June 26, 2020 - a podcast by COVID19LST

On today's episode we discuss:

—Climate:  A survey of 426 emergency physicians from seven medical institutions in California, New Jersey, and Louisiana found inadequacy of PPE, inability to quickly and accurately diagnose COVID-19, and fear of infecting family members to be the most salient stressors.

—Epidemiology:  A systematic review and meta-analysis, including 148 articles comprised of 24,410 COVID-19 positive adults from 9 countries, found that the most common symptoms at presentation were fever (78%), cough (57%), and fatigue (31%), with prevalence of dyspnea in only 23% of patients. The authors conclude that the most common symptoms are fever and cough, although it is noted that these prevalence findings are about 10% less than previously reported.

—Management:  A case series of 7 patients found that postmortem tissue samples from patients who died from COVID-19 pneumonia <7 days after onset of respiratory failure (RF) showed acute diffuse alveolar damage (DAD) while samples from those who died >14 days after onset of RF showed organizing DAD, with SARS-CoV-2 detected in tissues with acute DAD but not in tissues with organizing DAD.

—Diagnosis and Treatment:  

- Analysis of three case series with conflicting data on mechanically ventilated COVID-19 patients indicated that: 1) low respiratory system compliance (Crs) may be associated with a higher gradient of arterial partial pressures of oxygen to alveolar partial pressures of oxygen (PaO2-PAO2) in COVID-19 respiratory failure, 2) positive end-expiratory pressure (PEEP) levels should be selected by measuring Crs, and 3) increasing tidal volume can reduce both serial dead space ventilation and parallel dead space ventilation. The authors suggest that clinicians focus on individual patient's needs when operating respirators given the heterogeneity in presentations of COVID-19 respiratory failure.

- A cross-sectional study conducted by Tulane University School of Medicine using 29 nasal swab samples and found that COVID-19 could be diagnosed within 50 minutes via a COVID-19 CRISPR fluorescent detection system (FDS) with 100% sensitivity and 71.4% specificity when compared to results obtained by a state testing laboratory via reverse transcriptase (RT)-PCR of the same samples

—Mental Health and Resilience:  

- Authors of the Department of Addictive Behavior and Addictive Medicine in Mannheim, Germany evaluated the effect of social isolation on alcohol consumption during the pandemic through an anonymous online survey of 2,102 participants and found that 34.7% of participants reported drinking more alcohol since the lockdown began, highlighting the need for healthcare providers to stay informed on this increased alcohol consumption during the lockdown and to be aware of its potential long-term effects.

- A systematic review conducted at the Galatea Care Programme for Sick Health Professionals in Barcelona, Spain analyzed 30 studies and found a high prevalence of anxiety (30-70%) and depressive symptoms (20-40%) reported among healthcare professionals (HPs), raising concerns that increased psychological support is needed in these population.

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