October 26, 2020 - a podcast by COVID19LST

In today's episode we discuss: 

—Climate: Navigating through health care data showed disruption by the COVID-19 pandemic and was found to be variable and potentially unreliable due to the pandemic's effects on health-seeking, patient triage, and overall outcomes. Authors note that analytic methods for many study designs rely on the assumption that these factors are constant over time. They suggest that researchers should be cognizant of this disruption when planning studies and performing analyses in order to prevent potential confounding biases in future research studies.

—Management: Longitudinal profile of laboratory parameters and their application in the prediction for fatal outcome among 642 hospitalized patients infected with SARS-CoV-2 were evaluated and authors found that abnormal lactate dehydrogenase, urea, lymphocyte count, and procalcitonin levels were predictors of death during the acute phase (days 1-9), in addition to abnormal procalcitonin, lactate dehydrogenase, lymphocyte count, monocyte percentage, and cholinesterase being predictors of death in the critical phase (days 10-15). This study suggests that these labs should be followed as markers for prognosis and aggressive care should be considered should abnormalities in these markers arise.

—Adjusting Practice During COVID-19: Powered air purifying respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among healthcare workers during the COVID-19 outbreak according to a study evaluating cerebral hemodynamic changes using Transcranial Doppler (TCD) of the middle cerebral artery (MCA) flow among 154 COVID-19 healthcare workers, of whom 123/154 developed de-novo headache due to N95 use (38/154 had preexisting migraine co-morbidity). Wearing an N95 increased Mean Flow Velocity (MFV) and ET-CO2, while Pulsatility Index (PI) decreased (p<0.001), whereas 24 participants donning N95 with a PAPR exhibited values nearer to baseline. These results implicate combined use of N95 with PAPR to potentially maintain cerebral homeostasis, mitigating PPE-induced headaches among healthcare workers, although larger trials may be required.

—Mental Health & Resilience Needs: Mental health disorders may be related to COVID-19-related deaths based on a commentary by psychiatrists. The authors cite the Center for Disease Control and Prevention (CDC) June 2020 survey with 40.9% of participants reporting “at least one adverse mental or behavioral health condition," which is 3-4 times higher than one year ago. Health disparities and a distressed healthcare workforce are additional areas of concern. The authors recommend screening (e.g. trauma, grieving, depression, anxiety) by primary care physicians and mental health professionals as well as broad supportive public health strategies (e.g. online resources for grieving families) in an effort to identify and aid those in need of assistance.

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