Up-to-date information on hearth health, respiratory & 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%).

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.