October 20, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Epidemiology: Clinical features and outcomes of adults with COVID-19 admitted to the hospital based on a systematic review and pooled analysis of the literature

—Understanding the Pathology: Endotheliopathy is induced by plasma from critically-ill patients and associated with organ failure in severe COVID-19 based on a retrospective cohort study at Lille University Hospital assessing cytotoxicity of plasma from 28 patients (12 ICU and 16 non-ICU) hospitalized with COVID-19. Samples from COVID-19 patients had significantly decreased human pulmonary microvascular endothelial cells (HPMVEC) viability (p<0.01) and increased cytotoxicity compared to plasma from 8 healthy donors. The authors suggest their findings bolster the growing body of evidence indicating SARS-CoV-2 induces endothelial damage that contributes to organ dysfunction, respiratory failure, and thrombosis.

—Transmission & Prevention: Regeneration Processes for Filtering Facepiece Respirators (FFRs) in Terms of the Bacteria Inactivation Efficiency and Influences on Filtration Performance were investigated through the ability of microwave irradiation (MWI), UV irradiation (UVI), MWI + UVI, steam, and ethanol. Authors found ethanol unacceptably reduced filtration efficiency while steam and MWI effectively decontaminated FFRs (100% inactivation in 90 min and 30 min, respectively) without sacrificing filtration, though long exposure to MWI did damage fiber morphology. While UVI successfully inactivated surface bacteria, efficiency decreased from outer to inner layers and authors suggest that a combination of UVI and short-duration MWI can best decontaminate used FFRs while maintaining filtration performance.

—Management: Anti-androgens may protect against severe COVID-19 outcomes based on results from a prospective cohort study of 77 hospitalized men.  The authors found patients taking anti-androgens (dutasteride [n=9], finasteride [n=2], spironolactone [n=1]) were significantly less likely to be admitted to the ICU than men not taking anti-androgens (p=0.0002), even after stratifying for age (p=0.018). Given the reduced risk of experiencing severe COVID-19 (RR: 0.14, 95% CI: 0.02-0.94), they suggest anti-androgens could be utilized therapeutically to improve COVID-19 disease course in men.

—Adjusting Practice During COVID-19: Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal Anti-VEGF Injections and transmission of COVID-19 were constructed by ophthalmologists in New Zealand through statistical model that weighed risks and benefits of performing anti-VEGF intraocular injections in patients with neovascular age-related macular degeneration (nAMD) during the COVID-19 pandemic. 

—R&D: Diagnosis & Treatments: Sensitivity of nasopharyngeal, oropharyngeal, and nasal wash specimens for SARS-CoV-2 detection in the setting of sampling device shortage was explored though a cross-sectional study comparing sensitivities of different samples for detection of ORF1 and E-protein genes via RT-PCR in 29 SARS-CoV-2 positive patients.

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