August 6, 2020 - a podcast by COVID19LST

Epidemiology

· A recent case report describes an 18-year old male patient diagnosed with COVID-19 after presenting with fever, anorexia, and headache at a clinic on Reunion Island in the Indian Ocean. He later returned with fever, rash, dyspnea, and arthromyalgias and was discovered to be positive for dengue as well highlighting the importance to test for both conditions when clinically indicated.

Understanding the Pathology

· Single cell RNA sequencing of human kidney cells revealed that the expression of angiotensin converting enzyme 2 was highest in the proximal convoluted tubule cells and glomerular parietal cells providing cellular evidence of the means and location by which SARS-CoV-2 can cause direct kidney injury.

Management

· A literature review studied the clinical outcomes of 221 COVID-19 positive kidney transplant patients recipients and found that symptoms were predominantly respiratory with accompanying fever, lymphopenia and elevated CRP were each present in roughly 80% of patients, and 20% of patients died.

· A study conducted in Spain details the effects of an on-site medicalization program at 4 nursing homes with COVID-19 outbreaks in Spain. After implementation, COVID-19 mortality was decreased by 10-15% in the facilities that implemented the programs when compared to other outbreaks in long-term care facilities. These data suggest that medicalization programs such as this can greatly reduce the impact of COVID-19 on long term care facilities.

Adjusting Practice During COVID-19

· A cross-sectional study of adult emergency department visits across 7 medical centers in the United States found that the onset of the pandemic was associated with a decrease in ED visits of roughly 25% as well as reductions in diagnosis of cardiac, surgical, neurological, orthopedic, gastrointestinal, and chronic respiratory emergencies. These data add to the large amount of existing evidence that individuals may be avoiding care, even emergency care, during the pandemic.

R&D: Diagnosis and Treatment

· A group of clinicians from the University of Utah discuss the conflicting data that has emerged regarding corticosteroid use in treatment of COVID-19, citing studies that showed either mortality reduction of COVID-19 when treated with steroids, harm caused by steroid use, or no association between steroid use and mortality. They caution against use of steroids for COVID-19 until randomized clinical trials can be performed to clarify their impact on COVID-19.

· A study conducted in China found several differences in peripheral blood parameters between people infected with COVID-19, influenza, and a healthy control group. Among the differences, monocyte count and percentage of basophils were the key differences between COVID-19 and influenza, indicating their utility in differentiating between COVID-19 and influenza.

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