January 5, 2021 - a podcast by COVID19LST

In today's episode we discuss:

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

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

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

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

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

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