]; P < 0.001). Increased D-dimer levels and higher ratio of neutrophils to lymphocytes (N/L) were also found to increase these patients’ mortality risk. After matching on propensity score, we still came to similar conclusions. After we applied the same method in critically ill patients, we found that hypertension also increased risk of death in patients with severe COVID-19.


Guidelines for Family Presence Policies During the COVID-19 Pandemic

JAMA Health Forum, July 6, 2020

Active engagement of patients and their families in decisions about their own care is a foundation of a high-quality, person-centered health care system. Expanding the acceptance and participation of family care partners at the bedside has been an ongoing effort by patient advocacy communities over the past several decades. In this context, family refers to any support person defined by the patient or resident as family, including friends, neighbors, relatives, and/or professional support persons. Great progress has been made to invite partners into the labor and delivery room, to welcome parents to stay at their child’s side throughout a hospitalization, and to honor the wishes of terminally ill individuals to have family with them during end-of-life care. Significant clinical, psychological, and emotional benefits of these practices have been well documented for patients, family, and health care professionals. The National Academy of Medicine has asserted the importance that “family and/or care partners are not kept an arm’s length away as spectators but participate as integral members of their loved one’s care team.”


Q&A: With or without COVID-19, we will transform the care delivery system

Modern Healthcare, July 6, 2020

Dr. Sanjay Doddamani is chief operating officer and chief physician executive at Southwestern Health Resources, a clinically integrated network comprising independent community practices together with Texas Health Resources and the University of Texas Southwestern Medical Center in the Dallas-Fort Worth area. He started in his role in mid-March, just weeks before a national emergency was declared due to the COVID-19 outbreak. He previously served as senior physician adviser at the Center for Medicare and Medicaid Innovation and was chief medical officer for the accountable care organization and the home-based program at Geisinger Health. Read this Q&A session with Dr. Doddamani about Southwestern’s experience and the network’s approach to dealing with the pandemic and the organization’s emphasis on value-based care.


Hundreds of scientists say coronavirus is airborne, ask WHO to revise recommendations: NYT

Reuters, July 5, 2020

Hundreds of scientists say there is evidence that the novel coronavirus in smaller particles in the air can infect people and are calling for the World Health Organization to revise recommendations, the New York Times reported on Saturday. The WHO has said the coronavirus disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes or speaks. In an open letter to the agency, which the researchers plan to publish in a scientific journal next week, 239 scientists in 32 countries outlined the evidence showing smaller particles can infect people, the NYT said.


Potential effective treatment for COVID-19: systematic review and meta-analysis of the severe infectious disease with convalescent plasma therapy

International Journal of Infectious Diseases, July 4, 2020

Convalescent plasma (CP) has been used successfully to treat many types of infectious diseases, and it has shown initial effects in the treatment of the emerging 2019 coronavirus disease (COVID-19). However, its curative effect and feasibility have yet to be confirmed by formal evaluation and well-designed clinical trials. To explore the effectiveness of treatment and predict the potential effect of CP for COVID-19, studies of different types of infectious diseases treated with CP were included in this systematic review and meta-analysis. Related studies were obtained from databases and screened based on the inclusion criteria. The data quality was assessed, and the data were extracted and pooled for analysis.


Coronavirus Update With Anthony Fauci

JAMA Network, July 2, 2020

Editor in Chief of JAMA, Howard Bauchner, MD, interviews Anthony Fauci, MD, White House Coronavirus Task Force member and Director of the National Institutes of Allergy and Infectious Diseases. The two discuss latest developments in the COVID-19 pandemic, including latest developments, protecting the elderly, genetic shift and mutations, vaccine durability and more.


Moving From The Five Whys To Five Hows: Addressing Racial Inequities In COVID-19 Infection And Death

Health Affairs, July 2, 2020

In recent months, states and municipalities have begun releasing data on COVID-19 infections and death that reveal profound racial disparities. In Louisiana, Black patients account for 57 percent of COVID-19 deaths, while making up only 33 percent of the total population. In Wisconsin, Hispanic patients constitute 12 percent of confirmed COVID-19 cases, but only 7 percent of the total population. In New York City, the epicenter of the pandemic in the US, age-adjusted mortality rates are more than double for Black and Hispanic patients (243.6 and 237.7 per 100,000) compared to white and Asian patients (121.5 and 109.4 per 100,000). Studies of patients hospitalized across New York have found that hypertension, diabetes, and obesity are associated with an elevated risk for COVID-19 morbidity and mortality. But why are there higher rates of hypertension, diabetes, and obesity in communities of color? The answer does not lie in biology. Here again, structural and environmental factors such as resource deprivation, poor access to health care, discrimination, and racism have driven a higher burden of these diseases in communities of color.


US posts largest single-day jump in new COVID-19 cases

Center for Infectious Disease and Research Policy (CIDRAP) News, July 2, 2020

The Centers for Disease Control and Prevention (CDC) today reported a record of 54,357 new coronavirus cases over yesterday—a record single-day jump that presses the United States further than what some thought was the peak this spring. For reference, as CNN reported, it took the United States a little more than 2 months to report its first 50,000 cases. Total US cases were at 2,679,230, including 128,024 deaths, according to the CDC. The infection curve is rising in 40 of 50 states, and 36 states are seeing an increase in the percentage of positive coronavirus tests, AP reported today. Some public health officials and governors are blaming bars for the increase in cases, the New York Times reported today, while others are pointing to hasty business reopenings, according to Politico.


Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza

JAMA Neurology, July 2, 2020
It is uncertain whether coronavirus disease 2019 (COVID-19) is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection. The objective was to compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke. This retrospective cohort study was conducted at 2 academic hospitals in New York City, New York, and included adult patients with emergency department visits or hospitalizations with COVID-19 from March 4, 2020, through May 2, 2020.


Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis

Heart, July 1, 2020

It has been hypothesised that the use of ACE inhibitors and angiotensin receptor blockers (ARBs) might either increase or reduce the risk of severe or lethal COVID-19. The findings from the available observational studies varied, and summary estimates are urgently needed to elucidate whether these drugs should be suspended during the pandemic, or patients and physicians should be definitely reassured. This meta-analysis of adjusted observational data aimed to summarise the existing evidence on the association between these medications and severe/lethal COVID-19. Ten studies, enrolling 9890 hypertensive subjects were included in the analyses. Compared with untreated subjects, those using either ACE inhibitors or ARBs showed a similar risk of severe or lethal COVID-19 (summary OR: 0.90; 95%CI 0.65 to 1.26 for ACE inhibitors; 0.92; 95% CI 0.75 to 1.12 for ARBs).


Emergency transfers for STEMI, stroke reduced during pandemic

Helio | Cardiology Today, July 1, 2020

Daily emergency transfers for STEMI and stroke within the Cleveland Clinic regional health system dropped significantly after the onset of the COVID-19 pandemic, researchers reported. In an analysis of the Cleveland Clinic critical care transport system published in Circulation: Cardiovascular Quality and Outcomes, investigators compared emergency transfer data for STEMI, stroke and abdominal aortic aneurysm from 2019 to March 8, 2020 (baseline), with data collected from March 9 and May 6, 2020 (pandemic period). “The Cleveland Clinic has a long-established ‘auto-launch’ process that clinicians can activate to bypass the need for an accepting provider or available bed and to initiate the immediate emergency transfer for patients experiencing STEMI, acute stroke and aortic emergencies,” Umesh N. Khot, MD, vice chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine and a staff cardiologist in the Section of Clinical Cardiology in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, and colleagues wrote.Guidelines: Cardiovascular risks in COVID-19 infection


Blood type may contribute to likelihood of acquiring COVID-19

Helio | Primary Care, July 1, 2020

A patient’s blood type plays a role in the likelihood of developing COVID-19, data from two genetic studies show. An infectious disease expert unaffiliated with the studies told Healio Primary Care that the results are possible, but with some important caveats. In the first study, which appeared in The New England Journal of Medicine, David Ellinghaus, a scientist at the Institute of Clinical Molecular Biology in Germany, and colleagues analyzed nearly 8.6 million single nucleotide polymorphisms from 1,610 Spanish and Italian patients with COVID-19 and respiratory failure. Another 2,205 uninfected participants served as controls. Participants’ age, ethnicity and sex were also part of the analysis.


Recommendations for the Management of ACS in COVID-19

Cardiology Advisor, June 30, 2020

A comprehensive protocol-based triaging and decision making at the point of care in patients with COVID-19 presenting with acute myocardial injury is necessary to reduce provider anxiety and confusion, offer a pathway for streamlined management of these challenging patients, while simultaneously minimizing the exposure of medical personnel to this highly contagious virus, according to a report published in Atherosclerosis. COVID-19 has forced the healthcare system to reconsider its approach to even the most basic practices. Recent reports show that acute myocardial injury and subsequent troponin and/or ST-segment elevation are common findings and risk predictors among patients with COVID-19.


Coronavirus (COVID-19) Update: FDA Takes Action to Help Facilitate Timely Development of Safe, Effective COVID-19 Vaccines

FDA.gov, June 30, 2020

Today, the U.S. Food and Drug Administration took important action to help facilitate the timely development of safe and effective vaccines to prevent COVID-19 by providing guidance with recommendations for those developing COVID-19 vaccines for the ultimate purpose of licensure. The guidance, which reflects advice the FDA has been providing over the past several months to companies, researchers, and others, describes the agency’s current recommendations regarding the data needed to facilitate the manufacturing, clinical development, and approval of a COVID-19 vaccine. The guidance also discusses the importance of ensuring that the sizes of clinical trials are large enough to demonstrate the safety and effectiveness of a vaccine. It conveys that the FDA would expect that a COVID-19 vaccine would prevent disease or decrease its severity in at least 50% of people who are vaccinated.


How to maintain momentum on telehealth after COVID-19 crisis ends

American Medical Association, June 30, 2020

The use of telehealth has exploded as many regulatory barriers to its use have been temporarily lowered during the COVID-19 pandemic. The AMA is advocating for making many of these emergency policy changes permanent. “The expansion of telehealth and the offering of new telehealth services that were not previously covered really enabled physicians to care for their patients in the midst of this crisis,” Todd Askew, the AMA’s senior vice president of advocacy, said during a recent “AMA COVID-19 Update” video. “We have moved forward a decade in the use of telemedicine in this country and it’s going to become, and will remain, an increasingly important part of physician practices going forward.”


Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study

The Lancet, June 30, 2020

An important feature of severe acute respiratory syndrome coronavirus 2 pathogenesis is COVID-19-associated coagulopathy, characterised by increased thrombotic and microvascular complications. Previous studies have suggested a role for endothelial cell injury in COVID-19-associated coagulopathy. To determine whether endotheliopathy is involved in COVID-19-associated coagulopathy pathogenesis, we assessed markers of endothelial cell and platelet activation in critically and non-critically ill patients admitted to the hospital with COVID-19. Our findings show that endotheliopathy is present in COVID-19 and is likely to be associated with critical illness and death. Early identification of endotheliopathy and strategies to mitigate its progression might improve outcomes in COVID-19.


COVID-19 sparks increased telehealth use for arrhythmia management

Helio | Cardiology Today, June 30, 2020

The COVID-19 pandemic has been a catalyst for rapid adoption of telehealth to remotely manage and monitor patients with arrhythmias, which will continue even after the pandemic passes, the authors of a multi-society practice update wrote. The practice update, which was published in the Journal of the American College of Cardiology, was prepared by arrhythmia experts and representatives from the American Heart Association, American College of Cardiology, Heart Rhythm Society and several other organizations from Europe, Asia Pacific and Latin America. “These technologies are here to stay,” Niraj Varma, MD, PhD, professor of medicine and cardiac electrophysiologist at Cleveland Clinic and chair of the writing group, told Healio. “Patients and doctors have found them very useful. We would like the accessibility to these technologies to increase on a worldwide basis because we think it’s going to be integrated with general medical practice in the future.”


U.S. coronavirus cases rise by 47,000, biggest one-day spike of pandemic

Reuters, June 30, 2020

New U.S. COVID-19 cases rose by more than 47,000 on Tuesday according to a Reuters tally, the biggest one-day spike since the start of the pandemic, as the government’s top infectious disease expert warned that number could soon double. California, Texas and Arizona have emerged as new U.S. epicenters of the pandemic, reporting record increases in COVID-19 cases. “Clearly we are not in total control right now,” Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told a U.S. Senate committee. “I am very concerned because it could get very bad.”


HHS will renew public health emergency

Modern Healthcare, June 29, 2020

HHS spokesman Michael Caputo on Monday tweeted that HHS intends to extend the COVID-19 public health emergency that is set to expire July 25. The extension would prolong the emergency designation by 90 days. Several payment policies and regulatory adjustments are attached to the public health emergency, so the extension is welcome news for healthcare providers. HHS “expects to renew the Public Health Emergency due to COVID-19 before it expires. We have already renewed this PHE once,” Caputo said. Provider groups including the American Hospital Association have urged HHS to renew the distinction.


Global coronavirus deaths top half a million

Reuters, June 28, 2020

The death toll from COVID-19 surpassed half a million people on Sunday, according to a Reuters tally, a grim milestone for the global pandemic that seems to be resurgent in some countries even as other regions are still grappling with the first wave. The respiratory illness caused by the new coronavirus has been particularly dangerous for the elderly, although other adults and children are also among the 501,000 fatalities and 10.1 million reported cases. While the overall rate of death has flattened in recent weeks, health experts have expressed concerns about record numbers of new cases in countries like the United States, India and Brazil, as well as new outbreaks in parts of Asia.


Who Is Most At-Risk for Severe COVID-19?

MedPage Today, June 27, 2020
[Quiz] New information is posted daily, but keeping up can be a challenge. As an aid for readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include COVID-19 risk factors, future pandemic preparation, and effects on kids from parents’ mental illness. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.


Myocarditis in a 16-year-old boy positive for SARS-CoV-2

The Lancet | Clinical Picture, June 27, 2020

A 16-year-old boy was admitted to our emergency department, in Lombardy, complaining of intense pain in his chest—radiating to his left arm—which had started 1 h earlier. The day before he had a fever of 38·3°C that decreased after 100 mg of nimesulide. He reported no other symptoms, no medical history, and no contact with anyone with confirmed COVID-19. We found his vital signs to be normal apart from his temperature which was raised at 38·5°C. On auscultation of the patient’s chest, we heard normal heart sounds, no pericardial rub, and no abnormal respiratory signs. We found no lymphadenopathy, no rash, and no areas of localised tenderness on the chest wall. An electrocardiogram (ECG) showed inferolateral ST-segment elevation and a transthoracic echocardiography showed hypokinesia of the inferior and inferolateral segments of the left ventricle, with a preserved ejection fraction of 52%; no pericardial effusion was seen. Investigations showed raised high-sensitivity cardiac troponin I (9449 ng/L), creatine phosphokinase (671·0 U/L), C-reactive protein (32·5 mg/L), and lactate dehydrogenase (276·0 U/L) concentrations. The leucocyte count was 12·75 × 109 per L, the neutrophil count was 10·04 × 109 per L, and the lymphocyte count was 0·78 × 109 per L.


Colchicine for COVID-19; Metabolic Syndrome Prevalence

MedPage Today, June 27, 2020
[Podcast] Topics include colchicine for heart complications of COVID, black versus white patients with COVID-19 hospitalization, prevalence of metabolic syndrome in the U.S., and ACE inhibitors and ARBs and COVID. TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.


COVID-19 Practice Financial Assistance

American College of Physicians, Updated June 26, 2020

The ACP provides resources to help guide practices in plans for re-opening. Resources include guides, checklists, staffing and workflow modifications, and materials for communicating with patients. The ACP also offers clinical and public policy guidance on how to resume some economic, social and medical care activities to mitigate COVID-19 and allow expansion of healthcare capacity. For more information, the CDC offers a framework for providing non-COVID-19 care during the pandemic.


CMS Announces Additional QPP, MIPS Flexibilities for 2020

American College of Cardiology, Jun 25, 2020

The Centers for Medicare and Medicaid Services (CMS) continues to provide flexibilities to clinicians participating in the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) in 2020 as a result of the COVID-19 pandemic. Clinicians significantly impacted by the public health emergency may submit an Extreme & Uncontrollable Circumstances Application to reweight any or all of the MIPS performance categories for performance year 2020. Clinicians requesting relief will need to provide a justification of the impacts to their practice as a result of the public health emergency.


Stroke increases mortality risk in younger patients with COVID-19

Helio | Cardiology Today, June 23, 2020

Acute ischemic stroke increased the risk for all-cause mortality in young adults with COVID-19 despite a low prevalence in this patient group, according to a study published in The American Journal of Cardiology. “To our knowledge, this is the first study to report the incidence and outcomes of acute ischemic stroke in young adults with COVID-19 infection,” Frank Annie, PhD, research scientist at Charleston Area Medical Center Institute for Academic Medicine in West Virginia, and colleagues wrote. “We found a low overall incidence but a grim prognosis of acute ischemic stroke among unselected young adults with COVID-19.”


Home BP Monitoring ‘More Important Than Ever’ During Pandemic

MedPage Today, June 23, 2020

The USPSTF, AHA, AMA re-up support for out-of-office measurement. Keep screening for hypertension, the U.S. Preventive Services Task Force (USPSTF) reiterated in draft guidelines, while other groups urged home blood pressure monitoring as well. The USPSTF gave a grade A recommendation to in-office screening for hypertension in adults with confirmation outside of the clinical setting before starting treatment. The draft recommendations — open for public comment until July 20 — match the group’s 2015 final recommendations, but buttressed with additional research from the past 5 years. A separate joint policy statement from the American Heart Association and American Medical Association (AHA/AMA) affirmed that self-measured blood pressure (SMBP) at home is a validated approach and cost effective when added to office monitoring.


Cardiologists shed new light on COVID-19 and cardiac arrhythmias

Cardiovascular Business, June 23, 2020

A higher rate of cardiac arrhythmias has been observed in hospitalized COVID-19 patients, but new research suggests there’s more behind that trend than the virus itself. The study, published in Heart Rhythm Journal, explored data from 700 COVID-19 patients admitted to a single facility in Pennsylvania from March 6 to May 19, 2020. Eleven percent of the cohort was admitted to the ICU, and all nine cardiac arrests occurred among those patients. In addition, ICU admission was specifically associated with atrial fibrillation (AF) and nonsustained ventricular tachycardia; cardiac arrests were associated with “acute, in-hospital mortality.” These findings, the authors explained, highlight why cardiac arrests and arrhythmias “are likely the consequence of systemic illness and not solely the direct effect of COVID-19 infection.”


Targeting the Immune System for Pulmonary Inflammation and Cardiovascular Complications in COVID-19 Patients

Frontiers in Immunology, June 23, 2020

In December 2019, following a cluster of pneumonia cases in China caused by a novel coronavirus (CoV), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection disseminated worldwide and, on March 11th, 2020, the World Health Organization officially declared the pandemic of the relevant disease named coronavirus disease 2019 (COVID-19). In Europe, Italy was the first country facing a true health policy emergency, and, as at 6.00 p.m. on May 2nd, 2020, there have been more than 209,300 confirmed cases of COVID-19. Due to the increasing number of patients experiencing a severe outcome, global scientific efforts are ongoing to find the most appropriate treatment. The usefulness of specific anti-rheumatic drugs came out as a promising treatment option together with antiviral drugs, anticoagulants, and symptomatic and respiratory support. For this reason, the authors share their experience and knowledge on the use of these drugs in the immune-rheumatologic field, providing in this review the rationale for their use in the COVID-19 pandemic.


Stroke increases mortality risk in younger patients with COVID-19

Helio | Cardiology Today, June 23, 2020

Acute ischemic stroke increased the risk for all-cause mortality in young adults with COVID-19 despite a low prevalence in this patient group, according to a study published in The American Journal of Cardiology. “To our knowledge, this is the first study to report the incidence and outcomes of acute ischemic stroke in young adults with COVID-19 infection,” Frank Annie, PhD, research scientist at Charleston Area Medical Center Institute for Academic Medicine in West Virginia, and colleagues wrote. “We found a low overall incidence but a grim prognosis of acute ischemic stroke among unselected young adults with COVID-19.”


Could Extended Anticoagulation Help After COVID-19?

MedPage Today, June 22, 2020

After hospitalization for medical illness, an extended course of low-dose anticoagulation reduced arterial and venous thromboembolic events combined, secondary analysis of a randomized trial suggested — a finding with implications for post-COVID care. Taking 10-mg rivaroxaban (Xarelto) for 45 days post-discharge reduced fatal and major events by a relative 28% in patients with additional risk factors for venous thromboembolism (VTE) in a prespecified secondary analysis of the MARINER trial.


Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association

Circulation, June 22, 2020

The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse selfmeasured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of whitecoat effect and masked uncontrolled hypertension.


Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality

Journal of the American Medical Association, June 19, 2020

Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major threat to global health. Research on modifiable risk factors potentially linked to increased susceptibility to infection or to worse outcomes among those who have the disease has focused on cardiovascular comorbidity, hypertension, and diabetes. Interest has been directed to the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) because these drugs may affect the ability of SARS-CoV-2 to infect cells through upregulation of angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 cell entry. Based on this suggested mechanism, media reports have raised questions about ACEI/ARB treatment in the setting of COVID-19.


Coronavirus and Health Inequities

JAMA Medical News, June 19, 2020

Recorded today, Linda Rae Murray, MD, MPH discusses topics in health equity with JAMA Medical News Associate Managing Editor Jennifer Abbasi.


Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City

JAMA Cardiology, June 19, 2020

Risk factors for out-of-hospital death due to novel coronavirus disease 2019 (COVID-19) are poorly defined. From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year. This study describes the characteristics (race/ethnicity, comorbidities, and emergency medical services [EMS] response) associated with outpatient cardiac arrests and death during the COVID-19 pandemic in NYC.


Degree of myocardial injury severity may affect survival in COVID-19

Helio | Cardiology Today, June 19, 2020

The prevalence of myocardial injury in acute COVID-19 is approximately 36%, but its presence was significantly associated with worse outcomes, researchers reported. Elevated troponin levels, an indicator of myocardial injury, conferred a higher risk for death among patients hospitalized with COVID-19. According to a report published in the Journal of the American College of Cardiology, patients with confirmed COVID-19 (mean age, 66 years; 60% men; 35% with history of CVD) admitted between Feb. 27 and April 12 who had troponin levels measured within 24 hours of admission were assessed to determine the effect of myocardial injury.


Steroid treatment for COVID-19 has NYC doctors cautiously optimistic

Modern Healthcare, June 19, 2020

Local physicians said a U.K. study of the use of the steroid dexamethasone in treating severe COVID-19 patients showed promising results, but they’re reserving judgment until more data from the study is published. Initial results were announced Tuesday in a press release. The randomized trial, supported by the University of Oxford, tested dexamethasone in about 2,100 patients with an additional 4,300 receiving only usual care. The study found that the drug reduced the number of deaths by one-third in patients using mechanical ventilators and one-fifth in patients receiving only oxygen. There was no benefit among patients who didn’t require respiratory support.


Lifting COVID-19 “Lockdown” Restrictions May Cause Infection Resurgence

Pulmonary Advisor, June 18, 2020

Data from multiple countries demonstrate that lifting restrictions imposed to reduce the spread of coronavirus disease 2019 (COVID-19) would result in a resurgence of infections, according to provisional analyses published in the European Respiratory Journal. Most countries with significant COVID-19 outbreaks have introduced social distancing or “lockdown” measures to reduce viral transmission, however, the question of when, how, and to what extent these measures can be lifted remains.


Telehealth visits during COVID-19 may exacerbate inequities in cardiology care

Helio | Cardiology Today, June 18, 2020

Inequities persist in telehealth during the COVID-19 pandemic, as patients who completed telehealth visits at cardiology clinics were more likely to be older men who spoke English, according to a study published in Circulation. “We have seen how COVID-19 has been the great unequalizer,” Lauren A. Eberly, MD, MPH, cardiology fellow at the University of Pennsylvania, told Healio. “The findings of this study demonstrate significant inequities are also present among non-COVID patients in accessing necessary telemedicine care. … These results call for immediate implementation of strategies to ensure more equitable access to telemedicine care.”


Chicago has a unique COVID strain: research

Modern Healthcare, June 18, 2020

Chicagoans are being infected with a unique strain of COVID-19 that’s linked to the early coronavirus outbreak in China, according to new research. Northwestern Medicine scientists have determined that the Chicago area “is a melting pot for different versions of the virus because it is such a transportation hub,” Dr. Egon Ozer, an assistant professor at Northwestern University’s Feinberg School of Medicine and a Northwestern Medicine physician, said in a statement today. Ozer’s team is learning how variations of the severe acute respiratory syndrome that causes COVID-19 infects people differently. It’s a finding they say could help shape a potential vaccine.


Accelerated COVID-19 vaccine effort should not mean compromises, experts say

Helio | Infectious Disease, June 18, 2020

Public-private partnerships, collaboration among researchers and knowledge of existing coronaviruses have all contributed to the accelerated development of COVID-19 vaccine candidates, according to Infectious Disease News Editorial Board Member Kathleen M. Neuzil, MD, MPH, FIDSA. Neuzil, a professor of vaccinology and director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, said vaccine development overall is a “continuum” from the discovery phase to “delivery and impact.” Neuzil and other presenters opened the National Foundation for Infectious Diseases’ Annual Conference on Vaccinology Research with a discussion on the current state of vaccine development for COVID-19.


R-107 Shows Promise in Early Study for PAH Linked to COVID-19

Pulmonary Hypertension News, June 17, 2020

Kalytera Therapeutics has announced positive early results for R-107, a liquid form of nitric oxide designed to treat pulmonary arterial hypertension (PAH) associated with COVID-19. Nitric oxide, known as NO, is a gas naturally present in the lungs. It facilitates oxygenation by relaxing, or dilating, the blood vessels, allowing blood to flow smoothly. R-107 is a liquid prodrug of nitric oxide, meaning that the compound is a precursor to its pharmacologically active form. Once injected into the body, R-107 is converted into its active form, called R-100, which steadily releases NO into lung tissues over the course of several days.


COVID-19 Anticoagulation Trial; Kids’ Healthy Vessels; Rebooting EP

MedPage Today, June 16, 2020

As the SARS-CoV-2 virus’s endothelial effects emerge as important in its clotting complications, the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) trial is preparing to launch to compare low-dose thromboprophylaxis versus full anticoagulation. (NIH Director’s Blog) Implantable loop recorders could be used to monitor for fever as a sign of COVID-19 infection, a case report in HeartRhythm Case Reports showed. Conscious sedation for transcatheter aortic valve replacement was associated with a small reduction in mortality and more discharge to home than seen with those procedures done under general anesthesia in an instrumental variable analysis in JACC: Cardiovascular Interventions.


US taking ‘wrong approach’ to COVID-19 testing, expert warns

Helio | Infectious Diseases, June 16, 2020

The American Lung Association recently held a virtual Town Hall meeting to debunk widespread misperceptions in the United States about which populations should be prioritized for COVID-19 testing and how to interpret the results. “Far too many people have misinterpreted testing,” Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, said during the meeting. “While we need to greatly expand our SARS-CoV-2 testing as a critical component of our response to COVID-19, the pandemic messaging to date needs to move beyond the ‘Test, test, test!’ mantras. That is the wrong approach.”


China’s COVID-19 vaccine candidate shows promise in human trials, CNBG says

Reuters, June 16, 2020

China National Biotec Group (CNBG) said on Tuesday its experimental coronavirus vaccine has triggered antibodies in clinical trials and the company plans late-stage human trials in foreign countries. No vaccines have been solidly proven to be able to effectively protect people from the virus that has killed more than 400,000 people, while multiple candidates are in various stages of development globally. The vaccine, developed by a Wuhan-based research institute affiliated to CNBG’s parent company Sinopharm, was found to have induced high-level antibodies in all inoculated people without serious adverse reaction, according to the preliminary data from a clinical trial initiated in April involving 1,120 healthy participants aged between 18 and 59.


Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19

Oxford University, June 16, 2020

In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK. On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit. A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).


Coronavirus death rate is higher for those with chronic ills

Associated Press, June 15, 2020

Death rates are 12 times higher for coronavirus patients with chronic illnesses than for others who become infected, a new U.S. government report says. The Centers for Disease Control and Prevention report released Monday highlights the dangers posed by heart disease, diabetes and lung ailments. These are the top three health problems found in COVID-19 patients, the report suggests. The report is based on 1.3 million laboratory-confirmed coronavirus cases reported to the agency from January 22 through the end of May. Information on health conditions was available for just 22% of the patients. It shows that 32% had heart-related disease, 30% had diabetes and 18% had chronic lung disease, which includes asthma and emphysema.


Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic?

Current Hypertension Reports (via Springer Link), June 13, 2020

There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest because it is common in adults and there are concerns related to the use of renin-angiotensin system (RAS) inhibitors in patients with hypertension infected with COVID-19. In this review, we provide a critical review to the following questions: (1) Does hypertension influence immunity or ACE2 expression favoring viral infections? (2) Are the risks of complications in hypertension mediated by its treatment? (3) Is aging a major factor associated with worse prognosis in patients with COVID-19 and hypertension?


Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series

European Heart Journal (Case Reports), June 13, 2020

The pandemic of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been rapidly spreading worldwide, exhausting resources across health systems. First appearing in Wuhan, China, it commonly manifested with respiratory symptoms of cough, dyspnoea, fever, chills, and myalgias. Individuals with history of cardiovascular disease are predisposed to infection and are at increased risk of adverse outcomes. Previous beta-coronavirus infections, such as severe acute respiratory syndrome, were associated with tachyarrhythmias and heart failure. Cardiac manifestations of COVID-19 were later reported, typically from viral myocarditis and treatment side effects.5 Given the increased incidence and saturation of resources, COVID-19 has had indirect effects on care, impacting timing and optimal treatment of acute cardiovascular disease. The objective of this clinical case series is to highlight cardiac complications of COVID-19.


Anti-contagion interventions prevented up to 62 million confirmed

Helio | Infectious Disease News, June 12, 2020

Anti-contagion policies have prevented or delayed as many as 62 million confirmed COVID-19 infections, which corresponded with the prevention of an estimated 530 million cases in six countries, according to a study published in Nature. “We found that in the absence of policy intervention, the number of COVID-19 infections doubled approximately every 2 days,” Esther Rolf, a PhD candidate in the computer science department at University of California, Berkeley, told Healio. “In all six countries we studied, we found that the anti-contagion policies put in place significantly slowed the spread of the disease, resulting in an estimated 500 million infections prevented or delayed, across the six countries in the time frame that we studied.”


HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic

Heart Rhythm, June 11, 2020

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), started in the city of Wuhan late in 2019. Within a few months, the disease spread toward all parts of the world and was declared a pandemic on March 11, 2020. The current health care dilemma worldwide is how to sustain the capacity for quality services not only for those suffering from COVID-19 but also for non-COVID-19 patients, all while protecting physicians, nurses, and other allied health care workers. The pandemic poses challenges to electrophysiologists at several levels. Hospitalized COVID-19-positive patients may have preexisting arrhythmias, develop new arrhythmias, or be placed at increased arrhythmic risk from therapies for COVID-19.


More Calls for Routine VTE Prophylaxis in Severe COVID-19

MedPage Today, June 11, 2020

Given the coagulopathy that often complicates severe COVID-19 illness, certain best practices should be followed for venous thromboembolism (VTE) prevention and treatment, even if data to inform these decisions are scarce, experts said. Critically or acutely ill COVID-19 patients should receive anticoagulant thromboprophylaxis (unless contraindicated), according to recent guidance from the American College of Chest Physicians.


U.S. Coronavirus Cases Hit 2 Million as New Hotspots Surface

HealthDay News, June 11, 2020

The number of confirmed U.S. coronavirus cases passed 2 million on Thursday, as public health experts warned of the emergence of new COVID-19 hotspots across the country. Just three weeks after Arizona Gov. Doug Ducey lifted the state’s stay-at-home order, there has been a significant spike in coronavirus cases, with lawmakers and medical professionals warning that hospitals might not be able to handle a big influx of new cases. Already, hospitals in the state are at 83 percent capacity, the Associated Press reported. But Arizona is not alone in seeing increases in hospitalizations: new U.S. data shows at least eight other states with spikes since Memorial Day. In Texas, North and South Carolina, California, Oregon, Arkansas, Mississippi and Utah, increasing numbers of COVID-19 patients are showing up at hospitals.


COVID-19 may impair certain kinds of ventricular function

Cardiology Today, June 10, 2020

Patients with COVID-19 had impaired left ventricular diastolic and right ventricular function despite most patients having preserved LV systolic function, researchers found in a study published in Circulation. Yishay Szekely, MD, a cardiologist at Tel Aviv Sourasky Medical Center and Tel Aviv University Sackler School of Medicine, and colleagues analyzed data from 100 patients (mean age, 66 years; 63% men) with COVID-19 who were admitted to Tel Aviv Medical Center between March 21 and April 16. All patients underwent an echocardiographic evaluation within 24 hours of hospital admission. The assessment was repeated in patients with clinical deterioration, defined as death or hemodynamic, respiratory or cardiac deterioration.


Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Induced Cardiovascular Syndrome: Etiology, Outcomes, and Management

Cureus, June 10, 2020

As the number of coronavirus disease 2019 (COVID-19) cases grows, more complications associated with the disease become apparent. One of the more concerning complications affects the cardiovascular system. Thus far, there is limited information available on the etiology, clinical outcomes, and management options for cardiovascular complications caused by COVID-19. The more common cardiovascular sequalae are acute coronary syndrome, cardiomyopathy, arrythmia, myocarditis, cardiogenic shock, and cardiac arrest. Interestingly, the observed cardiovascular injury is similar to that caused by Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), and influenza.


Lack of Health Literacy a Barrier to Grasping COVID-19

MedPage Today, June 10, 2020

A lack of health literacy is preventing people from having a good understanding of the novel coronavirus, two speakers said Wednesday at an online briefing sponsored by the National Academies of Sciences, Engineering, and Medicine. “So many people are confused about the symptoms” of COVID-19, said Lisa Fitzpatrick, MD, MPH, founder of Grapevine Health, a nonprofit organization in Washington that helps design culturally appropriate health information campaigns targeted at underserved populations. When Grapevine Health sent workers out to talk to people about the pandemic, “So many told us they didn’t know the symptoms,” said Fitzpatrick.


The Variety of Cardiovascular Presentations of COVID-19

Circulation, June 9, 2020

The global pandemic caused by coronavirus disease 2019 (COVID-19) has affected more than 880,000 people in over 180 countries or regions worldwide. COVID-19 is the clinical manifestation of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and most frequently presents with respiratory symptoms that can progress to pneumonia and, in severe cases, acute respiratory distress syndrome and shock. However, there is increasing awareness of the cardiovascular manifestations of COVID-19 disease and the adverse impact that cardiovascular involvement has on prognosis. Discriminating between a cardiac or respiratory etiology of symptoms can be challenging since each may present predominantly with dyspnea. It is also critical to recognize when cardiac and pulmonary involvement coexist. In this paper, we present 4 cases that illustrate a variety of cardiovascular presentations of COVID-19 infection. In addition to discussing the basic clinical physiology, we also discuss clinical decision making in the current environment, while considering resource allocation and the welfare of healthcare professionals.


Cholesterol and COVID-19; Novel HFpEF Drug; Full Speed on CV Surgery?

MedPage Today, June 9, 2020

High cholesterol in tissue may increase entry points into cells for SARS CoV-2, the virus that causes COVID-19, such that rapidly dropping cholesterol in the blood could increase risk, researchers found in preclinical experiments reported on the preprint server bioRxiv, which is not peer reviewed. The Pittsburgh Post-Gazette has an explainer. ST-segment-elevation MI admissions have dropped by an average 50%, with about half presenting later than usual, according to an international survey by the European Society of Cardiology. The first molecular profile comparing blood samples of people with and without COVID-19 showed that differences fell into two groups – those related to the immune system and those related to platelet function.


Out of the lab and into people’s arms: A list of COVID-19 vaccines that are being studied in clinical trials

ABC News, June 9, 2020

The world’s leading drug companies, universities and governments are racing to develop a vaccine for COVID-19, the disease that has taken more than 400,000 lives globally. Of the 133 candidates being explored, ten have been approved for human trials, according to the World Health Organization. Companies and research groups in China, the early epicenter of the coronavirus outbreak, are testing five of those vaccines in human trials. Meanwhile, U.S.-based companies are involved in the development of four additional vaccines, including one that has NIAID Director Anthony Fauci “cautiously optimistic.”


Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome

Circulation, June 9, 2020

[White Paper] Coronavirus disease 2019 (COVID-19) is a rapidly expanding global pandemic caused by severe acute respiratory syndrome coronavirus 2, resulting in significant morbidity and mortality. A substantial minority of patients hospitalized develop an acute COVID-19 cardiovascular syndrome, which can manifest with a variety of clinical presentations but often presents as an acute cardiac injury with cardiomyopathy, ventricular arrhythmias, and hemodynamic instability in the absence of obstructive coronary artery disease. The cause of this injury is uncertain but is suspected to be related to myocarditis, microvascular injury, systemic cytokine-mediated injury, or stress-related cardiomyopathy. Although histologically unproven, severe acute respiratory syndrome coronavirus 2 has the potential to directly replicate within cardiomyocytes and pericytes, leading to viral myocarditis.


When the Dust Settles: Preventing a Mental Health Crisis in COVID-19 Clinicians

Annals of Internal Medicine, June 9, 2020

On 26 April, after spending weeks caring for patients with coronavirus disease 2019 (COVID-19) in New York City, emergency room physician Lorna Breen took her own life. Her grieving family recounts days of helplessness leading up to this as Dr. Breen described how COVID-19 upended her emergency department and left her feeling inadequate despite years of training and expertise. The clinical experience of Dr. Breen during this pandemic has not been unique. During the past 5 months, COVID-19 has caused an upheaval of medical systems around the world, with more than 4 million cases and 300 000 deaths worldwide so far. Unfortunately, we’ve also seen that the experience in caring for patients with the virus may have profound effects on clinicians’ mental health. A recent study conducted at the center of the outbreak in China reported that more than 70% of frontline health workers had psychological distress after caring for patients with COVID-19.


Coronavirus: What We Know Now

WebMD, June 8, 2020

The first confirmed cases of coronavirus in the U.S. appeared in January. At the time, the world knew almost nothing about how the virus spreads or how to treat it. Six months later, our knowledge has grown, but researchers continue to make discoveries almost daily. At first, health experts believed COVID-19, the disease caused by the new coronavirus, primarily affected patients’ lungs. While it’s still primarily a lung disease, other symptoms have appeared often, and they’ve been added to the list of signs of COVID.


Heart injury among hospitalized COVID-19 patients associated with higher risk of death

Medical Express, June 8, 2020

Mount Sinai researchers have found that myocardial injury (heart damage) is prevalent among patients hospitalized with COVID-19 and is associated with higher risk of mortality. More specifically, a serious myocardial injury can triple the risk of death. “There has been a lot of speculation about how COVID-19 affects the heart and blood vessels, and with what frequency. Our observational study may help to shed some light on this. We found that 36 percent of patients who were hospitalized with COVID-19 had elevated troponin levels—which represents heart injury—and were at higher risk of death,” says lead author Anu Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai.


Risk of Dying Doubled in Wuhan COVID-19 Patients With Hypertension

tctMD | The Heart Beat (by the Cardiovascular Research Foundation, June 8, 2020

New observational data from Wuhan, China, suggest that hypertensive patients hospitalized with COVID-19 had a twofold increased risk of dying compared to those without hypertension, and that not being on medication for hypertension at the time of hospitalization worsens outcomes. The study also provides additional reassurance about the use of antihypertensives that target the renin-angiotensin-aldosterone system (RAAS). “Patients with RAAS inhibitors were not exposed to a higher risk of mortality in our study and, after pooling previously published data in a study-level meta-analysis, the use of RAAS inhibitors was shown to be possibly associated with lower risk of mortality,” write Chao Gao, MD (Xijing Hospital, Xi’an, China), and colleagues. Nevertheless, they urge caution in interpreting the results due to the observational nature of the study.


High Fatality Rate in Heart Transplant Recipients With COVID-19

Cardiology Advisor, June 8, 2020

Novel coronavirus disease 2019 (COVID-19) was found to be associated with a higher fatality rate in recipients of heart transplant, according to a case series published in JAMA Cardiology. Heart transplant recipients may be at increased risk for complications of COVID-19 due to a high burden of comorbidities and treatment with immunosuppressive agents. However, immunosuppression has also been proposed as a possible option for treatment of COVID-19, as it may curb the “cytokine storm” that has been observed in severe cases. With this retrospective review of adult heart transplant recipients at a large academic center in New York, New York, investigators aimed to determine the outcomes of heart transplant recipients with COVID-19 while receiving chronic immunosuppression.


Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

Journal of the American Medical Association, June 8, 2020

This case series included 58 hospitalized children, a subset of whom required intensive care, and met definitional criteria for pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS), including fever, inflammation, and organ dysfunction. Of these children, all had fever and nonspecific symptoms, such as abdominal pain (31 [53%]), rash (30 [52%]), and conjunctival injection (26 [45%]); 29 (50%) developed shock and required inotropic support or fluid resuscitation; 13 (22%) met diagnostic criteria for Kawasaki disease; and 8 (14%) had coronary artery dilatation or aneurysms. Some clinical and laboratory characteristics had important differences compared with Kawasaki disease, Kawasaki disease shock syndrome, and toxic shock syndrome.


COVID-19 Critical Care Update

View this COVID-19 Critical Care Update with Howard Bauchner, MD, Editor in Chief, JAMA, talks with Maurizio Cecconi, MD of Humanitas University in Milan and Derek C. Angus, MD, MPH of the University of Pittsburgh.


First Study Investigating Antibody Treatment for COVID-19 Begins

Pulmonology Advisor, June 8, 2020

The first patients have been dosed in a phase 1 trial evaluating a potential antibody therapy designed to treat coronavirus disease 2019 (COVID-19). These patients received treatment at major medical centers in the US, including NYU Grossman School of Medicine and Cedars-Sinai in Los Angeles. The investigational agent, LY-CoV555, is a potent, neutralizing lgG1 monoclonal antibody directed against the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The randomized, double-blind, placebo-controlled study is investigating the safety, tolerability, pharmacokinetics, and pharmacodynamics of 1 dose of LY-CoV555 in patients hospitalized with COVID-19; those requiring mechanical ventilation or who have received convalescent COVID-19 plasma treatment prior to enrollment were excluded from the study.


Coronavirus Cases in the U.S.

Center for Disease Control and Prevention, June 8, 2020

The U.S. Centers for Disease Control and Prevention (CDC) on Sunday reported 1,920,904 cases of new coronavirus, an increase of 29,214 cases from its previous count, and said COVID-19 deaths in the United States had risen by 709 to 109,901. The CDC reported its tally of cases of COVID-19, the respiratory illness caused by the new coronavirus, as of 4 p.m. EDT on June 6. Its previous tally was released on Friday.


Blood Test May Predict Clot Risk in Severe COVID-19

MedPage Today, June 7, 2020

Hypercoagulability on thromboelastography (TEG) was a good predictor of thrombotic events among COVID-19 patients entering the ICU, according to a single-center study. The clinically significant thrombosis that developed in 13 of 21 PCR-test-positive patients (62%) seen at Baylor St. Luke’s Medical Center ICU from March 15 to April 9 was associated with hypercoagulable TEG parameters in all cases. Maximum amplitude on that test was elevated in all 10 patients with two or more thrombotic complications compared with 45% of those with no more than one such event (nearly all arterial, central venous, or dialysis catheter or filter thromboses).


COVID-19 vaccine development pipeline gears up

The Lancet, June 6, 2020

Vaccine makers are racing to develop COVID-19 vaccines, and have advanced ten candidates into clinical trials. But challenges remain. Vaccine development is typically a long game. The US Food and Drug Administration only approved a first vaccine against Ebola virus last year, 43 years after the deadly virus was discovered. Vaccinologists have made little headway with HIV or respiratory syncytial virus, despite huge investments. On average, it takes 10 years to develop a vaccine. With the COVID-19 crisis looming, everyone is hoping that this time will be different. Already, ten vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) are in clinical trials, and researchers at the University of Oxford and AstraZeneca hope to have the first phase 3 data in hand this summer.


ACC Roundtable Convenes Stakeholders to Better Understand COVID-19 Implications on CV Research

American College of Cardiology, June 4, 2020

The emergence of COVID-19 has forced clinical researchers to endure major setbacks related to existing academic and industry-sponsored clinical trials. Recognizing these constraints, the ACC convened a focused Heart House Roundtable on May 29 to better understand the pandemic’s implications for ongoing and future cardiovascular research. “Because of the global COVID-19 pandemic, we are facing unprecedented times in clinical research,” said James L. Januzzi, Jr., MD, FACC, who co-chaired the Roundtable along with Harlan M. Krumholz, MD, SM, FACC. “Unforeseen obstacles are now present in all types of clinical investigation, from observational research to clinical trials. This meeting reflects the ACC’s commitment to facilitating generation of actionable knowledge to improve heart health even in these challenging times.”


Telehealth in the era of COVID-19: Concerns for patients with cancer, heart disease

Helio | Cardiology Today, June 4, 2020

Many physicians are now at the front lines of the COVID-19 pandemic. Those who do not have direct COVID-19 roles, including those in cardio-oncology, are trying to maintain normalcy in medicine as much as possible amid the chaos. About 1.8 million people will be diagnosed with cancer in the U.S. in 2020, 5% of whom have elevated risk for heart disease, according to estimates from the American Cancer Society. Unfortunately, this same population — our clinic patients with heart disease and cancer — are also at highest risk for infection, complications and death from COVID-19 due to their cancer, heart disease or a combination of both.


Retraction of Two Published Studies Related to COVID-19 From Lancet, NEJM

American College of Cardiology, June 4, 2020

Two studies of drug therapy and COVID-19 have been retracted from two different journals, a day after each issued an expression of concern about the quality of the data. Both studies used data from an international database held by Surgisphere Corporation which included electronic health records from 169 hospitals on three continents. The Lancet has retracted the paper titled Hydroxychloroquine or Chloroquine With or Without a Macrolide for Treatment of COVID-19: A Multinational Registry Analysis. The New England Journal of Medicine has retracted the paper titled Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19.


Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study

European Heart Journal, June 4, 2020

This is a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension [4.0% vs. 1.1%, adjusted HR 2.12, 95% CI 1.17–3.82, P = 0.013]. While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19.


Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020

Center for Disease Control and Prevention, June 3, 2020

As the number of persons hospitalized with COVID-19 increased, early reports from Austria (1), Hong Kong (2), Italy (3), and California (4) suggested sharp drops in the numbers of persons seeking emergency medical care for other reasons. To quantify the effect of COVID-19 on U.S. emergency department (ED) visits, CDC compared the volume of ED visits during four weeks early in the pandemic March 29–April 25, 2020 (weeks 14 to 17; the early pandemic period) to that during March 31–April 27, 2019 (the comparison period). During the early pandemic period, the total number of U.S. ED visits was 42% lower than during the same period a year earlier, with the largest declines in visits in persons aged ≤14 years, females, and the Northeast region.


Pediatric Acute Heart Failure and SARS-CoV-2 Infection

American College of Cardiology, June 3, 2020

Although it initially appeared that school-aged children are not greatly impacted by SARS-CoV-2 infection, there have been increasing concerns about a related multisystem inflammatory condition. This multicenter report with predominantly French centers (one center in Switzerland) describes experience with cardiac involvement of this disease process. Pro-BNP was often severely elevated in affected patients, and participating centers ultimately employed pro-BNP in the assessment of children in the emergency room with prolonged and unexplained fever.


Coronavirus in Context: The Latest Update on COVID-19 and the Heart

WebMD, June 3, 2020

[Video] Deepak L. Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart & Vascular Center, and Professor of Medicine at Harvard Medical School, is interviewed by WebMD’s Chief Medical Officer to talk about the relations between COVID-19 and the heart.


The Collision of COVID-19 and the U.S. Health System

Annals of Internal Medicine, June 2, 2020

The coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc and causing fear, illness, suffering, and death across the world. This outbreak lays bare the fault lines in our society and highlights that the United States could have been better prepared for the pandemic had we a more equitable and just health care system. As leaders in the American College of Physicians (ACP), we have helped develop ACP’s wide-ranging policies on health care in the United States. The College has adopted a “health in all policies” approach, integrating health considerations into policymaking across sectors to improve the health and health care of all communities and people, which we believe, if enacted, would have enabled the United States to more effectively respond to the COVID-19 pandemic.


Heart pump authorized for emergency use for right HF, decompensation from COVID-19

Helio | Cardiology Today, June 2, 2020

Abiomed announced that the FDA issued an emergency use authorization for a temporary heart pump for patients with COVID-19 with right HF or decompensation including pulmonary embolism. The emergency use authorization indicates that the heart pump (Impella RP) can be used in the hospital for temporary right ventricular support for up to 14 days for the treatment of patients with acute right HF or decompensation associated with COVID-19 complications, according to a press release from the company.


Frailty Score Joins the COVID-19 Battle

MedPage Today, June 2, 2020

A clinical frailty scale (CFS) developed at Nova Scotia’s Dalhousie University is helping doctors predict outcomes of older COVID-19 patients in urgent care settings and decide who gets more aggressive treatments. Because the CFS quickly offers a quantitative number, it avoids age bias when it comes to treatment decisions, said Kenneth Rockwood, MD, of the Division of Geriatric Medicine, Department of Community Health and Epidemiology, School of Health Administration, whose team developed the scale.


Mass gatherings, erosion of trust upend coronavirus control

Associated Press, June 1, 2020

Protests erupting across the nation over the past week — and law enforcement’s response to them — are threatening to upend efforts by health officials to track and contain the spread of coronavirus just as those efforts were finally getting underway. Health experts need newly infected people to remember and recount everyone they’ve interacted with over several days in order to alert others who may have been exposed, and prevent them from spreading the disease further. But that process, known as contact tracing, relies on people knowing who they’ve been in contact with — a daunting task if they’ve been to a mass gathering.


Drop in type A aortic dissection surgeries during COVID-19 pandemic raises concerns

Helio | Cardiology Today, June 1, 2020

During the height of the COVID-19 pandemic in New York, cases requiring surgical repair of acute type A aortic dissection dropped dramatically in the city, according to a new report. The decline may be due to an increase in patients dying at home and/or not wanting to present to the ED because of fear of acquiring COVID-19 at the hospital, the researchers wrote in the Journal of the American College of Cardiology. “From conversations with other aortic surgeons in New York City and posts on social media, we noticed we were all seeing fewer and fewer acute cases, whether aortic dissections or STEMIs,” Ismail El-Hamamsy, MD, PhD, FRCSC, system director of aortic surgery and Randall B. Griepp Professor of Cardiovascular Surgery at The Mount Sinai Health System, told Healio.


Learning Through Rapid Change: Summer COVID-19 Education Series

American College of Cardiology, June 1, 2020

The COVID-19 pandemic has and will continue to take its toll on clinicians and the health care system. Each day brings new discoveries — provoking more unanswered questions and posing unprecedented challenges. The Summer COVID-19 Education Series will present weekly episodes of targeted and easy-to-consume education to address current and evolving knowledge and practice gaps to help you manage your patients with COVID-19 and heart disease both now and into the future. No registration is required. Join us June 6, 2020, 9:00 a.m. – 12:15 p.m. ET.


COVID-19: ACE2centric infective disease?

Hypertension, June 1, 2020

Diffuse pulmonary inflammation, endothelial inflammation and enhanced thrombosis are cardinal features of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These features are reminiscent of several adverse reactions triggered by angiotensin II, and opposed by angiotensin, in many experimental models. Experimental and clinical data suggest that the imbalance between angiotensin II and angiotensin1-7 resulting from the ACE2 down-regulation and deficiency induced by the virus might play an important role in conditioning some clinical features of COVID-19. Thus, from a mechanistic standpoint, this novel disease could be considered a sort of ‘ACE2centric’ infective disease. Some potential therapeutic implications including recombinant ACE2, angiotensin1-7 and angiotensin II type 1 receptor blockers are under clinical testing.


Did Volunteers Tolerate This Coronavirus Vax?

MedPage Today, May 30, 2020

24-hour news cycle is just as important to medicine as it is to politics, finance, or sports. New information is posted daily, but keeping up can be a challenge. As an aid for readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include coronavirus vaccine research, LGBTQ deaths by suicide, and hypertension. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.


Coronavirus May Be a Blood Vessel Disease, Which Explains Everything

Elemental, May 29, 2020

In April, blood clots emerged as one of the many mysterious symptoms attributed to Covid-19, a disease that had initially been thought to largely affect the lungs in the form of pneumonia. Quickly after came reports of young people dying due to coronavirus-related strokes. Next it was Covid toes — painful red or purple digits. What do all of these symptoms have in common? An impairment in blood circulation. Add in the fact that 40% of deaths from Covid-19 are related to cardiovascular complications, and the disease starts to look like a vascular infection instead of a purely respiratory one.


The COVID-19 Rehabilitation Pandemic

Age and Aging, May 29, 2020

The COVID-19 pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.


COVID-19: An ACP Physician’s Guide

American College of Physicians, Updated May 28, 2020

This ACP Physician’s Guide and its collected national resources support physicians as they respond to the Covid-19 pandemic. The ACP-produced resource can be easily accessed on handheld devices and other computers to provide a clinical overview of infection control and patient care guidance. CME credit and MOC points available.


Admission of patients with STEMI since the outbreak of the COVID-19 pandemic. A survey by the European Society of Cardiology

European Heart Journal – Quality of Care and Clinical Outcomes, May 28, 2020

COVID-19, caused by the SARS-CoV2 virus, is a highly contagious condition which may lead to severe respiratory failure and premature mortality. The present pandemic has required the rapid redeployment and mobilization of substantial healthcare resources worldwide, along with widespread “lockdown”, with estimates suggesting that by April over a third of the global population was under some form of restrictive measure. 3 Over the same time, a reduction in hospital admissions for acute non-communicable conditions, such as myocardial infarction and stroke has been reported in several countries. Presented here are the results of a survey conducted by the ESC probing the perception of cardiologists and cardiovascular nurses with regards to ST-elevation myocardial infarction (STEMI) admissions to their hospitals.


ED visits for suspected MI, stroke down during COVID-19 pandemic

Helio | Cardiology Today, May 28, 2020

Many U.S. institutions have reported significant declines in the volume of patients presenting to the ED with potential MI or stroke due to fears associated with COVID-19. Some health care professionals have noticed a dropoff in acute MI and stroke cases since the United States began taking stringent measures to combat the pandemic in mid-March, likely caused by patients delaying their presentation to the ED with MI or stroke or not seeking medical attention at all.


Asymptomatic transmission during the COVID-19 pandemic and implications for public health strategies

Clinical Infectious Diseases, May 28, 2020

SARS-CoV-2 spread rapidly within months despite global public health strategies to curb transmission by testing symptomatic patients and encouraging social distancing. Here, we summarize rapidly emerging evidence highlighting transmission by asymptomatic and pre-symptomatic individuals. Viral load of asymptomatic carriers is comparable to symptomatic patients, viral shedding is highest before symptom onset suggesting high transmissibility before symptoms. Within universally tested subgroups, surprisingly high percentages of COVID-19 positive asymptomatic individuals were found. Asymptomatic transmission was reported in several clusters.


Researchers scramble to meet ‘urgent need’ for COVID-19 vaccine

Helio | Infectious Disease News, May 28, 2020

As deaths from COVID-19 increase to more than 100,000 in the United States, institutions around the world are working to develop an effective vaccine. Kaiser Permanente Washington Health Research Institute in Seattle is conducting a phase 1 clinical trial to assess an investigational vaccine, while Johnson & Johnson plans to initiate human clinical studies for its potential candidate by September. According to WHO, there are 10 COVID-19 vaccine candidates under clinical evaluation and an additional 115 candidates in preclinical evaluation. In a remote hearing of the U.S. Senate Committee on Health, Education, Labor & Pensions earlier this month, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said an NIH-directed trial is expected to enter phase 2/3 in late spring or early summer.


Biomedical scientist to explore how COVID-19 and cardiovascular disease are linked

University of California Riverside, May 27, 2020

Changcheng Zhou, a professor of biomedical sciences at the UCR School of Medicine, will join colleagues in studying the potential impact of COVID-19 on the cardiovascular system. Recent data shows COVID-19 patients with hypertension and cardiovascular disease are highly susceptible to their more severe effects, with mortality rates up to three times higher than the general population. In collaboration with the American Heart Association COVID-19 Coordinating Center, the team will aim to address unanswered questions following the long-term effects of the coronavirus crisis on cardiovascular and cerebrovascular health.


Seniors with COVID-19 taking ACE inhibitors have lower hospitalization risk

Yale News, May 27, 2020

A Yale-led study suggests that older COVID-19 patients taking ACE inhibitors for hypertension have a lower risk of hospitalization for the novel coronavirus. The study is posted on the medical pre-print website medRxiv and has been submitted for peer-reviewed publication. Researchers analyzed retrospective data from about 10,000 patients with hypertension who tested positive for SARS-CoV-2, the virus that causes COVID-19. All patients were enrolled in either Medicare Advantage or a commercially insured health care plan and had a prescription for at least one hypertension medication, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB).


ASPC: Telehealth, fast response to CV symptoms crucial during COVID-19 pandemic

Helio | Cardiology Today, May 27, 2020

During the COVID-19 pandemic, cardiologists can utilize telehealth to reach out to their patients without disruption and should encourage them to get CV symptoms addressed immediately, according to a scientific statement. The statement by the American Society for Preventive Cardiology (ASPC), published in the American Journal of Preventive Cardiology, also focused on emphasizing the importance of CV health and continued care. “The COVID-19 pandemic has created several disruptions in outpatient care for patients at higher risk of cardiovascular disease, and we are concerned about future waves of preventable cardiovascular events that will follow,” Amit Khera, MD, MSc, FACC, FAHA, professor of internal medicine at UT Southwestern Medical Center, director of the UT Southwestern Preventive Cardiology Program and president of the ASPC, said in a press release.


Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review

Annals of Internal Medicine, May 27, 2020

Hydroxychloroquine and chloroquine have antiviral effects in vitro against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). This article summarizes evidence (from Four randomized controlled trials, 10 cohort studies, and 9 case series) about the benefits and harms of hydroxychloroquine or chloroquine for the treatment or prophylaxis of coronavirus disease 2019 (COVID-19).


Management of hypertension in COVID-19

World Journal of Cardiology | May 26, 2020

The ACE2 receptor plays a central role in severe acute respiratory syndrome coronavirus 2 host cell entry and propagation. It has therefore been postulated that angiotensin converting enzyme inhibitors and angiotensin receptor blockers may upregulate ACE2 expression and thus increase susceptibility to infection. We suggest that alternative anti-hypertensive agents should be preferred among individuals who may be exposed to this increasingly common and potentially lethal virus.


Could the D614 G substitution in the SARS-CoV-2 spike (S) protein be associated with higher COVID-19 mortality?

International Journal of Infectious Diseases |May 26, 2020

Increasing number of deaths due to COVID-19 pandemic has raised serious global concerns. Higher testing capacity and ample intensive care availability could explain lower mortality in some countries compared to others. Nevertheless, it is also plausible that the SARS-CoV-2 mutations giving rise to different phylogenetic clades are responsible for the obvious death disparities around the world. Current research literature linking the genetic make-up of SARS-CoV-2 with fatality is lacking. Here, we suggest that this disparity in fatality rates may be attributed to SARS-CoV-2 evolving mutations and urge the international community to begin addressing the phylogenetic clade classification of SARS-CoV-2 in relation to clinical outcomes.


UN virus therapy trial pauses hydroxychloroquine testing

Associated Press | May 25, 2020

The World Health Organization said Monday that it will temporarily drop hydroxychloroquine — the anti-malarial drug U.S. President Trump says he is taking — from its global study into experimental COVID-19 treatments, saying that its experts need to review all available evidence to date. In a press briefing, WHO director-general Tedros Adhanom Ghebreyesus said that in light of a paper published last week in the Lancet that showed people taking hydroxychloroquine were at higher risk of death and heart problems, there would be “a temporary pause” on the hydroxychloroquine arm of its global clinical trial.


Cost-Related Antihypertensive Medication Nonadherence: Action in the Time of COVID-19 and Beyond

American Journal of Hypertension | May 25, 2020

In this issue of the American Journal of Hypertension, Dr. Jing Fang and colleagues add to the existing literature on cost-related medication nonadherence (CRMN) with their study, “Association between cost-related medication nonadherence and hypertension management among US adults.”7 In their study, they examined the percentage of US adults who experienced CRMN using data from the 2017 National Health Interview Survey (NHIS). The authors also investigated the association of CRMN with current antihypertensive medication use and self-reporting having normal blood pressure. The NHIS is a nationally representative study of non-institutionalized US adults conducted annually by the National Center for Health Statistics and the 2017 NHIS included 78,132 participants.


Has the curve flattened?

Johns Hopkins University & Medicine | May 25, 2020

Countries around the world are working to “flatten the curve” of the coronavirus pandemic. Flattening the curve involves reducing the number of new COVID-19 cases from one day to the next. This helps prevent healthcare systems from becoming overwhelmed. When a country has fewer new COVID-19 cases emerging today than it did on a previous day, that’s a sign that the country is flattening the curve. On a trend line of total cases, a flattened curve looks how it sounds: flat. On the charts on this page, which show new cases per day, a flattened curve will show a downward trend in the number of daily new cases. This analysis uses a 5-day moving average to visualize the number of new COVID-19 cases and calculate the rate of change.


Op-Ed: Is coronavirus infectivity linked to blood pressure medication?

Digital Journal | May 23, 2020

As part of the review into why some people are more prone to contracting a coronavirus infection, some scientists are finding a connection with high blood pressure medication. Other researchers, however, have yet to find evidence. As part of considering why some people are more prone to contracting the SARS-CoV-2 coronavirus than others, it is important to factor in how the virus spreads. The primary way is through water or mucus droplets, which are passed from person to person. Second to this is direct contact – from hand to infected surface, and then to the nose, mouth or eyes. Viral RNA can be recovered from a variety of surfaces, including plastic and steel several days after it was originally deposited


Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents?

Journal of Microbiology, Immunology and Infection | May 23, 2020

Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus.


Rethinking the role of blood pressure drugs in COVID-19

Chemical and Engineering News | May 22, 2020

Once thought to boost levels of ACE2, the novel coronavirus’s doorway into human cells, these widely used medicines are now contenders to treat the respiratory disease. All it takes is a simple cough: a sharp intake of breath, the compression of air in the lungs, and the throat flying open to spew air, spit, and mucus. If the person coughing is infected with the novel coronavirus, it comes along for the ride on droplets, which can travel up to 50 miles per hour. When someone breathes those droplets in, the virus can get into the lungs. Once inside, it uses a spike protein on its surface to target an enzyme—ACE2—scattered over the outsides of the airway’s cells. If the spike protein connects with its target, the coronavirus uses ACE2 as a door to slip inside the cell. Thus begins an infection.


Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

The Lancet | May 22, 2020

In this large multinational real-world analysis, we did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or in combination with a macrolide) on in-hospital outcomes, when initiated early after diagnosis of COVID-19. Each of the drug regimens of chloroquine or hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard for clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19. The use of hydroxychloroquine or chloroquine in COVID-19 is based on widespread publicity of small, uncontrolled studies, which suggested that the combination of hydroxychloroquine with the macrolide azithromycin was successful in clearing viral replication.


CDC Releases Tips For Managing Workplace Fatigue During COVID-19

American College of Cardiology | May 20, 2020

Health care workers are working longer hours and more shifts with stressful and physically demanding work due to the COVID-19 pandemic. This has left health care teams with less time to sleep and care for their own well-being, increasing the risk for extreme fatigue. Workplace fatigue can increase the risk for injury, infections, illnesses and mental health disorders.


How to Discover Antiviral Drugs Quickly

New England Journal of Medicine | May 20, 2020

We urgently need effective drugs for coronavirus disease 2019 (Covid-19), but what is the quickest way to find them? One approach that sometimes seems akin to a “Hail Mary” pass in American football is to hope that drugs that have worked against a different virus (such as hepatitis C or Ebola) will also work against Covid-19. Alternatively, we can be rational and specifically target proteins of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so as to interrupt its life cycle.


COVID-19 Tip of the Week

Gemoji image for :clapper: American College of Cardiology | May 20, 2020

Dr. Kim Eagle provides a weekly tip for clinicians on the front lines of the COVID-19 pandemic. Dr. Eagle explains a recent Annals of Internal Medicine article, which examines false-negative rates according to time since exposure.


Study Finds Seniors with COVID-19 Taking Hypertension Medication at Lower Risk of Hospitalization, Clinical Trial to Follow Immediately

Business Wire | May 19, 2020

A study completed by UnitedHealth Group (NYSE: UNH) with the Yale School of Medicine found that older COVID-19 patients with hypertension taking angiotensin-converting enzyme (ACE) inhibitors had a lower risk of COVID-19 hospitalization. A pragmatic clinical trial will be a critical next step. The study, which was recently submitted for peer-reviewed publication, analyzed retrospective data from about 10,000 patients testing positive for SARS-CoV-2 who were enrolled in Medicare Advantage or commercially insured plans, and had a prescription for one or more anti-hypertensive medications. The use of ACE inhibitors was associated with an almost 40% lower risk of COVID-19 hospitalization for Medicare Advantage patients.


Study projects US COVID-19 deaths to triple by end of year

The Hill, May 19 | 2020

A new study suggests the number of Americans who will die after contracting the novel coronavirus is likely to more than triple by the end of the year, even if current social distancing habits continue for months on end. The study, conducted by the Comparative Health Outcomes, Policy and Economics Institute at the University of Washington’s School of Pharmacy, found that 1.3 percent of those who show symptoms of COVID-19 die, an infection fatality rate that is 13 times higher than a bad influenza season.


The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction

New England Journal of Medicine | May 19, 2020

During the Covid-19 pandemic, reports have suggested a decrease in the number of patients presenting to hospitals because of emergency conditions such as acute myocardial infarction. We examined this issue using data from Kaiser Permanente Northern California, a large integrated health care delivery system with 21 medical centers and 255 clinics that provides comprehensive care for more than 4.4 million persons throughout Northern California. We examined patient characteristics and weekly incidence rates of hospitalization for acute myocardial infarction STEMI or NSTEMI among adults in the Kaiser Permanente system before and after the first reported death from Covid-19 in Northern California on March 4, 2020.


Right Heart Problems Spell Trouble for COVID-19 Patients

MedPageToday | May 18, 2020

Right ventricular (RV) dilation was linked to in-hospital mortality among COVID-19 patients at one New York City hospital, researchers reported. That abnormal echocardiographic finding was observed in 31% of the 110 people hospitalized with the infection from March 26 to April 22 of this year, according to a group led by Edgar Argulian, MD, MPH, of Mount Sinai Morningside Hospital in New York City. Rates of in-hospital mortality were 41% for this subset with RV dilation compared with 11% among other patients.


Cardiac dysfunction and thrombocytopenia-associated multiple organ failure inflammation phenotype in a severe paediatric case of COVID-19

The Lancet | May 18, 2020

A 16-year-old male with chromosome 18q deletion and well controlled epilepsy presented to the Children’s National Hospital (Washington, DC, USA) with haemodynamic shock after 4 days of fever and one generalised seizure at home. Although he had no respiratory symptoms, his mother was ill with a cough. Upon arrival (hospital day 0), he was intubated and resuscitated with intravenous crystalloid fluids (>40 mL/kg), an intravenous epinephrine infusion (0·4 μg/kg per min), and intravenous stress-dose hydrocortisone (100 mg). His initial infectious disease evaluation, including testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), did not detect an infectious aetiology; however, a second test for SARS-CoV-2 on day 3 after hospital admission was positive.


Moderna posts ‘positive’ early data for COVID-19 vaccine

FiercePharma | May 18, 2020

With eyes on a phase 3 study this summer, Moderna posted promising early data for its COVID-19 vaccine. The jab prompted an immune response similar to those seen in patients who have recovered from the disease. The study, being run by the National Institute of Allergy and Infectious Diseases (NIAID), is testing three dose levels of the vaccine, mRNA-1273, given in two injections a month apart. Eight patients who received the two lowest dose levels—25 micrograms and 100 micrograms—developed neutralizing antibodies against SARS-CoV-2, the virus that causes COVID-19, two weeks after receiving their second dose.


Cardiac Surgery during the COVID‐19 Pandemic: Perioperative Considerations and Triage Recommendations

Journal of the American Heart Association | May 16, 2020

The epidemic caused by the SARS-CoV-2 virus, the etiologic agent of Coronavirus Disease 2019 (COVID-19), represents the third introduction of the highly pathogenic coronavirus into the population. COVID-19 and the previous iterations, SARS-CoV-1 in 2002 and Middle East Respiratory Syndrome (MERS-CoV) in 2012, are RNA viruses transmitted from animals to humans that can cause a spectrum of respiratory symptoms, ranging from mild symptoms (cough, fever, malaise, anosmia, fatigue, loss of appetite) to acute respiratory distress syndrome (ARDS). Due to the highly contagious nature of COVID-19, the unprecedented rate of spread on a global scale, and lack of effective treatment, healthcare systems around the world are already overwhelmed and their infrastructure strained. Accordingly, several societies have offered guidelines and recommendations on how to conserve resources and triage patients that need more urgent care.


Impact of the COVID-19 pandemic on ongoing cardiovascular research projects: considerations and adaptations

European Journal of Cardiovascular Nursing |May 16, 2020

COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was initially identified in December 2019 as a case of pneumonia in Wuhan, China. The World Health Organization declared the outbreak a public health emergency of international concern on 30 January 2020, and a pandemic on 11 March 2020. This outbreak is considered the biggest global health crisis of our times, leading to severe socioeconomic disruption, closures of educational institutions, significant mortality, shortages of medical supplies and major unprecedented challenges for healthcare systems around the world. The impact on healthcare extends beyond COVID-19 management and entails important considerations for clinical services, research and education across primary care and most medical subspecialties; the deferral of activities deemed non-essential (i.e. unrelated to COVID-19 planning and management) are commonplace during this pandemic.


CMS issues more rule changes to cope with COVID-19 — are they enough?

Healio | Primary Care | May 15, 2020

CMS recently announced a second round of regulatory waivers and rule changes to expand care to the nation’s seniors and provide health care systems flexibility. Though physicians applauded the new measures, they also said that CMS could do more to help primary care physicians recover from the financial toll of COVID-19.


Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults

Annals of Internal Medicine | May 15, 2020

The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in COVID-19 disease susceptibility, severity, and treatment is unclear. Two retrospective cohort studies found that ACEI and ARB use was not associated with a higher likelihood of receiving a positive SARS-CoV-2 test result, and 1 case–control study found no association with COVID-19 illness in a large community (moderate-certainty evidence). Fourteen observational studies, involving a total of 23 565 adults with COVID-19, showed consistent evidence that neither medication was associated with more severe COVID-19 illness (high-certainty evidence). Four registered randomized trials plan to evaluate ACEIs and ARBs for treatment of COVID-19.


Coronavirus May Pose a New Risk to Younger Patients: Strokes

New York Times | May 14, 2020

Doctors have reported a flurry of cases in Covid-19 patients — including a healthy 27-year-old emergency medical technician in Queens. After a month in the hospital, he is learning to walk again. Ravi Sharma was doubled over on his bed when his father found him. He’d had a bad cough for a week and had self-quarantined in his bedroom. As an emergency medical technician, he knew he was probably infected with the coronavirus. Now, Mr. Sharma, 27, could not move the right side of his body, and could only grunt in his father’s direction. His sister, Bina Yamin, on the phone from her home in Fort Wayne, Ind., could hear the sounds. “Call 911,” she told her father. “I think Ravi’s having a stroke.” She was right.


The New Normal: Key Considerations for Effective Serious Illness Communication Over Video or Telephone During the Coronavirus Disease 2019 (COVID-19) Pandemic

Annals of Internal Medicine | May 14, 2020

On 4 March 2019, a year before the coronavirus disease 2019 (COVID-19) pandemic descended on the United States, a doctor delivered difficult news to a 78-year-old man who was in the intensive care unit with advanced chronic obstructive pulmonary disease. His granddaughter, sitting beside him, recorded the interaction on her cellphone. First, we see the nurse roll in a piece of equipment with a screen. She attends to other tasks in the patient’s room while a man on the screen—the doctor—begins to speak. We hear only parts of what he says: damage to the man’s lungs cannot be fixed; morphine may help him feel better. The granddaughter asks her grandfather if he understands; we cannot hear his response. The clip ends. The man died the next day. His family, deeply dissatisfied with the interaction, released the video to the press, and articles with titles like “Doctor delivers end-of-life news via robot” were broadly disseminated.


Assessment of Deaths From COVID-19 and From Seasonal Influenza

JAMA Internal Medicine | May 14, 2020

As of early May 2020, approximately 65 000 people in the US had died of coronavirus disease 2019 (COVID-19),1 the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This number appears to be similar to the estimated number of seasonal influenza deaths reported annually by the Centers for Disease Control and Prevention (CDC). This apparent equivalence of deaths from COVID-19 and seasonal influenza does not match frontline clinical conditions, especially in some hot zones of the pandemic where ventilators have been in short supply and many hospitals have been stretched beyond their limits. The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons. Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic.


COVID-19, hypertension and cardiovascular diseases: Should we change the therapy?

Pharmacological Research | May 13, 2020

The coronavirus disease (COVID-19) has spread all around the world in a very short period of time. Recent data are showing significant prevalence of arterial hypertension and cardiovascular diseases (CVD) among patients with COVID-19, which raised many questions about higher susceptibility of patients with these comorbidities to the novel coronavirus, as well as the role of hypertension and CVD in progression and the prognosis of COVID-19 patients.


Inequity in Crisis Standards of Care

New England Journal of Medicine | May 13, 2020

In Racism without Racists, Eduardo Bonilla-Silva articulates why “color blindness,” an ethos based on the belief that race is no longer relevant, is contradictory and harmful. Color-blind policies, such as race-neutral mortgage practices and Medicare and Medicaid rules, have resulted in discrimination against black people and greater burdens on communities of color. To insist on color blindness is to deny the experience of people of color in a highly racialized society and to absolve oneself of any role in the process. Many clinicians and policymakers are therefore alarmed by recent state-based crisis standards of care (CSCs) that provide a color-blind process for determining whether a patient with Covid-19 respiratory failure lives or dies.


Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being

New England Journal of Medicine | May 13, 2020

The Covid-19 pandemic, which had killed more than 60,000 Americans by May 1, has been compared with Pearl Harbor and September 11 — cataclysmic events that left indelible imprints on the U.S. national psyche. Like the volunteers who flooded into Manhattan after the World Trade Center attacks, the health care providers working on the front lines of the Covid-19 pandemic will be remembered by history as heroes. These courageous people are risking their lives, threatened not only by exposure to the virus but also by pervasive and deleterious effects on their mental health.


‘No Intubation’: Seniors Fearful Of COVID-19 Are Changing Their Living Wills

Kaiser Health News | May 12, 2020

Last month, Minna Buck revised a document specifying her wishes should she become critically ill. “No intubation,” she wrote in large letters on the form, making sure to include the date and her initials. Buck, 91, had been following the news about COVID-19. She knew her chances of surviving a serious bout of the illness were slim. And she wanted to make sure she wouldn’t be put on a ventilator under any circumstances. “I don’t want to put everybody through the anguish,” said Buck, who lives in a continuing care retirement community in Denver. For older adults contemplating what might happen to them during this pandemic, ventilators are a fraught symbol, representing a terrifying lack of personal control as well as the fearsome power of technology.


With little data, doctors struggle to decide which Covid-19 patients should get remdesivir

STAT | May 12, 2020

Now that the federal government has begun distributing the experimental Covid-19 drug remdesivir, hospitals are in a bind. So far, it’s the only medication that has shown benefit for coronavirus patients in rigorous studies. But there isn’t enough for everyone who’s eligible. That leaves doctors with a wrenching ethical decision: Who gets the drug, and who doesn’t? As if the question wasn’t hard enough on moral grounds alone, it’s made even trickier by a dearth of data: Clinicians still don’t have the fine-grained study results showing which patients are most likely to benefit from the medication.


How COVID-19’s egregious impact on minorities can trigger change

American Medical Association, May 12, 2020

There have been more than 1 million cases of COVID-19 in the U.S., leading to tens of thousands of deaths. Since the start of the pandemic, tens of millions have lost their jobs with many losing their health insurance too. The impact on the nation’s minorities has been particularly harsh. So severe, in fact, that one physician suggested in a JAMA Viewpoint essay that the enormity of the pandemic’s impact on African Americans and other racial and ethnic minorities may create the will that finally leads to meaningful action on health inequity.


ACE2: the molecule that helps coronavirus invade your cells

The Conversation, May 12, 2020

The more we learn about the science behind COVID-19, the more we are beginning to understand the vital role a single molecule in our bodies plays in how we contract the disease. That molecule, angiotensin-converting enzyme 2, or ACE2, essentially acts as a port of entry that allows the coronavirus to invade our cells and replicate. It occurs in our lungs, but also in our heart, intestines, blood vessels and muscles. And it may be behind the vastly different death rates we are seeing between men and women.


COVID-19 Update

Gemoji image for :clapper American Medical Association | May 11, 2020

AMA experts and health professionals discuss how senior physicians are contributing their experience and expertise during the COVID-19 pandemic.


Men’s blood contains greater concentrations of enzyme that helps COVID-19 infect cells

European Society of Cardiology | May 11, 2020

This finding may explain why men with heart failure suffer more from the coronavirus than women. Evidence from a large study of several thousand patients shows that men have higher concentrations of angiotensin-converting enzyme 2 (ACE2) in their blood than women. Since ACE2 enables the coronavirus to infect healthy cells, this may help to explain why men are more vulnerable to COVID-19 than women. The study, published in the European Heart Journal, also found that heart failure patients taking drugs targeting the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), did not have higher concentrations of ACE2 in their blood.


Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

Journal of the American College of Cardiology | May 2020

The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission.


Collateral Effect of Covid-19 on Stroke Evaluation in the United States

The New England Journal of Medicine | May 8, 2020

The effect of the Covid-19 pandemic on medical care for conditions other than Covid-19 has been difficult to quantify. Any decrease in care for patients with acute conditions such as ischemic stroke may be consequential because timely treatment may decrease the incidence of disability. We used the numbers of patients in a commercial neuroimaging database associated with the RAPID software platform (iSchemaView) as a surrogate for the quantity of care that hospitals provided to patients with acute ischemic stroke. This software system is typically used to select patients who may benefit from endovascular thrombectomy by identifying occlusions of major brain arteries or regions of the brain with potentially reversible ischemia that have not become infarcted. Imaging data with demographic information are uploaded in real time to a data repository.


100 Days Into COVID-19, Where Do We Stand?

WebMD | May 7, 2020

The United States saw its first confirmed case of COVID-19 on Jan. 20. By the end of February, we had our first American death. We’ve now passed the 100-day mark, and the numbers are alarming, with 1.2 million confirmed cases here. More than 70,000 people have died here. And because testing has been limited, experts say those numbers are really much larger. So obviously, it’s bad. But is it getting better? “We’re not doing well at all,” says Jeffrey Shaman, PhD, a professor of environmental health sciences at Columbia University Mailman School of Public Health, who has led work to model national projections. “We had our first confirmed case the same day as South Korea. We have six times as many people, but 100 times as many cases.”


Results from 11 AHA-funded COVID-19 studies expected within months

Cardiology News | May 7, 2020

The American Heart Association (AHA) has awarded $1.2 million in grants to teams at 11 institutions to study COVID-19 effects on the cardiovascular and cerebrovascular systems. Work is set to start in June, with findings reported in as few as 6 months. The Cleveland Clinic will coordinate the efforts, collecting and disseminating the findings. There were more than 750 research proposals in less than a month after the association announced its COVID-19 and its Cardiovascular Impact Rapid Response Grant initiative.


Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past

Journal of Clinical Virology | June 2020

Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an important issue in patients infected with COVID-19.


Eagle’s Eye View: COVID-19 Tip of the Week [Podcast]

🎧 American College of Cardiology | May 6, 2020

Dr. Kim Eagle provides a weekly tip for clinicians on the front lines of the COVID-19 pandemic. This week highlights remdesivir, an antiviral drug that appears to have some benefit in COVID-19 patients.


New angiotensin studies in COVID-19 give more reassurance

Cardiology News, May 6 | 2020

Four more studies of the relationship of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) with COVID-19 have been published in the past few days in top-tier peer-reviewed journals, and on the whole, the data are reassuring. Although all the studies are observational in design and have some confounding factors, overall, the results do not suggest that continued use of ACE inhibitors and ARBs causes harm. However, there are some contradictory findings in secondary analyses regarding possible differences in the effects of the two drug classes.


ACE2, COVID-19, and ACE Inhibitor and ARB Use during the Pandemic: The Pediatric Perspective

Hypertension | May 5, 2020

Potential but unconfirmed risk factors for coronavirus disease 2019 in adults and children may include hypertension, cardiovascular disease, and chronic kidney disease, as well as the medications commonly prescribed for these conditions, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Coronavirus binding to angiotensin-converting enzyme 2, a crucial component of the renin-angiotensin-aldosterone system, underlies much of this concern. Children are uniquely impacted by the coronavirus but the reasons are unclear. This review will highlight the relationship of coronavirus disease 2019 with hypertension, use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, and lifetime risk of cardiovascular disease from the pediatric perspective.


Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19)

JAMA Cardiology | May 5, 2020

What is the association of use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) with testing positive for coronavirus disease 2019 (COVID-19)? In this cohort study of 18 472 patients, 1322 (7.2%) were taking ACEIs and 982 (5.3%) were taking ARBs. A positive COVID-19 test result was observed in 1735 (9.4%) tested patients, and among all patients with positive test results, 116 (6.7%) were taking ACEIs, and 98 (5.6%) were taking ARBs; there was no association between ACEI/ARB use and testing positive for COVID-19 (overlap propensity score–weighted odds ratio, 0.97; 95% CI, 0.81-1.15).


Study to determine incidence of novel coronavirus infection in U.S. children begins

National Institutes of Health | May 4, 2020

A study to help determine the rate of novel coronavirus infection in children and their family members in the United States has begun enrolling participants. The study, called Human Epidemiology and Response to SARS-CoV-2 (HEROS), also will help determine what percentage of children infected with SARS-CoV-2, the virus that causes COVID-19, develop symptoms of the disease. In addition, the HEROS study will examine whether rates of SARS-CoV-2 infection differ between children who have asthma or other allergic conditions and children who do not.


RAAS Inhibitors Not Linked to Higher COVID-19 Risks

Renal & Urology News | May 4, 2020

Inhibitors of the renin-angiotensin-aldosterone system (RAAS) do not appear to increase the risk of COVID-19 or its severity, according to the findings of 3 studies published on May 1 in the New England Journal of Medicine. Physicians have been concerned about a potential increased risk of COVID-19 related to medications that act on the RAAS because the viral receptor is angiotensin-converting enzyme 2 (ACE2).


ACC, Other CV Societies Issue Guide to Safely Resume Cardiovascular Procedures, Diagnostic Tests

American College of Cardiology | May 4, 2020

American College of Cardiology together with other North American cardiovascular societies has issued a framework for ethically and safely reintroducing invasive cardiovascular procedures and diagnostic tests after the initial peak of the COVID-19 pandemic. The COVID-19 pandemic has forced appropriate, but significant, restrictions on routine medical care, including invasive procedures to treat heart disease and diagnostic tests to diagnose heart disease.


Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19

New England Journal of Medicine | May 1, 2020

There is concern about the potential of an increased risk related to medications that act on the renin–angiotensin–aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2). The study assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.


COVID-19 Practice Management Resource

American College of Physicians | May 1, 2020

The ACP provides this toolkit intended to help practices now and in the coming weeks make adjustments due to COVID-19. Any new clinical guidance for physicians will be posted on this ACP page including telehealth coding and billing information, state and private payer policies, practice financial assistance and more.


Patients With Familial Hypercholesterolemia at Higher Risk for Cardiac Complications From COVID-19

Endocrinology Advisor | May 1, 2020

Individuals with novel coronavirus disease 2019 (COVID-19) who have familial hypercholesterolemia (FH) may be at higher risk for cardiac complications and atherosclerotic cardiovascular disease (ASCVD) in the long-term, according to study results published in the Journal of Internal Medicine. FH is characterized by a lifelong a 2- to 3-fold increase in plasma low-density lipoprotein-cholesterol concentration. If left untreated, FH may lead to premature ASCVD and a higher risk for acute coronary events during middle age.


COVID-19: Caring for Patients With Cardiovascular Disease in the Outpatient Setting

Pharmacy Times | May 1, 2020

It has been just over 2 months since the first United States reported case of coronavirus disease 2019 (COVID-19), a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Everyday life has been subject to many, previously inconceivable changes over the past several weeks. Each day, there are new data pouring in from around the globe and it is becoming more difficult to stay on top of the information. The number of cases just surpassed 1 million in the United States, putting the global total at just more than 3 million, as of the writing of this article on April 29, 2020. The Centers for Disease Control and Prevention and the Johns Hopkins Coronavirus Resource Center both point to 1 million cases by this day.


Trial To Determine if Hypertension Drug Reduces COVID-19 Severity

Technology Networks | May 1, 2020

Researchers at University of California San Diego School of Medicine have launched a clinical trial to investigate whether a drug approved for treating high blood pressure, heart failure and diabetic kidney disease might also reduce the severity of COVID-19 infections, lowering rates for intensive care unit admissions, the use of mechanical ventilators and all-cause mortality. The trial will be randomized, double-blind and placebo-controlled, the gold standard for clinical trials. It will involve multiple sites, with the University of California San Diego as coordinating institution. Up to 560 participants will be recruited, either presenting with COVID-19 symptoms at emergency departments or currently hospitalized with the disease caused by the novel coronavirus, SARS-CoV-2. The trial is expected to run one year.


Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

New England Journal of Medicine | May 1, 2020

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context. Using an observational database from 169 hospitals, the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years, coronary artery disease, heart failure, cardiac arrhythmia, chronic obstructive pulmonary disease, and current smoking.


Covid-prompted 400% rise in engagement led this home health startup to emerge from stealth

MedCity News | April 30, 2020

Tomorrow Health, a home health medical equipment and supplies startup founded in 2018, was planning to fly under the radar until August but huge demand and interest since Covid-19 hit led it to emerge from stealth this week. Startups come out of stealth for a variety of reasons but what’s common to the unveiling is that they always follow a predetermined calendar. A pandemic, of course, can wreak havoc on the best-laid plans. But for New York based Tomorrow Health Covid-19 is a crisis that equals a great opportunity.


Nearly 6 in 10 Oregonians Who Died of COVID-19 Had Heart Disease, State Says

Willamette Week | April 30, 2020

Oregon passed a bleak milestone today, announcing deaths 100 and 101 from the novel coronavirus. But the more significant data about COVID-19 was released without fanfare Tuesday afternoon: The Oregon Health Authority disclosed comorbidity data, or underlying conditions, for COVID-19 deaths in the state. The data show that nearly 6 in 10 of the victims of COVID-19 suffered from heart disease. Nearly 1 in 3 had diabetes. Almost a quarter of the deaths are of former smokers, but just one out of the 73 cases the OHA reviewed was a current smoker at the time they contracted the virus.


Remdesivir shows success in large COVID-19 trial. Will become ‘new standard of care,’ Fauci says.

LiveScience | April 29, 2020

The drug remdesivir significantly reduces the time it takes for COVID-19 patients to recover, as compared with a placebo treatment, according to a large, international study. “The data shows that remdesivir has a clear-cut, significant, positive effect in diminishing the time to recovery,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said in an interview with NBC News today (April 29). Patients treated with remdesivir took an average of 11 days to recover as compared with 15 days for those who received a placebo, he said.


Rare inflammatory syndrome seen in US child with Covid-19

CNN | April 29, 2020

US doctors say they may have seen a possible complication of coronavirus infection in a young child: a rare inflammatory condition called Kawasaki disease. National Health Service England sent an alert to doctors and on Sunday the Paediatric Intensive Care Society tweeted it out to members. It warned about a small increase in cases of critically ill children with “common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters” with some children testing positive for COVID-19.


Widely Used Surgical Masks Are Putting Health Care Workers At Serious Risk

Kaiser Health News | April 29, 2020

With medical supplies in high demand, federal authorities say health workers can wear surgical masks for protection while treating COVID-19 patients — but growing evidence suggests the practice is putting workers in jeopardy. The Centers for Disease Control and Prevention recently said lower-grade surgical masks are “an acceptable alternative” to N95 masks unless workers are performing an intubation or another procedure on a COVID patient that could unleash a high volume of virus particles.


US hits 1 million COVID-19 cases as states take on testing

CIDRAP News (Center for Infectious Disease Research and Policy) | April 28, 2020

The US case count for COVID-19 topped 1 million cases today, meaning the country has accounts for a third of all reported cases of the novel coronavirus in the world. In total, a tracker maintained by Johns Hopkins University shows 1,002,498 cases, including 57,533 fatalities. The milestone comes a day after the world surpassed 3 million cases in the 4 months since the virus was first detected in Wuhan, China. Less than 1 month ago—on April 2—the global total hit 1 million cases.


CDC Adds Six Symptoms to COVID-19 List

WebMD | April 28, 2020

The CDC has added several new symptoms to its list for the coronavirus: chills, muscle pain, headache, sore throat, repeated shaking with chills and a loss of taste or smell. The six new symptoms join the existing list with fever, cough and shortness of breath or difficulty breathing. The expanded list could help those who are trying to identify whether they have symptoms related to COVID-19. With a limited number of test kits available, those who want to take a test typically must show symptoms first.


Infectious Diseases Society of America Guidelines on Infection Prevention in Patients with Suspected or Known COVID-19

Infectious Diseases Society of America (ISDA) | April 27, 2020

IDSA formed a multidisciplinary guideline panel including front-line clinicians, infectious disease specialists, experts in infection control and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. The IDSA guideline panel agreed on eight recommendations and provided narrative summaries of other interventions undergoing evaluations.


Discussing COVID-19 and hypertension

Medical News Today | April 26, 2020

Hypertension, or high blood pressure, is highly prevalent in the United States and beyond. As the COVID-19 pandemic continues, researchers are keen to understand whether hypertension or the drugs that treat it might interact with the virus. To date, the novel coronavirus, SARS-CoV-2, has reached every continent on Earth other than Antarctica. The disease that it causes —COVID-19—has led to the deaths of thousands of people. Risk factors are of particular interest to both scientists and the public alike.


COVID-19 Quick Notes From FDA, CMS, HHS and Others

Cardiology | April 25, 2020

An overview of recent information from the FDA, CMS, HHS and more to help guide addressing COVID-19.


Report Proposes COVID-19 National Surveillance Plan

JAMA Health Forum | April 24, 2020

As state governments continue to focus on mitigating further spread of the SARS-CoV-2 coronavirus through stay-in-place orders, building a national COVID-19 surveillance system is crucial for containing transmission of the virus now and preparing for future waves of the infection, according to a new report issued by the Duke-Margolis Center for Health Policy.


ACEI/ARB Use in COVID-19 Patients With Hypertension

American College of Cardiology | April 24, 2020

What is the association between in-hospital use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and all-cause mortality in COVID-19 patients with hypertension? The authors concluded that among hospitalized COVID-19 patients with hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers.


Child Abuse Awareness Month During the Coronavirus Disease 2019 Pandemic

JAMA Pediatrics | April 24, 2020

April is Child Abuse Awareness month, even during the coronavirus disease 2019 (COVID-19) pandemic. Social isolation, the public health measure now in place across the world, is also a proven risk factor for child abuse. Other risks include stress, uncertain access to food and housing, and worries about making ends meet. Owing to the current COVID-19 pandemic, we recognize that parents and caregivers feel overwhelmed with these stresses. They may be experiencing job loss, childcare struggles, and schedule changes.


Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

Journal of the American Medical Association | April 22, 2020

In this case series that included 5700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%).


Thrombosis and COVID-19: FAQs for Current Practice

Cardiology | April 22, 2020

An FAQ on the potential impact of COVID-19 on thrombotic and/or bleeding risk from ACC’s Science and Quality Committee summarize the current data on the risk, potential need for hemostasis/coagulation testing, VTE prophylaxis, and therapeutic anticoagulation in patients with COVID-19 without confirmed/suspected thrombosis.


The New Pandemic Threat: People May Die Because They’re Not Calling 911

American Heart Association | April 22, 2020

Leaders of major national organizations – dedicated to saving people from heart disease and stroke – speak out. Reports from the front lines of hospitals indicate a marked drop in the number of heart attacks and strokes nationally. But, COVID-19 is definitely not stopping people from having heart attacks, strokes and cardiac arrests. We fear it is stopping people from going to the hospital and that can be devastating. You might think a hospital is the last place you should go now. That’s why we – the leaders of major national organizations dedicated to saving people from heart disease and stroke – feel it’s necessary to say this loud and clear: Calling 911 immediately is still your best chance of surviving or saving a life.


Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection

Journal of the American Medical Association | April 22, 2020

Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally. A spectrum of disease severity has been reported, with main symptoms that include fever, fatigue, dry cough, myalgia, and dyspnea. Previous strains of coronavirus have been demonstrated to invade the central nervous system through the olfactory neuroepithelium and propagate from within the olfactory bulb. Furthermore, nasal epithelial cells display the highest expression of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2, in the respiratory tree. This study evaluated prevalence, intensity, and timing of an altered sense of smell or taste in patients with SARS-CoV-2 infections.


Lost on the Frontline

Kaiser Health News | April 22, 2020

America’s health care workers are dying. In some states, medical staff account for as many as 20% of known coronavirus cases. They tend to patients in hospitals, treating them, serving them food and cleaning their rooms. Others at risk work in nursing homes or are employed as home health aides. Some of them do not survive the encounter. Many hospitals are overwhelmed and some workers lack protective equipment or suffer from underlying health conditions that make them vulnerable to the highly infectious virus. Many cases are shrouded in secrecy. “Lost on the Frontline” is a collaboration between The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to understand why so many are falling victim to the pandemic.


Thrombosis and COVID-19: FAQs for Current Practic

Cardiology Magazine | April 22, 2020

An FAQ on the potential impact of COVID-19 on thrombotic and/or bleeding risk from ACC’s Science and Quality Committee summarize the current data on the risk, potential need for hemostasis/coagulation testing, VTE prophylaxis, and therapeutic anticoagulation in patients with COVID-19 without confirmed/suspected thrombosis.


Managing the Patient with AMI and COVID-19 – JACC Consensus Statement

emDocs.net | April 21, 2020

In the midst of the current COVID-19 pandemic, we often focus on pulmonary complications including hypoxemic respiratory failure. However, patients with COVID-19 are at risk of cardiac complications including heart failure, myocarditis, acute myocardial infarction (AMI), and several others. Even more challenging is that many patients with cardiovascular disease and AMI may not be infected with COVID-19. Fortunately, the American College of Cardiology, the American College of Emergency Physicians, and the Society for Cardiovascular Angiography and Interventions published a joint statement in the Journal of the American College of Cardiology, detailing personal protective equipment (PPE), ST elevation myocardial infarction (STEMI) and NSTEMI management, emergency medical systems (EMS), and systems of care.


Health Care Workers Are Scared, Sad, Exhausted—and Angry

Scientific American | April 21, 2020

Front line health care professionals, particularly nurses, physician assistants and doctors, are experiencing a range of complex emotions during the COVID-19 pandemic. They risk their lives to save others. They place their loved ones at risk because of their exposure. This makes them fearful. They are forced to make hard decisions concerning life and death, and witness and support those patients die alone and often painfully. This makes them sad. This is the state of affairs in a number of hot spots within the United States and around the world. But there is another common emotion they may be experiencing that is less talked about: anger.


ST-Segment Elevation in Patients With COVID-19

American College of Cardiology | April 20, 2020

The investigators included patients with confirmed COVID-19 who had ST-segment elevation on electrocardiography from six New York hospitals in this case series. Patients with COVID-19 who had nonobstructive disease on coronary angiography or had normal wall motion on echocardiography in the absence of angiography were presumed to have noncoronary myocardial injury.


CDC’s Failed Coronavirus Tests Were Tainted With Coronavirus, Feds Confirm

Ars Technica | April 20, 2020

A federal investigation found CDC researchers not following protocol. As the new coronavirus took root across America, the US Centers for Disease Control and Prevention sent states tainted test kits in early February that were themselves seeded with the virus, federal officials have confirmed. The contamination made the tests uninterpretable, and—because testing is crucial for containment efforts—it lost the country invaluable time to get ahead of the advancing pandemic.


AHA calls for more hospital support in next COVID-19 bill

Modern Healthcare | April 19, 2020

The American Hospital Association on Sunday said hospitals still need more funding to provide care and ensure they have adequate supplies for their workforce. In a letter to House Minority Leader Kevin McCarthy (R-Calif.), the association thanked him for supporting additional hospital funding and said they still must be a priority as their finances take a hit from the pandemic.


US coronavirus death toll tops 40,000 as researchers call for more testing before reopening economy

CNN | April 19, 2020

The United States’ coronavirus death toll topped 40,000 on Sunday afternoon, according to data from Johns Hopkins University. The 40,461 deaths are among more than 755,533 coronavirus cases, the university’s Covid-19 tracker says.
The grim milestone was reached as Harvard researchers warned that if the country wants the economy to open back up — and stay that way — testing must go up to at least 500,000 people per day.


How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes

Science | April 17, 2020

On rounds in a 20-bed intensive care unit (ICU) one recent day, physician Joshua Denson assessed two patients with seizures, many with respiratory failure and others whose kidneys were on a dangerous downhill slide. Days earlier, his rounds had been interrupted as his team tried, and failed, to resuscitate a young woman whose heart had stopped. All shared one thing, says Denson, a pulmonary and critical care physician at the Tulane University School of Medicine. “They are all COVID positive.” As the number of confirmed cases of COVID-19 surges past 2.2 million globally and deaths surpass 150,000, clinicians and pathologists are struggling to understand the damage wrought by the coronavirus as it tears through the body. They are realizing that although the lungs are ground zero, its reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain.


JACC Paper Outlines Implications, Considerations For Thrombotic Disease Patients During COVID-19 Pandemic

Journal of the American College of Cardiology | April 17, 2020

The COVID-19 pandemic has implications in the prevention and management of patients with thrombotic and thromboembolic disease, according to a state-of-the-art review published April 17 in the Journal of the American College of Cardiology. Behnood Bikdeli, MD, MS, et al., summarize the pathogenesis, epidemiology, treatment and available outcomes data related to thrombotic disease in COVID-19 patients, as well as management of thrombotic events in patients without COVID-19, providing clinical guidance when possible. The authors outline investigational therapies for COVID-19 and their interactions, as well as other considerations, when used in patients taking antiplatelet agents or anticoagulants.


How to Obtain a Nasopharyngeal Swab Specimen

Gemoji image for :clapper:  New England Journal of Medicine | April 17, 2020

Collection of specimens from the surface of the respiratory mucosa with nasopharyngeal swabs is a procedure used for the diagnosis of Covid-19 in adults and children. The procedure is also commonly used to evaluate patients with suspected respiratory infection caused by other viruses and some bacteria. This video describes the collection of nasopharyngeal specimens for detection of Covid-19, the illness caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).


Those with High Blood Pressure Are at a Greater Risk for COVID-19

CNN Health | April 17, 2020

As the novel coronavirus sweeps the globe, people with high blood pressure are among those who are at heightened risk for more severe complications should they contract Covid-19. “If you get an extraordinary viral disease that will damage your lungs, you need a heart that can work with how your body responds to the virus,” said Dr. Maria Carolina Delgado-Lelievre, an assistant professor of medicine at the University of Miami’s Miller School of Medicine.


Audio Interview: Caring for Patients with Covid-19

New England Journal of Medicine | April 16, 2020

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission, diagnosis, and treatment is the subject of ongoing updates from infectious disease experts at the Journal. In this audio interview conducted on April 15, 2020, the editors discuss making clinical decisions for patients with Covid-19 as we await evidence from randomized trials.


Early peek at data on Gilead coronavirus drug suggests patients are responding to treatment

STAT | April 16, 2020

Chicago hospital treating severe Covid-19 patients with Gilead Sciences’ antiviral medicine remdesivir in a closely watched clinical trial is seeing rapid recoveries in fever and respiratory symptoms, with nearly all patients discharged in less than a week, STAT has learned. Remdesivir was one of the first medicines identified as having the potential to impact SARS-CoV-2, the novel coronavirus that causes Covid-19, in lab tests. The entire world has been waiting for results from Gilead’s clinical trials, and positive results would likely lead to fast approvals by the Food and Drug Administration and other regulatory agencies. If safe and effective, it could become the first approved treatment against the disease.


Thanks to COVID-19, Cardiology Fellows Gain Unexpected Skills but Risk Losing Others

tctMD/the heart beat | April 16, 2020

Trading catheters for central lines, many fellows are stepping into roles they’d never imagined, while programs adapt. For fellows, this time of year is usually filled with planning solo cases, finalizing contracts, and looking forward to the next stages of their careers. This year is not like other years. The COVID-19 pandemic has swept through cardiology training programs across the country, sending program directors scrambling to maintain some sense of a normal curriculum through virtual platforms. Fellows, on the other hand, are trading their planned education for shifts in ICU wards, all while doing their best to ensure safety and sanity.


Healthcare Workers With COVID-19 Relatively Young, Mostly Female: CDC

tctMD/the heart beat | April 15, 2020

Although the majority did not require hospitalization, severe disease and death were reported across age groups. The Centers for Disease Control and Prevention (CDC) has released its first report on US healthcare personnel (HCP) who’ve developed COVID-19, with details published in Morbidity and Mortality Weekly Report. Fully three-quarters of these providers were women, and the median age was 42 years. Less than half had an underlying medical condition. Although most healthcare workers did not require hospitalization, severe disease and death were reported across age groups.


An Age/Old Dilemma? Pulling Senior Cardiologists From the Front During COVID-19

tctMD/the heart beat | April 14, 2020

Some US hospitals have asked doctors over a certain age to work from home, but surge situations may mean all hands on deck. Around the United States, hospital leaders either preparing for or already coping with an influx of patients with COVID-19 are facing a difficult dilemma: how do you protect your most senior—and most vulnerable—physicians from infection without losing their decades of knowledge and experience? In many places, that means asking older cardiologists to work from home or otherwise away from the front lines to lessen their risk of contracting SARS-CoV-2 but still contribute to the fight.


Children With COVID-19 May Not Show Symptoms, Still Spread Disease to Others

American College of Cardiology | Apr 13, 2020

Some children with COVID-19 may experience mild illness and may not show symptoms, but they can still spread the disease to others, according to the first report from the Centers for Disease Control and Prevention (CDC) that examines data on the disease in children and published in Morbidity and Mortality Weekly Report. The report analyzed data from 149,760 laboratory-confirmed COVID-19 cases in the U.S. occurring between Feb. 12 and April 2. Among the 149,082 (99.6%) reported cases for which age was known, 2,572 (1.7%) were among children <18 years.


Cardiac Rehab During COVID-19: Telehealth, Unpaid Heroes Step Up to Help at Home

tctMD/the heart beat | April 10, 2020

Experts say there’s no better time than now to keep preventive CV care going and forge a new path for outpatient cardiac rehab. Although patients across the United States can no longer physically go to cardiac rehab facilities, advocates are working behind the scenes to make sure patients in need do not fall between the cracks while the COVID-19 crisis rages on. “In speaking with program directors and being involved with various forums, it is clear that the majority of cardiac rehab programs across the country right now are at a standstill,” Laurence Sperling, MD (Emory University School of Medicine, Atlanta, GA), told TCTMD. The scope of the problem is large, with 2,685 cardiac rehab programs and 1,758 pulmonary rehab programs across the United States that typically provide services to hundreds of thousands of patients.


Structural Heart Interventions in the Midst of COVID-19: Today’s Advice, Tomorrow’s Unknowns

tctMD/the heart beat | April 13,2020

Which TAVR can be deferred, which MV should be repaired? Advice from ACC, SCAI, and the heart of the US pandemic. Many transcatheter interventions for structural heart disease have been cancelled or postponed indefinitely amid the COVID-19 pandemic, but some patients can’t wait, according to a new consensus statement. The joint document issued last week by the American College of Cardiology (ACC) and the Society for Cardiovascular Angiography and Interventions (SCAI) proposes triage considerations to help heart teams decide which procedures should happen ASAP.


Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization to Decontaminate Millions of N95 Respirators

FDA | April 12, 2020

The U.S. Food and Drug Administration issued an emergency use authorization (EUA) that has the potential to decontaminate approximately 4 million N95 or N95-equivalent respirators per day in the U.S. for reuse by health care workers in hospital settings. “Our nation’s health care workers are among the many heroes of this pandemic and we need to do everything we can to increase the availability of the critical medical devices they need, like N95 respirators,” said FDA Commissioner Stephen M. Hahn, M.D. “FDA staff continue to work around the clock, across government and with the private sector to find solutions. This authorization will help provide access to millions of respirators so our health care workers on the front lines can be better protected and provide the best care to patients with COVID-19.”


Why African-Americans may be especially vulnerable to COVID-19

Science News | April 10, 2020

COVID-19 was called the great equalizer. Nobody was immune; anybody could succumb. But the virus’ spread across the United States is exposing racial fault lines, with early data showing that African-Americans are more likely to die from the disease than white Americans.


Don’t Overlook COVID-19’s Cardiovascular Footprint, Say NYC Physicians

tctMD/the heart beat | April 9,2020

A case series from this United States hot spot shows the diversity of CV presentations and the care individual patients may require. Cardiovascular risks sparked by COVID-19—and their diverse presentations—are becoming ever more apparent as the disease spreads worldwide. Clinicians are faced with developing unique diagnostic algorithms and treatment pathways to help these patients as patterns emerge.


Reinventing Cardiovascular Care in Two Weeks: An Industry Adapts to a Pandemic

MedAxiom | April 9, 2020

Healthcare as an industry is not known for its speed in making changes, instead being identified as steady and traditional. This is particularly true when considering the patient encounter or office visit; the experience today would largely mirror its corollary from 1980. However, when a worldwide pandemic came crashing down the U.S. provider community – in particular the cardiovascular community – responded in lightning speed. Within a matter of weeks, cardiovascular patient visits using telemedicine went from near zero to 75 percent. This is disruptive change that would make even a startup technology company proud. More importantly, it allowed critical patient care to continue and afforded providers a much-needed reduction in exposure. The reaction by the medical community thus far has been nothing short of heroic and provides a strong reason for optimism at a time when the world needs it most.


Guidance on treating COVID-19 patients with signs of acute heart attack

Science Daily, April 9 | 2020

Much remains unknown about COVID-19, but many studies already have indicated that people with cardiovascular disease are at greater risk of COVID-19. There also have been reports of ST-segment elevation (STE), a signal of obstructive coronary artery disease, in patients with COVID-19 who after invasive coronary angiography show no sign of the disease.


COVID-19 and Cardiology

European Society of Cardiology | April 9, 2020

The ESC is a vast, diverse community. We learn from each other so that we can give our patients the best possible care. Never has this been more important than during a pandemic. This page is designed to provide you with an array of useful resources, updated regularly.


AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

Diagnostic and Interventional Cardiology | April 8, 2020

The scientific community is learning more about the impact and interaction of cardiovascular diseases with novel coronavirus (COVID-19, SARS-CoV-2), including the impact of drug therapies being used and their negative cardiovascular impact. Together, the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS) April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19.


French Hospital Stops Hydroxychloroquine Treatment for Covid-19 Patient Over Major Cardiac Risk

Newsweek | April 8, 2020

A hospital in France has had to stop an experimental treatment using hydroxychloroquine on at least one coronavirus patient after it became a “major risk” to their cardiac health.
The University Hospital Center of Nice (CHU de Nice) is one of many hospitals trialing hydroxychloroquine in COVID-19 patients. It announced it had been selected for the trial on March 22. A statement from the hospital said it was testing four experimental treatments, one of which included hydroxychloroquine. It hoped to establish its effectiveness and side effects of this and the other treatments being tested.


C.D.C. Releases Early Demographic Snapshot of Worst Coronavirus Cases

The New York Times | April 8, 2020

The agency’s study of hospitalizations for Covid-19 in March shows heightened numbers for those with underlying conditions, men and African-Americans. On March 1, there were 88 confirmed cases of the coronavirus in the United States. By month’s end, there were more than 170,000. The Centers for Disease Control and Prevention has compiled data on people who were hospitalized from the virus during that month to get a clearer demographic picture of infected patients who have required the most serious medical care.


Novel Coronavirus Information Center

Elsevier | Updated April 8, 2020

Elsevier’s free health and medical research on the novel coronavirus (SARS-CoV-2) and COVID-19. Under the Clinical information tab, you will find evidence-based skill guides and care


Hypertension and COVID-19

American Journal of Hypertension | April 6, 2020

The world is currently suffering from the outbreak of a pandemic caused by the severe acute respiratory syndrome coronavirus SARS-CoV-2 that causes the disease called COVID-19, first reported in Wuhan, Hubei Province, China on December 31, 2019. As of March 29, 2020, there have been 732153 confirmed cases of COVID-19 reported worldwide, with 34686 deaths. The clinical and epidemiological features of COVID-19 have been repeatedly published in the last few weeks. Interestingly, specific comorbidities associated with increased risk of infection and worse outcomes with development of increased severity of lung injury and mortality have been reported. The most common comorbidities in one report were hypertension (30%), diabetes (19%), and coronary heart disease (8%).


Heart Damage in COVID-19 Patients Puzzles Doctors

Scientific American | April 6, 2020

While the focus of the COVID-19 pandemic has been on respiratory problems and securing enough ventilators, doctors on the front lines are grappling with a new medical mystery. In addition to lung damage, many COVID-19 patients are also developing heart problems—and dying of cardiac arrest.


COVID-19: AHA Guidance on Hypertension, Latest on Angiotensin Link

Medscape | April 1, 2020

The American Heart Association (AHA) has issued new guidance for patients with hypertension during the COVID-19 outbreak. At the same time, several new review articles have been published further exploring the possible relationship between the renin-angiotensin system (RAS) and the virus.


Renin-Angiotensin System Blockers and the COVID-19 Pandemic

American Heart Association | March 25, 2020

During the spread of the severe acute respiratory syndrome coronavirus-2, some reports of data still emerging and in need of full analysis indicate that certain groups of patients are at risk of COVID-19. This includes patients with hypertension, heart disease, diabetes mellitus, and clearly the elderly. Many of those patients are treated with reninangiotensin system blockers.


ESC Council on Hypertension Says ACE-I and ARBs Do Not Increase COVID-19 Mortality

Diagnositc and Interventional Cardiology | March 16, 2020

The European Society of Cardiology (ESC) issued a statement March 13 recommending in novel coronavirus (COVID-19, and now clinically referred to as SARS‐CoV‐2) patients not discontinuing angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARBs) used to control hypertension.


Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

The Lancet | March 11, 2020

The most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues1 were cerebrovascular diseases (22%) and diabetes (22%).

Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform

The Lancet, September 24, 2020

Early descriptions of patients admitted to hospital during the COVID-19 pandemic showed a lower prevalence of asthma and chronic obstructive pulmonary disease (COPD) than would be expected for an acute respiratory disease like COVID-19, leading to speculation that inhaled corticosteroids (ICSs) might protect against infection with severe acute respiratory syndrome coronavirus 2 or the development of serious sequelae. We assessed the association between ICS and COVID-19-related death among people with COPD or asthma using linked electronic health records (EHRs) in England, UK. In this observational study, we analysed patient-level data for people with COPD or asthma from primary care EHRs linked with death data from the Office of National Statistics using the OpenSAFELY platform. For the COPD cohort, individuals were eligible if they were aged 35 years or older, had COPD, were a current or former smoker, and were prescribed an ICS or long-acting β agonist plus long-acting muscarinic antagonist (LABA–LAMA) as combination therapy within the 4 months before the index date. For the asthma cohort, individuals were eligible if they were aged 18 years or older, had been diagnosed with asthma within 3 years of the index date, and were prescribed an ICS or short-acting β agonist (SABA) only within the 4 months before the index date. We compared the outcome of COVID-19-related death between people prescribed an ICS and those prescribed alternative respiratory medications.


Asthma disparities during the COVID-19 pandemic: a survey of patients and physicians

Journal of Allergy and Clinical Immunology, September 24, 2020

The COVID-19 pandemic has demonstrated significantly worse outcomes for Minority (Black and Hispanic) individuals. Understanding the reasons for COVID-19-related disparities among asthma patients has important public health implications. The objective of this survey was to determine factors contributing to health disparities in those with asthma during the COVID-19 pandemic. The anonymous survey was sent through social media to adult patients with asthma, and a separate survey was sent to physicians who provide asthma care. The patient survey addressed demographic information including socioeconomic status (SES), asthma control, and attitudes/health behaviors during COVID-19. A total of 1171 patients (10.1% Minority individuals) and 225 physicians completed the survey. Minority patients were more likely to have been affected by COVID-19 (e.g., became unemployed, lived in a community with high COVID-19 cases). They had worse asthma control (increased emergency visits for asthma, lower ACT score), were more likely to live in urban areas, and had a lower household income. Initial differences in attitudes and health behaviors disappeared after controlling for baseline demographic features. Institutional racism was demonstrated by findings that Minority individuals were less likely to have a primary care physician, had more trouble affording asthma medications due to COVID-19, were more likely to have lost health insurance due to COVID-19, and that 25% of physicians found it more challenging to care for Black individuals with asthma during COVID-19.


Tocilizumab Reduces Need for Mechanical Ventilation in COVID-19 Pneumonia Trial

Pulmonology Advisor, September 23, 2020

Genentech announced that a phase 3 study assessing tocilizumab (Actemra®) plus standard of care for the treatment of hospitalized adults with coronavirus disease 2019 (COVID-19) associated pneumonia met its primary end point. The multicenter, randomized, double-blind, placebo-controlled EMPACTA study included hospitalized COVID-19 patients with oxygen saturation less than 94% while on ambient air who did not require noninvasive or invasive mechanical ventilation. Patients were randomized to receive 1 intravenous infusion of tocilizumab or placebo plus standard of care, and could be given up to 1 additional infusion. The primary end point was the cumulative proportion of patients dying or requiring mechanical ventilation by day 28. Results showed that patients treated with tocilizumab were 44% less likely to progress to mechanical ventilation or death compared with placebo (hazard ratio [HR] 0.56; 95% CI, 0.32-0.97; log-rank P =.0348). The cumulative proportion of patients who progressed to mechanical ventilation or death by day 28 was 12.2% in the tocilizumab arm compared with 19.3% in the placebo arm.


Routine blood test may predict mortality risk in patients with COVID-19

Helio | Primary Care, September 23, 2020

A standard test that evaluates blood cells can help identify patients hospitalized with COVID-19 who are at an elevated risk for death, according to research published in JAMA Network Open. “We were surprised to find that one standard test that quantifies the variation in size of red blood cells — called red cell distribution width, or RDW — was highly correlated with patient mortality, and the correlation persisted when controlling for other identified risk factors like patient age, some other lab tests, and some pre-existing illnesses,” Jonathan Carlson, MD, PhD, an instructor in medicine at Massachusetts General Hospital, said in a press release. In their cohort study, Carlson and colleagues retrospectively analyzed adult patients with SARS-CoV-2 infection who were admitted to one of four participating hospitals in the Boston area from March 4 through April 28. As part of standard critical care, all patients had their RDW, absolute lymphocyte count and dimerized plasmin fragment D levels collected daily. According to the researchers, RDW reflects cellular volume variation, and elevated RDW (more than 14.5%) has previously been associated with an increased risk for morbidity and mortality in a variety of diseases, including heart disease, pulmonary diseases, influenza, cancer and sepsis. A total of 1,641 patients were included in the analyses. The final discharge among these patients was June 26, and there were no COVID-19-related readmissions through July 25.


Risk Factors for Hospitalization, Mechanical Ventilation, or Death Among 10 131 US Veterans With SARS-CoV-2 Infection

JAMA Network Open, September 23, 2020

Identifying independent risk factors for adverse outcomes in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can support prognostication, resource utilization, and treatment. The objective of this study was to identify excess risk and risk factors associated with hospitalization, mechanical ventilation, and mortality in patients with SARS-CoV-2 infection. In this national cohort study of 88 747 veterans tested for SARS-CoV-2, hospitalization, mechanical ventilation, and mortality were significantly higher in patients with positive SARS-CoV-2 test results than among those with negative test results. Significant risk factors for mortality included older age, high regional coronavirus disease 2019 burden, higher Charlson Comorbidity Index score, fever, dyspnea, and abnormal results in many routine laboratory tests; however, obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking were not associated with mortality.


COVID Death Toll Hits 200,000 in the U.S.

WebMD, September 22, 2020

Just over 6 months after the World Health Organization declared COVID-19 a pandemic, the United States has reached a grim milestone: the novel coronavirus death toll has climbed to a staggering 200,000. “It’s sobering. It’s a large number, and clearly it tells us that everything we’re doing right now to contain it needs to continue,” says Erica Shenoy, MD, associate chief of the Infection Control Unit at Massachusetts General Hospital. “Especially heading into the fall, where we don’t know if there will be a second surge, or if this will be compounded by other respiratory illnesses.” Doctors and scientists say the number sends a clear message: Although people are itching to return to pre-pandemic life, Americans should continue to wear masks, practice hand-washing hygiene, and keep physical distance from others. While the high death toll is a bleak glimpse into how severe the illness is, there are two silver linings: The numbers seem to be trending in the right direction, and researchers have had time to discover more about a virus that at first baffled even the world’s leading scientists.


Pneumothorax Reported as Complication of COVID-19

Pulmonology Advisor, September 22, 2020

Pneumothorax is being reported as a complication of COVID-19, and has higher incidence among men and lower survival among older patients, according to a study published online Sept. 9 in the European Respiratory Journal. Anthony W. Martinelli, Ph.D., from Addenbrooke’s Hospital in Cambridge, England, and colleagues retrospectively collected cases from U.K. hospitals limited to patients with a diagnosis of COVID-19 and presence of pneumothorax or pneumomediastinum. Data were included for 71 patients, 60 of whom had pneumothoraces (six with pneumomediastinum) and 11 had pneumomediastinum alone. Two of the patients with pneumomediastinum alone had distinct episodes of pneumothorax, resulting in a total of 62 pneumothoraces. The researchers observed no difference in survival at 28 days following pneumothorax or isolated pneumomediastinum (63.1 ± 6.5 percent and 53.0 ± 18.7 percent, respectively). Men had higher incidence of pneumothorax. Survival at 28 days did not differ for men versus women (62.5 ± 7.7 percent versus 68.4 ± 10.7 percent). Compared with younger patients, those aged 70 years and older had significantly lower 28-day survival (41.7 ± 13.5 percent versus 70.9 ± 6.8 percent survival).


ACIP Mulls Priority Groups for COVID-19 Vaccines

MedPage Today, September 22, 2020

Members of the CDC’s Advisory Committee on Immunization Practices (ACIP) meeting Tuesday appeared to agree that healthcare workers should be first in line to receive a COVID-19 vaccine when one is approved, followed by some combination of essential workers, those with high-risk medical conditions, and older adults. However, with no formal vote taken — that won’t happen until one or more vaccines are authorized or approved by the FDA for clinical use — it’s not yet official policy, and not much was settled about priorities for later rounds of immunizations. ACIP chair José Romero, MD, said once data is available from phase III clinical trials, an ACIP work group will conduct an independent review of its safety and efficacy. “If and when the FDA authorizes or approves vaccines, ACIP will have an emergency meeting and then vote on recommendations and populations for use,” he said.


Hydrocortisone Did Not Reduce Mortality, Respiratory Support Need in COVID-19

Pulmonology Advisor, September 22, 2020

Low-dose hydrocortisone was not associated with a significant reduction in death or need for persistent respiratory support by day 21 of treatment compared with placebo in critically ill patients with coronavirus disease 2019 (COVID-19), according to study results published in the Journal of the American Medical Association. A total of 149 patients (mean age, 62.2 years) admitted to the intensive care unit (ICU) for COVID-19-related acute respiratory failure from March 7 to June 1, 2020, were recruited into this French multicenter, randomized double-blind trial. Last available follow-up data were for June 29, 2020. Researchers planned to enroll up to 290 patients, but recommendations from the data and safety monitoring board resulted in early termination of the study. Approximately 81.2% of patients in this cohort were mechanically ventilated. Patients were randomly assigned to either continuous infusion of low-dose hydrocortisone (n=76) or placebo (n=73). The initial dose of hydrocortisone was 200 mg/d and continued at this dose until day 7, after which the dose was decreased to 100 mg/d for 4 days and 50 mg/d for 3 days. A short treatment regimen comprising 200 mg/d for 4 days, followed by 100 mg/d for 2 days and then 50 mg/d for the next 2 days was administered if the patient’s respiratory and generally status sufficiently improved by 4 days of treatment.


COVID-19 mortality rates higher among men than women

Science Daily, September 22, 2020

A new review article from Beth Israel Deaconess Medical Center (BIDMC) shows people who are biologically male are dying from COVID-19 at a higher rate than people who are biologically female. In a review published in Frontiers in Immunology, researcher-clinicians at BIDMC explore the sex-based physiological differences that may affect risk and susceptibility to COVID-19, the course and clinical outcomes of the disease and response to vaccines. “The COVID-19 pandemic has revealed a striking gender bias with increased mortality rates in men compared with women across the lifespan,” said corresponding author Vaishali R. Moulton, MD, PhD, an assistant professor of medicine in the Division of Rheumatology and Clinical Immunology at BIDMC. “Apart from behavioral and lifestyle factors that differ between men and women, sex chromosome-linked genes, sex hormones and the microbiome control aspects of the immune responses to infection and are potentially important biological contributors to the sex-based differences we’re seeing in men and women in the context of COVID-19.”


Most COVID-19 infections are spread through respiratory droplets or aerosols and not surfaces: study

Medical Xpress, September 18, 2020

COVID-19 is spread most often through respiratory droplets or aerosols and little evidence exists supporting transmission through surfaces. As such, social distance and proper ventilation are key determinants of transmission risk. Findings from a review of published research, articles, and reports is published in Annals of Internal Medicine. Researchers from Montefiore Medical Center, Hospital of the University of Pennsylvania, Massachusetts General Hospital, Harvard Medical School, and Brigham and Women’s Hospital studied scientific articles published between January and September 2020, as well as relevant articles and institutional or governmental reports, to determine the viral, host, and environmental factors that contribute to transmission of COVID-19. They found that although several experimental studies suggest that virus particles could live for hours after inoculation in aerosols or on surfaces, the real-world studies that detect viral RNA in the environment report very low levels on surfaces, and few have isolated viable virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or transmission from materials or surfaces was presumed, respiratory transmission could still not be ruled out.


Histopathological findings in fatal COVID-19 severe acute respiratory syndrome: preliminary experience from a series of 10 Spanish patients

BMJ Journals | Thorax, September 18, 2020

In December 2019, an outbreak of severe acute respiratory syndrome associated to SARS-CoV2 was reported in Wuhan, China. To date, little is known on histopathological findings in patients infected with the new SARS-CoV2. Lung histopathology shows features of acute and organising diffuse alveolar damage. Subtle cellular inflammatory infiltrate has been found in line with the cytokine storm theory. Medium-size vessel thrombi were frequent, but capillary thrombi were not present. Despite the elevation of biochemical markers of cardiac injury, little histopathological damage could be confirmed. Viral RNA from paraffin sections was detected at least in one organ in 90% patients. Novel coronavirus-associated disease (COVID-19) was first detected in Spain on 31 January 2020, with more than 204 178 cases subsequently identified in 3 months. Severe COVID-19 is associated with high circulating levels of inflammatory cytokines akin to a cytokine release syndrome that frequently results in respiratory failure. To date, scant histopathological information of infected patients is available. Few descriptions of histopathological findings have mainly reported pneumonitis and diffuse alveolar damage (DAD). To advance in the knowledge of COVID-19-associated tissue damage is important to understand the mechanisms of damage caused by SARS-COV-2. Postmortem multiorgan biopsies in 10 patients who died with SARS COV-2 infection were performed after oral authorisation of a first-degree relative. Biopsies were obtained without ultrasound guidance with the patient‘s corpse still on the hospital bed.


Lung ultrasonography for risk stratification in patients with COVID-19: a prospective observational cohort study

Clinical Infectious Diseases, September 17, 2020

Point-of-care lung ultrasound (LUS) is a promising pragmatic risk stratification tool in COVID-19. This study describes and compares LUS characteristics between patients with different clinical outcomes. This prospective observational study included PCR-confirmed COVID-19 adults with symptoms of lower respiratory tract infection presenting in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (acquired within 24hours of presentation to the ED) between patient groups based on their outcome at 7 days after inclusion: 1) outpatients, 2) hospitalised and 3) intubated/death. Normalized LUS score was used to discriminate between groups. We included 80 patients (17 outpatients, 42 hospitalized and 21 intubated/dead). 73 patients (91%) had abnormal LUS (70% outpatients, 95% hospitalised and 100% intubated/death; p=0.003). The proportion of involved zones was lower in outpatients compared with other groups (median 30% [IQR 0-40%], 44% [31-70%] and 70% [50-88%], p<0.001). Predominant abnormal patterns were bilateral and multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%) and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of 0.80 (95% CI 0.68-0.92).


HHS Outlines COVID Vax Distribution Strategy

MedPage Today, September 17, 2020

The Health and Human Services (HHS) department on Wednesday unveiled general outlines for how the first COVID-19 vaccine doses will be shipped and administered. Developed with the Department of Defense (DOD), the four-part strategy addresses engagement with state and local partners and other stakeholders; distribution under a “phased allocation methodology” still to be developed; safe vaccine administration and availability of auxiliary supplies; and data gathering via information technology to track distribution and administration. The strategy gives January 2021 as the target to begin distribution of an FDA-approved or authorized vaccine. Also released Wednesday was a COVID-19 Vaccination Program Interim Playbook from the CDC to assist local, state, tribal and territorial partners in rolling out their COVID-19 vaccination programs. The playbook identifies healthcare personnel and other essential workers as among the “critical populations,” although final decisions remain to be made by the CDC’s Advisory Committee on Immunization Practices.


Six traits predict need for mechanical ventilation in patients with COVID-19

Helio | Critical Care, September 17, 2020

Among patients hospitalized for COVID-19 in the United States, male sex, age 60 years and older, obesity, chronic kidney disease, cardiovascular disease and living in the Northeast were associated with an increased risk for mechanical ventilation, data show. The findings, published in Clinical Infectious Diseases, also indicated that the same characteristics, except for obesity, were linked to an increased risk for mortality. “This was the first attempt to try and get a broader sense of the risk factors for adverse outcome and how they interacted with one another in a much more specific manner,” Robert S. Brown, Jr., MD, MPH, clinical chief of the division of gastroenterology and hepatology at Weill Cornell Medicine Center, told Healio Primary Care. Researchers reviewed data from 11,721 patients with COVID-19 who were admitted to 245 hospitals across 38 states between Feb. 15 and April 20. Among all patients, 48 received remdesivir (Gilead) and 4,232 received hydroxychloroquine. Researchers also identified a benefit to early mechanical ventilation vs. later mechanical ventilation, suggesting that perhaps there should be a lower threshold for initiating mechanical ventilation. However, this last point is very case specific and should be based on a physician’s observations, not the findings of a descriptive study.


Flu, COVID-19 or Both? Don’t Overlook Co-Infection, CDC Urges

MedPage Today, September 17, 2020

With overlapping signs and symptoms, surveillance, testing more important than ever. When a patient presents with acute respiratory symptoms this fall, clinicians should consider three options: influenza, COVID-19, or co-infection, CDC experts said. And given the likelihood that influenza and SARS-CoV-2 will be co-circulating in the community, clinicians should pay special attention to local surveillance data about each virus. On a CDC Clinician Outreach and Communication Activity call, CDC officials reminded clinicians that not only do influenza and COVID-19 have overlapping signs and symptoms, but co-infection with both has been documented in both case reports and case series. Co-infection, or even distinguishing SARS-CoV-2 from influenza, is particularly important because of the implications of treatment. For example, Uyeki noted that dexamethasone is recommended for severe COVID-19 infection in hospitalized patients, but corticosteroids actually prolong viral replication in influenza. Testing then becomes key in distinguishing the viruses, and Uyeki said that, as noted by Department of Health and Human Services officials, there are several kinds of “multiplex” assays that received FDA emergency use authorization (EUA), including some that received EUAs “this week,” he added.


Efforts to prevent COVID-19 led to global decline in flu

Infectious Disease News, September 17, 2020

Interventions to prevent SARS-CoV-2 transmission have led to a global decline in influenza during the COVID-19 pandemic, researchers reported in MMWR. In addition to causing a significant drop in the percentage of respiratory specimens that tested positive for influenza in the early days of the pandemic in the United States, measures such as mask wearing, social distancing, school closures and telework have kept positive tests at “historically low interseasonal levels,” the researchers said. The Southern Hemisphere has experienced a similar effect. If the measures continue through the fall, the influenza season in the U.S. “might be blunted or delayed,” according to the report. “The global decline in influenza virus circulation appears to be real and concurrent with the COVID-19 pandemic and its associated community mitigation measures,” Sonja J. Olsen, PhD, an epidemiologist in the CDC’s Influenza Division, and colleagues wrote. Olsen and colleagues reviewed data from around 300 U.S. laboratories in all 50 states, Puerto Rico, Guam and the District of Columbia. They also analyzed influenza laboratory data from surveillance platforms in Australia, Chile and South Africa to determine viral activity in the Southern Hemisphere.


Characterization of the Inflammatory Response to Severe COVID-19 Illness

American Journal of Respiratory and Critical Care Medicine, September 15, 2020

Coronavirus disease (COVID-19) is a global threat to health. Its inflammatory characteristics are incompletely understood. The objective here, was to define the cytokine profile ofCOVID-19 and to identify evidence of immunometabolic alterations in those with severe illness. Levels of IL-1b, IL-6, IL-8, IL-10, and sTNFR1 (soluble tumor necrosis factor receptor 1) were assessed in plasma from healthy volunteers, hospitalized but stable patients with COVID-19 (COVID stable patients), patients with COVID-19 requiring ICU admission (COVIDICU patients), and patients with severe community acquired pneumonia requiring ICU support (CAPICU patients). Immunometabolic markers were measured in circulating neutrophils from patients with severe COVID-19. The acute phase response of AAT (alpha-1 antitrypsin) to COVID-19 was also evaluated. Measurements and Main Results: IL-1b, IL-6, IL-8, and sTNFR1 were all increased in patients with COVID-19. COVIDICU patients could be clearly differentiated from COVID stable patients, and demonstrated higher levels of IL-1b, IL-6, and sTNFR1 but lower IL-10 than CAPICU patients. COVID-19 neutrophils displayed altered immunometabolism, with increased cytosolic PKM2 (pyruvate kinase M2), phosphorylated PKM2, HIF-1a (hypoxia-inducible factor1a), and lactate. The production and sialylation of AAT increased in COVID-19, but this antiinflammatory response was overwhelmed in severe illness, with the IL-6:AAT ratio markedly higher in patients requiring ICU admission (P , 0.0001). In critically unwell patients with COVID-19, increases in IL-6:AAT predicted prolonged ICU stay and mortality, whereas improvement in IL-6:AAT was associated with clinical resolution (P , 0.0001).


Post COVID-19, Lung Function Improves Over Time

WebMD, September 15, 2020

Patients who have long-term effects for weeks or months after they contract the coronavirus may see improvements in their lung function after 12 weeks, according to a new study. The study, which tracked 86 COVID-19 “long-haulers” in Austria, was presented at the European Respiratory Society International Congress last week. “The bad news is that people show lung impairment from COVID-19 weeks after discharge. The good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” Sabina Sahanic, one of the study authors and a PhD student at the University Clinic in Innsbruck, said in a statement. The research team evaluated the patients between April and June at the 6-week and 12-week points after being released from a hospital. At 6 weeks, about 88% had observable lung damage on CT scans. In addition, 47% had trouble with breathing and 15% had a persistent cough. At 12 weeks, about 56% had lung damage, 39% had trouble with breathing, and the persistent cough remained about the same. CT scans also showed that lung damage severity decreased by the 12-week mark. The damage, which occurs from inflammation and fluid in the lungs, shows up on scans as white patches known as “ground glass.” At 6 weeks, the patches showed up in nearly all of the patients, and by 12 weeks, was observable in about half of the patients. Tests showed an improvement in lung function, too. At 6 weeks, about 28% of patients had less than 80% of normal functioning, but at 12 weeks, that dropped to 19%. The 24-week checkup is underway now.


Convalescent plasma treatment of severe COVID-19: a propensity score–matched control study

Nature Medicine, September 15, 2020

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a new human disease with few effective treatments. Convalescent plasma, donated by persons who have recovered from COVID-19, is the acellular component of blood that contains antibodies, including those that specifically recognize SARS-CoV-2. These antibodies, when transfused into patients infected with SARS-CoV-2, are thought to exert an antiviral effect, suppressing virus replication before patients have mounted their own humoral immune responses. Virus-specific antibodies from recovered persons are often the first available therapy for an emerging infectious disease, a stopgap treatment while new antivirals and vaccines are being developed. This retrospective, propensity score–matched case–control study assessed the effectiveness of convalescent plasma therapy in 39 patients with severe or life-threatening COVID-19 at The Mount Sinai Hospital in New York City. Oxygen requirements on day 14 after transfusion worsened in 17.9% of plasma recipients versus 28.2% of propensity score–matched controls who were hospitalized with COVID-19 (adjusted odds ratio (OR), 0.86; 95% confidence interval (CI), 0.75–0.98; chi-square test P value = 0.025). Survival also improved in plasma recipients (adjusted hazard ratio (HR), 0.34; 95% CI, 0.13–0.89; chi-square test P = 0.027).


How COVID-19 can damage the brain

Nature, September 15, 2020

In the early months of the COVID-19 pandemic, doctors struggled to keep patients breathing, and focused mainly on treating damage to the lungs and circulatory system. But even then, evidence for neurological effects was accumulating. Some people hospitalized with COVID-19 were experiencing delirium: they were confused, disorientated and agitated. In April, a group in Japan published the first report of someone with COVID-19 who had swelling and inflammation in brain tissues. Another report described a patient with deterioration of myelin, a fatty coating that protects neurons and is irreversibly damaged in neurodegenerative diseases such as multiple sclerosis. “The neurological symptoms are only becoming more and more scary,” says Alysson Muotri, a neuroscientist at the University of California, San Diego, in La Jolla. The list now includes stroke, brain haemorrhage and memory loss. It is not unheard of for serious diseases to cause such effects, but the scale of the COVID-19 pandemic means that thousands or even tens of thousands of people could already have these symptoms, and some might be facing lifelong problems as a result. Yet researchers are struggling to answer key questions — including basic ones, such as how many people have these conditions, and who is at risk. Most importantly, they want to know why these particular symptoms are showing up.


Immunomodulators in COVID-19 – Two Sides to Every Coin

American Journal of Respiratory and Critical Care Medicine, September 14, 2020

The COVID-19 pandemic has triggered precipitous entry of multiple novel therapeutic candidates into clinical trials often without control groups, randomisation, or adequate statistical power. To this long list can be added a re-purposing of existing therapeutic strategies used for other inflammatory or viral illnesses. Our still incomplete understanding of the COVID-19 disease process, including temporal change, has driven arguably inappropriate, ill-timed or ill-judged interventions, either within trials or compassionate use. Description of the ‘cytokine storm’ epithet to COVID-19 has driven the application of immunosuppressive therapies. At the time of writing, 47 registered RCTs were evaluating inhibition of interleukin-6 (IL-6), mostly recruiting on clinical criteria alone and without incorporating measurement of circulating IL-6 levels. Although circulating IL-6 levels are higher among COVID-19 non-survivors compared to survivors, circulating IL-6 levels in COVID-19 are often 1-2 log-orders lower than other causes of ARDS or viral influenza. While there may indeed be benefit from inhibiting IL-6, timing, dosing and patient selection are key. Outcome improvements in some subsets may be diluted or counterbalanced by lack of effect or harm in others. An acceptable toxicity profile for use in other inflammatory conditions does not necessarily translate to COVID-19, especially in the critically ill subset where both the severity of the disease process and multiple iatrogenic factors magnify immunosuppression and the risk of secondary nosocomial infection. A single dose of the IL-6 inhibitor, tociluzimab, can significantly dampen any C-reactive protein and temperature response for a week.


The lasting misery of coronavirus long-haulers

Nature, September 14, 2020
Months after infection with SARS-CoV-2, some people are still battling crushing fatigue, lung damage and other symptoms of ‘long COVID’. People with more severe infections might experience long-term damage not just in their lungs, but in their heart, immune system, brain and elsewhere. Evidence from previous coronavirus outbreaks, especially the severe acute respiratory syndrome (SARS) epidemic, suggests that these effects can last for years. And although in some cases the most severe infections also cause the worst long-term impacts, even mild cases can have life-changing effects — notably a lingering malaise similar to chronic fatigue syndrome. Many researchers are now launching follow-up studies of people who had been infected with SARS-CoV-2, the virus that causes COVID-19. Several of these focus on damage to specific organs or systems; others plan to track a range of effects. In the United Kingdom, the Post-Hospitalisation COVID-19 Study (PHOSP-COVID) aims to follow 10,000 patients for a year, analysing clinical factors such as blood tests and scans, and collecting data on biomarkers. A similar study of hundreds of people over 2 years launched in the United States at the end of July. What they find will be crucial in treating those with lasting symptoms and trying to prevent new infections from lingering.


A reminder about choosing the proper code for a telehealth visit

Helio | Infectious Diseases in Children, September 14, 2020

Telehealth has helped immensely during the COVID-19 crisis. Insurance companies, although slow to approve payments, joined in to allow us to aid and interact with our patients and their families. How long this arrangement will last and how long they will waive coinsurance payments is a moving target. The AAP continues to discuss these matters with insurers. Rules have changed, confusion over which modifiers to use have been resolved and by now we are all familiar with telephone-only CPT codes 99441-3 and our old friends 99212-5 that we used for our “sick visits.” One thing has not changed, though — our fear to use 99214 and 99215, particularly when we cannot actually physically examine our patients. However, we can still use time as the main factor in choosing the proper code — 10 minutes for 99212, 15 minutes for 99213, 25 minutes for 99214 and 40 minutes for 99215. Remember, you must write down the time: For example, either 9:00 to 9:25, or 25 minutes (99214). On the other hand, do not forget that until Jan. 1, 2021, if you fulfill two-thirds of the key factors — history, physical examination and medical decision-making — you can still use 99214 with proper documentation.


Type I IFN deficiency: an immunological characteristic of severe COVID-19 patients

Signal Transduction and Targeted Therapy, September 14, 2020

Recently, a paper published in Science by Hadjadj et al. reported that type I interferon (IFN) deficiency, could be a hallmark of severe coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe COVID-19 was also associated with a lymphocytopenia, persistent blood viral load, and an exacerbated inflammatory response. These findings provide insights into the treatment of severe COVID-19 patients with type I IFN. The immunological features and mechanisms involved in COVID-19 severity are unclear. In order to test whether the severity disease can be caused by SARS-CoV-2 viral infection and hyperinflammation, Hadjadj et al. conducted a comprehensive immune analysis of grouped 50 COVID-19 patients with different disease severity. First, to identify whether the severe disease induced lymphocytopenia, Hadjadj et al. compared the peripheral blood leukocytes density of variously severe patients by combining mass cytometry with visualization of high-dimensional single-cell data based on t-distributed stochastic neighbor embedding. There is a significantly decreased density of NK cells and CD3+ T cells in severe and critical patients, while the density of B cells and monocytes was increased. The authors determined the functional status of specific T-cell subsets (CD4+/CD8+) and NK cells based on the expression of activation (CD38, HLA-DR) and exhaustion (PD-1, Tim-3) markers. They observed that the activated NK and CD4+/CD8+ T cells were increased in all infected patients, while the exhausted CD4+/CD8+ T cells and NK cells were increased in only severity patients. This result supported lymphocytopenia correlates with disease severity.


Low-Cost, Open-Source Mechanical Ventilator with Pulmonary Monitoring for COVID-19 Patients

Actuators, September 12, 2020

Since mechanical ventilators potentially expose the patient’s lungs to damage, all initiatives of constructing low-cost mechanical ventilators must provide the regulation of not only the lung’s pressure but also the positive end-expiratory pressure (PEEP). This paper shows the construction of a low-cost, open-source mechanical ventilator. The motivation for constructing this kind of ventilator comes from the worldwide shortage of mechanical ventilators for treating COVID-19 patients—the COVID-19 pandemic has been striking hard in some regions, especially the deprived ones. Constructing a low-cost, open-source mechanical ventilator aims to mitigate the effects of this shortage on those regions. The equipment documented here employs commercial spare parts only. This paper also shows a numerical method for monitoring the patients’ pulmonary condition. The method considers pressure measurements from the inspiratory limb and alerts clinicians in real-time whether the patient is under a healthy or unhealthy situation. Experiments carried out in the laboratory that had emulated healthy and unhealthy patients illustrate the potential benefits of the derived mechanical ventilator.


COVID-19 Storms: Bradykinin In, Cytokine Out?

MedPage Today, September 11, 2020

In the last week, questions have been raised about whether cytokine storm is indeed a culprit in severe COVID-19, while a paper from a government lab has made an intriguing and much-discussed case for a new mechanism, bradykinin storm. While the concepts are not necessarily mutually exclusive, scientists trying to understand how COVID-19 wreaks its damage on the human body have been buzzing about the new possibilities. The theory connects many of the disparate symptoms of COVID-19, from a loss of sense of smell and taste, to a gel-like substance forming in the lungs, and abnormal coagulation. It posits that SARS-CoV-2 disrupts both the renin-angiotensin system (RAS) and the kinin-kallikrein pathways, sending bradykinin — a peptide that dilates blood vessels and makes them leaky — out of whack. The process impedes the transfer of oxygen from the lung to the blood and subsequently to all other tissues, a common abnormality in COVID-19 patients. They found the COVID-19 cases had extremely high levels (increased nearly 200-fold) of angiotensin-converting enzyme 2 (ACE2), the surface protein used by the coronavirus to enter the cell. When the virus interacts with ACE2, it triggers an abnormal response in the bradykinin pathway, Jacobson said. At the same time, levels of angiotensin-converting enzyme, which is involved in the breakdown of bradykinin, were lower in COVID-19 patients than in controls.


Rehabilitation Levels in COVID-19 Patients Admitted to Intensive Care Requiring Invasive Ventilation: An Observational Study

Annals of the American Thoracic Society, September 11, 2020

Patients with severe COVID-19 have complex organ support needs that necessitate prolonged stays in the intensive care, likely to result in a high incidence of neuromuscular weakness and loss of well being. Early and structured rehabilitation has been associated with improved outcomes for patients requiring prolonged periods of mechanical ventilation, but at present no data are available to describe similar interventions or outcomes in COVID-19 populations. The objective of this observational study was to describe the demographics, clinical status, level of rehabilitation and mobility status at ICU discharge of patients with COVID-19. Study participants were adults admitted to ICU with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours. Rehabilitation status was measured daily using the Manchester Mobility Score (MMS) to identify the time taken to first mobilise (defined as sitting on the edge of the bed or higher) and highest level of mobility achieved at ICU discharge.


Low glycosylated ferritin is a sensitive biomarker of severe COVID-19

Cellular & Molecular Immunology, September 11, 2020

Severe forms of coronavirus disease 2019 (COVID-19) have been associated with a cytokine storm mainly involving interleukin (IL)-6, IL-1β, and TNF. Several authors have reported features of macrophage activation, thus comparing the cytokine storm of COVID-19 to reactive hemophagocytic lymphohistiocytosis (reHLH). However, these data have been balanced by other studies primarily involving IL-6 and, therefore, a mechanism closer to the complex immune dysregulation observed in sepsis. Considering these discrepancies, serum cytokine profiling may not be the best option for assessing COVID-19 severity and prognosis. Serum ferritin, an inflammatory biomarker, is elevated in most COVID-19 patients and has been correlated with severity and mortality. The measurement of the glycosylated fraction of ferritin (GF), which could be readily implemented in routine diagnosis, is of great interest in the diagnosis of reHLH (and in Still’s disease, which is frequently associated with macrophage activation syndrome). Indeed, a GF rate < 25% has a positive predictive value of 88% and a negative predictive value of 100% for reHLH. This study assessed whether the GF rate could serve as a biomarker for COVID-19 severity and prognosis.


In Pursuit of Microbiome-based Therapies for Acute Respiratory Failure

American Journal of Respiratory and Critical Care Medicine, September 10, 2020

A presumably overly robust inflammatory response has been associated with poor clinical outcomes in patients with acute respiratory failure including patients with acute respiratory distress syndrome (ARDS) and sepsis. Likewise, both abnormal gut and respiratory microbiota patterns (termed “dysbiosis”) are also predictive of increased mortality among critically ill patients. The ambitious aim of the study by Kitsios and colleagues, here, is to better define the interplay between the host inflammatory response and the lung microbiome, and the impact of this relationship on clinical outcomes in a heterogenous population of critically ill patients with acute respiratory failure. The results of this investigation represent an important step in the process of developing a microbiome-guided or based treatment for critically ill patients with acute respiratory failure. The cohort characteristics in the study by Kitsios and colleagues were typical of an intensive care unit (ICU) population with acute respiratory failure patients requiring mechanical ventilation: extrapulmonary sepsis (18%), ARDS (24%), pneumonia (40%) were common diagnoses and 32% of the patients received antibiotics prior to admission to the ICU.


Single-cell transcriptomic atlas of primate cardiopulmonary aging

Cell Research, September 10, 2020

Aging is a major risk factor for many diseases, especially in highly prevalent cardiopulmonary comorbidities and infectious diseases including Coronavirus Disease 2019 (COVID-19). Resolving cellular and molecular mechanisms associated with aging in higher mammals is therefore urgently needed. Here, we created young and old non-human primate single-nucleus/cell transcriptomic atlases of lung, heart and artery, the top tissues targeted by SARS-CoV-2. Analysis of cell type-specific aging-associated transcriptional changes revealed increased systemic inflammation and compromised virus defense as a hallmark of cardiopulmonary aging. With age, expression of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) was increased in the pulmonary alveolar epithelial barrier, cardiomyocytes, and vascular endothelial cells. We found that interleukin 7 (IL7) accumulated in aged cardiopulmonary tissues and induced ACE2 expression in human vascular endothelial cells in an NF-κB-dependent manner. Furthermore, treatment with vitamin C blocked IL7-induced ACE2 expression. Altogether, our findings depict the first transcriptomic atlas of the aged primate cardiopulmonary system and provide vital insights into age-linked susceptibility to SARS-CoV-2, suggesting that geroprotective strategies may reduce COVID-19 severity in the elderly.


New Recovery Programs Target COVID Long-Haulers

MedPage Today, September 10, 2020

Pulmonologists, cardiologists, neurologists, psychiatrists, and more join to get patients on their feet for good. Zijian Chen, MD, leads Mount Sinai’s COVID-19 recovery program, which is currently treating about 400 patients. At their first visit, patients are evaluated by a primary care physician for symptoms and referred to the appropriate specialists, Chen said. “Right now, we have almost every medical specialty working with the program,” Chen told MedPage Today. “We’re looking at a broad spectrum of disease. Some may have permanent lung fibrosis … that may last for the rest of their lives. Others have reactive airway or inflammatory problems that will subside over time. It’s unpredictable. It’s the same for cardiac symptoms and neurological symptoms.” At Hackensack Meridian’s COVID Recovery Center, primary care physicians develop a customized care plan and connect patients with specialists. Pulmonologists there have been treating patients with shortness of breath and exertional fatigue; cardiologists are treating heart function and rhythm disorders, and neurologists are treating comorbidities arising from strokes and clotting disorders, as well as neuropathy and cognitive impairment, according to program chair Laurie Jacobs, MD.


Aldeyra to undertake phase 2 trial of ADX-629 in patients hospitalized with COVID-19

Helio | Ocular Surgery News, September 10, 2020

Aldeyra Therapeutics has received a “study may proceed” letter from the FDA for a phase 2 clinical trial evaluating ADX-629 as a treatment for adult patients hospitalized with COVID-19, according to a press release. “What’s exciting about ADX-629 is its potential to act like a dimmer switch to modulate the aggressive immune response that is a hallmark of SARS-CoV-2, the virus that causes COVID-19,” Todd C. Brady, MD, PhD, president and CEO of Aldeyra, told Healio/OSN. “We’re still in the early innings in terms of clinical testing, but in animal models, ADX-629 has demonstrated a broad and highly statistically significant reduction in cytokine levels, which are critical mediators of inflammation in COVID-19. As a first-in-class, orally available inhibitor of RASP, ADX-629 has the potential to be clinically relevant not only for treating COVID-19 but also an array of inflammatory diseases that are not being adequately addressed by currently available therapies.” The trial will enroll about 30 patients with COVID-19. Enrollment will occur upon hospitalization, and patients will be treated for up to 28 days with orally administered ADX-629 or placebo twice daily. The trial’s key endpoints will include the National Institute of Allergy and Infectious Diseases COVID-19 scale, in addition to levels of cytokines and RASP.


Low Prevalence of Lung Obstruction, Restriction in COVID-19 After ICU Discharge

Pulmonology Advisor, September 9, 2020

Researchers observed a low prevalence of lung obstruction and restriction and either mild or no cognitive impairment in patients with coronavirus disease 2019 (COVID-19) approximately 6 weeks after discharge from the intensive care unit (ICU), according to findings from a small case series published in CHEST. A total of 102 patients who were admitted to a university medical center ICU with COVID-19 as of July 30, 2020, were included in this case series. All patients in underwent follow up at a post-COVID-19 ICU clinic around 6 weeks following discharge. Spirometry was used to assess lung function and exercise capacity. Lung volumes, diffusion capacity, and the 6-minute walking distance (6MWD) were also assessed. The Patient-Reported Outcomes Measurement Information System depression 8a-short score, Quality of Life in Neurological Disorders (Neuro-QoL™) adult cognitive function v2.0 score, the Montreal Cognitive assessment (MOCA) scores, and insomnia severity index were used to assess depression, cognitive function, and insomnia. The majority of patients (85.71%) required mechanical ventilation; the median number of days on ventilation was 11. The median ICU length of stay was 14 days and the median hospital length of stay was 22 days. Additionally, the median days to postdischarge clinic follow-up was 39.5 days.


AstraZeneca halts COVID-19 vaccine trial following adverse reaction in UK participant

Helio | Infectious Disease News, September 9, 2020

AstraZeneca’s phase 3 trial of a COVID-19 vaccine candidate has been put on hold because of a “suspected serious adverse reaction” in a participant from the United Kingdom, according to a report by STAT. AstraZeneca began the phase 3 trial in the United States on August 17. According to information available on clinicaltrials.gov, the trial is being held at 62 sites across the U.S., although not all locations have started enrolling participants. According to STAT, the trials were halted at all locations after a participant in the U.K. trial developed a suspected serious adverse reaction during the trial. In a statement from AstraZeneca issued to STAT, representatives said this is a “routine action” that happens whenever an unexplained illness occurs during a trial. “We are working to expedite the review of the single event to minimize any potential impact on the trial timeline,” they wrote. “We are committed to the safety of our participants and the highest standards of conduct in our trials.”


Abnormal Respiratory Vital Signs, ECG Findings May Predict Early Deterioration in COVID-19

Pulmonology Advisor, September 9, 2020

Abnormal respiratory vital signs coupled with electrocardiogram (ECG) findings of atrial fibrillation (AF)/flutter, right ventricular (RV) strain, or ST-segment abnormalities were found to predict early deterioration in patients with coronavirus disease 2019 (COVID-19), according to a study published in the Mayo Clinic Proceedings. Early triage is crucial for hospitalized patients with COVID-19 who require a higher level of care. In this study, researchers examined medical record data from 3 hospitals in New York City, New York to determine whether early data at emergency department presentation could predict the composite outcome of mechanical ventilation or death within the next 48 hours. The data of 1258 adults with COVID-19 (mean age, 61.6 years) who were hospitalized in March and April 2020 were examined. Electrophysiologists systematically read each patient’s ECG recordings conducted at presentation. A model adjusted for demographics, comorbidities, and vital signs was used to assess the prognostic value of ECG abnormalities. The most common comorbidities in this cohort included hypertension (57%), diabetes (37%), obesity (34%), primary lung disease (17%), and chronic kidney disease (16%). In this cohort, 73 patients (6%) died within 48 hours of presentation, and 14% of patients (n=174) were still alive at this time but were receiving mechanical ventilation. Another 277 patients (22%) died by 30 days. A total of 53% of all intubations occurred within 48 hours of presentation.


Pediatric COVID-19 cases surpass half-million

Infectious Diseases in Children, September 9, 2020

The AAP announced that a total of 513,415 pediatric cases of COVID-19 have been reported, according to an analysis of state-level data. The report found 70,630 new pediatric cases from August 20 to September 3 — a 16% increase from the total case count of 442,785 that was reported on August 19. “These numbers are a chilling reminder of why we need to take this virus seriously,” AAP President Sally Goza, MD, FAAP, said in a statement. “While much remains unknown about COVID-19, we do know that the spread among children reflects what is happening in the broader communities. A disproportionate number of cases are reported in Black and Hispanic children and in places where there is high poverty. We must work harder to address societal inequities that contribute to these disparities.” As of September 3, the total number of pediatric COVID-19 cases represents 9.8% of all reported cases.


Long-Term Lung, Health Issues Common in COVID-19

MedPage Today, September 8, 2020

Persistent lung issues are common following hospital discharge for COVID-19, but recovery is more the rule than the exception, according to two studies presented at the virtual European Respiratory Society International Congress. Among 86 patients admitted for COVID-19 at three hospitals in the Tyrolean Alps from late April through early June, 39% and 15% of patients, respectively, were still experiencing shortness of breath and coughing after 12 weeks, reported Sabrina Sahanic of the University Clinic of Internal Medicine in Innsbruck. Moreover, 56% showed evidence of COVID-19-related lung damage on CT scans. “COVID-19 survivors had persistent lung impairment weeks after recovery. Yet, over time, a moderate improvement is detectable,” Sahanic said at a press briefing. That was documented in a second study led by doctoral candidate Yara Al Chikhanie of Grenoble Alps University in France — another international ski destination — examining outcomes in 19 patients who had required mechanical ventilation for COVID-19.


Increased Odds of Death for Patients with Interstitial Lung Disease and COVID-19: A Case-Control Study

American Journal of Respiratory and Critical Care Medicine, September 8, 2020

Coronavirus disease 2019 (COVID-19) is an international public health emergency. While the prevalence of chronic respiratory disease in patients with COVID-19 has been reportedly low (1.5%), it is associated with increased risk of severe disease and—in chronic obstructive pulmonary disease—increased mortality. Along with numerous previously reported risk factors for severe COVID-19, it has been hypothesized that patients with interstitial lung diseases (ILD) may have poorer outcomes from COVID-19. In this letter, we present the results of a multicenter retrospective case-control study examining outcomes from COVID-19 in patients with pre-existing ILD. Adult patients (>18 years) with pre-existing ILD diagnosed with COVID-19 by real-time polymerase chain reaction (RT-PCR) or with negative RT-PCR but positive immunoglobulin M (IgM) and/or G (IgG) serology between March 1 and June 8, 2020 at six Mass General Brigham hospitals (Boston, MA) were identified using the electronic health record-integrated centralized clinical data registry. ILD was defined as physician diagnosis or, if no pulmonology visit existed in our system, ILD was defined as radiologic evidence with confirmatory histopathology.


Bedside MRI Feasible in ICU, for COVID-19

MedPage Today, September 8, 2020

A bedside low-field MRI scanner proved its mettle in Yale New Haven Hospital’s ICU, including for COVID-19 patients, clinicians there reported. Among 50 patients scanned in their ICU, the Hyperfine’s Swoop portable MRI system identified neuroimaging abnormalities for eight of the 20 on ventilation for COVID-19 (40%) and 29 of the 30 without COVID-19 (97%) reported in JAMA Neurology. No adverse events or complications occurred with the device or in-room scanning. No ICU equipment had to be removed from the room; the MRI imaging operator and bedside nurse remained in the room for the 0.064-T scans. The Swoop MRI device, which was cleared by the FDA last month for bedside use, wheels to the patient’s bedside, plugs into a standard electrical outlet, and is controlled through a wireless tablet.


The coronavirus is mutating — does it matter?

Nature, September 8, 2020

When COVID-19 spread around the globe this year, David Montefiori wondered how the deadly virus behind the pandemic might be changing as it passed from person to person. Montefiori is a virologist who has spent much of his career studying how chance mutations in HIV help it to evade the immune system. The same thing might happen with SARS-CoV-2, he thought. In March, Montefiori, who directs an AIDS-vaccine research laboratory at Duke University in Durham, North Carolina, contacted Bette Korber, an expert in HIV evolution and a long-time collaborator. Korber, a computational biologist at the Los Alamos National Laboratory (LANL) in Sante Fe, New Mexico, had already started scouring thousands of coronavirus genetic sequences for mutations that might have changed the virus’s properties as it made its way around the world. Compared with HIV, SARS-CoV-2 is changing much more slowly as it spreads. But one mutation stood out to Korber. It was in the gene encoding the spike protein, which helps virus particles to penetrate cells. Korber saw the mutation appearing again and again in samples from people with COVID-19. At the 614th amino-acid position of the spike protein, the amino acid aspartate (D, in biochemical shorthand) was regularly being replaced by glycine (G) because of a copying fault that altered a single nucleotide in the virus’s 29,903-letter RNA code. Virologists were calling it the D614G mutation.


Developing a COVID-19 mortality risk prediction model when individual-level data are not available

Nature Communications, September 7, 2020

At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a post-processing method to calibrate the predictions to reported COVID-19 case-fatality rates. With the accumulation of a COVID-19 patient cohort, this predictor is validated to have good discrimination (area under the receiver-operating characteristics curve of 0.943) and calibration (markedly improved compared to that of the baseline predictor). At a 5% risk threshold, 15% of patients are marked as high-risk, achieving a sensitivity of 88%. We thus demonstrate that even at the onset of a pandemic, shrouded in epidemiologic fog of war, it is possible to provide a useful risk predictor, now widely used in a large healthcare organization.


T cells in COVID-19 — united in diversity Nature Immunology, September 7, 2020

Comprehensive mapping reveals that functional CD4+ and CD8+ T cells targeting multiple regions of SARS-CoV-2 are maintained in the resolution phase of both mild and severe COVID-19, and their magnitude correlates with the antibody response. CD4+ and CD8+ T cells work with other constituents of a coordinated immune response to first resolve acute viral infections and then to provide protection against reinfection. Careful delineation of the frequency, specificity, functionality and durability of T cells during COVID-19 is vital to understanding how to use them as biomarkers and targets for immunotherapies or vaccines. In this issue of Nature Immunology, Peng et al. take a comprehensive approach to characterizing circulating SARS-CoV-2-specific CD4+ and CD8+ T cells following resolution of COVID-19. They report a robust and diverse T cell response targeting multiple structural and non-structural regions of SARS-CoV-2 in most resolved cases, irrespective of whether the individual had mild or severe infection. While the most frequent responses were against peptides spanning spike, membrane and nucleoprotein antigens, all eight regions tested were recognized by multiple individuals, with a maximum of 23 reactive pools in two individuals. Such multispecific T cell responses are well suited to providing a failsafe form of multilayered protection, mitigating against viral escape by mechanisms such as mutation or variable antigen presentation.


PICS: A Serious Issue for COVID-19 Survivors

MedPage Today, September 6, 2020

Even healthcare professionals may not be aware of and prepared for a condition called post-intensive care unit (ICU) syndrome (PICS) that can occur in the aftermath of COVID-19. What about those who were hospitalized for COVID-19, treated in the ICU, and are unaware of the possible long-term impact and rehabilitation phase? There is a tendency to think that once the patient is discharged from the hospital, has tested negative, and looks well, the problem is resolved. However, the struggle of COVID-19 survivors and family members or caregivers may not end there. PICS is an ongoing challenge that may potentially present a public health crisis. PICS is a term used to describe the group of impairments faced by ICU survivors. It can persist for months or years. PICS encompasses a combination of physical, neurological, social, and psychological decline. The physical impairments include intensive care-acquired weakness, classified as critical illness myopathy, neuropathy, and neuromyopathy. Cognitive and psychological impairments involve impaired memory, language, delirium, depression, anxiety, and post-traumatic stress disorder (PTSD). During the COVID-19 pandemic, critically ill clients are considered the most vulnerable to PICS. Among these, 30% suffer from depression and 70% experience anxiety and PTSD after ICU discharge. Moreover, survivors can experience additional stress as a result of isolation and limited contact with loved ones and reduced contact with staff due to precautionary measures such as personal protective equipment.


CDC: Weekly COVID-19 Deaths Down, but Still Above Epidemic Threshold

Infectious Disease Special Edition, September 4, 2020

As of Sept 4, almost 190,000 people in the United States have died from COVID-19, according to the Johns Hopkins COVID-19 Dashboard, but the weekly numbers appear to be slowing. The deaths attributed to COVID-19 during the last week of August are down, but the percentage still exceeds the epidemic threshold, according to the National Center for Health Statistics (NCHS) database. Provisional data from across the United States show that based on death certificates available on Aug. 27, the percentage of deaths attributed to COVID-19, pneumonia or influenza for week 34 was 7.9%. During week 33, it was 23.3%. In addition, the statistics show that only 6% of deaths listed just COVID-19 as a cause of death. Most certificates list comorbid conditions, such as respiratory and cardiovascular conditions, as contributors to the deaths. “In 94% of deaths with COVID-19, other conditions are listed in addition to COVID-19,” the NCHS told Infectious Disease Special Edition. “These causes may include chronic conditions like diabetes or hypertension. They may also include acute conditions that occurred as a result of COVID-19, such as pneumonia or respiratory failure.”


Invasive fungal disease common among critically ill COVID-19 patients, study finds

Helio | Infectious Disease News, September 4, 2020

Invasive fungal disease occurs often in critically ill patients with COVID-19 on mechanical ventilation, according to a study published in Clinical Infectious Diseases. “With the COVID-19 pandemic far from over, it is paramount that our understanding of the risk from associated invasive fungal disease is enhanced,” P. Lewis White, PhD, FECMM, FRCPath, consultant clinical scientist and head of the mycology reference laboratory for Public Health Wales, told Healio. White and colleagues screened 135 patients with COVID-19 for invasive fungal disease to evaluate an enhanced testing strategy. The patients were from a national, multicenter cohort in Wales. The incidence of invasive fungal disease was 26.7% — 14.1% aspergillosis and 12.6% yeast infections. The overall mortality rate was 38%, including 53% in patients with fungal disease and 31% in patients without it (P = .0387). The overall mortality rate declined when antifungal therapy was used. It was 38.5% in patients who received antifungal therapy vs. 90% in patients who did not (P = .008). White said they did not expect the high rate of invasive yeast infections.


Will Labor Day Weekend Bring Another Holiday COVID Surge?

Kaiser Health News, September 4, 2020

Hopefully, summer won’t end the way it began. Memorial Day celebrations helped set off a wave of coronavirus infections across much of the South and West. Gatherings around the Fourth of July seemed to keep those hot spots aflame. And now Labor Day arrives as those regions are cooling off from COVID-19. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned Wednesday that Americans should be cautious to avoid another surge in infection rates. But travelers are also weary of staying home — and tourist destinations are starved for cash. “Just getting away for an hour up the street and staying at a hotel is like a vacation, for real,” says Kimberly Michaels, who works for NASA in Huntsville, Alabama, and traveled to Nashville, Tennessee, with her boyfriend to celebrate his birthday last weekend. In time for the tail end of summer, many local governments are lifting restrictions to resuscitate tourism activity and rescue small businesses.


COVID-19 impact on treatment for chronic illness revealed

UN News, September 4, 2020

The four most common NCDs are cardiovascular disease, cancer, diabetes and chronic respiratory diseases; together, they contribute to more than 40 million deaths a year, said Dr Bente Mikkelsen, Director, WHO Division of Noncommunicable Diseases. “The most recent study shows that there is a disruption in healthcare services including NCD diagnosis and treatments in 69 per cent of cases”, she said. “In cancer, there are the highest numbers, with 55 per cent of people living with cancer (having) their health services disrupted.” Dr Mikkelsen noted that those living with one or more NCDs were among the most likely to become severely ill and die from the new coronavirus. Studies from several countries had indicated this, she said, highlighting how data on indigenous communities in Mexico, showed that diabetes was the most commonly found disease among COVID-19 fatalities. Research also found that in Italy, of those who succumbed to COVID-19 in hospital, 67 per cent suffered from hypertension and 31 per cent had type 2 diabetes.


Early outcomes show survival benefit with ECMO support in severe COVID-19

Helio | Pulmonology, September 3, 2020

Early outcomes of a single-center study demonstrate clinical benefit of extracorporeal membrane oxygenation support in patients with severe COVID-19, according to a study published in The Annals of Thoracic Surgery. “Our experience differs from other published data which suggested that ECMO is of limited value for patients with COVID-19. Although still early in many of these patients’ clinical courses, these initial outcomes are encouraging with an overall current survival of 96%, with nearly half of the patients already weaned from ECMO support, mechanical ventilation and supplemental oxygen. Furthermore, a significant number of these patients have been discharged from the hospital,” Zachary N. Kon, MD, cardiothoracic surgeon in the department of cardiothoracic surgery at NYU Langone Health, and colleagues wrote. Researchers conducted a retrospective analysis of 321 endotracheal-intubated patients with COVID-19 from March 10 to April 24, 2020. Of those, 77 (24%) were evaluated for ECMO support. ECMO support was selected based on patients’ partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio less than 150 mm Hg or pH less than 7.25 with an arterial partial pressure of carbon dioxide greater than 60 mm Hg. Patients were cannulated and managed with protective lung ventilation, early tracheostomy, bronchoscopies and proning in NYU Langone Health’s Manhattan campus ICU.


FDA Could Issue EUA for COVID-19 Vaccine Before Clinical Trials Are Completed

Pulmonology Advisor, September 3, 2020

Emergency use authorization (EUA) or approval for a COVID-19 vaccine before phase 3 clinical trials are complete could be considered by the U.S. Food and Drug Administration, according to the agency’s commissioner, Stephen Hahn, M.D. “It is up to the sponsor [vaccine developer] to apply for authorization or approval, and we make an adjudication of their application,” he told the Financial Times, CNN reported. “If they do that before the end of phase 3, we may find that appropriate. We may find that inappropriate, we will make a determination.” An EUA is not the same as full-fledged approval, Hahn noted. “Our emergency use authorization is not the same as a full approval,” he said. “The legal, medical, and scientific standard for that is that the benefit outweighs the risk in a public health emergency.” Two vaccines are currently in phase 3 trials in the United States and two more are expected to begin phase 3 trials by mid-September, CNN reported.


Technology Aids Fight Against COVID-19 — Nine innovations in health tech that help to manage the pandemic

MedPage Today, September 3, 2020

As the COVID-19 cases continue to rise across the globe, companies are working hard to develop innovative solutions to fight the coronavirus pandemic. Chinese companies such as Alibaba have led the way using artificial intelligence, data science, and technology. Startups are teaming up with clinicians, engineers, and government entities to reduce the spread of COVID-19. As we continue our fight in the management and eventual eradication of the virus, read about nine innovative ways companies are helping on the front lines.


Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19 – The CoDEX Randomized Clinical Trial

Journal of the American Medical Association, September 2, 2020

In patients with coronavirus disease 2019 (COVID-19) and moderate or severe acute respiratory distress syndrome (ARDS), does intravenous dexamethasone plus standard care compared with standard care alone increase the number of days alive and free from mechanical ventilation? ARDS due to COVID-19 is associated with substantial mortality and use of health care resources. Dexamethasone use might attenuate lung injury in these patients. The objective of the clinical trial was to determine whether intravenous dexamethasone increases the number of ventilator-free days among patients with COVID-19–associated ARDS. This multicenter, randomized, open-label, clinical trial was conducted in 41 intensive care units (ICUs) in Brazil. Patients with COVID-19 and moderate to severe ARDS, according to the Berlin definition, were enrolled from April 17 to June 23, 2020. Final follow-up was completed on July 21, 2020. The trial was stopped early following publication of a related study before reaching the planned sample size of 350 patients. Twenty mg of dexamethasone intravenously daily for 5 days, 10 mg of dexamethasone daily for 5 days or until ICU discharge, plus standard care (n =151) or standard care alone (n = 148).


Fewer serious asthma events in Philadelphia after COVID-19 stay-at-home orders

Helio | Pulmonology, September 2, 2020

Public health interventions and stay-at-home orders issued in March in the Philadelphia region to limit the transmission of COVID-19 also led to a marked decrease in health care visits for outpatient and hospitalized patients with asthma. Researchers with the Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania reviewed electronic health records to analyze asthma-related encounters and weekly summaries of respiratory viral testing in the 60 days leading up to March 17, when Philadelphia issued a series of stay-at-home orders, compared with the 60 days following stay-at-home orders. They found a 60% decrease in total daily asthma health care visits across CHOP’s hospital and Care Network, according to data published in The Journal of Allergy and Clinical Immunology: In Practice. Further, fewer rhinovirus infections due to mask wearing, social distancing and hygiene measures may have contributed to these findings, the researchers reported. After March, in-person asthma encounters decreased by 87% in the outpatient setting and by 84% in the emergency and inpatient settings, according to the findings. During the pandemic, video telemedicine was the most-utilized modality for asthma encounters and was used in 61% of all visits, while telephone encounters increased by 19%. During the same period, the researchers observed decreases in asthma-related systemic steroid prescriptions and the frequency of rhinovirus test positivity.


Understanding the Association Between COVID-19, Thromboembolism, and Therapeutic Anticoagulation

Pulmonology Advisor, September 2, 2020

Among hospitalized patients with coronavirus disease 2019 (COVID-19), those who receive anticoagulation treatment have lower adjusted risk of mortality and intubation compared with in-hospital patients who do not receive anticoagulation, according to study results published in the Journal of the American College of Cardiology. A team of investigators at Icahn School of Medicine at Mount Sinai in New York, New York, expanded on previous findings that suggested an association between in-hospital anticoagulation and reduced mortality. In the present investigation, the researchers compared the effects of therapeutic and prophylactic anticoagulation treatment with the absence of such treatment. Choice of agent, survival outcomes, intubation, and major bleeding were also analyzed. In addition, the study authors also reviewed the first consecutive autopsies performed at their institution to characterize the premortem management of this patient population as it relates to anticoagulation therapy. The primary outcome was in-hospital mortality, and secondary outcomes included intubation and major bleeding. Participants were all older than 18 years, had clinically confirmed severe acute respiratory syndrome coronavirus 2 infection between March 1, 2020, and April 30, 2020, and were admitted to 1 of 5 New York City hospitals included in the study.


Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 – A Meta-analysis

Journal of the American Medical Association, September 2, 2020

Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support. The objective of this analysis was to estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality. Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I2 statistic. The primary analysis was an inverse variance–weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance–weighted fixed-effect analysis using risk ratios. Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients).


Kevzara fails to meet endpoints in ex-US phase 3 trial for severe COVID-19

Helio | Rheumatology, September 2, 2020

Sanofi announced that its IL-6 inhibitor Kevzara failed to meet primary and secondary endpoints in a phase 3 trial of patients outside the United States hospitalized with severe COVID-19. “Although this trial did not yield the results we hoped for, we are proud of the work that was achieved by the team to further our understanding of the potential use of Kevzara for the treatment of COVID-19,” John Reed, MD, PhD, global head of research and development at Sanofi, said in a company press release. The randomized trial included 420 patients who were severely or critically ill with COVID-19, recruited from hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia and Spain. Among the participants, 161 received 200 mg of Kevzara (sarilumab), 173 were treated with 400 mg and 86 received a placebo. According to the press release, although not statistically significant, the researchers observed numerical trends toward a decrease in hospital stay duration as well as faster time to better clinical outcomes, defined as a two-point improvement on a seven-point scale. In addition, the researchers noted a trend toward reduced mortality in the critical patient group, but not in the severe group. Lastly, the time to discharge was reduced by 2 to 3 days among patients who received sarilumab within the first 2 weeks of treatment, although, again, this was not statistically significant.


Safety, Immunogenicity of Investigational Inactivated Whole-Virus COVID-19 Vaccine

Pulmonology Advisor, September 1, 2020

An investigational inactivated whole-virus coronavirus disease 2019 (COVID-19) vaccine has demonstrated safety and immunogenicity, according to the results of an interim analysis published in JAMA. The study authors examined safety outcomes 28 days, and immunogenicity outcomes 14 days after 3 doses in a phase 1 trial and 2 doses in a phase 2 trial of an inactivated COVID-19 vaccine candidate in healthy adults in China. The double-blind, randomized, placebo-controlled study was designed by the Wuhan Institute of Biological Products Co Ltd, and Henan Provincial Center for Disease Control and Prevention (CDC). Healthy adults aged 18 to 59 years without a history of severe acute respiratory syndrome coronavirus (SARS-CoV) or SARS-CoV-2 infection were eligible for enrollment. Currently, there are 160 COVID-19 candidate vaccines in various stages of development, with 25 in different phases of clinical trials. This is the first report of phase 1 and 2 clinical trials of a whole virus-inactivated COVID-19 vaccine in adults.


Comparing Asthma Complications in COVID-19 With Flu

ContagionLive, August 31, 2020

A research letter published in Annals of the American Thoracic Society has challenged US Centers for Disease Control and Prevention (CDC) assumptions that those with asthma are at higher risk for severe SARS-CoV-2 infection. Research was led by Fernando Holguin, MD, MPH, of the Pulmonary Division at University of Colorado’s Anschutz Medical Campus. People living with asthma often make up more than 20 percent of those hospitalized in the United States during the annual influenza season. For SARS-CoV-2, several noteworthy risk factors for hospitalization such as hypertension, diabetes, chronic obstructive pulmonary disease, and obesity have been demonstrated. Amid the outbreak of Middle East Respiratory Syndrome (MERS), there was sparse evidence asthma patients may be at higher risk. But the underwhelming proportion of people with asthma among patients across several international studies raises questions about asthma as a particular risk factor when it comes to being hospitalized for coronavirus disease 2019 (COVID-19). The study team examined asthma prevalence among patients hospitalized for COVID-19 reported in 15 studies with population asthma prevalence and a 4-year average of asthma prevalence in influenza hospitalizations across the United States.


Coronavirus in Context: Do Antibodies Provide Protection?

WebMD, August 31, 2020

[Video] What’s the role of antibodies against coronavirus infection? It’s one of the biggest questions over the past six months. WebMD’s Chief Medical Officer, Dr. John Whyte, speaks with Alexander Greninger, MD, PhD, Assistant Director of the UW Medicine Clinical Virology Laboratory, University of Washington, about the effectives of antibodies for COVID-19 immunity and transmission.


1st U.S. COVID-19 Reinfection Reported in Nevada Patient

WebMD, August 31, 2020

The first U.S. case of a confirmed coronavirus reinfection looks to be a patient in Nevada. The U.S. case comes a few days after the first reinfection in the world was announced in Hong Kong. The Nevada case is detailed in a new paper published in The Lancet on an online preprint server. The study has not yet been reviewed by peers. Reinfection is rare, researchers said, but people should still be cautious. “If you’ve had it, you can’t necessarily be considered invulnerable to the infection,” Mark Pandori, one of the authors and director of the Nevada State Public Health Laboratory, told NBC. According to the report, the 25-year-old man from Reno, Nevada, first tested positive for COVID-19 in mid-April after experiencing a sore throat, cough, headache, nausea, and diarrhea. He recovered but got sick again in late May, marking 48 days between two positive tests after two negative tests in between the infections. During the second round, his illness was more severe, and he was hospitalized with pneumonia. Researchers found that the genetic sequencing of the virus varied, and the patient was infected with slightly different strains of the coronavirus. They aren’t sure why he was reinfected, which could be related to the virus itself or the patient’s immune system.


Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience

Interactive CardioVascular and Thoracic Surgery, August 31, 2020

Pneumothorax, a major and potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. The rate of pneumothorax in such patients has not yet been quantified. However, previous experience from the SARS outbreak, also caused by a coronavirus, suggests a high incidence (20–34%) of pneumothorax in mechanically ventilated SARS patients. Mechanical ventilation is the most common cause of iatrogenic pneumothoraces in the ICU setting; however, it is a rare occurrence in intubated patients who have relatively normal lung parenchyma. Most pneumothoraces related to mechanical ventilation are associated with a combination of high ventilation pressures and underlying chronic lung pathology such as emphysema. Previous studies have suggested that high inspiratory airway pressures and positive end-expiratory pressure were correlated with increased incidence of barotrauma. Currently, there is limited literature on how to manage pneumothoraces in mechanically ventilated COVID-19 patients. We present a case series (nine patients) and a suggested protocol for how to manage and treat pneumothoraces in COVID-19 patients in an ICU setting.


Duration of COVID-19: Data from an Italian Cohort and Potential Role for Steroids

Microorganisms, August 31, 2020
The diffusion of SARS-CoV-2, starting from China in December 2019, has led to a pandemic, reaching Italy in February 2020. Previous studies in Asia have shown that the median duration of SARS-CoV-2 viral shedding was approximately 12–20 days. We considered a cohort of patients recovered from COVID-19 showing that the median disease duration between onset and end of COVID-19 symptoms was 27.5 days (interquartile range (IQR): 17.0–33.2) and that the median duration between onset of symptoms and microbiological healing, defined by two consecutive negative nasopharyngeal swabs, was 38 days (IQR: 31.7–50.2). A longer duration of COVID-19 with delayed clinical healing (symptom-free) occurred in patients presenting at admission a lower PaO2/FiO2 ratio (p < 0.001), a more severe clinical presentation (p = 0.001) and a lower lymphocyte count (p = 0.035). Moreover, patients presenting at admission a lower PaO2/FiO2 ratio and more severe disease showed longer viral shedding (p = 0.031 and p = 0.032, respectively). In addition, patients treated with corticosteroids had delayed clinical healing (p = 0.013).


New insights into the cell- and tissue-specificity of glucocorticoid actions

Cellular & Molecular Immunology, August 31, 2020

Glucocorticoids (GCs) are endogenous hormones that are crucial for the homeostasis of the organism and adaptation to the external environment. Because of their anti-inflammatory effects, synthetic GCs are also extensively used in clinical practice. However, almost all cells in the body are sensitive to GC regulation. As a result, these mediators have pleiotropic effects, which may be undesirable or detrimental to human health. This articles summarizes the recent findings that contribute to deciphering the molecular mechanisms downstream of glucocorticoid receptor activation. Also discussed, is the complex role of GCs in infectious diseases such as sepsis and COVID-19, in which the balance between pathogen elimination and protection against excessive inflammation and immunopathology needs to be tightly regulated. An understanding of the cell type- and context-specific actions of GCs from the molecular to the organismal level would help to optimize their therapeutic use. Here, we highlight the many levels of GR-mediated regulation that have been identified so far and may help to predict the effect of GCs from the molecular to the organismal level. Taking this complexity into account, we also summarize the pathways regulated by endogenous and synthetic GCs in lymphocytes and myeloid cells. Finally, we use sepsis as an example of a pathological condition for which molecular and cellular studies can improve predictions regarding the systemic response to GCs. We stress the need for cell-targeted GC therapy to prevent not only the well-known adverse effects of GCs but also those effects that may reduce treatment efficacy.


Fad or future? Telehealth expansion eyed beyond pandemic

Modern Healthcare, August 30, 2020

Consultations via tablets, laptops and phones linked patients and doctors when society shut down in early spring. Telehealth visits dropped with the reopening, but they’re still far more common than before and now there’s a push to make them widely available in the future. Permanently expanding access will involve striking a balance between costs and quality, dealing with privacy concerns and potential fraud, and figuring out how telehealth can reach marginalized patients, including people with mental health problems. “I don’t think it is ever going to replace in-person visits, because sometimes a doctor needs to put hands on a patient,” said CMS Administrator Seema Verma, the Trump administration’s leading advocate for telehealth. Caveats aside, “it’s almost a modern-day house call,” she added. “It’s fair to say that telemedicine was in its infancy prior to the pandemic, but it’s come of age this year,” said Murray Aitken of the data firm IQVIA, which tracks the impact. In the depths of the coronavirus shutdown, telehealth accounted for more than 40% of primary care visits for patients with traditional Medicare, up from a tiny 0.1% sliver before the public health emergency. As the government’s flagship health care program, Medicare covers more than 60 million people, including those age 65 and older, and younger disabled people.


Findings from a probability-based survey of U.S. households about prevention measures based on race, ethnicity, and age in response to SARS-CoV-2

Journal of Infectious Diseases, August 29, 2020

There are 21.7 million reported cases of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and over 776,000 deaths due to the coronavirus disease 2019 (COVID-19) worldwide through August 17, 2020. Over one-fourth of cases are in the U.S., with African American and Latinos being disproportionately impacted in case counts and death rates. Prevention control messages and efforts, such as sheltering in place and quarantining, may not have been as successful among African Americans and Latinos for numerous reasons, such as needing to work outside of the home, living in large households in close quarters, and including the effects of structural racism (i.e., access to health insurance and care, limited health literacy). Little is known about individual prevention measures that were taken in response to COVID-19 or how people may engage with surveillance/reporting strategies as we enter phase two of the pandemic. We investigated individual behaviors taken by White, African American, and Latino U.S. households in response to SARS-CoV-2, and likelihood of using digital tools for symptom surveillance/reporting. We analyzed cross-sectional week one data (April 2020) of the COVID Impact Survey in a large, nationally-representative sample of U.S. adults. In general, all groups engaged in the same prevention behaviors, but Whites reported being more likely to use digital tools to report/act on symptoms and seek testing, versus African Americans and Latinos.


Fauci on ‘Highly Specific, Direct’ Therapy for COVID-19

MedPage, August 28, 2020

Monoclonal antibodies could hold promise in COVID-19 treatment and prevention if the results bear out in clinical trials for efficacy, the nation’s leading infectious diseases expert told MedPage Today. “There’s a lot of activity and it’s a highly concentrated, highly specific, direct antiviral approach to a number of diseases. The success in Ebola was very encouraging,” said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD. Most recently thrust into the spotlight as effective treatments for Ebola, monoclonal antibodies are currently being researched as a potential treatment for HIV, as well as COVID-19. This month, the NIH highlighted trials of monoclonal antibodies being conducted among several different COVID-19 patient populations: outpatients with COVID-19, patients hospitalized with the disease, and even a trial in household contacts of confirmed cases, where the therapy was used as prophylaxis. Fauci explained how the mechanism of monoclonal antibodies “is really one of a direct antiviral. It’s like getting a neutralizing antibody that’s highly, highly concentrated and highly, highly specific. So, the mechanism involved is blocking of the virus from essentially entering its target cell in the body and essentially interrupting the course of infection,” he said.


The FIB-4 Index Is Associated with Need for Mechanical Ventilation and 30-day Mortality in Patients Admitted with COVID-19

Journal of Infectious Diseases, August 28, 2020

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), can be associated with a severe systemic disease leading to respiratory failure and the need for mechanical ventilation. Patients with underlying medical comorbidities, such as respiratory, cardiac, and liver disease, diabetes mellitus (DM), and obesity are at higher risk for respiratory failure. Therefore, prediction factors are needed to help front line providers to identify who might be at higher risk for intensive care and ventilator support for respiratory failure. The fibrosis-4 index (FIB-4), developed to predict fibrosis in liver disease, was used to identify patients with COVID-19 who will require ventilator support as well as associated with 30-day mortality. Multivariate analysis found obesity (OR 4.5), diabetes (OR 2.55), and FIB-4 ≥ 2.67 (OR 3.09) independently associated with need for mechanical ventilation. When controlling for ventilator use, gender, and comorbid conditions, FIB-4 ≥ 2.67 was also associated with increased 30-day mortality (OR 8.4; 95% CI 2.23-31.7). While it may not be measuring hepatic fibrosis, its components suggest that increases in FIB-4 may be reflecting systemic inflammation associated with poor outcomes.


Sudden Cardiac Arrest in a Patient with Myxedema Coma and COVID-19

Journal of the Endocrine Society, August 28, 2020

SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of COVID-19. We present the first case of myxedema coma in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multi-organ damage and sudden cardiac arrest in our patient. A 69-year-old female with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyroid stimulating hormone, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died two days later from multi-organ failure. This is the first report of SARS-CoV-2 infection with myxedema coma. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and myxedema coma – all of which were associated with the patient’s SARS-CoV-2 infection.


The coronavirus is most deadly if you are older and male — new data reveal the risks

Nature, August 28, 2020

For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19. Trends in coronavirus deaths by age have been clear since early in the pandemic. Research teams looking at the presence of antibodies against SARS-CoV-2 in people in the general population — in Spain, England, Italy and Geneva in Switzerland — have now quantified that risk, says Marm Kilpatrick, an infectious-disease researcher at the University of California, Santa Cruz. The studies reveal that age is by far the strongest predictor of an infected person’s risk of dying — a metric known as the infection fatality ratio (IFR), which is the proportion of people infected with the virus, including those who didn’t get tested or show symptoms, who will die as a result. “COVID-19 is not just hazardous for elderly people, it is extremely dangerous for people in their mid-fifties, sixties and seventies,” says Andrew Levin, an economist at Dartmouth College in Hanover, New Hampshire, who has estimated that getting COVID-19 is more than 50 times more likely to be fatal for a 60-year-old than is driving a car. But “age cannot explain everything”, says Henrik Salje, an infectious-disease epidemiologist at the University of Cambridge, UK. Gender is also a strong risk factor, with men almost twice more likely to die from the coronavirus than women.


Heparin may neutralize virus that causes COVID-19

Helio | HemOnc Today, August 28, 2020

The COVID-19 pandemic has prompted a flurry of scientific studies of various potential treatments and vaccines for the novel coronavirus. One such study, conducted by researchers at Rensselaer Polytechnic Institute and published in Antiviral Research, showed the FDA-approved anticoagulant heparin may neutralize SARS-CoV-2, the virus that causes COVID-19. SARS-CoV-2 uses a surface spike protein to attach to human cells and infect them, according to the study background. However, because heparin binds tightly with the surface spike protein, it potentially could serve as a decoy and prevent infection from occurring. “We’ve known for quite some time that heparin possesses the ability to be antiviral; it has the ability to bind to very specific proteins on the surfaces of viruses,” Jonathan S. Dordick, PhD, the Howard P. Isermann Professor of Chemical and Biological Engineering at Rensselaer and one of the study authors, said in an interview with Healio. “So that wasn’t really a surprise. The other reason we studied heparin had nothing to do with its antiviral properties.”


Trial Evaluating Half-Life Extended Monoclonal Antibodies for COVID-19 Begins

Pulmonary Advisor, August 27, 2020

A phase 1 study of AstraZeneca’s investigational monoclonal antibody AZD7442 for the prevention and treatment of coronavirus disease 2019 (COVID-19) has been initiated. AZD7442 is a combination of 2 monoclonal antibodies derived from convalescent patients who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The monoclonal antibodies have been optimized with an extended half-life to afford at least 6 months of protection from COVID-19. According to preclinical data recently published in Nature, the monoclonal antibodies protect against infection by blocking SARS-CoV-2 virus from binding to host cells. The randomized, double-blind, placebo-controlled phase 1 study will evaluate the safety, tolerability, and pharmacokinetics of AZD7442 in up to 48 healthy participants aged 18 to 55 years. The study is funded by the Defense Advanced Research Projects Agency (DARPA) and the Biomedical Advanced Research and Development Authority (BARDA) at the US Department of Health and Human Services.


Sex differences in immune responses that underlie COVID-19 disease outcomes

Nature, August 26, 2020

A growing body of evidence reveals that male sex is a risk factor for a more severe disease, including death. Globally, ~60% of deaths from COVID-19 are reported in men, and a cohort study of 17 million adults in England reported a strong association between male sex and risk of death from COVID-19 (hazard ratio 1.59, 95% confidence interval 1.53-1.65. .53-1.65). Past studies have demonstrated that sex has a significant impact on the outcome of infections and has been associated with underlying differences in immune response to infection. For example, prevalence of hepatitis A and tuberculosis are significantly higher in men compared with women. Viral loads are consistently higher in male patients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Conversely, women mount a more robust immune response to vaccines. However, the mechanism by which SARS-CoV-2 causes more severe disease in male patients than in female patients remains unknown. To elucidate the immune responses against SARS-CoV-2 infection in men and women, we performed detailed analysis on the sex differences in immune phenotype via the assessment of viral loads, SARS-CoV-2 specific antibody levels, plasma cytokines/chemokines, and blood cell phenotypes.


The Transformational Effects of COVID-19 on Medical Education

JAMA Network, August 26, 2020

[Podcast] The onset of the COVID-19 pandemic and the public health response required to minimize the catastrophic spread of the disease required an immediate change in the traditional approach to medical education and clearly amplified the need for expanding the competencies of the US physician workforce. Medical educators responded at the local and national levels to outline concerns and offer guiding principles so that academic health systems could support a robust public health response while ensuring that physician graduates are prepared to contribute to addressing current and future threats to the health of communities. While each school approached their response somewhat differently, several common themes have emerged. Join Howard Bauchner, MD, Editor in Chief of JAMA, as he interviews Catherine Lucey, MD, FACP, Department of Medicine, University of California San Francisco School of Medicine and author of The Transformational Effects of COVID-19 on Medical Education.


HF Nasal Cannula Oxygen Reduces Mechanical Ventilation Rates in Severe COVID-19

Pulmonology Advisor, August 26, 2020

High flow nasal cannula oxygen (HFNC) significantly reduced intubation and subsequent invasive mechanical ventilation, but did not affect case fatality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) for acute respiratory failure, according to study results published in the American Journal of Respiratory and Critical Care Medicine. Symptomatic management to restore oxygenation of severe acute respiratory failure is key during the COVID-19 pandemic, according to the authors of this retrospective study. HFNC has been shown to improve oxygenation, and reduce minute ventilation and the work of breathing in severe de novo acute hypoxemic respiratory failure. Thus, researchers in Paris, France, tested the hypothesis that HFNC reduces the rates of intubation and mortality in 379 critically ill patients admitted to the ICU for acute respiratory failure between February 21 and April 24, 2020. Overall, 146 (39%) patients received HFNC (all within the first 24 hours following ICU admission) and were compared with 233 patients who did not. The percentage of patients requiring invasive mechanical ventilation at day 28 was 56% in the HFNC group vs 75% in those who did not receive HFNC (P <.0001), and mortality at day 28 was 21% vs 30%, respectively.


Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Clinical Imaging, August 26, 2020

Subcutaneous emphysema (SE) and pneumomediastinum refer to the presence of air in the subcutaneous tissue and mediastinum, respectively. Spontaneous pneumomediastinum (SPM) results from a sudden rise in intra-alveolar pressure (such as in the setting of reactive airways disease, Valsalva maneuver, cough, emesis, and barotrauma), resulting in the rupture of alveoli and subsequent dissection of air along the bronchovascular sheath into the mediastinum (Macklin effect). Air may then enter the pleural, pericardial, and peritoneal spaces or the soft tissues of the chest wall, neck, or face causing subcutaneous cervicothoracic emphysema. On their own, these conditions are not typically life-threatening and often resolve with conservative treatment. However, they may indicate the presence of severe underlying pathology. While SE and SPM have been observed in patients with a variety of viral pneumonias as a complication of mechanical ventilation, the development of these conditions in non-intubated patients suggests an alternative etiology. A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist.


Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (Covid-19)

International Journal of Environmental Research and Public Health, August 26, 2020

Healthcare workers (HCWs) facing COVID-19 pandemic represented an at-risk population for new psychosocial COVID-19 strain and consequent mental health symptoms. The aim of the present study was to identify the possible impact of working contextual and personal variables (age, gender, working position, years of experience, proximity to infected patients) on professional quality of life, represented by compassion satisfaction (CS), burnout, and secondary traumatization (ST), in HCWs facing COVID-19 emergency. Further, two multivariable linear regression analyses were fitted to explore the association of mental health selected outcomes, anxiety and depression, with some personal and working characteristics that are COVID-19-related. A sample of 265 HCWs of a major university hospital in central Italy was consecutively recruited at the outpatient service of the Occupational Health Department during the acute phase of COVID-19 pandemic. HCWs were assessed by Professional Quality of Life-5 (ProQOL-5), the Nine-Item Patient Health Questionnaire (PHQ-9), and the Seven-Item Generalized Anxiety Disorder scale (GAD-7) to evaluate, respectively, CS, burnout, ST, and symptoms of depression and anxiety. Females showed higher ST than males, while frontline staff and healthcare assistants reported higher CS rather than second-line staff and physicians, respectively. Burnout and ST, besides some work or personal variables, were associated to depressive or anxiety scores.


Prediction and Analysis of SARS-CoV-2-Targeting MicroRNA in Human Lung Epithelium

Genes, August 26, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an RNA virus, is responsible for the coronavirus disease 2019 (COVID-19) pandemic of 2020. Experimental evidence suggests that microRNA can mediate an intracellular defence mechanism against some RNA viruses. The purpose of this study was to identify microRNA with predicted binding sites in the SARS-CoV-2 genome, compare these to their microRNA expression profiles in lung epithelial tissue and make inference towards possible roles for microRNA in mitigating coronavirus infection. We hypothesize that high expression of specific coronavirus-targeting microRNA in lung epithelia may protect against infection and viral propagation, conversely, low expression may confer susceptibility to infection. We have identified 128 human microRNA with potential to target the SARS-CoV-2 genome, most of which have very low expression in lung epithelia. Six of these 128 microRNA are differentially expressed upon in vitro infection of SARS-CoV-2. Additionally, 28 microRNA also target the SARS-CoV genome while 23 microRNA target the MERS-CoV genome. We also found that a number of microRNA are commonly identified in two other studies. Further research into identifying bona fide coronavirus targeting microRNA will be useful in understanding the importance of microRNA as a cellular defence mechanism against pathogenic coronavirus infections.


Compartmentalized Replication of SARS-Cov-2 in Upper vs. Lower Respiratory Tract Assessed by Whole Genome Quasispecies Analysis

Microorganisms, August 26, 2020

We report whole-genome and intra-host variability of SARS-Cov-2 assessed by next generation sequencing (NGS) in upper (URT) and lower respiratory tract (LRT) from COVID-19 patients. The aim was to identify possible tissue-specific patterns and signatures of variant selection for each respiratory compartment. Six patients, admitted to the Intensive Care Unit, were included in the study. Thirteen URT and LRT were analyzed by NGS amplicon-based approach on Ion Torrent Platform. Bioinformatic analysis was performed using both realized in-house and supplied by ThermoFisher programs. Phylogenesis showed clade V clustering of the first patients diagnosed in Italy, and clade G for later strains. The presence of quasispecies was observed, with variants uniformly distributed along the genome and frequency of minority variants spanning from 1% to ~30%. For each patient, the patterns of variants in URT and LRT were profoundly different, indicating compartmentalized virus replication. No clear variant signature and no significant difference in nucleotide diversity between LRT and URT were observed. SARS-CoV-2 presents genetic heterogeneity and quasispecies compartmentalization in URT and LRT. Intra-patient diversity was low. The pattern of minority variants was highly heterogeneous and no specific district signature could be identified, nevertheless, analysis of samples, longitudinally collected in patients, supported quasispecies evolution.


After Care of Survivors of COVID-19—Challenges and a Call to Action

JAMA Health Forum, August 26, 2020

For most patients with severe illness requiring hospitalization, COVID-19 has been a frightening and life-changing experience. At the peak of the pandemic, the attention of health care teams was focused on saving lives and protecting health services from being overwhelmed. Those who survived were often discharged without a robust process of follow-up. The prevalence of post–COVID-19 complications is not yet fully known and may only become apparent in the months and years to come. Data from previous coronavirus (severe acute respiratory syndrome coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus [MERS-CoV]) outbreaks indicate that between 20% and 40% of survivors experience long-term complications. In a recent report of 143 patients with COVID-19 who were evaluated a mean of 2 months after hospital discharge at a follow-up clinic in Rome, Italy, many patients reported persistent fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%), and chest pain (21.7%). Drawing on these experiences, respiratory, cardiovascular, neurologic, metabolic, and psychosocial complications may be important long-term sequelae of COVID-19. It is therefore essential that systems are in place for timely and thorough identification of such sequelae followed by appropriate interventions. We discuss the challenges we have addressed in establishing a multidisciplinary COVID-19 follow-up clinic in a secondary care setting at the University Hospital of Birmingham, England.


Inhaled steroids reduce SARS-CoV-2-related genes in COPD

News Medical, August 25, 2020

The chronic lung condition called COPD (chronic obstructive pulmonary disease) increases the risk of severe COVID-19. Inhaled corticosteroids (ICS) are commonly prescribed to stabilize respiratory function in these patients, but the associated risk of bacterial infection has daunted some healthcare professionals from using them. Moreover, in vitro, studies show that they have an immunosuppressive effect on cells exposed to viruses. There is no evidence to reveal the effects of ICS on either susceptibility to COVID-19 or the severity of infection in patients with COPD. A new study published on the preprint server medRxiv* aims to explore the effects of treatment with ICS on the expression of specific genes related to SARS-CoV-2 infection in bronchial epithelial cells in a prospective interventional design. It is known that COPD can upregulate the expression of angiotensin-converting enzyme (ACE2) in the human lungs. However, in vitro, studies show that ICS reduces ACE2 expression. Observational studies have shown that in both asthma and COPD, the use of ICS reduces the concentration of ACE2 mRNA in sputum. In the DISARM study, the researchers randomized 68 volunteers with mild to very severe COPD to receive either ICS along with a long-acting beta-agonist (LABA) or the LABA alone. Most were male, and the degree of blockage of the airways ranged from moderate to severe. The regimens in the two groups consisted of formoterol/budesonide 12/400 μg twice daily or salmeterol/fluticasone propionate 25/250 μg twice daily), for the first group, and formoterol 12 μg twice daily for the second.


Respiratory distress the cause of most post-COVID hospital readmissions

McKinght’s Long-term Care News, August 25, 2020

Respiratory distress is the most common cause of near-term hospital readmission for patients with COVID-19, investigators have found. Among nearly 2,900 discharged patients studied, 103 returned to the emergency department within two weeks of discharge. Fully 56 of these required hospital readmittance. Respiratory complications were the chief complaint in half of these patients. They also had higher rates of chronic obstructive pulmonary disease and hypertension than their peers who did not return to the hospital, reported Girish Nadkarni, M.D., and colleagues from the Mount Sinai COVID Informatics Center. Hospital readmittance also was tied to shorter length of initial hospital stay, lower rates of anticoagulation treatment, and lower incidence of intensive care. There were no differences in age, sex or race/ethnicity in readmitted patients compared with those who did not return, the researchers wrote. The results show that some patients have substantial lingering effects from COVID-19, corresponding author Anuradha Lala, M.D., said. “As we move into a phase where COVID-19 is no longer a novel disease, we must transition our attention to the post-acute phase to understand how to keep patients well and out of the hospital,” she concluded.


Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19

Frontiers in Medicine, August 25, 2020

We set out to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19. We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA). A total of 1,275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients, and a diagnosis of PE was made in 32 (2.6% [95%CI 1.7–3.5%]). Patients with PE were older, and they exhibited lower PaO2:FiO2 ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation, and they often had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (≥150 mg/L and ≥1,000 ng/ml, respectively) and a peak D-dimer ≥6,000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2:FiO2.


AstraZeneca starts trial of COVID-19 antibody treatment

Reuters, August 25, 2020

British drugmaker AstraZeneca has begun testing an antibody-based cocktail for the prevention and treatment of COVID-19, adding to recent signs of progress on possible medical solutions to the disease caused by the novel coronavirus. The London-listed firm, already among the leading players in the global race to develop a successful vaccine, said the study would evaluate if AZD7442, a combination of two monoclonal antibodies (mAbs), was safe and tolerable in up to 48 healthy participants between the ages of 18 and 55 years. If the UK-based early-stage trial, which has dosed its participants, shows AZD7442 is safe, AstraZeneca said it would proceed to test it as both a preventative treatment for COVID-19 and a medicine for patients who have it, in larger, mid-to-late-stage studies. Development of mAbs to target the virus, an approach already being tested by Regeneron, ELi Lilly, Roche and Molecular Partners, has been endorsed by leading scientists. mAbs mimic natural antibodies generated in the body to fight off infection and can be synthesised in the laboratory to treat diseases in patients. Current uses include treatment of some types of cancers.


U.S. Public Health Resources for COVID-19 That Are Relevant to Allergy/Immunology

Annals of Allergy, Asthma & Immunology, August 24, 2020

U.S. public health responses to emerging infections have involved public health agencies, healthcare systems, community leaders, and others. This Perspective will focus on providing an overview of U.S. public health resources (as of August 2020) related to the coronavirus disease 2019 (COVID-19) pandemic that might be most relevant to allergists/immunologists. A novel coronavirus was first reported in January 2020. This virus, subsequently named SARS-CoV-2, is thought to spread mainly from person to person through respiratory droplets among people who are in close contact (within about 6 feet). SARS-CoV-2 infection can result in mild to severe symptoms, which can include but are not limited to fever, chills, cough, difficulty breathing, fatigue, body aches, headache, new loss of taste or smell, sore throat, nasal congestion, rhinorrhea, nausea, vomiting, or diarrhea. Among >1.3 million laboratory-confirmed, adult and pediatric COVID-19 cases reported in the United States during January 22–May 30, 2020, 14% of cases were hospitalized, 2% were admitted to an intensive care unit, and 5% died. Limited available data suggest that among adults with severe COVID-19, dysregulated innate and adaptive immune responses contribute to host tissue damage.


COVID-19 Not Likely to Trigger Asthma Exacerbations in Hospitalized Patients

Pulmonology Advisor, August 24, 2020

People with asthma were not overrepresented in patients with severe pneumonia because of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who required hospitalization, according to study results published in the European Respiratory Journal. Researchers evaluated patient demographics, clinical history, asthma control history, and comorbid conditions from adult patients hospitalized with a diagnosis of SARS-CoV-2 infection and reporting a history of asthma. The outcomes of interest were mortality, length of intensive care unit (ICU) stay, and total length of hospital stay, which were compared with a random control group of individuals without asthma hospitalized for COVID-19 pneumonia. Of the 768 hospitalized patients with COVID-19, 37 reported a history of asthma, and 75 were randomly assigned to the nonasthma control group. Of the 37 patients with asthma, 70% were women, the mean age was 54 years, and body mass index was 28.3 kg/m², respectively. The median time from onset of symptoms to admission in the emergency room was 6 days. Compared with the control group, all differences between groups pointed to worse COVID-19 pneumonia in individuals without asthma. None of the patients with asthma presented with an exacerbation while in the hospital.


Scientists say Hong Kong man got coronavirus a second time

Modern Healthcare, August 24, 2020

University of Hong Kong scientists claim to have the first evidence of someone being reinfected with the virus that causes COVID-19. Genetic tests revealed that a 33-year-old man returning to Hong Kong from a trip to Spain in mid-August had a different strain of the coronavirus than the one he’d previously been infected with in March, said Dr. Kelvin Kai-Wang To, the microbiologist who led the work. The man had mild symptoms the first time and none the second time; his more recent infection was detected through screening and testing at the Hong Kong airport. “It shows that some people do not have lifelong immunity” to the virus if they’ve already had it, To said. “We don’t know how many people can get reinfected. There are probably more out there.” Whether people who have had COVID-19 are immune to new infections and for how long are key questions that have implications for vaccine development and decisions about returning to work, school and social activities.


How to Prepare Patients for the New Influenza Season During COVID-19 Pandemic

Pulmonology Advisor, August 24, 2020

Every influenza season brings with it uncertainty about what strain will predominate and how severe it will be. While much of the world still is focusing on COVID-19, the potential for another serious influenza season can’t be ignored, and the strain on the health care system of 2 epidemics could be severe. As the SARS–CoV-2 virus continues to spread across the country, the 2020-2021 influenza season will be particularly challenging. Recent influenza seasons have been particularly serious: 2017-2018 was one of the deadliest in decades, with an estimated 61,000 deaths, and 2018-2019 was one of the longest flu seasons, lasting 21 weeks. In March 2019, the World Health Organization (WHO) announced a Global Influenza Strategy for 2019-2030 aimed at “protecting people in all countries from the threat of influenza.” The goals include the prevention of seasonal influenza, the control of spread from animals to humans, and preparation for the next influenza pandemic.


An inflammatory cytokine signature predicts COVID-19 severity and survival

Nature Medicine, August 24, 2020

Several studies have revealed that the hyper-inflammatory response induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major cause of disease severity and death. However, predictive biomarkers of pathogenic inflammation to help guide targetable immune pathways are critically lacking. We implemented a rapid multiplex cytokine assay to measure serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α and IL-1β in hospitalized patients with coronavirus disease 2019 (COVID-19) upon admission to the Mount Sinai Health System in New York. Patients (n = 1,484) were followed up to 41 d after admission (median, 8 d), and clinical information, laboratory test results and patient outcomes were collected. We found that high serum IL-6, IL-8 and TNF-α levels at the time of hospitalization were strong and independent predictors of patient survival (P < 0.0001, P = 0.0205 and P = 0.0140, respectively). Notably, when adjusting for disease severity, common laboratory inflammation markers, hypoxia and other vitals, demographics, and a range of comorbidities, IL-6 and TNF-α serum levels remained independent and significant predictors of disease severity and death.


DARE-19: Dapagliflozin could target key mechanisms activated in COVID-19

Helio | Endocrine Today, August 22, 2020

SGLT2 inhibitors could potentially target key mechanisms activated in COVID-19, increasing lipolysis, reducing glycolysis, inflammation and oxidative stress, and improving endothelial function to reduce organ damage, according to a speaker. “We know that favorable effects on mechanisms such as endothelial function, a key driver of adverse outcomes in COVID-19, can occur very quickly after treatment with SGLT2 inhibitors,” Mikhail Kosiborod, MD, FACC, FAHA, cardiologist at Saint Luke’s Mid America Heart Institute, professor of medicine at the University of Missouri-Kansas City School of Medicine, said during an online presentation during the virtual Heart in Diabetes conference. “If you think through these mechanisms and the fact that SGLT2 inhibitors can have a positive impact on many of them, what becomes clear is that testing SGLT2 inhibitors as potential agents for organ protection in COVID-19 may be one of the key hypotheses.” The concept is relatively simple, Kosiborod said. Viral replication and spread after COVID-19 infection trigger metabolic derangements that lead to inflammatory “overdrive,” endothelial injury and, ultimately, organ damage leading to complications and death. Data suggest antiviral treatments can work in the early phase of the disease; anti-inflammatory medications show promise during the mid-phase of the disease.


Noninvasive Respiratory Support Outside of ICU Feasible for COVID-19

Pulmonary Advisor, August 21, 2020

Patients hospitalized with coronavirus disease 2019 (COVID-19) who were treated with noninvasive respiratory support outside of the intensive care unit (ICU) had favorable outcomes, but a risk of staff contamination persisted, according to study results published in The European Respiratory Journal. Medication, mode, and usage of noninvasive respiratory support were evaluated from hospitalized patients with COVID-19 treated outside of the ICU. The primary study outcomes were the length of stay in hospital, rate of endotracheal intubation, deaths, and staff infection rates. Of the 670 consecutive patients with confirmed COVID-19 referred to pulmonology units in 9 hospitals, 69.3% were men and the mean age was 68 years. Nearly half of the patients (49.3%) were treated with continuous positive airway pressure. The overall 30-day mortality rate was 26.9%, with specific rates of 16%, 30%, and 30%, for high-flow nasal cannula, continuous positive airway pressure, and noninvasive ventilation, respectively. The rates of endotracheal intubation and the length of stay in hospital were not different among the groups.


Pulmonary Pathobiology Distinct in Lungs of People Who Died From COVID-19 vs Influenza

Pulmonology Advisor, August 21, 2020

The pulmonary pathobiology of patients who died from respiratory failure caused by coronavirus disease 2019 (COVID-19) vs influenza was found to be distinct, according to a study published in the New England Journal of Medicine. A total of 24 lungs were obtained during the autopsy of patients who died from COVID-19 (n=7), from acute respiratory distress syndrome (ARDS) caused by influenza A (H1N1; n=7), or from causes other than infection (n=10). The lungs from patients infected with H1N1 were collected in 2009 and the lungs from control individuals were matched for age. Lungs were examined using a 7-color immunohistochemical analysis, micro-computed tomographic imaging, scanning electron microscopy, corrosion casting, and gene expression analysis through direct multiplexed measurement. The lungs from patients who died from COVID-19 were from 2 women (mean age, 68±9.2 years) and 5 men (mean age, 80±11.5 years). The H1N1 lungs were from 2 women (mean age, 62.5±4.9 years) and 5 men (mean age, 55.4±10.9 years). The control lungs were from 5 women (mean age, 68.2±6.9 years) and 5 men (mean age, 79.2±3.3 years). The lungs from patients with COVID-19 vs H1N1 were (2404±560 g vs 1681±49 g, respectively; P =.04), and lungs from control individuals (1045±91 g) were lighter compared with those from patients with COVID-19 and H1N1 vs (P <.001 and P =.003, respectively).


Corticosteroids in the Treatment of Severe Covid-19 Lung Disease: The Pulmonology Perspective From the First United States Epicenter

International Journal of Infectious Diseases, August 21, 2020

The SARS-CoV-2 pandemic has introduced the medical community to a lung disease heretofore unknown to most clinicians. In much of the discourse about COVID-19 lung disease, the more familiar clinical entity of ARDS has been used as the guiding paradigm. Reflecting on studies in ARDS, particularly that due to influenza, and on data from the SARS-CoV and MERS epidemics, many authorities, including within the discipline of infectious diseases, were initially passionate in their opposition to the use of corticosteroids for lung involvement in COVID-19. The voice of the pulmonology community—the community of lung experts—has continued to be among the quietest in this conversation. Herein we offer our perspective as academic pulmonologists who encountered COVID-19 in its first United States epicenter of New York City. We encourage a conceptual separation between early COVID-19 lung involvement and ARDS. We draw on history with other immune cell-mediated lung diseases, on insights from the SARS-CoV experience, and on frontline observations in an attempt to allay the skepticism towards corticosteroids in COVID-19 lung disease that is likely to persist even as favorable study results emerge.


Performance of a multiplex polymerase chain reaction panel for identifying bacterial pathogens causing pneumonia in critically ill patients with COVID-19

Diagnostic Microbiology and Infectious Disease, August 21, 2020

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has rapidly spread worldwide. Several studies have reported complications of COVID-19, such as bacterial pneumonia, acute respiratory distress syndrome (ARDS) and multiple organ failure syndromes. Recent guidelines for the management of adults critically ill with COVID-19 have suggested the empiric use of antimicrobial agents in patients with respiratory failure. The accurate and timely diagnosis of bacterial pneumonia, particularly in cases of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), is particularly challenging, and this condition remains a major cause of morbidity and mortality. Molecular tests provide a rapid turnaround time (TAT), together with identifications and semi-quantitative results for many pathogens responsive to antimicrobial therapy. Multiplex testing may provide additional information concerning the presence of antibiotic resistance genes, thereby improving antibiotic management. We performed a prospective single-center study on critically ill patients with COVID-19, in which we conducted parallel tests of blind bronchoalveolar lavage (BBAL) by conventional culture and FilmArray® Pneumonia Plus (FA-PP) panel. The aim of this study was to evaluate the performance of FA-PP and to compare its TAT with that of conventional cultures.


Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy

Journal of Hospital Infection, August 21, 2020

Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. Our objective was to investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. We collected environmental swab samples and air samples from the isolation rooms of three COVID-19 patients with severe pneumonia. Patient 1 and Patient 2 received mechanical ventilation with a closed suction system, while Patient 3 received high-flow oxygen therapy and noninvasive ventilation. Real-time reverse transcription polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR.


Evidence mounts for ECMO in patients with severe COVID-19 respiratory failure

Helio | Pulmonology, August 20, 2020

Two recently published studies report success with extracorporeal membrane oxygenation support in patients with acute respiratory distress syndrome associated with COVID-19. In a retrospective cohort study published in The Lancet Respiratory Medicine, researchers analyzed clinical characteristics and outcomes of 492 patients treated with ECMO for COVID-19-associated ARDS at five ICUs within the Paris-Sorbonne University Hospital Network from March 8 to May 2. The researchers reported complete day-60 follow-up for 83 patients (median age, 49 years; 73% men) who received ECMO. Before ECMO, 94% of patients were prone positioned (median driving pressure, 18 cm H2O; ratio of arterial oxygen partial pressure to fractional inspired oxygen, 60 mm Hg). Sixty days after initiation of ECMO, the researchers’ estimated probability of death was 31% and the probability of being alive and out of the ICU was 45%.


Asthma-COPD overlap strong risk factor for COVID-19 hospitalization

Helio | Pulmonology, August 19, 2020

It is important to distinguish asthma from chronic pulmonary diseases to elucidate COVID-19 risk, researchers reported in The Journal of Allergy and Clinical Immunology. “U.S.-based studies report that approximately 7% to 9% of hospitalized patients with COVID-19 had chronic lung disease, with asthma more prevalent than COPD. Recent analyses of COVID-19 cohorts suggest that chronic respiratory disease may unexpectedly be less of a risk factor for COVID-19 infection and severity than nonrespiratory diseases. However, most studies to date do not distinguish asthma from COPD within chronic respiratory disease, limiting identification of asthma-specific risk factors,” Liqin Wang, PhD, postdoctoral research fellow at the division of general internal medicine and primary care at Brigham and Women’s Hospital, Boston, and colleagues wrote in a letter to the editor. The researchers reported data from a case series of patients in the Mass General Brigham health system with a positive diagnosis of COVID-19, aged at least 18 years and a previous diagnosis of asthma. Wang and colleagues analyzed data on demographics, socioeconomic markers, BMI, insurance, smoking status, asthma medications, comorbidities and course of COVID-19 care. Patients were followed for 14 days from COVID-19 diagnosis for hospitalization and/or ICU admission, or by June 8, for death.


Post COVID -19 Pneumonia Pulmonary Fibrosis

QJM: An International Journal of Medicine, August 19, 2020

Clinical manifestations of COVID-19 have ranged from asymptomatic/mild symptoms to severe illness and mortality. Most of the mild and moderate cases are recovered completely but a small proportion of severe cases with acute respiratory distress syndrome continued to remain hypoxemic despite adequate treatment. Chest imaging of this subset of patients revealed fibrotic changes in the form of traction bronchiectasis, architectural distortion and septal thickening similar to the changes seen in other fibrotic lung diseases. The pathogenesis of post infective pulmonary fibrosis include dysregulated release of matrix metalloproteinases during the inflammatory phase of ARDS causing epithelial and endothelial injury with unchecked fibroproliferation. There is also a vascular dysfunction which is a key component of the switch from ARDS to fibrosis, with VEGF and cytokines such as IL-6 and TNFα being implicated. Although the role of presently available antifibrotic drugs (pirfenidone and nintedanib) for fibrotic lung diseases beyond idiopathic pulmonary fibrosis have been evaluated by some authors their role in post COVID-19 pneumonia pulmonary fibrosis need further research in the present pandemic.


Ex-CDC director Tom Frieden provides strategies for protecting HCWs amid COVID-19

Helio | Primary Care, August 19, 2020

Former CDC director Tom Frieden, MD, MPH, recently described a hierarchy of controls — elimination, substitution, engineering, administration and personal protective equipment — that may help prevent COVID-19 among health care workers. His remarks came during the National Medical Association’s Annual Meeting, held virtually due to the pandemic. Frieden said the “most effective” step is eliminating the hazard or infection. This can be accomplished by not allowing people who are ill to enter nursing homes and other congregate facilities. It can also be accomplished by ensuring that all hospitals and nursing home staffs have paid sick leave, so that there is no economic incentive to work while ill. If patients with COVID-19 cannot be separated from other patients and staff by engineering and substitution, PPE becomes necessary, Frieden said. When PPE is necessary, supply has to be ensured.


As U.S. schools reopen, concerns grow that kids spread coronavirus

Reuters, August 19, 2020

U.S. students are returning to school in person and online in the middle of a pandemic, and the stakes for educators and families are rising in the face of emerging research that shows children could be a risk for spreading the new coronavirus. Several large studies have shown that the vast majority of children who contract COVID-19, the disease caused by the virus, have milder illness than adults. And early reports did not find strong evidence of children as major contributors to the deadly virus that has killed more than 780,000 people globally. But more recent studies are starting to show how contagious infected children, even those with no symptoms, might be. “Contrary to what we believed, based on the epidemiological data, kids are not spared from this pandemic,” said Dr. Alessio Fasano, director of the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital and author of a new study.


The Physicians Foundation 2020 Physician Survey

Physicians Foundation, August 18, 2020

The Physicians Foundation’s 2020 Survey of America’s Physicians finds that the majority of physicians believe COVID-19 won’t be under control until January 2021, with nearly half not seeing the virus being under control until after June 1, 2021. Furthermore, a majority of physicians believe that the virus will severely impact patient health outcomes due to delayed routine care during the pandemic. Read and download the findings. The survey, conducted in July with more than 3,500 respondents, asked physicians how the pandemic is affecting their practices and patients. Nearly three-quarters of those surveyed said COVID-19 would have serious consequences for health in their communities because many are delaying needed care. Health insurance is another problem; 76% cited changes in employment and insurance status is a primary cause of harm to patients caused by COVID-19. But 59% believed opening schools, businesses and other public places posed a greater risk to their patients than continued social isolation. “The data reveals a near-consensus among America’s physicians about COVID-19’s immediate and lasting impact on our healthcare system,” said Dr. Gary Price, president of The Physicians Foundation, in a prepared statement.


FDA flags accuracy issue with widely used coronavirus test

Associated Press, August 18, 2020

Potential accuracy issues with a widely used coronavirus test could lead to false results for patients, U.S. health officials warned. The Food and Drug Administration issued the alert Monday to doctors and laboratory technicians using Thermo Fisher’s TaqPath genetic test. Regulators said issues related to laboratory equipment and software used to run the test could lead to inaccuracies. The agency advised technicians to follow updated instructions and software developed by the company to ensure accurate results. The warning comes nearly a month after Connecticut public health officials first reported that at least 90 people had received false positive results for the coronavirus. Most of those receiving the false results were residents of nursing homes or assisted living facilities. A spokeswoman for Thermo Fisher said the company was working with FDA “to make sure that laboratory personnel understand the need for strict adherence to the instructions for use.” She added that company data shows most users “follow our workflow properly and obtain accurate results.”


Assessment of COVID-19 Hospitalizations by Race/Ethnicity in 12 States

JAMA Internal Medicine, August 17, 2020

Given the reported health disparities in coronavirus disease 2019 (COVID-19) infection and mortality by race/ethnicity, there is an immediate need for increased assessment of the prevalence of COVID-19 across racial/ethnic subgroups of the population in the US. We examined the racial/ethnic prevalence of cumulative COVID-19 hospitalizations in the 12 states that report such data and compared how this prevalence differs from the racial/ethnic composition of each state’s population. Using data extracted from the University of Minnesota COVID-19 Hospitalization Tracking Project, we identified the 12 states that reported the race/ethnicity of individuals hospitalized with COVID-19 between April 30 and June 24, 2020. We calculated the percentage of cumulative hospitalizations by racial/ethnic categories averaged over the study period and then calculated the difference between the percentage of cumulative hospitalizations for each subgroup and the corresponding percentage of the state’s population for each racial/ethnic subgroup as reported in the US Census. The race/ethnicity categories included were White, Black, American Indian and/or Alaskan Native, Asian, and Hispanic. Descriptive statistical analyses were conducted using Stata/MP, version 14 (Stata Corp). The University of Minnesota Institutional Review Board reviewed the study data and deemed it exempt from review and informed consent requirements because the study was not human subjects research. This analysis of COVID-19 hospitalizations in 12 US states during nearly a 2-month period represented a total of 48 788 cumulative hospitalizations among a total population of 66 796 666 individuals in 12 US states.


COVID-19: Utility of Antibiotic Therapy for Nosocomial Coinfection Unclear

Pulmonary Advisor, August 17, 2020

Patients diagnosed with coronavirus disease 2019 (COVID-19) who are not admitted to the intensive care unit (ICU) may not require antibiotic therapy due to the low frequency of community-acquired coinfection, according to the results of a single-center study published in Clinical Infectious Diseases. Current literature estimates that coinfection in COVID-19 could range from 0% to 40% of patients. As such, concerns have been raised on whether coinfection could be a significant complication in COVID-19. However, only a few studies were designed to assess co-infection and differentiate between community- and hospital-acquired coinfection, coinfection definitions are variable, and microbiologic data are inconsistently reported. As a result of these challenges, the current guidelines on antibiotic use in COVID-19 patients are not strong. This retrospective, observational study described the rates of community-acquired coinfection in patients with COVID-19. In total, 321 patients with COVID-19 (³18 years of age) were admitted to the University of Chicago Medical Center in Chicago, Illinois during the evaluation period (March 1, 2020-April 11, 2020). The date of hospital admission, ICU admission, mortality, antibiotic administration, and microbiologic test results were examined. If positive test results were collected after the fifth day of hospital admission, patients were excluded to make sure only community-acquired coinfection was captured.


AANP National Survey Reveals Progress, Challenges as Nurse Practitioners (NPs) Combat COVID-19

Cision, August 17, 2020

The findings of a second, nationwide trend survey of NPs assessing COVID-19’s impacts on NP professional practice demonstrate both significant progress and lingering challenges as health care providers work to stem the tide of the pandemic in communities nationwide. More than 80% of the profession reports their practices are better prepared to manage COVID-19 patients than at the start of the pandemic, with 35% indicating they are ready for a surge in COVID-19 cases. Despite marked progress in practice readiness and improving supplies of PPE, the number of NPs now testing positive for COVID-19 has increased three-fold since the early days of the pandemic. While acknowledging improvements in access, NPs identify testing as the most significant barrier to combatting COVID-19 in their communities, with one-third of NPs reporting patients being turned away from centralized testing sites for failure to meet pre-determined criteria, and 78% of NPs citing significant delays in receiving patients’ viral test results. Test result delays range from a low-end range of seven to 10 business days to a high-end of up to 20 days. This is the second national survey fielded by the American Association of Nurse Practitioners® (AANP), the largest national association of NPs of all specialties, aimed at understanding how COVID-19 is affecting the clinical practice of NPs across settings, specialties, and geographic location.


CDC: Sorry, People Do Not Have COVID-19 ‘Immunity’ for 3 Months

MedPage Today, August 17, 2020

People infected with COVID-19 do not necessarily have immunity to reinfection for three months, the CDC said late Friday night, trying to squelch speculation the agency had inadvertently stimulated. While people can continue to test positive for SARS-CoV-2 for up to three months after diagnosis and not be infectious to others, that does not imply that infection confers immunity for that period, the agency said. The confusion stemmed from an August 3 update to CDC’s isolation guidance, which stated: Who needs to quarantine? People who have been in close contact with someone who has COVID-19 — excluding people who have had COVID-19 within the past 3 months. People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms. These statements could be read as suggesting that those recovering from COVID-19 will likely be safe from reinfection for three months even with close exposure to infected people. Media reports took this as a tacit acknowledgment of immunity from the agency.


Household Transmission of SARS-CoV-2 in the United States

Clinical Infectious Diseases, August 16, 2020

Although many viral respiratory illnesses are transmitted within households, the evidence base for SARS-CoV-2 is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. We recruited laboratory-confirmed COVID-19 patients and their household contacts in Utah and Wisconsin during March 22–April 25, 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 rRT-PCR and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (OR) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Thirty-two (55%) of 58 households had evidence of secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI]: 23–36%) overall, 42% among children (<18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions had increased odds of infection (OR: 15.9, 95% CI: 2.4–106.9). Household contacts who themselves had diabetes mellitus had increased odds of infection (OR: 7.1, 95% CI: 1.2–42.5).


FDA clears Masimo device for ventilated patients

Mass Device, August 14, 2020

Masimo announced today that it received FDA clearance for its PVi for fluid responsiveness indication in ventilated adult patients. PVi (pleth variability index) now has indication as a continuous, non-invasive, dynamic indicator of responsiveness in select populations of mechanically ventilated adult patients, as it measures dynamic changes in the perfusion index that occur during the respiratory cycle, according to a news release. Irvine, Calif.-based Masimo’s PVi is available alongside its SET pulse oximetry and Rainbow pulse co-ocimetry on a variety of sensors, using a proprietary algorithm based on the relative variability of the pleth waveform. In an 18,716-patient study in France, researchers found that using PVi alongside Masimo’s SpHb continuous hemoglobin monitoring technology led to earlier transfusion and fewer units of blood transfused, as well as a 33% lower mortality rate 30 days after surgery, which trickled down to a 29% rate 90 days after surgery.


Outcomes Associated With Use of a Kinin B2 Receptor Antagonist Among Patients With COVID-19

JAMA Network Open, August 13, 2020

Pulmonary edema is a prominent feature in patients with severe COVID-19. SARS-CoV-2 enters the cell via ACE2. ACE2 is involved in degrading the kinin des-Arg9-bradykinin, a potent vasoactive peptide that can cause vascular leakage. Loss of ACE2 might lead to plasma leakage and further activation of the plasma kallikrein-kinin system with more bradykinin formation that could contribute to pulmonary angioedema via stimulation of bradykinin 2 receptors. We investigated whether treatment with the bradykinin 2 receptor antagonist icatibant in patients with COVID-19 could be used as a treatment strategy. This case-control study was approved by CMO region Arnhem-Nijmegen, the local ethical committee, which granted a waiver of consent because treatment concerned a licensed drug that would be given in an off-label setting. Informed consent was obtained in all patients. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. We included 10 patients for treatment with 3 doses of 30 mg of icatibant by subcutaneous injection at 6-hour intervals. Patients were eligible for icatibant treatment if they had confirmed SARS-CoV-2 by polymerase chain reaction assay, an oxygen saturation of less than 90% without supplemental oxygen, needed 3 L/min supplemental oxygen or more, and had a computed tomography severity score of 7 or greater. Patients with acute ischemic events at time of eligibility were excluded. For 9 patients who received icatibant on the ward, 2 matched control patients admitted prior to approval of this treatment were selected. Control patients with COVID-19 were matched on the factors sex, age, body mass index, and day of illness.


The Impact of COVID-19 on Pulmonary Hypertension

American College of Cardiology, August 13, 2020

COVID-19 has had a significant impact on all aspects of PH, from diagnosis and management to observing an increased risk of death in patients with PAH. In addition, because of the vulnerable nature of this population, the pandemic has impacted the very manner in which care is delivered in PH. The risks associated with COVID-19 in patients with PH are significant. In a US survey of 77 PAH Comprehensive Care Centers, the incidence of COVID-19 infection was 2.1 cases per 1,000 patients with PAH, which is similar to the incidence of COVID-19 infection in the general US population. But although COVID-19 did not seem to be more prevalent in patients with PAH, the mortality did appear to be higher at 12%. In addition, 33% of patients with PAH who were infected with COVID-19 ended up being hospitalized. With the outbreak of COVID-19, it became necessary to revisit the manner in which patients receive care to decrease risk of contracting the virus.


Venous thromboembolism in hospitalized patients with COVID-19 receiving prophylactic anticoagulation

Mayo Clinic Proceedings, August 13, 2020

Venous thromboembolism (VTE) has been reported in mechanically ventilated patients with severe SARS-CoV-2 infection (COVID-19). Two of the first 31 non-mechanically ventilated patients with moderate severity COVID-19 admitted to our hospital developed VTE while receiving uninterrupted prophylactic anticoagulation. Both non-mechanically ventilated patients hospitalized with COVID-19 developed symptomatic VTE while receiving uninterrupted standard prophylactic dose unfractionated or low molecular weight heparin. Reports linking severe COVID-19 and increased risk for VTE have emerged, including a high incidence of abnormal D-dimer levels among patients with COVID-19, an association between COVID-19-associated disturbances in the coagulation pathway and increased mortality, and lower 28-day mortality among patients with COVID-19 who received prophylactic heparin if they had D-dimer >3.0 mg/L or sepsis-induced coagulopathy score >4. Experts also have published interim summaries and guidance for managing VTE risk in patients with COVID-19, although the optimal approach for inpatient VTE risk stratification and prophylaxis remains uncertain. Our observations suggest that moderate severity COVID-19 might also predispose hospitalized patients to higher VTE risk than standard RAMS would predict and might even precipitate acute VTE despite use of standard prophylactic-dose anticoagulant medications.


Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes – Interim Analysis of 2 Randomized Clinical Trials

Journal of the American Medical Association, August 13, 2020

What are the safety and immunogenicity of an inactivated vaccine against coronavirus disease 2019 (COVID-19)? This was an interim analysis of 2 randomized placebo-controlled trials. In 96 healthy adults in a phase 1 trial of patients randomized to aluminum hydroxide (alum) only and low, medium, and high vaccine doses on days 0, 28, and 56, 7-day adverse reactions occurred in 12.5%, 20.8%, 16.7%, and 25.0%, respectively; geometric mean titers of neutralizing antibodies at day 14 after the third injection were 316, 206 and 297 in the low-, medium-, and high-dose groups, respectively. In 224 healthy adults randomized to the medium dose, 7-day adverse reactions occurred in 6.0% and 14.3% of the participants who received injections on days 0 and 14 vs alum only, and 19.0% and 17.9% who received injections on days 0 and 21 vs alum only, respectively; geometric mean titers of neutralizing antibodies in the vaccine groups at day 14 after the second injection were 121 vs 247, respectively.


Model-based Prediction of Critical Illness in Hospitalized Patients with COVID-19

Radiology, August 13, 2020

The prognosis of hospitalized patients with severe coronavirus disease 2019 (COVID-19) is difficult to predict, while the capacity of intensive care units (ICUs) is a limiting factor during the peak of the pandemic and generally dependent on a country’s clinical resources. The purpose of the study was to determine the value of chest radiographic findings together with patient history and laboratory markers at admission to predict critical illness in hospitalized patients with COVID-19. In this retrospective study including patients from 7th March 2020 to 24th April 2020, a consecutive cohort of hospitalized patients with RT-PCR-confirmed COVID-19 from two large Dutch community hospitals was identified. After univariable analysis, a risk model to predict critical illness (i.e. death and/or ICU admission with invasive ventilation) was developed, using multivariable logistic regression including clinical, CXR and laboratory findings. Distribution and severity of lung involvement was visually assessed using an 8-point scale (chest radiography score). Internal validation was performed using bootstrapping. Performance is presented as an area under the receiver operating characteristic curve (AUC). Decision curve analysis was performed, and a risk calculator was derived. The cohort included 356 hospitalized patients (69 ±12 years, 237 male) of whom 168 (47%) developed critical illness.


Researchers Strive to Recruit Hard-Hit Minorities Into COVID-19 Vaccine Trials

Journal of the American Medical Association, August 13, 2020

Seldom does a vaccine researcher’s job include calling city hall, big-box stores like Walmart and Target, and the US Postal Service. But Ann Falsey, MD, had those tasks on her to-do list in June as she prepared to recruit volunteers to test potential vaccines for coronavirus disease 2019 (COVID-19). Falsey, of the University of Rochester School of Medicine, hoped large employers in her area would publicize vaccine trials to their essential workers, many of whom are Black or Hispanic. “We are thinking very hard about not only how to get a diverse population that reflects the US population but also people at high risk—postal workers, home health workers, you name it,” she said. COVID-19’s startling toll on minorities has drawn widespread attention to the need for diversity in large-scale phase 3 vaccine trials. Two 30 000-person trials, led by Moderna and a joint effort of Pfizer and BioNTech, began on July 27. AstraZeneca was expected to start US recruitment to test its vaccine, developed with Oxford University, in August, followed by Johnson & Johnson in September and Novavax later this fall.


A SARS-CoV-2 Prediction Model from Standard Laboratory Tests

Clinical Infectious Diseases, August 12, 2020

With the limited availability of testing for the presence of the SARS-CoV-2 virus and concerns surrounding the accuracy of existing methods, other means of identifying patients are urgently needed. Previous studies showing a correlation between certain laboratory tests and diagnosis suggest an alternative method based on an ensemble of tests. Here, a machine learning model was trained to analyze the correlation between SARS-CoV-2 test results and 20 routine laboratory tests collected within a 2-day period around the SARS-CoV-2 test date. We used the model to compare SARS-CoV-2 positive and negative patients. In a cohort of 75,991 veteran inpatients and outpatients who tested for SARS-CoV-2 in the months of March through July, 2020, 7,335 of whom were positive by RT-PCR or antigen testing, and who had at least 15 of 20 lab results within the window period, our model predicted the results of the SARS-CoV-2 test with a specificity of 86.8%, a sensitivity of 82.4%, and an overall accuracy of 86.4% (with a 95% confidence interval of [86.0%, 86.9%]). While molecular-based and antibody tests remain the reference standard method for confirming a SARS-CoV-2 diagnosis, their clinical sensitivity is not well known. The model described herein may provide a complementary method of determining SARS-CoV-2 infection status, based on a fully independent set of indicators, that can help confirm results from other tests as well as identify positive cases missed by molecular testing.


Global COVID-19 Cases Top 20 Million

WebMD, August 12, 2020

The total of number of confirmed COVID-19 cases worldwide went over the 20 million mark on Tuesday, the Johns Hopkins Coronavirus Resource Center reported. The number of us cases has grown exponentially since the virus was first reported in China about 6-and-a-half months ago. Total cases hit the 1 million mark on April 2, CNN reported. Ten million cases were recorded in late June. It took less than 6 weeks to double that figure as case counts surged in the United States and Latin America. The number of cases is probably much higher because of testing limitations and a high number of infected people who show no symptoms. Deaths have also gone up. More than 737,000 have people died worldwide, Johns Hopkins said. The nations with the most cases are the United States (almost 5.1 million with more than 163,000 deaths), Brazil (3 million cases and 101,000 deaths), India (2.2 million cases and 45,000 deaths), Russia (895,000 cases and 15,000 deaths), and South Africa (563,000 cases and 10,600 deaths). Africa recorded its 1 millionth case last week. The 7-day average of new cases has been more than 250,000 for two weeks, CNN said.


Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With COVID-19 (Metcovid): A Randomised, Double-Blind, Phase IIb, Placebo-Controlled Trial

Clinical Infectious Diseases, August 12, 2020

Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-Co-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. This parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution), twice daily, for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. During the study, 647 patients were screened, 416 randomized, and 393 analyzed as mITT, MP in 194 and placebo in 199 individuals. SARS-CoV-2 infection was confirmed by RT-PCR in 81.3%. Mortality at day 28 was not different between groups. A subgroup analysis showed that patients over 60 years in the MP group had a lower mortality rate at day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until day 7.


Annals On Call – Diagnosing SARS-CoV-2 Infection: Symptoms or No Symptoms?

Annals of Internal Medicine, August 12, 2020

[Podcast] In this episode of Annals On Call, Dr. Centor discusses challenges to diagnosing COVID-19 with Dr. Jeanne Marrazzo. Annals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.


COVID-19 surge moves to Midwest, as young people fuel US case rise

Center for Infectious Disease Research and Policy, August 12, 2020

Many states initially spared from the COVID-19 pandemic is March, April, and May, are now reporting increasing transmission rates in non-metropolitan counties fueled by community spread. According to the Wall Street Journal, in Ohio, Missouri, Wisconsin, and Illinois, the weekly change in COVID-19 cases has been higher in rural regions compared to metro areas, and outbreaks are linked to social events, rather than workplace exposure or congregate living situations. A summer of waning social distancing restrictions has made bars and restaurants common COVID-19 outbreak sites, on par with nursing homes and prisons states across the country. In Louisiana, the New York Times reports bars and restaurants are linked to 25% of the state’s cases, and in Maryland, that percentage was 12%. Fueling these outbreaks are the twin forces of a national “quarantine fatigue” and young adults, who are more likely than older, more at-risk Americans, to be both patrons and employees in dining and drinking establishments. Young adults are driving outbreaks in many states, and experts worry those with mild or asymptomatic cases are spreading the disease to more vulnerable household members.


This Fall Could Be ‘Worst’ We’ve Seen

WebMD, August 12, 2020

We are in a war against COVID-19, and this fall could be one of the worst from a public health standpoint that the U.S. has ever faced, says CDC Director Robert Redfield, MD. The surging coronavirus pandemic, paired with the flu season, could create the “worst fall” that “we’ve ever had,” he said during an interview on “Coronavirus in Context,” a video series hosted by John Whyte, MD, WebMD’s chief medical officer. Redfield also said the agency’s efforts to understand the virus were hampered by a lack of cooperation from China. He reached out to China CDC Director George Gao on Jan. 3 to see if the agency could work with health officials in Wuhan to better understand the outbreak. But he never received an invitation, Redfield said. “I think if we had been able to get in at that time, we probably would have learned quicker than we learned here,” Redfield said.


Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure

JAMA Surgery, August 11, 2020

Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS), necessitating prolonged mechanical ventilation. In some cases, even ventilatory support fails. Venovenous extracorporeal membrane oxygenation (ECMO) has been used in severe cases of respiratory failure. However, the need for prolonged ventilation, sedation, and immobility may limit its long-term benefits. The application of ECMO in patients with COVID-19 whose condition has rendered mechanical ventilatory support insufficient is not fully established. Data were collected retrospectively from 40 consecutive patients with COVID-19 who were in severe respiratory failure and supported with ECMO. Each diagnosis of COVID-19 was confirmed using polymerase chain reaction–based assays. Patients were treated at 2 tertiary medical centers in Chicago, Illinois. The research protocol was approved by the institutional review boards of the Advocate Christ Medical Center and the Rush University Medical Center with a waiver for consent because of the inability of patients to give consent. A single-access, dual-stage right atrium–to-pulmonary artery cannula was implanted, following which ventilation was discontinued while the patient continued to receive ECMO. Patient selection criteria were similar to those of the ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial group. The primary outcome was survival following safe discontinuation of ventilatory and ECMO supports.


Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure

JAMA Surgery, August 11, 2020

Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS), necessitating prolonged mechanical ventilation. In some cases, even ventilatory support fails. Venovenous extracorporeal membrane oxygenation (ECMO) has been used in severe cases of respiratory failure. However, the need for prolonged ventilation, sedation, and immobility may limit its long-term benefits. The application of ECMO in patients with COVID-19 whose condition has rendered mechanical ventilatory support insufficient is not fully established. We present our experience in using single-access, dual-stage venovenous ECMO, with an emphasis on early extubation of patients while they received ECMO support. Data were collected retrospectively from 40 consecutive patients with COVID-19 who were in severe respiratory failure and supported with ECMO. Each diagnosis of COVID-19 was confirmed using polymerase chain reaction–based assays. A single-access, dual-stage right atrium–to-pulmonary artery cannula was implanted, following which ventilation was discontinued while the patient continued to receive ECMO. Patient selection criteria were similar to those of the ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial group. The primary outcome was survival following safe discontinuation of ventilatory and ECMO supports. Excel for Office 365 2020 (Microsoft) was used for data analysis.


Regulatory T Cells Tested in Patients With COVID-19 ARDS

Journal of the American Medical Association, August 11, 2020

Two men with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) survived after treatment with off-the-shelf regulatory T cells, also known as Tregs, Johns Hopkins physicians recently reported. The investigational allogenic Tregs with lung-homing markers were derived from cord blood. The critically ill patients, aged 69 years and 47 years, had multiorgan failure and had been treated with therapies including tocilizumab, hydroxychloroquine, broad-spectrum antibiotics, vasopressors, and inhaled nitric oxide. The men were intubated in prone positions and the 47-year-old received extracorporeal membrane oxygenation (ECMO) support. The men eventually were extubated and needed tracheostomies. When the study was written, the patient who had undergone ECMO was discharged home and the other was at a ventilator weaning facility.


Exclusive: Over 900 health workers have died of COVID-19. And the toll is rising

News Medical, August 11, 2020

More than 900 front-line health care workers have died of COVID-19, according to an interactive database unveiled Wednesday by The Guardian and KHN. Lost on the Frontline is a partnership between the two newsrooms that aims to count, verify and memorialize every U.S. health care worker who dies during the pandemic. KHN and The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened in their final days. It is the most comprehensive accounting of U.S. health care workers’ deaths in the country. As coronavirus cases surge — and dire shortages of lifesaving protective gear like N95 masks, gowns and gloves persist — the nation’s health care workers are again facing life-threatening conditions in Southern and Western states. Through crowdsourcing and reports from colleagues, social media, online obituaries, workers unions and local media, Lost on the Frontline reporters have identified 922 health care workers who reportedly died of COVID-19 and its complications. A team of more than 50 journalists from the Guardian, KHN and journalism schools have spent months investigating individual deaths to make certain that they died of COVID-19, and that they were indeed working on the front lines in contact with COVID patients or working in places where they were being treated. Thus far, we have independently confirmed 167 deaths and published their names, data and stories about their lives and how they will be remembered. The tally includes doctors, nurses and paramedics, as well as crucial support staff such as hospital custodians, administrators and nursing home workers, who put their own lives at risk during the pandemic to care for others.


Diagnostic Performance of Chest CT for SARS-CoV-2 Infection in Individuals with or without COVID-19 Symptoms

Radiology, August 10, 2020

The use of chest CT for COVID-19 diagnosis or triage in healthcare settings with limited SARS-CoV-2 PCR capacity is controversial. CO-RADS categorization of the level of COVID-19 suspicion might improve diagnostic performance. Our purpose was to investigate the value of chest CT with CO-RADS classification to screen for asymptomatic SARS-CoV-2 infections and to determine its diagnostic performance in individuals with COVID-19 symptoms during the exponential phase of viral spread. In this secondary analysis of a prospective trial (Clinical Trial Number: IRB B1172020000008), from March 2020 to April 2020, we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, for individuals with COVID-19 symptoms and controls without COVID-19 symptoms admitted to the hospital for medical urgencies unrelated to COVID-19. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC were calculated in symptomatic versus asymptomatic individuals to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds.


A Great Unknown: When Flu Season and COVID Collide

WebMD, August 10, 2020

For months scientists have urged the public to wear masks, wash their hands and socially distance. And as the flu season approaches, those practices have never been more crucial. Depending on whether people heed this advice, the U.S. could either see a record drop in flu cases or a dangerous viral storm, doctors say. “We just have no idea what’s going to happen. Are we going to get a second surge [of coronavirus]?” says Peter Chai, MD, an emergency physician at the Brigham and Women’s Hospital in Boston. . “Hopefully, knock on wood, that won’t happen.” To get an idea of how the flu season might go, public health officials in the U.S. often look to Australia and other countries in the southern hemisphere, where they are in the winter flu season. This season so far in Australia, COVID-19 precautions have served to curb the pandemic while also protecting residents against the flu. Canberra had only one case for the week ending July 26, the most recent report available. It’s had 190 total cases so far this flu season – which runs March through August – compared to 2,000 last year. Activity is low in the country overall, with just 36 deaths reported so far. And that’s not just true in Australia. The World Health organization reports few cases worldwide. But only time will tell whether the U.S. will follow suit. If not, the consequences could be dire, leaving people even more vulnerable to COVID-19 and potentially overwhelming hospitals, says Aubree Gordon, associate professor of epidemiology at the University of Michigan School of Public Health.


Ventilator Triaging Policies During the COVID-19 Pandemic

American College of Cardiology, August 10, 2020

The authors surveyed the Association of Bioethics Program Directors, advisors to hospital governing leadership in over 70 institutions throughout North America, asking:
o Whether a ventilator triage policy had been implemented in the wake of the COVID-19 pandemic,
o What criteria would be used in such a policy, and
o Which individuals are or would be involved in creating or activating the policy, or in adjudicating individual decisions.
A majority of institutions did not have a ventilator triage policy in place at the time of the survey. With 92% response rate, over half (54%) of the respondents reported no ventilator triage policy in their institution, and 10% reported inability to publicly share their policy. Findings from the 26 unique available policies were thus reported.


IV High-Dose Vitamin C Success Story in COVID-19

MedPage Today, August 10, 2020

A 74-year-old white woman presents to an emergency department in Flint, Michigan, after suffering with low-grade fever, dry cough, and shortness of breath for the previous 2 days. Her medical history for the week before includes elective surgery at an¬other hospital for total replacement of the right knee. She notes that she was healthy on admission and at discharge. She stayed in a private room, and had no contact with individuals who were ill or who had traveled recently. Lung auscultation reveals bilateral rhonchi with rales, and chest radiography shows patchy air space opacity in the right upper lobe suspicious for pneumonia. Concerns about community transmission of COVID-19 prompt a nasopharyngeal swab for detection of SARS-CoV-2. The patient is admitted to the airborne-isolation unit, maintaining compliance to the CDC recommendations for contact, droplet, and airborne precautions. Results of the nasopharyngeal swab are positive for SARS-CoV-2. Clinicians start treatment with oral hydroxychloroquine 400 mg once and then 200 mg twice a day, along with intravenous azithromycin 500 mg once a day, zinc sulfate 220 mg three times a day, and oral vitamin C 1 g twice a day. When blood and sputum cultures are negative for any organisms, broad-spectrum antibiotics are discontinued. The patient’s dyspnea rapidly worsens, and oxygen requirements increase to 15 liters. She is drowsy, in moderate distress, and her airways remain unprotected. On day 7, the second day of mechanical ventilation, at the request of the family when the patient develops ARDS, she is started on a continuous intravenous infusion of high-dose vita¬min C (11 g /24 hours). Two days later, her clinical condition gradually begins to improve, and the clinicians discontinue supportive treatment with norepinephrine. On day 10, the fifth day of mechanical ventilation, another chest x-ray shows that both the pneumonia and interstitial edema have improved considerably. The patient responds well to a spontaneous breathing trial with continuous positive airway pressure/pressure support, with the settings of positive end-expiratory pressure (PEEP) of 7 mm Hg, pressure support above PEEP of 10 mm Hg, and a fraction of inspired oxygen of 40%.


No End in Sight as U.S. Cases Pass 5 Million

WebMD, August 9, 2020

The U.S. logged 5 million confirmed COVID-19 cases, hitting another grim milestone in the nearly 6-month long pandemic that has devastated the country. The U.S. tally is substantially larger than the next closest country, Brazil, which has logged roughly 3 million cases. It is roughly 2.5 times the size of the outbreak in India, though the total population in that country is more than 4 times as large. Experts say the number of cases underscores the failure of our national response. In July, newly reported cases in the U.S. topped 70,000 a day. “Seventy thousand was the number of cases that they had in Wuhan, China where this started, in total. So we were having a Wuhan a day in this country,” says Carlos Del Rio, MD, an infectious disease specialist and a professor of Global Health and Epidemiology at Emory University in Atlanta. “We’re doing a crappy job.” While cases have slowed slightly in recent days, they have been rapidly accelerating in the U.S. Since the introduction of the virus, it took the U.S. more than 12 weeks to reach its first 1 million cases, 7 weeks to amass 2 million cases, 3.5 weeks to reach 3 million, and 2.5 weeks to hit 4 million, and another 2.5 weeks to reach 5 million.


Clinical Outcomes Associated with Methylprednisolone in Mechanically Ventilated Patients with COVID-19

Clinical Infectious Diseases, August 9, 2020

The efficacy and safety of methylprednisolone in mechanically ventilated patients with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19) are unclear. In this study, we evaluated the association between use of methylprednisolone and key clinical outcomes. Clinical outcomes associated with the use of methylprednisolone were assessed in an unmatched, case-control study; a subset of patients also underwent propensity-score matching. The primary outcome was ventilator-free days by 28 days after admission. Secondary outcomes included extubation, mortality, discharge, positive cultures, and hyperglycemia. A total of 117 patients met inclusion criteria. Propensity matching yielded a cohort of 42 well-matched pairs. Groups were similar except for hydroxychloroquine and azithromycin use, which were more common in patients who did not receive methylprednisolone. Mean ventilator free-days were significantly higher in patients treated with methylprednisolone (6.21±7.45 versus 3.14±6.22; P = 0.044). The probability of extubation was also increased in patients receiving methylprednisolone (45% versus 21%; P = 0.021), and there were no significant differences in mortality (19% versus 36%; P = 0.087). In a multivariable linear regression analysis, only methylprednisolone use was associated with higher number of ventilator-free days (P = 0.045). The incidence of positive cultures and hyperglycemia were similar between groups.


Coronavirus in Context: The Impact of COVID on Digital Health

WebMD, August 7, 2020

[Video] Dr. John Whyte, Chief Medical Officer at Web MD, discusses the future of healthcare right now during COVID and post-COVID? Dr. Whyte interviews Dr. Bertalan Mesko, a self-described “geek physician” with a PhD in genomics and a medical futurist.


What can we learn from a COVID-19 lung biopsy?

International Journal of Infectious Diseases, August 6, 2020

The newly emerging COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has swept nearly all over the world with stunning mortality. Even lots of researches have been investigated, few pathologies in living lung tissue has been reported due to barely accessible biopsy. Here, we investigated the pathological characteristics of an alive patient who suffered from severe infection with SARS-CoV-2. This study is in accordance with regulations issued by the National Health Commission of China. Our findings will facilitate understanding of the histopathology and the treatment of COVID-19, and improve clinical strategies against the disease. The patient’s lung morphological, ultrastructure, and some important inflammatory biological markers changes are presented to help better understand the disease and make a clue for all the multidisciplinary team to save more people.


Asthma Among Hospitalized Patients with COVID-19 and Related Outcomes

Journal of Allergy and Clinical Immunology, August 6, 2020

Several underlying conditions have been associated with severe SARS-CoV2 illness, it remains unclear if underlying asthma is associated with worse COVID-19 outcomes. Given the high prevalence of asthma in the New York City area, the objective was to determine if underlying asthma was associated with poor outcomes among hospitalized patients with severe COVID-19 disease compared to patients without asthma. Electronic heath records were reviewed for 1,298 sequential patients age <65 years without chronic obstructive pulmonary disease (COPD) who were admitted to our hospital system with a confirmed positive SARS-CoV-2 test. The overall prevalence of asthma among all hospitalized patients with COVID-19 was 12.6%, yet a higher prevalence (23.6%) was observed in the subset 55 patients <21 years of age. There was no significant difference in hospital length of stay, need for intubation, length of intubation, tracheostomy tube placement, hospital readmission or mortality between asthmatic vs. non-asthmatic patients.


Early Identification of COVID-19 Cytokine Storm and Treatment with Anakinra or Tocilizumab

International Journal of Infectious Diseases, August 6, 2020

The objective of the study was to examine outcomes among patients who were treated with the targeted anti-cytokine agents, anakinra or tocilizumab, for COVID-19 -related cytokine storm (COVID19-CS). We conducted a retrospective cohort study of all SARS-coV2-RNA-positive patients treated with tocilizumab or anakinra in Kaiser Permanente Southern California. Local experts developed and implemented criteria to define COVID19-CS. All variables were extracted from the electronic health record. At tocilizumab initiation (n = 52), 50 (96.2%) were intubated, and only 7 (13.5%) received concomitant corticosteroids. At anakinra initiation (n = 41), 23 (56.1%) were intubated, and all received concomitant corticosteroids. Fewer anakinra-treated patients died (n = 9, 22%) and more were extubated/never intubated (n = 26, 63.4%) compared to tocilizumab-treated patients (n = 24, 46.2% dead, n = 22, 42.3% extubated/never intubated).


COVID-19 Breakthrough: Scientists Identify Possible “Achilles’ Heel” of SARS-CoV-2 Virus

SciTechDaily, August 6, 2020

In the case of an infection, the SARS-CoV-2 virus must overcome various defense mechanisms of the human body, including its non-specific or innate immune defense. During this process, infected body cells release messenger substances known as type 1 interferons. These attract natural killer cells, which kill the infected cells. One of the reasons the SARS-CoV-2 virus is so successful — and thus dangerous — is that it can suppress the non-specific immune response. In addition, it lets the human cell produce the viral protein PLpro (papain-like protease). PLpro has two functions: It plays a role in the maturation and release of new viral particles, and it suppresses the development of type 1 interferons. The German and Dutch researchers have now been able to monitor these processes in cell culture experiments. Moreover, if they blocked PLpro, virus production was inhibited and the innate immune response of the human cells was strengthened at the same time. Professor Ivan Dikic, Director of the Institute of Biochemistry II at University Hospital Frankfurt and last author of the paper, explains: “We used the compound GRL-0617, a non-covalent inhibitor of PLpro, and examined its mode of action very closely in terms of biochemistry, structure and function. We concluded that inhibiting PLpro is a very promising double-hit therapeutic strategy against COVID-19. The further development of PLpro-inhibiting substance classes for use in clinical trials is now a key challenge for this therapeutic approach.”


Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea

JAMA Internal Medicine, August 6, 2020

Are there viral load differences between asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this study was to quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients. In this cohort study that included 303 patients with SARS-CoV-2 infection isolated in a community treatment center in the Republic of Korea, 110 (36.3%) were asymptomatic at the time of isolation and 21 of these (19.1%) developed symptoms during isolation. The cycle threshold values of reverse transcription–polymerase chain reaction for SARS-CoV-2 in asymptomatic patients were similar to those in symptomatic patients. Many individuals with SARS-CoV-2 infection remained asymptomatic for a prolonged period, and viral load was similar to that in symptomatic patients; therefore, isolation of infected persons should be performed.


Healthcare workers of color nearly twice as likely as whites to get COVID-19

Modern Healthcare, August 6, 2020

Healthcare workers of color were more likely to care for patients with suspected or confirmed COVID-19, more likely to report using inadequate or reused protective gear, and nearly twice as likely as white colleagues to test positive for the coronavirus, a new study found. The study from Harvard Medical School researchers also showed that healthcare workers are at least three times more likely than the general public to report a positive COVID test, with risks rising for workers treating COVID patients. Dr. Andrew Chan, a senior author and an epidemiologist at Massachusetts General Hospital, said the study further highlights the problem of structural racism, this time reflected in the front-line roles and personal protective equipment provided to people of color. “If you think to yourself, ‘healthcare workers should be on equal footing in the workplace,’ our study really showed that’s definitely not the case,” said Chan, who is also a professor at Harvard Medical School. The study was based on data from more than 2 million COVID Symptom Study app users in the U.S. and the United Kingdom from March 24 through April 23. The study, done with researchers from King’s College London, was published in the journal The Lancet Public Health.


How a Zoom forum is changing the way ICU doctors treat desperately ill Covid-19 patients\

STAT, August 6, 2020

It was late April, near the height of the Covid-19 pandemic in the big cities in the northeastern U.S., and anesthesiologist Joseph Savino was puzzled. In two months, an unexpectedly high number of coronavirus patients had died in his intensive care unit at the Hospital of the University of Pennsylvania after a stroke caused by bleeding in the brain. All were among 15 Covid-19 patients at the Philadelphia hospital who had been on a life-support technology called ECMO that is a last resort for patients when mechanical ventilators fail to help their virus-ravaged lungs. ECMO, for extracorporeal membrane oxygenation — essentially an artificial lung — is high-risk, but still, the number of fatal brain bleeds seemed unusual, said Savino, a critical-care specialist. It was too low, however, “to draw any substantive conclusions” about cutting back the blood-thinning drugs they were giving other Covid-19 patients on ECMO, because blood clots, not bleeds, were seen as the major risk to survival. Swamped by overflowing ICUs and the myriad not-seen-before ways the novel coronavirus attacks the body, doctors caring for the pandemic’s sickest patients are scrambling to share their experiences with each other in real time, hoping to find ways to stanch Covid-19’s devastating toll. Some 200 physicians from several countries and dozens of states have participated in the Friday Zoom sessions.


The effects of COVID-19 on the office visit

MJH Life Sciences, August 6, 2020

[Infographic] In this State of Physician Survey, COVID-19’s effect on the office visit was the subject. With over 1,000 responses from a variety of specialties, physicians were candid about navigating a new normal with COVID-19 and the office visit. Accommodating safe distancing in the waiting room to patient compliance and education are top areas of concern highlighted on the infographic.


Are patients with chronic rhinosinusitis with nasal polyps at a decreased risk of COVID-19 infection?

International Forum of Allergy & Rhinology, August 5, 2020

SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry to the cell and the serine protease TMPRSS2 for S protein prim. Higher ACE2 expression was recently reported in nasal compared to throat tissue. In fact, higher SARS-CoV-2 viral load was detected in nasal compared to throat swabs obtained from COVID-19 infected patients, and that was attributed to the difference in ACE2 expression between both tissues. In fact, higher SARS-CoV-2 viral load was detected in nasal compared to throat swabs obtained from COVID-19 infected patients. This was attributed to the difference in ACE2 expression between both tissues [4]. Recently, we have also shown that the upper airway expresses more SARS-CoV-2 entry genes, ACE2 and TMPRSS2 compared to the lower airway. Moreover, Hou et al, have recently established that multiciliated cells are the main cell types expressing ACE2 in nasal tissue and infected with SARS-CoV-2. Moreover, Sungnak et al by analyzing data of single-cell RNA-sequencing from healthy human nasal epithelial cells showed that ACE2 and TMPRSS2 are co-expressed in nasal epithelium with genes involved in host innate immunity, referring to the potential role of these cells in initiating SARS-CoV-2 infection. Therefore, the level of SARS-CoV-2 receptors in nasal tissue may determine the level of viral infectivity given the fact that these receptors are not upregulated following infection [1]. With that in mind, we decided to investigate potential factors that may affect the expression of SARS-CoV-2 receptors and hence the risk of infectivity with COVID-19 in various phenotypes of sinonasal inflammation.


Efforts Needed to Get Minorities Into Clinical Trials, Experts Say

MedPage, August 4, 2020

More work needs to be done to enroll people of color in clinical trials, Freda Lewis-Hall, MD, chief patient officer and executive vice president at Pfizer, said Sunday at the annual meeting of the National Medical Association. “One of the really interesting things the data tell us about participation in clinical trials of Black and brown people is they are much less likely to be asked,” Lewis-Hall said during the plenary session of the meeting, which was held remotely. Lewis-Hall said investigator bias against Black and brown patients is reflected in statements such as “I don’t know if they can get here; adherence might be a problem; it may take too long,” and this needs to improve. One thing that would help is having more Black and brown physicians, she added. “The numbers are woefully lagging. We need to increase our pipeline of physicians and physician-investigators, because over and over we heard that the trust issue is critical,” and that “we need to educate patients around clinical trials and their relative safety.”


Assessing Prone and Lateral Positioning in COVID-19 With Hypoxemic Respiratory Failure

Pulmonary Advisor, August 3, 2020

Patients with hypoxemic acute respiratory failure as a result of coronavirus disease 2019 (COVID-19) who received continuous positive airway pressure (CPAP) therapy had a high failure rate during prone/lateral positioning tests, according study results published in CHEST. Patients with COVID-19 at the high dependency unit of a hospital in Milan, Italy who were spontaneously breathing and not intubated but undergoing helmet CPAP treatment were assessed for lung function and blood oxygenation after a number of positioning tests. Patients who had monolateral lung impairment were placed laterally, while patients with bilateral impairment were placed prone. Alveolar-arterial gradient (A-aO2) was recorded at 3 time points: at baseline in a semi-seated position, after 1 hour with the patient in prone/lateral position, and 45 minutes with the patient returned to a semi-seated position. A decrease of ≥20% from baseline was considered clinically significant. Of the 26 patients with COVID-19, the mean age was 62 years and 67% were men. Systemic hypertension, diabetes, obesity, COPD, and asthma were common comorbidities. A total of 39 tests consisting of 12 prone and 27 lateral positioning were conducted. For the primary study end point, 15.4% of positioning trials were successful with a decrease of A-aO2 of ≥20% in comparison to baseline, 7.7% showed a A-aO2 decrease of ≥30% in comparison with baseline, 46.1% trials showed a decrease of <20% of A-aO2 compared with baseline, and a total of 38.5% trials failed.


Coronavirus Q&A With Anthony Fauci

JAMA Live, August 3, 2020

[Video] Anthony Fauci, MD, White House Coronavirus Task Force member and Director of the National Institutes of Allergy and Infectious Diseases, discusses latest developments in the COVID-19 pandemic with Howard Bauchner, MD, Editor in Chief, JAMA.


Covid-19: Obesity Ups Risk of Intubation, Death in Adults 65 or Younger

Physician’s Weekly, August 3, 2020

Obesity is associated with an increased risk of death or intubation in patients younger than age 65 who contract Covid-19, according to a retrospective cohort study published in the Annals of Internal Medicine. This association was independent of age, sex, race/ethnicity, and comorbid conditions, Michaela R. Anderson, MD, MS, of Columbia University Irving Medical Center, in New York, and colleagues reported. They did note that the associations varied by age. “Obesity was strongly associated with intubation or death among adults younger than 65 years, but not among those aged 65 years or older,” Anderson and colleagues noted. “Our findings provide evidence to support recommendations from the Centers for Disease Control and Prevention in the United States and the National Health Service in the United Kingdom, which state that patients with a BMI of 40 kg/m2 or greater are at high risk for poor outcomes from Covid-19 and should therefore consider prolonged social distancing. As the United States and other countries begin to lift stay-at-home orders, these findings might inform discussions between health care providers and patients regarding advanced care planning and benefits of prolonged social distancing, particularly for younger adults with class 2 or 3 obesity.”


The effect of sample site, illness duration and the presence of pneumonia on the detection of SARS-CoV-2 by real-time reverse-transcription PCR

Open Forum Infectious Diseases, August 3, 2020

The performance of rRT-PCR for SARS-CoV-2 varies with sampling site(s), illness stage and infection site were evaluated. Unilateral nasopharyngeal, nasal mid-turbinate, throat swabs, and saliva were simultaneously sampled for SARS-CoV-2 rRT-PCR from suspect or confirmed cases of COVID-19.True positives were defined as patients with at least one SARS-CoV-2 detected by rRT-PCR from any site on the evaluation day or at any time point thereafter, till discharge. Diagnostic performance was assessed and extrapolated for site combinations. We evaluated 105 patients; 73 had active SARS-CoV-2 infection. Overall, nasopharyngeal specimens had the highest clinical sensitivity at 85%, followed by throat, 80%, mid-turbinate, 62%, and saliva, 38-52%. Clinical sensitivity for nasopharyngeal, throat, mid-turbinate and saliva was 95%, 88%, 72%, and 44-56% if taken ≤7 days from onset of illness, and 70%, 67%, 47%, 28-44% if >7 days of illness. Comparing patients with URTI vs. pneumonia, clinical sensitivity for nasopharyngeal, throat, mid-turbinate and saliva was 92% vs 70%, 88% vs 61%, 70% vs 44%, 43-54% vs 26-45%. A combination of nasopharyngeal plus throat or mid-turbinate plus throat specimen afforded overall clinical sensitivities of 89-92%, this rose to 96% for persons with URTI and 98% for persons <7 days from illness onset.


No Benefit With Tocilizumab in COVID-19 Pneumonia Trial

Pulmonary Advisor, August 3, 2020

Genentech announced that a phase 3 study investigating tocilizumab (Actemra®) for the treatment of hospitalized patients with severe coronavirus disease 2019 (COVID-19) associated pneumonia did not meet its primary and key secondary end points. The multicenter, randomized, double-blind COVACTA study compared the efficacy and safety of tocilizumab, an interleukin-6 receptor antagonist, to placebo in hospitalized adult patients with severe COVID-19 pneumonia. Patients were randomized to receive 1 intravenous infusion of either tocilizumab or placebo, in addition to standard of care. The primary end point was clinical status as measured by a 7-category ordinal scale; key secondary end points included mortality, as well as mechanical ventilation and intensive care unit (ICU) variables. Results showed that the difference in clinical status between patients treated with tocilizumab and those who received placebo was not statistically significant (odds ratio 1.19; 95% CI, 0.81-1.76; P =.36). Additionally, no statistically significant differences were observed between the 2 groups with regard to mortality rate (19.7% with tocilizumab vs 19.4% with placebo; P =.9410) or ventilator-free days (22 days with tocilizumab vs 16.5 days with placebo; P =.3202).


Longitudinal dynamics of the neutralizing antibody response to SARS-CoV-2 infection

Clinical Infectious Diseases, August 3, 2020

Coronavirus disease 2019 (COVID-19) is a global pandemic with no licensed vaccine or specific antiviral agents for therapy. Little is known about the longitudinal dynamics of SARS-CoV-2-specific neutralizing antibodies (NAbs) in COVID-19 patients. In this study, blood samples (n=173) were collected from 30 COVID-19 patients over a 3-month period after symptom onset and analyzed for SARS-CoV-2-specific NAbs, using the lentiviral pseudotype assay, coincident with the levels of IgG and proinflammatory cytokines. SARS-CoV-2-specific NAb titers were low for the first 7–10 d after symptom onset and increased after 2–3 weeks. The median peak time for NAbs was 33 d (IQR 24–59 d) after symptom onset. NAb titers in 93·3% (28/30) of the patients declined gradually over the 3-month study period, with a median decrease of 34·8% (IQR 19·6–42·4%). NAb titers increased over time in parallel with the rise in IgG antibody levels, correlating well at week 3 (r = 0·41, p & 0·05). The NAb titers also demonstrated a significant positive correlation with levels of plasma proinflammatory cytokines, including SCF, TRAIL, and M-CSF.


Presidential order signed expanding use of virtual doctors

The Hill, August 3, 2020

On Monday, the President signed an executive order seeking to expand the use of virtual doctors visits, as his administration looks to highlight achievements in health care. The administration waived certain regulatory barriers to video and phone calls with doctors, known as telehealth, when the coronavirus pandemic struck and many people were stuck at home. Now, the administration is looking to make some of those changes permanent, arguing the moves will provide another option for patients to talk to their doctors. The order calls on the secretary of Health and Human Services to issue rules within 60 days making some of the changes permanent.


RLF-100 (aviptadil) clinical trial showed rapid recovery from respiratory failure and inhibition of coronavirus replication in human lung cells

Cision, August 2, 2020

NeuroRx, Inc. and Relief Therapeutics Holdings AG (SIX:RLF, OTC:RLFTF) “Relief” today announced that RLF-100 (aviptadil) showed rapid recovery from respiratory failure in the most critically ill patients with COVID-19. At the same time, independent researchers have reported that aviptadil blocked replication of the SARS coronavirus in human lung cells and monocytes. RLF-100 has been granted Fast Track designation by FDA and is being developed as a Material Threat Medical Countermeasure in cooperation with the National Institutes of Health and other federal agencies. Further research will be conducted. The first report of rapid clinical recovery under emergency use IND was posted by doctors from Houston Methodist Hospital. The report describes a 54-year-old man who developed COVID-19 while being treated for rejection of a double lung transplant and who came off a ventilator within four days. Similar results were subsequently seen in more than 15 patients treated under emergency use IND and an FDA expanded access protocol which is open to patients too ill to be admitted to the ongoing Phase 2/3 FDA trial. Patients with Critical COVID-19 were seen to have a rapid clearing of classic pneumonitis findings on x-ray, accompanied by an improvement in blood oxygen and a 50% or greater average decrease in laboratory markers associated with COVID-19 inflammation.


U.S. records over 25,000 coronavirus deaths in July

Reuters, July 31, 2020

U.S. coronavirus deaths rose by over 25,000 in July and cases doubled in 19 states during the month, according to a Reuters tally, dealing a crushing blow to hopes of quickly reopening the economy. The United States recorded 1.87 million new cases in July, bringing total infections to 4.5 million, for an increase of 69%. Deaths in July rose 20% to nearly 154,000 total. The biggest increases in July were in Florida, with over 310,000 new cases, followed by California and Texas with about 260,000 each. All three states saw cases double in June. Cases also more than doubled in Alabama, Alaska, Arizona, Arkansas, Georgia, Hawaii, Idaho, Mississippi, Missouri, Montana, Nevada, Oklahoma, Oregon, South Carolina, Tennessee and West Virginia, according to the tally. Connecticut, Massachusetts, New Jersey and New York had the lowest increases, with cases rising 8% or less.


Women Physicians and the COVID-19 Pandemic

Journal of the American Medical Association, July 31, 2020

Before the magnifying glass of the COVID-19 pandemic caused physicians to look more closely at many aspects of their profession, there was awareness of the general culture of overwork that affect all physicians and the expectation by some that women physicians would make adjustments in their professional roles to accommodate their personal roles. These professional adjustments were made, including part-time status, despite the known limitations on professional progression, career advancement, and economic potential. These adjustments further propagate gender inequities and the persistent compensation gap women physicians’ experience. Women physicians have diverse personal characteristics. There is no appropriate stereotype for a woman physician. Some are just starting their professional careers. Some are older, nearing retirement. Some are partnered, others are solo. Some are childless, others are parents. Family care responsibilities vary with some caring for their children, their aging parents, or both. Practice parameters and settings vary, including business owners, health care executives, academic physicians, and employees of hospitals and group practices. For partnered women physicians, a small number are the principal source of income with a partner assuming the primary role for home and family care. The increasing number of women physicians is accompanied by a rise in the number of dual physician households. This diversity of personal situations highlights the reason to avoid broad assumptions when considering the life-work preferences or professional work adjustments related to the COVID-19 epidemic for individuals or groups of physicians, by gender.


2nd US virus surge hits plateau, but few experts celebrate

Associated Press, July 31, 2020

While deaths from the coronavirus in the U.S. are mounting rapidly, public health experts are seeing a flicker of good news: The second surge of confirmed cases appears to be leveling off. The virus has claimed over 150,000 lives in the U.S., by far the highest death toll in the world, plus more than a half-million others around the globe. Over the past week, the average number of COVID-19 deaths per day in the U.S. has climbed more than 25%, from 843 to 1,057. Florida on Thursday reported 253 more deaths, setting its third straight single-day record, while Texas had 322 new fatalities and California had 391. The number of confirmed infections nationwide has topped 4.4 million, which could be higher because of limits on testing and because some people are infected without feeling sick.


Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

CDC Morbidity and Mortality Weekly Report, July 31, 2020

Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 (COVID-19). Characterizing return to baseline health among outpatients with milder COVID-19 illness is important for understanding the full spectrum of COVID-19–associated illness and tailoring public health messaging, interventions, and policy. During April 15–June 25, 2020, telephone interviews were conducted with a random sample of adults aged ≥18 years who had a first positive reverse transcription–polymerase chain reaction (RT-PCR) test for SARS-CoV-2, the virus that causes COVID-19, at an outpatient visit at one of 14 U.S. academic health care systems in 13 states. Interviews were conducted 14–21 days after the test date. Respondents were asked about demographic characteristics, baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview. Among 292 respondents, 94% (274) reported experiencing one or more symptoms at the time of testing; 35% of these symptomatic respondents reported not having returned to their usual state of health by the date of the interview (median = 16 days from testing date), including 26% among those aged 18–34 years, 32% among those aged 35–49 years, and 47% among those aged ≥50 years. Among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview.


Lung Compliance in a Case Series of Four COVID-19 Patients at a Rural Institution

Cureus, July 30, 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has generated a plethora of scientific articles. One interesting aspect of the virus is the binary phenotypic presentation in patients. While patients might meet the Berlin criteria for acute respiratory distress syndrome (ARDS), not all patients experience the same decrease in lung compliance as typically seen with ARDS. We have observed patients meeting ARDS criteria with higher lung compliance as measured through peak pressures at our institution. This phenotype difference is important with regard to how the patients are managed. Lower positive end-expiratory pressure (PEEP) and higher tidal volumes can be used in this phenotype. Read this case series of four patients with confirmed COVIID-19 admitted to our hospital, with a focus on lung compliance. Three of the four patients required intubation, while the fourth passed away before intubation.


Scientists develop human lung organoids to study SARS-CoV-2 infection

News Medical, July 30, 2020

The current COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to target primarily the distal lung, including the terminal bronchioles and alveoli, which are the sites of essential gas exchange in the human body. In a significant minority of patients, this results in critical pneumonia and acute respiratory distress syndrome (ARDS). However, the mechanism by which this occurs is far from clear, and one major contributing factor to this knowledge gap is the absence of a reliable and robust human lung cell culture system that will serve as a substrate for disease of the terminal lungs. Now, a new study reports the development of a human distal lung culture system that can be functionally tested. This will help not only to understand how this infection produces disease but also to test the proliferative capacity of the stem cells in this part of the body. As of now, mouse studies provide most of our knowledge about these stem cells, which are functionally part of the lung as well as providing a source of new cells during healing of the lung. These studies have shown that these bifunctional stem cells of the distal lung comprise the secretory club cells found in the distal bronchioles and the type 2 pneumonocytes or alveolar cells (AT2) that produce surfactant in the lung alveoli.


Treatment Options for COVID-19

Helio | Infectious Disease News, July 30, 2020

[Podcast] Research and data on potential treatment modalities continue to emerge at a rapid pace. This episode explores the IDSA and NIH guidelines for the treatment and management of COVID-19, as well as available evidence on antivirals, glucocorticoids and antibodies. Gitanjali Pai, MD, is an infectious disease physician at Memorial Hospital and Physicians’ Clinic in Stilwell, Oklahoma. She is a member of the Infectious Disease News Editorial Board and host of Healio’s podcast Unmasking COVID-19.


Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Intensive Care Medicine, July 29, 2020

This multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68–0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357. In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.


Researchers launch randomized, placebo-controlled clinical trial of pulmozyme in COVID-19 patients

NewsMedical, July 29, 2020

Researchers at Boston Children’s Hospital and Brigham and Women’s Hospital have launched a randomized, placebo-controlled clinical trial of dornase alfa (Pulmozyme) in patients with severe COVID-19 pneumonia and respiratory failure requiring mechanical ventilation. The study aims to enroll 60 adults and children (over age 3) admitted to intensive care units. Dornase alfa, also called DNase 1, is FDA-approved for patients with cystic fibrosis, to break up thick mucus secretions and prevent lung infections. The trial is supported by the Massachusetts Consortium on Pathogen Readiness, and the drug is being provided by Genentech, a member of the Roche Group, which is also providing supplementary financial support. The 18-month study will randomize patients to twice-daily nebulized dornase alfa or placebo (a saline solution) within 48 hours after intubation and placement on a ventilator.


Association between cytokine profiles and lung injury in COVID-19 pneumonia

Respiratory Research, July 29, 2020

The purpose of the present study was to investigate the association between cytokine profiles and lung injury in COVID-19 pneumonia. The retrospective study was conducted in COVID-19 patients. Demographic characteristics, symptoms, signs, underlying diseases, and laboratory data were collected. The patients were divided into COVID-19 with pneumonia and without pneumonia. CT severity score and PaO2/FiO2 ratio were used to assess lung injury. One hundred and six patients with 12 COVID-19 without pneumonia and 94 COVID-19 with pneumonia were included. Compared with COVID-19 without pneumonia, COVID-19 with pneumonia had significantly higher serum interleukin (IL)-2R, IL-6, and tumor necrosis factor (TNF)-α. Correlation analysis showed that CT severity score and PaO2/FiO2 were significantly correlated with age, presence of any coexisting disorder, lymphocyte count, procalcitonin, IL-2R, and IL-6. In multivariate analysis, log IL6 was the only independent explanatory variables for CT severity score (β = 0.397, p < 0.001) and PaO2/FiO2 (β = − 0.434, p = 0.003).


Phase 3 Trial of COVID-19 Vaccine Candidate mRNA-1273 Begins

Pulmonology Advisor, July 29, 2020

Moderna and the National Institutes of Allergy and Infectious Diseases have initiated a phase 3 trial evaluating the vaccine candidate mRNA-1273 against coronavirus disease 2019 (COVID-19). The trial, which is the first to be implemented under Operation Warp Speed, is expected to enroll around 30,000 adults and will be conducted at multiple clinical research sites across the US. In addition, the National Institutes of Health (NIH) Coronavirus Prevention Network will participate in conducting the trial. Testing sites in areas with emerging cases or high incidence rates will be prioritized for enrollment. Participants will be randomized to receive 2 intramuscular injections of either mRNA-1273 or saline placebo approximately 28 days apart. The study’s primary aim will be to assess whether the vaccine is able to prevent symptomatic COVID-19 after the administration of 2 doses; prevention after 1 dose will also be investigated as a secondary goal. Moreover, researchers will look at whether vaccination with mRNA-1273 prevents severe COVID-19 or laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with or without disease symptoms, as well as death.


U.S. records a coronavirus death every minute as total surpasses 150,000

Reuters, July 29, 2020

One person in the United States died about every minute from COVID-19 on Wednesday as the national death toll surpassed 150,000, the highest in the world. The United States recorded 1,461 new deaths on Wednesday, the highest one-day increase since 1,484 on May 27, according to a Reuters tally. U.S. coronavirus deaths are rising at their fastest rate in two months and have increased by 10,000 in the past 11 days. Nationally, COVID-19 deaths have risen for three weeks in a row while the number of new cases week-over-week recently fell for the first time since June. A spike in infections in Arizona, California, Florida and Texas this month has overwhelmed hospitals. The rise has forced states to make a U-turn on reopening economies that were restricted by lockdowns in March and April to slow the spread of the virus. Texas leads the nation with nearly 4,300 deaths so far this month, followed by Florida with 2,900 and California, the most populous state, with 2,700. The Texas figure includes a backlog of hundreds of deaths after the state changed the way it counted COVID-19 fatalities.


As pandemic rages, PPE supply remains a problem

Center for Infectious Disease Research and Policy, July 29, 2020

On top of being overwhelmed with severely ill people, healthcare workers are dealing with shortages of the personal protective equipment (PPE) that they need to keep from getting infected themselves. N95 respirators, surgical masks, gowns, and gloves were all were in short supply, forcing hospitals to ration them. At the root of the issue were several problems: a global surge in demand for protective gear that was outstripping supply, a lack of adequate supplies in the Strategic National Stockpile, which is intended to supplement state and local supplies during public health emergencies, and a response that lacked any federal coordination. A nationwide scrum for available PPE ensued, pitting state governments, healthcare systems, and individual hospitals against each other as they fought to outbid each other for adequate supplies for the pandemic response. Four months later, many hospitals have a better supply of PPE than they did in March and April. But with the dramatic nationwide rise in coronavirus cases that began in mid-June and shows no signs of slowing, concerns about PPE supplies remain. And demand is now coming not only from the hospitals that are treating COVID-19 patients, but also from nursing homes, primary care doctors who want to ensure a safe environment as they begin welcoming back patients for routine primary care, and other frontline healthcare workers.


Lung fibrosis: an undervalued finding in COVID-19 pathological series

The Lancet | Infectious Diseases, July 28, 2020

With the COVID-19 pandemic having reached tremendous proportions, post-mortem series are under the limelight to explain many of the peculiar clinical findings. Pathological descriptions of disease are fundamental for understanding pathogenetic features and might inform new treatments. Indeed, the widely discussed identification of thrombosis in patients with COVID-19 has garnered much interest, and has resulted in new treatment strategies, with anticoagulants now part of patient management. In their Article, Luca Carsana and colleagues describe the lung findings of 38 patients who died with COVID-19 and show that early-phase or intermediate-phase diffuse alveolar damage is the main pathological finding, as well as fibrin thrombi in small arterial vessels. Other autoptic series, composed of fewer cases, also show thrombotic events to be findings specifically related to COVID-19. The fibrotic changes seen in patients who died with COVID-19 who had severe disease of long duration have been, however, only briefly touched upon in published studies, and no complete pathological description of these cases is available.


SARS-CoV-2 Infection Does Not Necessarily Increase Asthma Exacerbation Risk

Pulmonary Advisor, July 28, 2020

Asthma is not a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), and SARS-CoV-2 pneumonia may not induce severe asthma exacerbation, according to the results of a retrospective cohort study published in The Journal of Allergy and Clinical Immunology: In Practice. Viral infections are known to exacerbate asthma in adults, however these patients are rare in epidemiologic studies of SARS-CoV-2 pneumonia. Thus, it is unknown whether there is an association between SARS-CoV-2 infection and severe asthma exacerbation. Researchers at Strasbourg University Hospital in France assessed the frequency of asthma exacerbation in 106 patients hospitalized for SARS-CoV-2 pneumonia between March 4 and April 6, 2020. Of these patients, 23 had asthma, with 63.6% considered well-controlled and 23.4% considered partially controlled. A total of 11 patients had ≥1 severe exacerbation in the previous year and 68.2% were considered to have allergic asthma because of their clinical history.


Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study

The Lancet | Respiratory Medicine, July 28, 2020

In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. Of 10,021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18–59 years, 382 [22%] were aged 60–69 years, 535 [31%] were aged 70–79 years, and 388 [23%] were aged ≥80 years). The median age was 72 years (IQR 57–82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199).


Effect of COVID-19 on Pulmonary Fibrosis Clinical Trials: Expert Interview

Pulmonary Advisor, July 27, 2020

For patients with chronic diseases such as pulmonary fibrosis, coronavirus disease 2019 (COVID-19) represents a threat beyond the immediate risk of infection. These individuals have a greater likelihood of developing serious complications as a result of the virus, and those awaiting organ transplantation and other surgical interventions may face delays because of the risk of viral exposure and strained resources in the current healthcare environment. In addition, clinical trials investigating potential therapies for various diseases including pulmonary fibrosis have been disrupted considerably since the pandemic emerged. According to data from the WIRB-Copernicus Group (WCG), the number of clinical research sites open to enrollment for non-COVID-19 trials decreased from 62% on March 24, 2020, to 11% on May 1, 2020. Although enrollment has begun to resume since that period, these developments have prompted experts to consider ways to address such issues in the context of ongoing and future trials.


The Color of COVID: Will Vaccine Trials Reflect America’s Diversity?

Kaiser Health News, July 27, 2020

Black and Latino people have been three times as likely as white people to become infected with COVID-19 and twice as likely to die, according to federal data obtained via a lawsuit by The New York Times. Asian Americans appear to account for fewer cases but have higher rates of death. Eight out of 10 COVID deaths reported in the U.S. have been of people ages 65 and older. And the Centers for Disease Control and Prevention warns that chronic kidney disease is among the top risk factors for serious infection. Historically, however, those groups have been less likely to be included in clinical trials for disease treatment, despite federal rules requiring minority and elder participation and the ongoing efforts of patient advocates to diversify these crucial medical studies. In a summer dominated by COVID-19 and protests against racial injustice, there are growing demands that drugmakers and investigators ensure that vaccine trials reflect the entire community.


Appropriate use of Tocilizumab in COVID-19 Infection

International Journal of Infectious Diseases, July 26, 2020

This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory, and radiologic observations. All the patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, complete blood count, and procalcitonin. Computerized thoracic tomography was obtained on admission, when oxygen support was necessary, and seven days after TCZ start. Disease course of the patients was grouped as severe or critical according to their clinical, laboratory, and radiologic evaluations. In total, 43 patients were included; 70% of the patients was male; the median age was 64 (min-max: 27-94), 6 (14%) patients were fatal. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs 4 days, p < 0.001). Only 3 cases out of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones.


Florida records 9,300 new coronavirus cases, blows past New York

Reuters, July 26, 2020

Florida on Sunday became the second state after California to overtake New York, the worst-hit state at the start of the U.S. novel coronavirus outbreak, according to a Reuters tally. Total COVID-19 cases in the Sunshine State rose by 9,300 to 423,855 on Sunday, just one place behind California, which now leads the country with 448,497 cases. New York is in third place with 415,827 cases. Still, New York has recorded the most deaths of any U.S. state at more than 32,000 with Florida in eighth place with nearly 6,000 deaths. On average, Florida has added more than 10,000 cases a day in July while California has been adding 8,300 cases a day and New York has been adding 700 cases.


U.S .agency vows steps to address COVID-19 inequalities

Modern Healthcare, July 25, 2020

If Black, Hispanic and Native Americans are hospitalized and killed by the coronavirus at far higher rates than others, shouldn’t the government count them as high risk for serious illness? That seemingly simple question has been mulled by federal health officials for months. And so far the answer is no. But federal public health officials have released a new strategy that vows to improve data collection and take steps to address stark inequalities in how the disease is affecting Americans. Officials at the Centers for Disease Control and Prevention stress that the disproportionately high impact on certain minority groups is not driven by genetics. Rather, it’s social conditions that make people of color more likely to be exposed to the virus and — if they catch it — more likely to get seriously ill. “To just name racial and ethnic groups without contextualizing what contributes to the risk has the potential to be stigmatizing and victimizing,” said the CDC’s Leandris Liburd, who two months ago was named chief health equity officer in the agency’s coronavirus response. Outside experts agreed that there’s a lot of potential downside to labeling certain racial and ethnic groups as high risk.


Early administration of Interleukin-6 inhibitors for patients with severe Covid-19 disease is associated with decreased intubation, reduced mortality, and increased discharge

International Journal of Infectious Diseases, July 25, 2020

This observational study aimed to determine optimal timing of interleukin-6 receptor inhibitors (IL6ri) administration for Coronavirus disease 2019 (Covid-19). Patients with Covid-19 were given an IL6ri (sarilumab or tocilizumab) based on iteratively reviewed guidelines. IL6ri were initially reserved for critically ill patients, but after review, treatment was liberalized to patients with lower oxygen requirements. Patients were divided into 2 groups: those requiring ≤ 45% fraction of inspired oxygen (FiO2) (termed stage IIB) and those requiring >45% FiO2 (termed stage III) at the time of IL6ri administration. Main outcomes were all-cause mortality, discharge alive from hospital, and extubation. Two hundred fifty-five Covid-19 patients were treated with IL6ri (149 stage IIB and 106 stage III). Patients treated in stage IIB had lower mortality than the stage III group (adjusted hazard ratio [aHR]: 0.24; 95% confidence interval [CI] 0.08-0.74). Overall, 218 (85.5%) patients were discharged alive. Patients treated in stage IIB were more likely to be discharged (aHR: 1.43; 95% CI 1.06 – 1.93) and were less likely to be intubated (HR: 0.43; 95% CI: 0.24-0.79).


US surpasses 1,000 COVID-19 deaths for fourth straight day

The Hill, July 25, 2020

The U.S. tallied over 1,000 coronavirus-related deaths Friday for the fourth straight day this week, yet another sign of the alarming spike in COVID-19 cases across the country. There were 1,178 new deaths Friday alone, according to the COVID Tracking project, compared with 1,038 Tuesday, 1,117 Wednesday, and 1,039 Thursday. Over 137,000 people have died in the U.S. and over 4 million people have contracted the virus in the country since the outbreak began. The alarming figures are largely driven by a surge in cases across the South and West, particularly in Arizona, California, Florida and Texas. The spikes have led to urgent calls from public health officials for Americans, particularly young people, to heed health guidance such as wearing masks and socially distancing.


Particle sizes of infectious aerosols: implications for infection control

The Lancet | Respiratory Medicine, July 24, 2020

The global pandemic of COVID-19 has been associated with infections and deaths among health-care workers. This Viewpoint of infectious aerosols is intended to inform appropriate infection control measures to protect health-care workers. Studies of cough aerosols and of exhaled breath from patients with various respiratory infections have shown striking similarities in aerosol size distributions, with a predominance of pathogens in small particles (<5 μm). These are immediately respirable, suggesting the need for personal respiratory protection (respirators) for individuals in close proximity to patients with potentially virulent pathogens. There is no evidence that some pathogens are carried only in large droplets. Surgical masks might offer some respiratory protection from inhalation of infectious aerosols, but not as much as respirators. However, surgical masks worn by patients reduce exposures to infectious aerosols to health-care workers and other individuals. The variability of infectious aerosol production, with some so-called super-emitters producing much higher amounts of infectious aerosol than most, might help to explain the epidemiology of super-spreading. Airborne infection control measures are indicated for potentially lethal respiratory pathogens such as severe acute respiratory syndrome coronavirus 2.


Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19

The New England Journal of Medicine, July 23, 2020

Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited. This multicenter, randomized, open-label, three-group, controlled trial involved hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were randomly assigned in a 1:1:1 ratio to receive standard care, standard care plus hydroxychloroquine at a dose of 400 mg twice daily, or standard care plus hydroxychloroquine at a dose of 400 mg twice daily plus azithromycin at a dose of 500 mg once daily for 7 days. The primary outcome was clinical status at 15 days as assessed with the use of a seven-level ordinal scale (with levels ranging from one to seven and higher scores indicating a worse condition) in the modified intention-to-treat population (patients with a confirmed diagnosis of Covid-19). Safety was also assessed. A total of 667 patients underwent randomization; 504 patients had confirmed Covid-19 and were included in the modified intention-to-treat analysis.


Time to Address Race-Ethnic COVID Disparities in Seniors, Senate Panel Told

MedPage Today, July 23, 2020

Enhancing data collection, investing in research, and building trust can help mitigate the disparate impacts of the COVID-19 pandemic on Black and Latinx seniors, witnesses told members of the Senate Special Committee on Aging during a hearing on Tuesday. The pandemic’s impact on minority and ethnic groups appears most acute in young people and seems to taper off among community-dwelling older adults, Mercedes Carnethon, PhD, an epidemiologist and preventive medicine specialist at Northwestern University in Chicago, told the committee. Nevertheless, disparities persist for seniors living in congregate care settings such as nursing homes. In fact, nursing homes with a higher proportion of Black and Latinx residents have double the rates of COVID-19 infections than facilities with a greater share of non-Hispanic whites, Carnethon said. Current policies don’t require universal reporting of race or ethnicities of individuals affected by COVID-19, she said.


Dexamethasone Lowers Mortality in Patients With COVID-19 Receiving Mechanical Ventilation

Pulmonology Advisor, July 23, 2020

Treatment with dexamethasone resulted in lower rates of 28-day mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation but not in those who received no respiratory support, according to findings published in the New England Journal of Medicine. Researchers conducted a controlled, open-label clinical trial (RECOVERY; ClinicalTrials.gov Identifier: NCT04381936) to evaluate the effects of potential treatments in patients hospitalized with COVID-19 in the United Kingdom. The primary outcome was 28-day mortality, with secondary outcomes being the time until hospital discharge and subsequent receipt of invasive ventilation or death in patients who did not receive mechanical ventilation at the beginning of the study. A total of 6425 patients were randomly assigned to receive oral or intravenous dexamethasone (n=2104) at 6 mg once daily for up to 10 days or usual care alone (n=4321). Mean patient age was 66.1 years and 36% were women. More than half of the patients had ≥1 major coexisting medical condition, including heart disease, chronic lung disease, and diabetes.


Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19

Journal of Hospital Medicine, July 22, 2020

The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.


Research Needed to Establish Diagnostic Chest CT Criteria for COVID-19

Pulmonary Advisor, July 22, 2020

More high-quality research is necessary to establish diagnostic chest computed tomography (CT) criteria for coronavirus disease 2019 (COVID-19), according to the results of a systematic review and meta-analysis published in Chest. Currently, real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swab specimens is considered the gold standard for the diagnosis of COVID-19. Real-time RT-PCR testing, however, is time-consuming and suboptimal for the rapid triaging of patients. In consideration of the potential benefit of chest CT for the diagnosis of COVID-19, in concert with clinical examination and RT-PCR, a team of researchers performed a systematic review to assess the methodologic quality of studies on the use of chest CT imaging in patients with COVID-19 and to determine the frequency of different chest CT findings. Studies that reported the prevalence of chest CT findings in patients with a diagnosis of COVID-19 confirmed by RT-PCR or gene sequencing were eligible for inclusion. In addition, only studies that provided a detailed description of chest CT findings according to the glossary of terms for thoracic imaging of the Fleischner Society were included.


Association of Interleukin 7 Immunotherapy With Lymphocyte Counts Among Patients With Severe Coronavirus Disease 2019 (COVID-19)

JAMA Network Open, July 22, 2020

[Research Letter] Cytokine storm–mediated organ injury continues to dominate current thinking as the primary mechanism for coronavirus disease 2019 (COVID-19). Although there is an initial hyper-inflammatory phase, mounting evidence suggests that virus-induced defective host immunity may be the real cause of death in many patients. COVID-19 has been called a serial lymphocyte killer because profound and protracted lymphopenia is a near uniform finding among patients with severe COVID-19 and correlates with morbidity and mortality. Autopsies demonstrate a devastating depletion of lymphocytes in the spleen and other organs. CD4, CD8, and natural killer cells, which play important antiviral roles, are depleted and have reduced function, leading to immune collapse. Clinical and pathological findings in patients with COVID-19 indicate that immunosuppression is a critical determinant of outcomes.


Financial Impact of COVID-19 on physicians and their practices

MJH Life Sciences, July 22, 2020

With over 1,600 responses from a variety of specialties, physicians weighed in on the financial impact of COVID-19 and how they are navigating the decrease in patient volume, telehealth reimbursements and financial relief. These results convey the challenges and concerns of physicians as they transition to the new normal with COVID-19. From anticipated loss in revenue to influence on headcount, the Financial Impact survey reveals the lasting repercussions COVID-19 will have practices for the remainder of 2020 and beyond.


HHS Rolls Out New COVID-19 Data Dashboard

MedPage Today, July 21, 2020

The Department of Health and Human Services (HHS) debuted its new COVID-19 dashboard on Monday, and the department’s data chief said it will provide even more data than the CDC’s old one did. Called the Coronavirus Data Hub, the HHS dashboard replaces the CDC’s National Healthcare Safety Network (NHSN), to which states and hospitals had previously been submitting COVID-19 data such as intensive care unit capacity, ventilator use, personal protective equipment (PPE) levels, and staffing shortages. But in guidance to hospitals, updated July 10 and published with little fanfare, HHS ordered hospitals to stop submitting such data to the NHSN and instead submit it either to HHS or to their state health department, which would then submit it to HHS. The data would then be put on the dashboard via the department’s new HHS Protect data system. The dashboard’s public-facing side allows users to see the overall number of confirmed coronavirus cases in the U.S. as well as the overall number of reported deaths. It also includes data on inpatient and ICU bed utilization.


Seroprevalence of Antibodies to SARS-CoV-2 in 10 Sites in the United States, March 23-May 12, 2020

JAMA Internal Medicine, July 21, 2020

In this cross-sectional study of 16 025 residual clinical specimens, estimates of the proportion of persons with detectable SARS-CoV-2 antibodies ranged from 1.0% in the San Francisco Bay area (collected April 23-27) to 6.9% of persons in New York City (collected March 23-April 1). Six to 24 times more infections were estimated per site with seroprevalence than with coronavirus disease 2019 (COVID-19) case report data. For most sites, it is likely that greater than 10 times more SARS-CoV-2 infections occurred than the number of reported COVID-19 cases; most persons in each site, however, likely had no detectable SARS-CoV-2 antibodies.


Asymptomatic carriers of COVID-19 still risk lung damage

Digital Journal, July 14, 2020

It’s established that many people infected with coronavirus are ‘asymptomatic’. While these people can spread the virus, the virus isn’t actually harming them, right? Not so says a new study published in Nature. Someone who is infected with the SARS-CoV-2 virus and remains asymptomatic, that is free of coughing, fever, fatigue and other common signs of infection, can still be adversely affected by the infection. A new study reveals that virus will still be causing some harm to their lungs. This may be mild and it may be reversible, but the effects will vary between different individuals. The study, published in Nature Medicine, reveals a high rate of minor lung inflammation in many individuals who exhibit no outward symptoms of coronavirus.


COVID-19-related gene expression higher in specific asthma subgroup

Helio | Pulmonology, July 14, 2020

Angiotensin-converting enzyme 2 and transmembrane protease serine 2 mediate SARS-COV-2 entry into host cells. Higher expression of ACE2 and TMPRSS2 in sputum cells of patients with asthma identified subgroups at risk of COVID-19 morbidity. “We found that among patients with asthma, gene expression of ACE2 and TMPRSS2 was higher in patients of male sex, Black race and patients with a history of diabetes mellitus,” Michael C. Peters, MD, assistant professor of medicine in the division of pulmonary and critical care medicine at the University of California, San Francisco, told Healio. Researchers analyzed gene expression for ACE2, TMPRSS2 and intercellular adhesion molecule 1 (ICAM-1), the major intercellular protein that mediates entry of human rhinoviruses, in sputum cells of 330 participants (mean age, 48.5 years; 69% female; 66% white) in the Severe Asthma Research Program-3 and in 79 healthy control participants (mean age, 40.6 years; 66% female; 57% white).


FDA grants emergency use of Gammacore for asthma in COVID-19 patient

BioWorld, July 13, 2020

Electrocore Inc. has snagged an emergency use authorization (EUA) from the U.S. FDA for use of its Gammacore Sapphire CV noninvasive vagus nerve stimulation (nVNS) to acutely treat asthma exacerbations in known or suspected COVID-19 patients. The hand-held therapy can be used at home and in a health care setting. The EUA indication covers adults who are experiencing exacerbation of asthma-related dyspnea and reduced airfow, for whom drug therapies either aren’t tolerated or provide insufficient relief. Gammacore is applied at to either side of the neck and delivers mild electrical impulses to the vagus nerve through the skin, stimulating the nerve receptors to reduce pain or distress. Patients can administer the treatment themselves, reducing reliance on medications with their potential side effects.


Tocilizumab for treatment of mechanically ventilated patients with COVID-1

Clinical Infectious Disease, July 11, 2020

Severe COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is approved treatment. Assessed, was the effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability post-intubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared to tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability weighting (IPTW). 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range 28-67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean 55 vs. 60 years), less likely to have chronic pulmonary disease (10% vs. 28%), and had lower D-dimer values at time of intubation (median 2.4 vs. 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death [hazard ratio 0.55 (95% CI 0.33, 0.90)] and improved status on the ordinal outcome scale [odds ratio per 1-level increase: 0.58 (0.36, 0.94)].


Extrapulmonary manifestations of COVID-19

Nature Medicine, July 10, 2020

Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications. Given that ACE2, the entry receptor for the causative coronavirus SARS-CoV-2, is expressed in multiple extrapulmonary tissues, direct viral tissue damage is a plausible mechanism of injury. In addition, endothelial damage and thromboinflammation, dysregulation of immune responses, and maladaptation of ACE2-related pathways might all contribute to these extrapulmonary manifestations of COVID-19. Here, the extrapulmonary organ-specific pathophysiology are reviewed, along with presentations and management considerations for patients with COVID-19 to aid clinicians and scientists in recognizing and monitoring the spectrum of manifestations, and in developing research priorities and therapeutic strategies for all organ systems involved.


Postmortem Lung Findings in a Patient With Asthma and Coronavirus Disease

Chest Journal, July 10, 2020

Asthma is increasingly recognized as an underlying risk factor for severe respiratory disease in patients with coronavirus disease 2019 (COVID-19), particularly in the United States. Here, we report the postmortem lung findings from a 37-year-old man with asthma, who met the clinical criteria for severe acute respiratory distress syndrome and died of COVID-19 less than 2 weeks after presentation to the hospital. His lungs showed mucus plugging and other histologic changes attributable to asthma, as well as early diffuse alveolar damage and a fibrinous pneumonia. The presence of diffuse alveolar damage is similar to descriptions of autopsy lung findings from patients with severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, and the absence of a neutrophil-rich acute bronchopneumonia differs from the histologic changes typical of influenza.


U.S. sets one-day record with more than 60,500 COVID cases; Americans divided

Reuters, July 9, 2020

More than 60,500 new COVID-19 infections were reported across the United States on Thursday, according to a Reuters tally, setting a one-day record as weary Americans were told to take new precautions and the pandemic becomes increasingly politicized. The total represents a slight rise from Wednesday, when there were 60,000 new cases, and marks the largest one-day increase by any country since the pandemic emerged in China last year. As infections rose in 41 of the 50 states over the last two weeks, Americans have become increasingly divided on issues such as the reopening of schools and businesses. Orders by governors and local leaders mandating face masks have become particularly divisive. “It’s just disheartening because the selfishness of (not wearing a mask) versus the selflessness of my staff and the people in this hospital who are putting themselves at risk, and I got COVID from this,” said Dr. Andrew Pastewski, ICU medical director at Jackson South Medical Center in Miami.


Cardiac Arrhythmias Seen in Critically Ill Patients With COVID-19

Pulmonary Advisor, July 8, 2020

Critically ill patients with COVID-19 are more likely to develop heart rhythm disorders than other hospitalized patients, according to a study published online June 22 in Heart Rhythm. Anjali Bhatla, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues reviewed the incidence of cardiac arrests, arrhythmias, and inpatient mortality among 700 COVID-19 patients (mean age 50 years; 45 percent male) admitted to one center over a nine-week period. The researchers found that 11 percent of patients received care in the intensive care unit (ICU), and there were nine cardiac arrests (all occurring in ICU patients), 25 incident atrial fibrillation (AF) events, nine clinically significant bradyarrhythmias, and 10 nonsustained ventricular tachycardias (NSVTs). Admission to the ICU was associated with incident AF (odds ratio, 4.68) and NSVT (odds ratio, 8.92) in adjusted analysis. There were also independent associations seen between age and incident AF (odds ratio, 1.05) and between prevalent heart failure and bradyarrhythmias (odds ratio, 9.75). In-hospital mortality was only associated with cardiac arrest.


Asthma inhalers being trialed for treatment of COVID-19

News Medical, July 7, 2020

Researchers from Queensland University of Technology and Oxford University are working in collaboration to begin human clinical trials of inhaled corticosteroids, commonly used for asthma patients, on patients with COVID-19. The researchers believe that this could be useful for patients with the novel coronavirus infection. COVID-19 is known to cause severe respiratory illness in some individuals. Studies have shown that some corticosteroids, such as dexamethasone, could reduce the inflammation of the respiratory tract in these patients and benefit them by alleviating the symptoms of severe disease. Researchers in this new trial are studying if the steroid inhalers used for reducing the exacerbations of asthma could be useful for patients with early COVID-19 and reduce their risk of severe disease. The clinical trial has been registered under the name of STOIC (STerOids In COVID-19). It has begun recruiting patients at the Churchill Hospital in Oxford, England. The study is being led by Associate Professor Nicolau, who is also a mathematician, physician, and Australian Research Council Future Fellow. As per the trial details, the researchers have plans to recruit a total of 478 participants in the study. Some of the patients would be administered the corticosteroid (Budesonide) containing inhaler while others would be prescribed a placebo inhaler.


Asthma does not appear to increase the risk of contracting COVID-19, shows study

News Medical, July 6, 2020

Asthma does not appear to increase the risk for a person contracting COVID-19 or influence its severity, according to a team of Rutgers researchers. Panettieri’s paper was published in the Journal of Allergy and Clinical Immunology. “However, people with asthma–even those with diminished lung function who are being treated to manage asthmatic inflammation–seem to be no worse affected by SARS-CoV-2 than a non-asthmatic person. There is limited data as to why this is the case–if it is physiological or a result of the treatment to manage the inflammation.” Panettieri discusses what we know about asthma and inflammation and the important questions that still need to be answered. Since the news has focused our attention on the effects of COVID-19 on people in vulnerable populations, those with asthma may become hyper-vigilant about personal hygiene and social distancing.


In Fight Against COVID-19, CSL Behring Begins Trial to Evaluate Monoclonal Antibody (CSL312) for Respiratory Distress

PR Newswire, July 6, 2020

Global biotherapeutics leader CSL Behring today announced that the first patient has been enrolled in its Phase 2 study to assess the safety and efficacy of CSL312 (garadacimab, Factor XIIa antagonist monoclonal antibody) to treat patients suffering from severe respiratory distress, a leading cause of death in patients with COVID-19 related pneumonia. In this multicenter, double-blind, placebo-controlled study, approximately 124 adult patients testing positive for the SARS CoV-2 infection will be randomized to receive either CSL312 or placebo, in addition to standard of care (SOC) treatment. The primary endpoint being the incidence of tracheal intubation or death.


Pulmonary alveolar regeneration in adult COVID-19 patients

Cell Research, July 6, 2020

[Letter to the Editor] Alveolar regeneration after an acute lung injury has been observed in many mammals. Results in animal models have shown that alveolar type II (AT2) cells function as resident alveolar stem cells that can proliferate and differentiate into alveolar type I (AT1) cells to build new alveoli after lung injury. However, alveolar regeneration after acute lung injury in adult humans is still poorly characterized, mainly due to the lack of lung samples and regeneration-specific molecular markers. In patients with COVID-19 pneumonia, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly attack alveolar epithelial cells and cause massive AT2 cell death. It is unknown whether alveolar regeneration occurs upon SARS-CoV-2 infection-induced lung injury. This knowledge will substantially improve our basic understanding of the COVID-19 disease and our ability to prognosticate patient outcomes.


Guidelines for Family Presence Policies During the COVID-19 Pandemic

JAMA Health Forum, July 6, 2020

Active engagement of patients and their families in decisions about their own care is a foundation of a high-quality, person-centered health care system. Expanding the acceptance and participation of family care partners at the bedside has been an ongoing effort by patient advocacy communities over the past several decades. In this context, family refers to any support person defined by the patient or resident as family, including friends, neighbors, relatives, and/or professional support persons. Great progress has been made to invite partners into the labor and delivery room, to welcome parents to stay at their child’s side throughout a hospitalization, and to honor the wishes of terminally ill individuals to have family with them during end-of-life care. Significant clinical, psychological, and emotional benefits of these practices have been well documented for patients, family, and health care professionals. The National Academy of Medicine has asserted the importance that “family and/or care partners are not kept an arm’s length away as spectators but participate as integral members of their loved one’s care team.”


Q&A: With or without COVID-19, we will transform the care delivery system

Modern Healthcare, July 6, 2020

Dr. Sanjay Doddamani is chief operating officer and chief physician executive at Southwestern Health Resources, a clinically integrated network comprising independent community practices together with Texas Health Resources and the University of Texas Southwestern Medical Center in the Dallas-Fort Worth area. He started in his role in mid-March, just weeks before a national emergency was declared due to the COVID-19 outbreak. He previously served as senior physician adviser at the Center for Medicare and Medicaid Innovation and was chief medical officer for the accountable care organization and the home-based program at Geisinger Health. Read this Q&A session with Dr. Doddamani about Southwestern’s experience and the network’s approach to dealing with the pandemic and the organization’s emphasis on value-based care.


Hundreds of scientists say coronavirus is airborne, ask WHO to revise recommendations: NYT

Reuters, July 5, 2020

Hundreds of scientists say there is evidence that the novel coronavirus in smaller particles in the air can infect people and are calling for the World Health Organization to revise recommendations, the New York Times reported on Saturday. The WHO has said the coronavirus disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes or speaks. In an open letter to the agency, which the researchers plan to publish in a scientific journal next week, 239 scientists in 32 countries outlined the evidence showing smaller particles can infect people, the NYT said.


Coronavirus Update With Anthony Fauci

JAMA Network, July 2, 2020

[Video] Editor in Chief of JAMA, Howard Bauchner, MD, interviews Anthony Fauci, MD, White House Coronavirus Task Force member and Director of the National Institutes of Allergy and Infectious Diseases. The two discuss latest developments in the COVID-19 pandemic, including latest developments, protecting the elderly, genetic shift and mutations, vaccine durability and more.


Moving From The Five Whys To Five Hows: Addressing Racial Inequities In COVID-19 Infection And Death

Health Affairs, July 2, 2020

In recent months, states and municipalities have begun releasing data on COVID-19 infections and death that reveal profound racial disparities. In Louisiana, Black patients account for 57 percent of COVID-19 deaths, while making up only 33 percent of the total population. In Wisconsin, Hispanic patients constitute 12 percent of confirmed COVID-19 cases, but only 7 percent of the total population. In New York City, the epicenter of the pandemic in the US, age-adjusted mortality rates are more than double for Black and Hispanic patients (243.6 and 237.7 per 100,000) compared to white and Asian patients (121.5 and 109.4 per 100,000). Studies of patients hospitalized across New York have found that hypertension, diabetes, and obesity are associated with an elevated risk for COVID-19 morbidity and mortality. But why are there higher rates of hypertension, diabetes, and obesity in communities of color? The answer does not lie in biology. Here again, structural and environmental factors such as resource deprivation, poor access to health care, discrimination, and racism have driven a higher burden of these diseases in communities of color.


US posts largest single-day jump in new COVID-19 cases

Center for Infectious Disease and Research Policy (CIDRAP) News, July 2, 2020

The Centers for Disease Control and Prevention (CDC) today reported a record of 54,357 new coronavirus cases over yesterday—a record single-day jump that presses the United States further than what some thought was the peak this spring. For reference, as CNN reported, it took the United States a little more than 2 months to report its first 50,000 cases. Total US cases were at 2,679,230, including 128,024 deaths, according to the CDC. The infection curve is rising in 40 of 50 states, and 36 states are seeing an increase in the percentage of positive coronavirus tests, AP reported today. Some public health officials and governors are blaming bars for the increase in cases, the New York Times reported today, while others are pointing to hasty business reopenings, according to Politico.


Homeless More Likely to Need Ventilators for Respiratory Illness

Physician’s Briefing, July 2, 2020

Homeless people in New York state are more likely to be hospitalized and treated with mechanical ventilators for respiratory infections than people who are not homeless, according to a study published online June 4 in the Journal of General Internal Medicine. Atsushi Miyawaki, M.D., Ph.D., from the University of Tokyo, and colleagues used the 2007 to 2012 New York State Inpatient Database to identify all hospitalizations with primary or secondary diagnosis of influenza in 214 hospitals (total 20,078 patients; median age 40 years). Hospitals directly reported homeless patients. The researchers found that 6.4 percent of hospitalized influenza patients were homeless, with the majority of these hospitalizations (99.9 percent) concentrated in 10 hospitals. During the study period, homeless patients experienced a higher rate of hospitalization for influenza versus nonhomeless persons.


Rates of coinfection with other respiratory pathogens in patients positive for coronavirus disease 2019 (COVID‐19)

Journal of the American College of Emergency Physicians Open, July 2, 2020

The purpose of this study was to assess coinfection rates of coronavirus disease 2019 (COVID‐19) with other respiratory infections on presentation. This is a retrospective analysis of data from a 2 hospital academic medical centers and 2 urgent care centers during the initial 2 weeks of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) , March 10, 2020 to March 23, 2020. Complete laboratory results from the first 2 weeks of testing were available for 471 emergency department patients and 117 urgent care center patients who were tested for SARS‐CoV.


Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology

American Journal of Respiratory and Critical Care Medicine, July 1, 2020

[Editorial] The world is scrutinizing every cohort and every outcome for patients with coronavirus disease (COVID-19), particularly the most critically ill who are receiving mechanical ventilation. The numbers that have been published are all over the place, and some of them—such as very high mortality—are causing panic. Two major issues are at play in these epidemiological studies. The first is when to intubate and assessment of the rates of intubation and mechanical ventilation for hospitalized patients in cohorts from across the world. The second is the reported mortality for patients who receive mechanical ventilation. Presentation and interpretation of the data for both of these issues is not straightforward and never has been. However, there are ways we can improve assessment of these cohort studies.


Blood type may contribute to likelihood of acquiring COVID-19

Helio | Primary Care, July 1, 2020

A patient’s blood type plays a role in the likelihood of developing COVID-19, data from two genetic studies show. An infectious disease expert unaffiliated with the studies told Healio Primary Care that the results are possible, but with some important caveats. In the first study, which appeared in The New England Journal of Medicine, David Ellinghaus, a scientist at the Institute of Clinical Molecular Biology in Germany, and colleagues analyzed nearly 8.6 million single nucleotide polymorphisms from 1,610 Spanish and Italian patients with COVID-19 and respiratory failure. Another 2,205 uninfected participants served as controls. Participants’ age, ethnicity and sex were also part of the analysis.


COVID-19 Severity Correlates with Weaker T Cell Immunity, Hypercytokinemia and Lung Epithelium Injury

American Journal of Respiratory and Critical Care Medicine, July 1, 2020

SARS-CoV-2 has caused a global pandemic which continues to wreak havoc on people’s lives and livelihoods. As of June 16th, 2020, the COVID-19 cases surpassed 8 million and the death toll stood at more than 400,000. Although the majority of the patients developed mild symptoms and eventually recovered from this disease, a significant proportion suffered from serious pneumonia and developed acute respiratory distress syndrome (ARDS), septic shock, and/or multi-organ failure. The degree of the disease severity should result from direct viral damages on epithelial surface layer (ESL) and the host immune response. SARS-CoV-2 infection may trigger a dysfunctional response leading to an overproduction of cytokines (cytokine storm) and the recruitment of more immune cells into the lungs, resulting in greater damages. However, the immune effectors that determine or influence the severity of the disease and the reason why immune response mediates recovery in some individuals, but not in others, are far from clear. In this study, we addressed these issues by analyzing the blood samples of COVID-19 patients with varying degrees of disease severity and by collecting their clinical data over a period of more than three months. Our findings highlight the importance of T cell immunity in COVID-19 recovery.


Respiratory failure and non-invasive respiratory support during the covid-19 pandemic: an update for re-deployed hospital doctors and primary care physicians

British Medical Journal, June 30, 2020

In response to the covid-19 pandemic, many health systems attempted to rapidly reorganise their healthcare workforce in the first half of 2020, including redeployment of doctors from primary care and non-frontline specialties to acute care wards. Preparedness for potential future redeployment remains essential given the risk of further waves of covid-19 as society negotiates repeated cycles of lockdown and reopening. Most people who become seriously unwell with covid-19 have an acute respiratory illness, and about 14% will require non-invasive respiratory support. In addition to shifting into acute care settings in the short term, primary care clinicians will also be caring for patients (or their loved ones) recovering from potentially traumatic experiences of respiratory illness. This article updates primary care and non-respiratory or intensivist specialist doctors on the recognition and non-invasive management of acute respiratory failure and will aid general practitioners in the subsequent outpatient support of patients during their recovery.


Coronavirus (COVID-19) Update: FDA Takes Action to Help Facilitate Timely Development of Safe, Effective COVID-19 Vaccines

FDA.gov, June 30, 2020

Today, the U.S. Food and Drug Administration took important action to help facilitate the timely development of safe and effective vaccines to prevent COVID-19 by providing guidance with recommendations for those developing COVID-19 vaccines for the ultimate purpose of licensure. The guidance, which reflects advice the FDA has been providing over the past several months to companies, researchers, and others, describes the agency’s current recommendations regarding the data needed to facilitate the manufacturing, clinical development, and approval of a COVID-19 vaccine. The guidance also discusses the importance of ensuring that the sizes of clinical trials are large enough to demonstrate the safety and effectiveness of a vaccine. It conveys that the FDA would expect that a COVID-19 vaccine would prevent disease or decrease its severity in at least 50% of people who are vaccinated.


Idiopathic Nonhistaminergic Acquired Angioedema in a Patient with COVID-19

Annals of Allergy, Asthma & Immunology, June 30, 2020

Idiopathic nonhistaminergic acquired angioedema (InH-AAE) is a rare disease characterized by submucosal swelling without concomitant urticaria and poor response to antihistamines and corticosteroids. Compared with other forms of hereditary and acquired angioedema, InH-AAE seems to have a predilection for facial and tongue swelling, and is often difficult to diagnose as patients have normal laboratory values and no family history. To our knowledge, there have been no publications to date describing idiopathic nonhistaminergic angioedema as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although nonhistaminergic angioedema has been seen in the setting of other viral infections. We describe a case of suspected InH-AAE in an intubated patient with coronavirus disease 2019 (COVID-19). We review post-intubation macroglossia as a potential differential diagnosis and why this etiology is unlikely in our patient. Finally, we briefly discuss the hyperinflammatory response to SARS-CoV-2 and its potential role in the development of InH-AAE.


How to maintain momentum on telehealth after COVID-19 crisis ends

American Medical Association, June 30, 2020

The use of telehealth has exploded as many regulatory barriers to its use have been temporarily lowered during the COVID-19 pandemic. The AMA is advocating for making many of these emergency policy changes permanent. “The expansion of telehealth and the offering of new telehealth services that were not previously covered really enabled physicians to care for their patients in the midst of this crisis,” Todd Askew, the AMA’s senior vice president of advocacy, said during a recent “AMA COVID-19 Update” video. “We have moved forward a decade in the use of telemedicine in this country and it’s going to become, and will remain, an increasingly important part of physician practices going forward.”


U.S. coronavirus cases rise by 47,000, biggest one-day spike of pandemic

Reuters, June 30, 2020

New U.S. COVID-19 cases rose by more than 47,000 on Tuesday according to a Reuters tally, the biggest one-day spike since the start of the pandemic, as the government’s top infectious disease expert warned that number could soon double. California, Texas and Arizona have emerged as new U.S. epicenters of the pandemic, reporting record increases in COVID-19 cases. “Clearly we are not in total control right now,” Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told a U.S. Senate committee. “I am very concerned because it could get very bad.”


HHS will renew public health emergency

Modern Healthcare, June 29, 2020

HHS spokesman Michael Caputo on Monday tweeted that HHS intends to extend the COVID-19 public health emergency that is set to expire July 25. The extension would prolong the emergency designation by 90 days. Several payment policies and regulatory adjustments are attached to the public health emergency, so the extension is welcome news for healthcare providers. HHS “expects to renew the Public Health Emergency due to COVID-19 before it expires. We have already renewed this PHE once,” Caputo said. Provider groups including the American Hospital Association have urged HHS to renew the distinction.


Global coronavirus deaths top half a million

Reuters, June 28, 2020

The death toll from COVID-19 surpassed half a million people on Sunday, according to a Reuters tally, a grim milestone for the global pandemic that seems to be resurgent in some countries even as other regions are still grappling with the first wave. The respiratory illness caused by the new coronavirus has been particularly dangerous for the elderly, although other adults and children are also among the 501,000 fatalities and 10.1 million reported cases. While the overall rate of death has flattened in recent weeks, health experts have expressed concerns about record numbers of new cases in countries like the United States, India and Brazil, as well as new outbreaks in parts of Asia.


Who Is Most At-Risk for Severe COVID-19?

MedPage Today, June 27, 2020

[Quiz] New information is posted daily, but keeping up can be a challenge. As an aid for readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include COVID-19 risk factors, future pandemic preparation, and effects on kids from parents’ mental illness. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.


COVID-19 Practice Financial Assistance

American College of Physicians, Updated June 26, 2020

The ACP provides resources to help guide practices in plans for re-opening. Resources include guides, checklists, staffing and workflow modifications, and materials for communicating with patients. The ACP also offers clinical and public policy guidance on how to resume some economic, social and medical care activities to mitigate COVID-19 and allow expansion of healthcare capacity. For more information, the CDC offers a framework for providing non-COVID-19 care during the pandemic.


Identification of pathophysiological patterns for triage and respiratory support in COVID-19

The Lancet | Respiratory Medicine, June 26, 2020

In the UK, more than 279 392 cases of COVID-19 had been documented by June 3, 2020, and more than 39 500 patients had died with the disease, according to the COVID-19 web-based dashboard at Johns Hopkins University. Data derived from the UK Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database show that, for the first 8062 patients admitted to the ICU across the UK with documented outcomes, by May 29, 2020, about 72% received advanced mechanical ventilation and the mortality rate was around 53%. This mortality far exceeds that of typical severe acute respiratory distress syndrome (ARDS). The significant surge in the number of patients requiring ventilatory support has presented the UK National Health Service with unprecedented challenges, including pressures on critical care capacity, resources, and supplies, concerns about staff protection, as well as ethical issues associated with triage and resource allocation.


CMS Announces Additional QPP, MIPS Flexibilities for 2020

American College of Cardiology, Jun 25, 2020

The Centers for Medicare and Medicaid Services (CMS) continues to provide flexibilities to clinicians participating in the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) in 2020 as a result of the COVID-19 pandemic. Clinicians significantly impacted by the public health emergency may submit an Extreme & Uncontrollable Circumstances Application to reweight any or all of the MIPS performance categories for performance year 2020. Clinicians requesting relief will need to provide a justification of the impacts to their practice as a result of the public health emergency.


Comorbid Asthma May Not Increase Risk for Severe COVID-19

Pulmonary Advisor, June 23, 2020

Individuals with coronavirus disease 2019 (COVID-19) with comorbid asthma may not have an increased risk for more severe disease, compared with those without asthma, according to a literature analysis published in The Journal of Allergy and Clinical Immunology. The impairment of antiviral responses in patients with asthma, which can, in turn, aggravate type 2 inflammation, suggests that these individuals may be at a high risk for morbidity and mortality from COVID-19.


Targeting the Immune System for Pulmonary Inflammation and Cardiovascular Complications in COVID-19 Patients

Frontiers in Immunology, June 23, 2020

In December 2019, following a cluster of pneumonia cases in China caused by a novel coronavirus (CoV), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infection disseminated worldwide and, on March 11th, 2020, the World Health Organization officially declared the pandemic of the relevant disease named coronavirus disease 2019 (COVID-19). In Europe, Italy was the first country facing a true health policy emergency, and, as at 6.00 p.m. on May 2nd, 2020, there have been more than 209,300 confirmed cases of COVID-19. Due to the increasing number of patients experiencing a severe outcome, global scientific efforts are ongoing to find the most appropriate treatment. The usefulness of specific anti-rheumatic drugs came out as a promising treatment option together with antiviral drugs, anticoagulants, and symptomatic and respiratory support. For this reason, the authors share their experience and knowledge on the use of these drugs in the immune-rheumatologic field, providing in this review the rationale for their use in the COVID-19 pandemic.


WHO reports record amount of COVID-19 cases in a single day

Helio | Infectious Disease News, June 22, 2020

As COVID-19 case counts reach 8.8 million worldwide, including 465,000 deaths, more than 183,000 new cases were reported to WHO on Sunday — the most in a single day since the beginning of the pandemic. “It seems that almost every day we reach a new and grim record,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said in a press briefing. According to WHO, demand for dexamethasone, which was previously shown to reduce mortality by one-third in ventilated patients with COVID-19, has surged worldwide. Tedros noted that the drug should be used only in patients with severe disease.


Lifelong Lung Damage: The Serious COVID-19 Complication That Can Hit People in Their 20s

Healthline, June 22, 2020

More than 3.8 million people worldwide have recovered from COVID-19. However, recent cases are showing that even those who recover may still be at risk for long-term health issues. Despite the fact that the earliest coronavirus reports indicated that younger people were at a lower risk of serious complications from COVID-19, recent findings are contradicting that belief. Most recently, a 20-year-old COVID-19 survivor in Chicago was the recipient of a new set of lungs, due to a lung transplant that was necessary to treat a condition now being called post-COVID fibrosis. There have been two other lung transplants performed on COVID-19 survivors with post-COVID fibrosis: one was in China and the other in Vienna.


Surging U.S. virus cases raise fear that progress is slipping

Modern Healthcare, June 22, 2020

Coronavirus cases in Florida surpassed 100,000 on Monday, part of an alarming surge across the South and West as states reopen for business and many Americans resist wearing masks or keeping their distance from others. The disturbing signs in the Sunshine State as well as places like Arizona, Alabama, Louisiana, Texas and South Carolina — along with countries such as Brazil, India and Pakistan — are raising fears that the progress won after months of lockdowns is slipping away.


Guidance for tracheostomy use during COVID-19 pandemic

Helio | Pulmonology, June 22, 2020

Three medical societies released an expert panel report on the use of tracheostomy during the COVID-19 pandemic while minimizing the risk for infection to health care workers. Critically ill patients with COVID-19 account for 5% of all cases and one-quarter of all hospitalizations. Many of these patients require prolonged mechanical ventilation. Performing tracheostomies on these patients may allow for faster removal from ventilation, shorter hospitalization and thus greater ICU resource availability, but there are currently unanswered questions regarding preparation, timing, technique and protection for health care workers.


Will COVID-19 become seasonal?

The Journal of Infectious Diseases, June 21, 2020

This manuscript explores the question of the seasonality of SARS-CoV-2 by reviewing four lines of evidence related to viral viability, transmission, ecological patterns and observed epidemiology of COVID-19 in the Southern Hemispheres’ summer and early fall. There are four lines of evidence: (1) seasonality of other human coronaviruses and influenza A, (2) in vivo experiments with influenza transmission, (3) ecological data and (4) the observed epidemiology of COVID-19 in the Southern Hemispheres’ summer and early fall.


The role of peripheral blood eosinophil counts in COVID‐19 patients

European Journal of Allergy and Clinical Immunology, June 20, 2020

Coronavirus disease 2019 (COVID‐19) emerged in Wuhan city and rapidly spread globally outside China. We aimed to investigate the role of peripheral blood eosinophil (EOS) as a marker in the course of the virus infection to improve the efficiency of diagnosis and evaluation of COVID‐19 patients. This article looks at 227 pneumonia patients who visited the fever clinics in Shanghai General Hospital and 97 hospitalized COVID‐19 patients admitted to Shanghai Public Health Clinical Center were involved in a retrospective research study. Clinical, laboratory, and radiologic data were collected. The trend of EOS level in COVID‐19 patients and comparison among patients with different severity are summarized.


Variation in Ventilator Allocation Guidelines by US State During the Coronavirus Disease 2019 Pandemic: A Systematic Review

Journal of the American Medical Association, June 19, 2020

Since the advent of worldwide mechanical ventilator use for patients with polio in the 1950s, ventilators have provided life-saving support to millions of people.1 In the US, ventilators have been widely available for the past 50 years. There have been concerns during the coronavirus disease 2019 (COVID-19) pandemic that the need for ventilators could exceed their availability, thus causing a widespread shortage of ventilators. In these circumstances, tragic choices would need to be made to determine who receives mechanical ventilatory support and who does not. Individual physicians, ethicists, medical societies, and US states have published multiple recommendations regarding how to allocate ventilators in a public health emergency and are largely in consensus that ventilators should be allocated to do the greatest good for the greatest number of people.


Coronavirus and Health Inequities

JAMA Medical News, June 19, 2020

Recorded today, Linda Rae Murray, MD, MPH discusses topics in health equity with JAMA Medical News Associate Managing Editor Jennifer Abbasi.


Steroid treatment for COVID-19 has NYC doctors cautiously optimistic

Modern Healthcare, June 19, 2020

Local physicians said a U.K. study of the use of the steroid dexamethasone in treating severe COVID-19 patients showed promising results, but they’re reserving judgment until more data from the study is published. Initial results were announced Tuesday in a press release. The randomized trial, supported by the University of Oxford, tested dexamethasone in about 2,100 patients with an additional 4,300 receiving only usual care. The study found that the drug reduced the number of deaths by one-third in patients using mechanical ventilators and one-fifth in patients receiving only oxygen. There was no benefit among patients who didn’t require respiratory support.


Lifting COVID-19 “Lockdown” Restrictions May Cause Infection Resurgence

Pulmonary Advisor, June 18, 2020

Data from multiple countries demonstrate that lifting restrictions imposed to reduce the spread of coronavirus disease 2019 (COVID-19) would result in a resurgence of infections, according to provisional analyses published in the European Respiratory Journal. Most countries with significant COVID-19 outbreaks have introduced social distancing or “lockdown” measures to reduce viral transmission, however, the question of when, how, and to what extent these measures can be lifted remains.


Accelerated COVID-19 vaccine effort should not mean compromises, experts say

Helio | Infectious Disease, June 18, 2020
Public-private partnerships, collaboration among researchers and knowledge of existing coronaviruses have all contributed to the accelerated development of COVID-19 vaccine candidates, according to Infectious Disease News Editorial Board Member Kathleen M. Neuzil, MD, MPH, FIDSA. Neuzil, a professor of vaccinology and director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine, said vaccine development overall is a “continuum” from the discovery phase to “delivery and impact.” Neuzil and other presenters opened the National Foundation for Infectious Diseases’ Annual Conference on Vaccinology Research with a discussion on the current state of vaccine development for COVID-19.


Chicago has a unique COVID strain: research

Modern Healthcare, June 18, 2020

Chicagoans are being infected with a unique strain of COVID-19 that’s linked to the early coronavirus outbreak in China, according to new research. Northwestern Medicine scientists have determined that the Chicago area “is a melting pot for different versions of the virus because it is such a transportation hub,” Dr. Egon Ozer, an assistant professor at Northwestern University’s Feinberg School of Medicine and a Northwestern Medicine physician, said in a statement today. Ozer’s team is learning how variations of the severe acute respiratory syndrome that causes COVID-19 infects people differently. It’s a finding they say could help shape a potential vaccine.


R-107 Shows Promise in Early Study for PAH Linked to COVID-19

Pulmonary Hypertension News, June 17, 2020

Kalytera Therapeutics has announced positive early results for R-107, a liquid form of nitric oxide designed to treat pulmonary arterial hypertension (PAH) associated with COVID-19. Nitric oxide, known as NO, is a gas naturally present in the lungs. It facilitates oxygenation by relaxing, or dilating, the blood vessels, allowing blood to flow smoothly. R-107 is a liquid prodrug of nitric oxide, meaning that the compound is a precursor to its pharmacologically active form. Once injected into the body, R-107 is converted into its active form, called R-100, which steadily releases NO into lung tissues over the course of several days.


Fossil Fuel Decrease in COVID-19 Quarantine May Positively Affect Allergic Diseases

Pulmonary Advisor, June 17, 2020

Global quarantine as a result of the coronavirus disease 2019 (COVID-19) pandemic has decreased fossil fuel use which may affect allergic and respiratory diseases, according to an editorial published in The Journal of Allergy and Clinical Immunology. Air pollution is a causative factor of symptoms such as bronchospasm, rhinorrhea, and eye redness and irritation, as well as allergic diseases such as asthma, chronic rhinitis, nasal polyps, atopic dermatitis, seasonal or perennial allergic conjunctivitis, and vernal or atopic keraconjunctivitis. Through climate change, worldwide emission of greenhouse gasses (ie, nitrogen dioxide and carbon dioxide) has caused an increase in air humidity, mold exposure, and modified pollen patterns, which in turn, increased sensitization rates and allergic disease prevalence.


US taking ‘wrong approach’ to COVID-19 testing, expert warns

Helio | Infectious Diseases, June 16, 2020

The American Lung Association recently held a virtual Town Hall meeting to debunk widespread misperceptions in the United States about which populations should be prioritized for COVID-19 testing and how to interpret the results. “Far too many people have misinterpreted testing,” Michael T. Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, said during the meeting. “While we need to greatly expand our SARS-CoV-2 testing as a critical component of our response to COVID-19, the pandemic messaging to date needs to move beyond the ‘Test, test, test!’ mantras. That is the wrong approach.”


China’s COVID-19 vaccine candidate shows promise in human trials, CNBG says

Reuters, June 16, 2020

China National Biotec Group (CNBG) said on Tuesday its experimental coronavirus vaccine has triggered antibodies in clinical trials and the company plans late-stage human trials in foreign countries. No vaccines have been solidly proven to be able to effectively protect people from the virus that has killed more than 400,000 people, while multiple candidates are in various stages of development globally. The vaccine, developed by a Wuhan-based research institute affiliated to CNBG’s parent company Sinopharm, was found to have induced high-level antibodies in all inoculated people without serious adverse reaction, according to the preliminary data from a clinical trial initiated in April involving 1,120 healthy participants aged between 18 and 59.


Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19

Oxford University, June 16, 2020

In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK. On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit. A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).


Prevalence and characterization of asthma in hospitalized and non-hospitalized patients with COVID-19

Journal of Allergy and Clinical Immunology (via Science Direct), June 15, 2020

The primary objective of this study was to determine the prevalence of asthma among COVID-19 patients in a major U.S. health system. We assessed the clinical characteristics and comorbidities in asthmatic and non-asthmatic COVID-19 patients. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. Medical records of patients with COVID-19 were searched by a computer algorithm (March 1–April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients were PCR-confirmed COVID-19. Demographics and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization.


COVID-19 associated with dramatic decline in ED use by pediatric asthma patients

Medical Express, June 15, 2020

The number of patients visiting the emergency department (ED) for asthma treatment dropped by 76% in the first month of the COVID-19 pandemic, according to a new study by researchers at Children’s Hospital of Philadelphia (CHOP). The proportion of ED visits that led to a patient being hospitalized also decreased over this period, suggesting the decrease in overall visits was not solely due to patients avoiding the hospital due to the pandemic or delays in care for less serious asthma events. “We were surprised by the magnitude and extent of the reduced utilization of emergency services for asthma during the emergence of the COVID-19 pandemic,” said Chén C. Kenyon, MD, MSHP, a pediatrician in CHOP’s Division of General Pediatrics and first author of the study, which was published in JACI in Practice.


Coronavirus death rate is higher for those with chronic ills

Associated Press, June 15, 2020

Death rates are 12 times higher for coronavirus patients with chronic illnesses than for others who become infected, a new U.S. government report says. The Centers for Disease Control and Prevention report released Monday highlights the dangers posed by heart disease, diabetes and lung ailments. These are the top three health problems found in COVID-19 patients, the report suggests. The report is based on 1.3 million laboratory-confirmed coronavirus cases reported to the agency from January 22 through the end of May. Information on health conditions was available for just 22% of the patients. It shows that 32% had heart-related disease, 30% had diabetes and 18% had chronic lung disease, which includes asthma and emphysema.


Anti-contagion interventions prevented up to 62 million confirmed

Helio | Infectious Disease News, June 12, 2020
Anti-contagion policies have prevented or delayed as many as 62 million confirmed COVID-19 infections, which corresponded with the prevention of an estimated 530 million cases in six countries, according to a study published in Nature. “We found that in the absence of policy intervention, the number of COVID-19 infections doubled approximately every 2 days,” Esther Rolf, a PhD candidate in the computer science department at University of California, Berkeley, told Healio. “In all six countries we studied, we found that the anti-contagion policies put in place significantly slowed the spread of the disease, resulting in an estimated 500 million infections prevented or delayed, across the six countries in the time frame that we studied.”


Northwestern Memorial performs lung transplant on COVID survivor

Modern Healthcare, June 11, 2020

Northwestern Memorial Hospital is believed to be the first U.S. facility to perform a life-saving double-lung transplant on a former COVID-19 patient. The Chicago hospital today announced that the patient, a woman in her 20s, had the procedure this month after suffering irreversible damage to her lungs while recovering from the coronavirus. The patient had spent six weeks in Northwestern’s COVID intensive care unit on a ventilator and a machine that supports the heart and lungs, Northwestern Medicine said in a statement. She needed to test negative for the virus before doctors could put her on the waiting list for a transplant.


Early Data Show Potential Benefit of Acalabrutinib in Severe COVID-19

Pulmonary Advisor, June 11, 2020

Acalabrutinib, a Bruton tyrosine kinase (BTK) inhibitor, appears to reduce respiratory distress as well as the hyperinflammatory immune response associated with coronavirus disease 2019 (COVID-19), according to a study led by researchers at the Center for Cancer Research at the National Cancer Institute and the National Institute of Allergy and Infectious Diseases, both part of the National Institutes of Health (NIH). The prospective study included 19 patients with confirmed COVID-19 who required hospitalization for hypoxemia and had evidence of inflammation. Patients received acalabrutinib 100mg twice daily for 10 days (supplemental oxygen cohort n=11) or 14 days (mechanical ventilation cohort n=8) plus best supportive care. A subset of patients in both cohorts received concomitant treatment with steroids and/or hydroxychloroquine.


U.S. Coronavirus Cases Hit 2 Million as New Hotspots Surface

HealthDay News, June 11, 2020

The number of confirmed U.S. coronavirus cases passed 2 million on Thursday, as public health experts warned of the emergence of new COVID-19 hotspots across the country. Just three weeks after Arizona Gov. Doug Ducey lifted the state’s stay-at-home order, there has been a significant spike in coronavirus cases, with lawmakers and medical professionals warning that hospitals might not be able to handle a big influx of new cases. Already, hospitals in the state are at 83 percent capacity, the Associated Press reported. But Arizona is not alone in seeing increases in hospitalizations: new U.S. data shows at least eight other states with spikes since Memorial Day. In Texas, North and South Carolina, California, Oregon, Arkansas, Mississippi and Utah, increasing numbers of COVID-19 patients are showing up at hospitals.


Lack of Health Literacy a Barrier to Grasping COVID-19

MedPage Today, June 10, 2020

A lack of health literacy is preventing people from having a good understanding of the novel coronavirus, two speakers said Wednesday at an online briefing sponsored by the National Academies of Sciences, Engineering, and Medicine. “So many people are confused about the symptoms” of COVID-19, said Lisa Fitzpatrick, MD, MPH, founder of Grapevine Health, a nonprofit organization in Washington that helps design culturally appropriate health information campaigns targeted at underserved populations. When Grapevine Health sent workers out to talk to people about the pandemic, “So many told us they didn’t know the symptoms,” said Fitzpatrick.


Avoiding COVID-19 in Children With Asthma and Allergies

Pulmonary Advisor, June 9, 2020

Social distancing of families with children who have asthma is the best method for preventing coronavirus diseases 2019 (COVID-19), according to a letter to the editor published in Allergy. COVID-19 affects all ages, and the US Centers for Disease Control and Prevention initially stated that people with chronic lung disease, including moderate severe asthma, and allergy may be at higher risk of developing a more severe course of COVID-19 than healthy people. Very few reports are available on pediatric patients with COVID-19; therefore, researchers analyzed data on pediatric patients referred for COVID-19 at 2 hub hospitals located in Italy.


Out of the lab and into people’s arms: A list of COVID-19 vaccines that are being studied in clinical trials

ABC News, June 9, 2020

The world’s leading drug companies, universities and governments are racing to develop a vaccine for COVID-19, the disease that has taken more than 400,000 lives globally. Of the 133 candidates being explored, ten have been approved for human trials, according to the World Health Organization. Companies and research groups in China, the early epicenter of the coronavirus outbreak, are testing five of those vaccines in human trials. Meanwhile, U.S.-based companies are involved in the development of four additional vaccines, including one that has NIAID Director Anthony Fauci “cautiously optimistic.”


When the Dust Settles: Preventing a Mental Health Crisis in COVID-19 Clinicians

Annals of Internal Medicine, June 9, 2020

On 26 April, after spending weeks caring for patients with coronavirus disease 2019 (COVID-19) in New York City, emergency room physician Lorna Breen took her own life. Her grieving family recounts days of helplessness leading up to this as Dr. Breen described how COVID-19 upended her emergency department and left her feeling inadequate despite years of training and expertise. The clinical experience of Dr. Breen during this pandemic has not been unique. During the past 5 months, COVID-19 has caused an upheaval of medical systems around the world, with more than 4 million cases and 300 000 deaths worldwide so far. Unfortunately, we’ve also seen that the experience in caring for patients with the virus may have profound effects on clinicians’ mental health. A recent study conducted at the center of the outbreak in China reported that more than 70% of frontline health workers had psychological distress after caring for patients with COVID-19.


Coronavirus: What We Know Now

WebMD, June 8, 2020

The first confirmed cases of coronavirus in the U.S. appeared in January. At the time, the world knew almost nothing about how the virus spreads or how to treat it. Six months later, our knowledge has grown, but researchers continue to make discoveries almost daily. At first, health experts believed COVID-19, the disease caused by the new coronavirus, primarily affected patients’ lungs. While it’s still primarily a lung disease, other symptoms have appeared often, and they’ve been added to the list of signs of COVID.


Relief Therapeutics and NeuroRx Expand Clinical Trial of RLF-100 to All Patients with Critical COVID-19 and Respiratory Failure

BioSpace, June 8, 2020

RELIEF THERAPEUTICS Holding AG (SIX:RLF) “Relief” and its U.S. partner, NeuroRx, Inc. announced that the Phase 2/3 clinical trial evaluating RLF-100 as a treatment for critical COVID-19 with respiratory failure has been expanded to include patients receiving high flow oxygen and noninvasive ventilation (CPAP), in addition to those on ventilators. RLF-100 (Aviptadil) is a patented formulation of synthetic human Vasoactive Intestinal Peptide (VIP), which has been granted Orphan Drug Designation by the U.S. Food and Drug Administration (FDA) in Acute Respiratory Distress Syndrome and chronic lung diseases.


First Study Investigating Antibody Treatment for COVID-19 Begins

Pulmonology Advisor, June 8, 2020

The first patients have been dosed in a phase 1 trial evaluating a potential antibody therapy designed to treat coronavirus disease 2019 (COVID-19). These patients received treatment at major medical centers in the US, including NYU Grossman School of Medicine and Cedars-Sinai in Los Angeles. The investigational agent, LY-CoV555, is a potent, neutralizing lgG1 monoclonal antibody directed against the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The randomized, double-blind, placebo-controlled study is investigating the safety, tolerability, pharmacokinetics, and pharmacodynamics of 1 dose of LY-CoV555 in patients hospitalized with COVID-19; those requiring mechanical ventilation or who have received convalescent COVID-19 plasma treatment prior to enrollment were excluded from the study.


COVID-19 Critical Care Update

🎬 Journal of the American Medical Association, June 8, 2020

Get this COVID-19 Critical Care Update when Howard Bauchner, MD, Editor in Chief, JAMA, speaks with Maurizio Cecconi, MD of Humanitas University in Milan and Derek C. Angus, MD, MPH of the University of Pittsburgh.


Coronavirus Cases in the U.S.

Center for Disease Control and Prevention, June 8, 2020

The U.S. Centers for Disease Control and Prevention (CDC) on Sunday reported 1,920,904 cases of new coronavirus, an increase of 29,214 cases from its previous count, and said COVID-19 deaths in the United States had risen by 709 to 109,901. The CDC reported its tally of cases of COVID-19, the respiratory illness caused by the new coronavirus, as of 4 p.m. EDT on June 6. Its previous tally was released on Friday.


Blood Test May Predict Clot Risk in Severe COVID-19

MedPage Today, June 7, 2020

Hypercoagulability on thromboelastography (TEG) was a good predictor of thrombotic events among COVID-19 patients entering the ICU, according to a single-center study. The clinically significant thrombosis that developed in 13 of 21 PCR-test-positive patients (62%) seen at Baylor St. Luke’s Medical Center ICU from March 15 to April 9 was associated with hypercoagulable TEG parameters in all cases. Maximum amplitude on that test was elevated in all 10 patients with two or more thrombotic complications compared with 45% of those with no more than one such event (nearly all arterial, central venous, or dialysis catheter or filter thromboses).


COVID-19 vaccine development pipeline gears up

The Lancet, June 6, 2020

Vaccine makers are racing to develop COVID-19 vaccines, and have advanced ten candidates into clinical trials. But challenges remain. Vaccine development is typically a long game. The US Food and Drug Administration only approved a first vaccine against Ebola virus last year, 43 years after the deadly virus was discovered. Vaccinologists have made little headway with HIV or respiratory syncytial virus, despite huge investments. On average, it takes 10 years to develop a vaccine. With the COVID-19 crisis looming, everyone is hoping that this time will be different. Already, ten vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) are in clinical trials, and researchers at the University of Oxford and AstraZeneca hope to have the first phase 3 data in hand this summer.


Don’t Skip Opiates for ‘Air Hunger’ From COVID-19 Ventilation

MedPage Today, June 5, 2020

Easing the traumatic “air hunger” created by mechanical ventilation settings for COVID-19 acute respiratory distress syndrome (ARDS) may take more than just sedation or paralytics, one group argued. Lung protective ventilation, with low tidal volumes and permissive hypercapnia, is a recipe for “the most uncomfortable form of dyspnea,” Richard Schwartzstein, MD, of Beth Israel Deaconess Medical Center and Harvard in Boston, wrote in the Annals of the American Thoracic Society.


Flu vaccine reduces influenza risk with no effect on coronaviruses

Healio | Infectious Disease, June 5, 2020

Influenza vaccination reduced the risk for influenza by more than 40%, with no effect on coronaviruses or other non-influenza respiratory viruses, according to a study assessing seasonal influenza and coronaviruses over seven seasons. “Vaccines induce specific antibody protection, targeting the viral or bacterial antigens that are included as vaccine components. On that basis, influenza vaccines are expected to reduce the risk for illness due to influenza viruses and have no effect on other non-influenza respiratory viruses (NIRV),” Danuta M. Skowronski, MD, FRCPC, of the British Columbia Centre for Disease Control and the University of British Columbia in Vancouver, told Healio.


Coronavirus: Nasal High Flow Therapy Alternative to Ventilator Care

HealthLeaders, June 5, 2020

Compared to ventilator care, nasal high flow therapy for seriously ill coronavirus patients has several benefits, including the ability to mobilize patients. Nasal high flow (NHF) therapy is a less invasive alternative to ventilator care for many seriously ill coronavirus patients, UnityPoint Health experts say. During the coronavirus disease 2019 (COVID-19) pandemic, ventilator care has been used commonly for coronavirus patients experiencing acute respiratory distress. However, ventilator care has posed several challenges, including shortages ventilators and the staff needed to manage patients on mechanical ventilation.


Are Symptoms From COVID-19 or Seasonal Allergies?

WebMD, June 4, 2020

In the thick of the coronavirus pandemic, it might be hard to tell if you’ve come down with COVID-19, spring allergies or a cold, which all have some similar symptoms. Fever and dry cough are common symptoms of COVID-19, along with shortness of breath and difficulty breathing, sore throat, diarrhea, fatigue, chills, muscle pain, loss of taste and smell, and body aches. But it’s rare for fever or diarrhea to occur with a cold or seasonal allergies, according to Dr. Michael Benninger, chairman of the Head and Neck Institute at the Cleveland Clinic. “It’s a matter of taking a logical approach to symptoms,” he said in a clinic news release.


Alternatives to Invasive Ventilation in the COVID-19 Pandemic

Journal of the American Medical Association, June 4, 2020

Since its invention in the 1940s, the positive pressure ventilator has always been known to have both risks and benefits. Although mechanical ventilation is unquestionably lifesaving, there are numerous associated drawbacks. Beyond the obvious and immediate limitations that patients require translaryngeal intubation and are physically attached to a ventilator, delivery of gas by positive pressure also creates mechanical stress and causes strain on lung tissue. This stress can lead to ventilator-induced lung injury, compounding the underlying lung condition that precipitated the initial respiratory failure.1 Despite advances in knowledge about protective ventilation strategies to limit ventilator-induced lung injury (most notably use of low tidal volumes), concern remains for this iatrogenic injury in all patients undergoing intubation and mechanical ventilation.


Future COVID-19 Pandemic Burden Could Be Mitigated Via Respiratory Muscle Training

Pulmonology Advisor, June 3, 2020

In cases of coronavirus disease 2019 (COVID-19), patients with poor baseline health have an elevated risk of severe respiratory complications and worse outcomes following hospital admission and mechanical ventilation. In addition, these patients are generally more likely to demonstrate impaired respiratory muscle performance. In a recent review published in the American Journal of Medicine, Rich Severin PT, DPT, PhD(c), CCS, a PhD candidate in the department of physical therapy at the University of Illinois-Chicago, and colleagues proposed that “impaired respiratory muscle performance is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic.”


The Collision of COVID-19 and the U.S. Health System

Annals of Internal Medicine, June 2, 2020

The coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc and causing fear, illness, suffering, and death across the world. This outbreak lays bare the fault lines in our society and highlights that the United States could have been better prepared for the pandemic had we a more equitable and just health care system. As leaders in the American College of Physicians (ACP), we have helped develop ACP’s wide-ranging policies on health care in the United States. The College has adopted a “health in all policies” approach, integrating health considerations into policymaking across sectors to improve the health and health care of all communities and people, which we believe, if enacted, would have enabled the United States to more effectively respond to the COVID-19 pandemic.


ATS/IDSA Guideline Authors Offer Insight Into COVID-19–Related Pneumonia Management

Pulmonary Advisor, June 2, 2020

The cochairs of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) Guideline for Treatment of Adults With Community-Acquired Pneumonia (CAP) have published their perspectives of the guideline as it relates to the management of patients with pneumonia associated with coronavirus disease 2019 (COVID-19). The authors’ comments were published in an Ideas and Opinions paper in the Annals of Internal Medicine. The guideline cochairs wrote that empirical coverage for bacterial pathogens in patients with CAP is not required for all patients with confirmed pneumonia related to COVID-19.


Frailty Score Joins the COVID-19 Battle

MedPage Today, June 2, 2020

A clinical frailty scale (CFS) developed at Nova Scotia’s Dalhousie University is helping doctors predict outcomes of older COVID-19 patients in urgent care settings and decide who gets more aggressive treatments. Because the CFS quickly offers a quantitative number, it avoids age bias when it comes to treatment decisions, said Kenneth Rockwood, MD, of the Division of Geriatric Medicine, Department of Community Health and Epidemiology, School of Health Administration, whose team developed the scale.


Mass gatherings, erosion of trust upend coronavirus control

Associated Press, June 1, 2020

Protests erupting across the nation over the past week — and law enforcement’s response to them — are threatening to upend efforts by health officials to track and contain the spread of coronavirus just as those efforts were finally getting underway. Health experts need newly infected people to remember and recount everyone they’ve interacted with over several days in order to alert others who may have been exposed, and prevent them from spreading the disease further. But that process, known as contact tracing, relies on people knowing who they’ve been in contact with — a daunting task if they’ve been to a mass gathering.


Did Volunteers Tolerate This Coronavirus Vax?

MedPage Today, May 30, 2020

The 24-hour news cycle is just as important to medicine as it is to politics, finance, or sports. New information is posted daily, but keeping up can be a challenge. As an aid for readers and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include coronavirus vaccine research, LGBTQ deaths by suicide, and hypertension. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.


Case Study: Typical Progression of COVID-19 in Metastatic Lung Adenocarcinoma

Pulmonology Advisor, May 29, 2020

Unlike other comorbidities, metastatic lung adenocarcinoma did not escalate the progression of COVID-19 according to results from a case report published in the American Society of Clinical Oncology. A 76-year-old man with metastatic lung adenocarcinoma and a history of chronic obstructive pulmonary disease tested positive for SARS-CoV-2 infection in Spain. He presented with fever, shortness of breath, and bibasal crackles 1 week after his 6th maintenance cycle of cisplatin-pemetrexed and pembrolizumab treatment for his cancer. A blood test showed lymphocytes 120/mL, neutrophils 430/mL, platelets 84,000/mL, C-reactive protein 24.4 mg/dL, and high D-dimer. A chest radiograph revealed diffuse infiltrate in his lungs. Read more.


Coronavirus May Be a Blood Vessel Disease, Which Explains Everything

Elemental, May 29, 2020

In April, blood clots emerged as one of the many mysterious symptoms attributed to Covid-19, a disease that had initially been thought to largely affect the lungs in the form of pneumonia. Quickly after came reports of young people dying due to coronavirus-related strokes. Next it was Covid toes — painful red or purple digits. What do all of these symptoms have in common? An impairment in blood circulation. Add in the fact that 40% of deaths from Covid-19 are related to cardiovascular complications, and the disease starts to look like a vascular infection instead of a purely respiratory one.


Lung function testing in the COVID-19 endemic

The Lancet, May 29, 2020

The COVID-19 pandemic has presented considerable challenges to global health services and dictates almost every aspect of medical practice and policy. Across Europe, a surge phase in acute caseload, led to a sudden curtailment of non-COVID-19 medical care, with immediate implications for routine diagnostic and surveillance investigations. As COVID-19-related hospital admissions subside, many lung function services have started to reconsider how best to operate, within the constraints dictated by a COVID-19 endemic scenario. Central to planning in this phase are the precautions needed to protect lung function staff, and to minimise cross-infection risk, given an ongoing need to test vulnerable patient groups—eg, immunocompromised or individuals with long-term conditions.


Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

The Lancet, May 29, 2020

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. This international, observational, cohort study provides cross-specialty, patient-level outcomes data for patients who had surgery and acquired perioperative SARS-CoV-2 infection. 1128 patients were included across 24 countries.


The COVID-19 Rehabilitation Pandemic

Age and Aging, May 29, 2020

The COVID-19 pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.


COVID-19: An ACP Physician’s Guide

American College of Physicians, Updated May 28, 2020

This ACP Physician’s Guide and its collected national resources support physicians as they respond to the Covid-19 pandemic. The ACP-produced resource can be easily accessed on handheld devices and other computers to provide a clinical overview of infection control and patient care guidance. CME credit and MOC points available.


Metatranscriptomic Characterization of COVID-19 Identified A Host Transcriptional Classifier Associated With Immune Signaling

Clinical Infectious Diseases, May 28, 2020

The recent identification of a novel coronavirus, also known as SARS-CoV-2, has caused a global outbreak of respiratory illnesses. The rapidly developing pandemic has posed great challenges to diagnosis of this novel infection. However, little is known about the metatranscriptomic characteristics of patients with Coronavirus Disease 2019 (COVID-19). Metatranscriptomics in 187 patients (62 cases with COVID-19 and 125 with non-COVID-19 pneumonia) were analyzed, and transcriptional aspects of three core elements – pathogens, the microbiome, and host responses – were interrogated.


Researchers scramble to meet ‘urgent need’ for COVID-19 vaccine

Helio | Infectious Disease News, May 28, 2020

As deaths from COVID-19 increase to more than 100,000 in the United States, institutions around the world are working to develop an effective vaccine. Kaiser Permanente Washington Health Research Institute in Seattle is conducting a phase 1 clinical trial to assess an investigational vaccine, while Johnson & Johnson plans to initiate human clinical studies for its potential candidate by September. According to WHO, there are 10 COVID-19 vaccine candidates under clinical evaluation and an additional 115 candidates in preclinical evaluation. In a remote hearing of the U.S. Senate Committee on Health, Education, Labor & Pensions earlier this month, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said an NIH-directed trial is expected to enter phase 2/3 in late spring or early summer.


Asymptomatic transmission during the COVID-19 pandemic and implications for public health strategies

Clinical Infectious Diseases, May 28, 2020

SARS-CoV-2 spread rapidly within months despite global public health strategies to curb transmission by testing symptomatic patients and encouraging social distancing. Here, we summarize rapidly emerging evidence highlighting transmission by asymptomatic and pre-symptomatic individuals. Viral load of asymptomatic carriers is comparable to symptomatic patients, viral shedding is highest before symptom onset suggesting high transmissibility before symptoms. Within universally tested subgroups, surprisingly high percentages of COVID-19 positive asymptomatic individuals were found. Asymptomatic transmission was reported in several clusters.


Pulmonary pathobiology may differ in COVID-19 vs. H1N1 respiratory failure

Helio | Pulmonology, May 27, 2020

Patients who died from COVID-19-associated respiratory failure had more intussusceptive angiogenesis in their lungs than those who died from influenza, according to an autopsy study. For the study, which was published in The New England Journal of Medicine, researchers used seven-color immunohistochemical analysis, micro-CT imaging, scanning electron microscopy, corrosion casting and direct multiplexed measurement of gene expression to evaluate and compare lungs from patients who died from COVID-19 with those who died from influenza A (H1N1)-associated acute respiratory distress syndrome in 2009 and those from age-matched uninfected controls.


Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review

Annals of Internal Medicine, May 27, 2020

Hydroxychloroquine and chloroquine have antiviral effects in vitro against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). This article summarizes evidence (from Four randomized controlled trials, 10 cohort studies, and 9 case series) about the benefits and harms of hydroxychloroquine or chloroquine for the treatment or prophylaxis of coronavirus disease 2019 (COVID-19).


Odds of Pulmonary Embolism Higher in COVID-19 With Obesity

Pulmonary Advisor | My 26, 2020

Patients with COVID-19 with a body mass index (BMI) >30 kg/m² have increased odds of developing pulmonary embolism (PE), according to a research letter published online May 14 in Radiology. Neo Poyiadi, M.D., from the Henry Ford Health System in Detroit, and colleagues assessed the clinical characteristics of COVID-19 patients who developed PE in a retrospective analysis involving 328 COVID-19 patients who underwent pulmonary computed tomography (CT) angiography. The researchers found that 22 percent of the patients had PE.


Could the D614 G substitution in the SARS-CoV-2 spike (S) protein be associated with higher COVID-19 mortality?

International Journal of Infectious Diseases | May 26, 2020

Increasing number of deaths due to COVID-19 pandemic has raised serious global concerns. Higher testing capacity and ample intensive care availability could explain lower mortality in some countries compared to others. Nevertheless, it is also plausible that the SARS-CoV-2 mutations giving rise to different phylogenetic clades are responsible for the obvious death disparities around the world. Current research literature linking the genetic make-up of SARS-CoV-2 with fatality is lacking. Here, we suggest that this disparity in fatality rates may be attributed to SARS-CoV-2 evolving mutations and urge the international community to begin addressing the phylogenetic clade classification of SARS-CoV-2 in relation to clinical outcomes.


Treating Allergic Asthma During the Emergence of COVID-19

HCP Live, May 26 | 2020

[Video] Experts in the field of pulmonology share concerns over managing patients with allergic asthma during the current COVID-19 pandemic. Thomas Casale, MD, speaks with Geoffrey L. Chupp, MD, Stanley Goldstein, MD, Syed Shahzad Mustafa, MD and Michael E. Wechsler, MD, MMSc about challenges for physicians.


Distinguishing ILD From COVID-19 in Patients Treated With EGFR-TKIs

Pulmonary Advisor, May 25 | 2020

A list of clinical and imaging findings that may help distinguish interstitial lung disease (ILD) associated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy used in the treatment of lung cancer from lung-associated manifestations of COVID-19 infection was published in the Journal of Thoracic Oncology. While EGFR-TKI–associated ILD is relatively rare, with a reported incidence in the range of 0.3% to 4.3% depending on patient population and specific EGFR-TKI used, it is considered to be the most serious adverse effect of EGFR-TKI treatment.


Has the curve flattened?

Johns Hopkins University & Medicine | May 25, 2020

Countries around the world are working to “flatten the curve” of the coronavirus pandemic. Flattening the curve involves reducing the number of new COVID-19 cases from one day to the next. This helps prevent healthcare systems from becoming overwhelmed. When a country has fewer new COVID-19 cases emerging today than it did on a previous day, that’s a sign that the country is flattening the curve. On a trend line of total cases, a flattened curve looks how it sounds: flat. On the charts on this page, which show new cases per day, a flattened curve will show a downward trend in the number of daily new cases. This analysis uses a 5-day moving average to visualize the number of new COVID-19 cases and calculate the rate of change.


ED Chest X-Ray Score Predicts COVID-19 Outcomes in Adults <50

Physician’s Weekly | May 24, 2020

A chest X-ray (CXR) severity score can predict outcomes among young and middle-aged adults with COVID-19 on presentation to the emergency department, according to a study published online May 14 in Radiology. Danielle Toussie, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues analyzed the prognostic value of a CXR severity scoring system for 338 younger patients with COVID-19 on presentation to the emergency department. Data were included for patients aged 21 to 50 years who presented to emergency departments from March 10 to 26, 2020, with confirmed COVID-19. Each CXR was divided into six zones and was examined for opacities, with scores collated into a total lung zone severity score.


Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents?

Journal of Microbiology, Immunology and Infection | May 23, 2020

Co-infection has been reported in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but there is limited knowledge on co-infection among patients with coronavirus disease 2019 (COVID-19). The prevalence of co-infection was variable among COVID-19 patients in different studies, however, it could be up to 50% among non-survivors. Co-pathogens included bacteria, such as Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumonia, Legionella pneumophila and Acinetobacter baumannii; Candida species and Aspergillus flavus; and viruses such as influenza, coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus.


Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

The Lancet | May 22, 2020

In this large multinational real-world analysis, we did not observe any benefit of hydroxychloroquine or chloroquine (when used alone or in combination with a macrolide) on in-hospital outcomes, when initiated early after diagnosis of COVID-19. Each of the drug regimens of chloroquine or hydroxychloroquine alone or in combination with a macrolide was associated with an increased hazard for clinically significant occurrence of ventricular arrhythmias and increased risk of in-hospital death with COVID-19. The use of hydroxychloroquine or chloroquine in COVID-19 is based on widespread publicity of small, uncontrolled studies, which suggested that the combination of hydroxychloroquine with the macrolide azithromycin was successful in clearing viral replication.


Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

New England Journal of Medicine | May 21, 2020

In patients who died from Covid-19–associated or influenza-associated respiratory failure, the histologic pattern in the peripheral lung was diffuse alveolar damage with perivascular T-cell infiltration. The lungs from patients with Covid-19 also showed distinctive vascular features, consisting of severe endothelial injury associated with the presence of intracellular virus and disrupted cell membranes. Histologic analysis of pulmonary vessels in patients with Covid-19 showed widespread thrombosis with microangiopathy. Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza (P<0.001). In lungs from patients with Covid-19, the amount of new vessel growth — predominantly through a mechanism of intussusceptive angiogenesis — was 2.7 times as high as that in the lungs from patients with influenza (P<0.001).

An Update on COVID-19 for the Practicing Allergist/immunologist

American Academy of Allergy, Asthma & Immunology | May 19, 2020

This year’s spring allergy season has been greatly overshadowed by the arrival of the coronavirus disease 2019 (COVID-19) pandemic. The presence of COVID-19 is affecting everyone and many allergists’ practices have slowed to a crawl because of state-wide limitations in non-essential medical visits and testing, and because of the risk to providers and their staff as well as to patients from COVID-19 infection and transmission. The CDC has issued many guidelines for healthcare providers, which include the use of appropriate PPE and the evaluation and testing of patients suspected of being infected with COVID-19. It has become more important than ever to recognize the differences between allergies and infection with COVID-19. Educating staff and patients to recognize the differences is paramount in appropriately screening those who may otherwise need isolation or referral based on rapidly evolving state and federal guidelines.


Clinician Wellness, Burnout, and Finding the Right Work-Life Balance

🎧 American Academy of Allergy, Asthma & Immunology | May 19, 2020

[Podcast] In this CME episode, Giselle S. Mosnaim, MD, MS, FAAAAI, discusses the factors associated with high rates of burnout for medical professionals. Listen in to learn great information and helpful tips to maintain wellness, which is especially pertinent during COVID-19.


COVID-19 and the impact of social determinants of health

The Lancet | Respiratory Medicine | May 18, 2020

The novel coronavirus disease 2019 (COVID-19), caused by the pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originated in Wuhan, China, and has now spread internationally with over 4·3 million individuals infected and over 297 000 deaths as of May 14, 2020, according to the Johns Hopkins Coronavirus Resource Center. While COVID-19 has been termed a great equaliser, necessitating physical distancing measures across the globe, it is increasingly demonstrable that social inequalities in health are profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Many social determinants of health—including poverty, physical environment (eg, smoke exposure, homelessness), and race or ethnicity—can have a considerable effect on COVID-19 outcomes.


Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19

Journal of Allergy and Clinical Immunology | May 18, 2020

COVID-19 can manifest as a viral induced hyperinflammation with multi-organ involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available. Maximal levels of IL-6 followed by CRP were highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP levels to guide escalation of treatment in patients with COVID-19 related hyperinflammatory syndrome.


Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome: Results From a Prospective, Single-Center, Clinicopathologic Case Series

Annals of Internal Medicine | May 14, 2020

Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become pandemic, with substantial mortality. COVID-19 predominantly involves the lungs, causing DAD and leading to acute respiratory insufficiency. Death may be caused by the thrombosis observed in segmental and subsegmental pulmonary arterial vessels despite the use of prophylactic anticoagulation. Studies are needed to further understand the thrombotic complications of COVID-19, together with the roles for strict thrombosis prophylaxis, laboratory, and imaging studies and early anticoagulant therapy for suspected pulmonary arterial thrombosis or thromboembolism.


COVID-19 Important Resources

American College of Allergy, Asthma & Immunology | Updated regularly

Review a collection of allergy and immunology clinician resources, from webinars to contingency planning and billing & coding information to Federal response updates. This comprehensive collection of links and downloads can assist you in navigating your practice during the pandemic.


COVID-19: unanswered questions on immune response and pathogenesis

Journal of Allergy and Clinical Immunology | May 7, 2020

The novel coronavirus disease 2019 (COVID-19) has rapidly increased in pandemic scale since it first appeared in Wuhan, China, in December 2019. In these troubled days the scientific community is asking rapid replies to prevent and combat the emergency. It is generally accepted that only achieving a better understanding of the interactions between the virus and host immune response and of the pathogenesis of infection is crucial to identify valid therapeutic tools to control virus entry, replication and spread as well as to impair its lethal effects. Based on the recent research progress of SARS-CoV-2 and the results on previous coronaviruses, in this contribution we underscore some of the main unsolved problems, mostly focusing on pathogenetic aspects and host immunity to the virus. On this basis, we also touch important aspects regarding the immune response in asymptomatic subjects, the immune-evasion of SARS-CoV-2 in severe patients and differences in disease severity by age and gender.


Tropism, replication competence, and innate immune responses of the coronavirus SARS-CoV-2 in human respiratory tract and conjunctiva: an analysis in ex-vivo and in-vitro cultures

The Lancet | Respiratory Medicine | May 7, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019, causing a respiratory disease (coronavirus disease 2019, COVID-19) of varying severity in Wuhan, China, and subsequently leading to a pandemic. The transmissibility and pathogenesis of SARS-CoV-2 remain poorly understood. We evaluate its tissue and cellular tropism in human respiratory tract, conjunctiva, and innate immune responses in comparison with other coronavirus and influenza virus to provide insights into COVID-19 pathogenesis.


Asthma and COVID-19 Risk: Good, Bad, or Indifferent?

MedPage Today | May 5, 2020

People with asthma are classified as being at increased risk for severe COVID-19 outcomes, although evidence is emerging that may point in the opposite direction. Under normal circumstances, viral infections are a big driver of flares in asthma patients. But research indicates asthma patients with COVID-19 do not appear to have a higher rate of hospitalization or mortality compared with other COVID-19 patients, Linda Rogers, MD, of Icahn School of Medicine at Mount Sinai in New York City, told MedPage Today.


COVID-19 and Asthma

American Academy of Allergy, Asthma & Immunology | Updated Regularly

[Infographic] Download and print this infographic to share with your patients and/or hang in your offices.


A Physician’s Guide to COVID-19

American Medical Association | April 30, 2020

This quick-start COVID-19 physician guide, curated from comprehensive CDC, JAMA and WHO resources, will help prepare your practice, address patient concerns and answer your most pressing questions.


Immunotherapies for COVID-19: lessons learned from sepsis

The Lancet | Respiratory Medicine | April 28, 2020

herapeutic approaches to mitigate the severe acute lung injury associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have rapidly entered clinical trials primarily on anecdotal observations and few clinical studies. Along with the clinical symptoms related to viral invasion, the reported molecular response known as the cytokine storm has attracted the greatest attention, in both the scientific and the lay press, as a cause of organ injury. The hypothesis that quelling this storm with anti-inflammatory therapies directed at reducing interleukin-6 (IL-6), IL-1, or even tumour necrosis factor α (TNFα) might be beneficial has led to several ongoing trials. Anecdotal evidence from non-controlled clinical trials has suggested a possible beneficial effect, and anti-IL-6 has been shown to be effective in chimeric antigen receptor T (CAR-T) and cytokine response syndrome (CRS).


What You Need to Know About COVID-19

Allergy & Asthma Network | April 20, 2020

COVID-19, a disease caused by coronavirus, is spreading worldwide and the World Health Organization (WHO) has declared it a pandemic. Here is a map of reported cases, deaths and reported recoveries around the world. In the United States, different parts of the country are seeing different levels of COVID-19 activity. Cases of COVID-19 and instances of community spread are being reported in all states. People in places where there is ongoing community spread of COVID-19 are at higher risk of exposure, with the risk level dependent on your location, according to the U.S. Centers for Disease Control and Prevention (CDC). Check out their COVID-19 Information Center.


What’s the Difference Between COVID-19 and Other Viruses?

Gemoji image for :clapper American College of Allergy, Asthma & Immunology | April 20, 2020

Allergist Jonathan Bayuk, MD, ACAAI member, explains how COVID-19 is different from other viruses, and how to avoid catching it.


Albuterol Inhaler Shortage Due to COVID-19 Could Impact People With Asthma

Asthma and Allergy Foundation of America | April 16, 2020

Certain areas of the country are experiencing shortages of albuterol inhalers. The shortage will probably spread throughout the U.S., although it is not a production problem. The shortage is occurring because of the increased use of albuterol inhalers in hospitals for COVID-19 and suspected COVID-19 patients to help with respiratory issues. There is a concern that nebulizers used on patients with COVID-19 in the hospital could spread the virus in the air. But the possible risk is to hospitalized patients with COVID-19 – not to patients using their nebulizer at home as directed.


A Closer Look at COVID-19, Allergies and the Flu

🖼 Allergy & Asthma Network

Check out this downloadable/printable infographic that helps distinguish the difference in COVID-19 versus allergies.


Using Telemedicine to Provide Care for Allergic Conditions

🎧 American Academy of Allergy Asthma & Immunology | April 16, 2020

Telemedicine expert Jennifer Shih, MD, discusses practical elements of performing virtual visits. This conversation is filled with amazing tips for both patients and clinicians – a must listen for telemedicine novices or experienced users.


Coronavirus (COVID-19): What People With Asthma Need to Know

Asthma and Allergy Foundation of America [Blog] | April 16, 2020

There are some symptoms that are similar between these respiratory illnesses. This chart can help you figure out if you may be feeling symptoms of allergies or a respiratory illness like COVID-19. If you have a fever and a cough, call your doctor. If you have seasonal allergies, there are things you can do to treat at home.


Psychosocial Impact & Interventions for Patients & Providers During the COVID-19 Crisis

Gemoji image for :clapper Allergy and Asthma Network | April 14, 2020

Scroll down the page for this webinar hosted by Tonya Winders, President & CEO of the Allergy & Asthma Network. Listen as she interviews Dr. Gia Rosenblum, Clinical Psychologist and Dr. Jackie Eghrari, Clinical Assistant Professor of Medicine, George Washington School of Medicine & Health Sciences.