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

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%).

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.