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Latest Publications and Scientific Information

July 13, 2020

Airborne Transmission of SARS-CoV-2

The coronavirus disease 2019 (COVID-19) pandemic has reawakened the long-standing debate about the extent to which common respiratory viruses, including the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are transmitted via respiratory droplets vs aerosols.

Communicating Science in the Time of a Pandemic

During the global SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, disseminating study findings (such as by preprints, news releases, news stories, or social media) and publishing the results of studies of testing and treatment in scientific journals increased quickly. As of July 6, a PubMed search for COVID-19 yielded almost 30 000 reports.

July 9, 2020

Audio Interview: Acute Lung Injury in Covid-19

The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.

Persistent Symptoms in Patients After Acute COVID-19

In Italy, a large proportion of patients with coronavirus disease 2019 (COVID-19) presented with symptoms (71.4% of 31 845 confirmed cases as of June 3, 2020).1 Common symptoms include cough, fever, dyspnea, musculoskeletal symptoms (myalgia, joint pain, fatigue), gastrointestinal symptoms, and anosmia/dysgeusia.2-4 However, information is lacking on symptoms that persist after recovery. We assessed persistent symptoms in patients who were discharged from the hospital after recovery from COVID-19.

July 8, 2020

The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings

Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders.

Challenges Estimating Total Lives Lost in COVID-19 Decisions

The coronavirus disease 2019 (COVID-19) pandemic has claimed hundreds of thousands of lives, directly and indirectly, and threatens to claim many more. Nations have made different policy decisions that have affected the rate of infection, mortality, the economy, and the life of the country differently.

July 7, 2020

Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities ― United States, April–May 2020

Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19–associated occupational risk and health disparities among vulnerable populations.

July 6, 2020

The Disproportionate Impact of Covid-19 on Communities of Color

Racism, cultural mistrust, miscommunication, chronic illness bred by limited food and living choices, and lived experience bind together communities of color as disparate as the Navajo Nation and Chelsea, Massachusetts. Why are we surprised? Because we are complacent.

On the Resources for the Public Page, at the top of the left column:

Gov. Edwards Orders Statewide Mask Mandate, Closes Bars to On Premises Consumption as COVID-19 Continues to Spread Across Louisiana

Today, Gov. John Bel Edwards announced a mandatory mask requirement for Louisiana and ordered bars in the state closed to on-premises consumption, as the state experiences increasing spread of COVID-19. The Governor also limited indoor social gatherings like wedding receptions, class reunions and parties to 50 total people. With these additional restrictions, Louisiana remains in Phase Two of the Roadmap for a Resilient Louisiana.

On the Resources for LSU Health New Orleans Page, at the top of the left column:

Gov. Edwards Orders Statewide Mask Mandate, Closes Bars to On Premises Consumption as COVID-19 Continues to Spread Across Louisiana

Today, Gov. John Bel Edwards announced a mandatory mask requirement for Louisiana and ordered bars in the state closed to on-premises consumption, as the state experiences increasing spread of COVID-19. The Governor also limited indoor social gatherings like wedding receptions, class reunions and parties to 50 total people. With these additional restrictions, Louisiana remains in Phase Two of the Roadmap for a Resilient Louisiana.

Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study

Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level.

It is Time to Address Airborne Transmission of COVID-19

We  appeal  to  the  medical  community  and  to  the  relevant  national  and  international  bodies  to recognize the potential for airborne spread of COVID-19. There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission.

Developing a SARS-CoV-2 Vaccine at Warp Speed

With this background, the US Department of Health and Human Services (HHS) launched Operation Warp Speed—a partnership between government and industry—with the goal of delivering 300 million doses of a safe and effective vaccine by January 2021.3 This ambitious plan initially focused on 125 potential vaccine candidates, but was rapidly narrowed to 14 candidates in May 2020, and, as reported in June 2020, the current administration plans to narrow this list to 5 core candidates.

The Development of COVID-19 Vaccines

A safe and effective vaccine against coronavirus disease 2019 (COVID-19) is the best way to control and ultimately end the pandemic. Vaccine development is moving at unprecedented speed, with more than 200 candidates, billions of dollars committed, and manufacturing often proceeding before even knowing whether a given vaccine candidate will succeed.

June 30, 2020

Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020

Case investigation, contact tracing, and isolation of infected persons are needed to prevent ongoing community transmission, given the frequent lack of a known contact. Enhanced measures to ensure workplace safety, including social distancing and more widespread use of cloth face coverings, are warranted.

Finding Antibodies that Neutralize SARS-CoV-2

It’s now clear that nearly everyone who recovers from coronavirus disease 2019 (COVID-19) produces antibodies that specifically target SARS-CoV-2, the novel coronavirus that causes the infection. Yet many critical questions remain. A major one is: just how well do those particular antibodies neutralize the virus to fight off the infection and help someone recover from COVID-19? Fortunately, most people get better—but should the typical antibody response take the credit?

June 29, 2020

Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility — Louisiana, April–May 2020

Early detection and isolation of persons with COVID-19, along with testing of close contacts, can slow the transmission of SARS-CoV-2 in correctional and detention facilities. Serial testing, particularly for close contacts of patients, is important for complete identification of cases and prompt public health response in congregate settings.

Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)

Multisystem Inflammatory Syndrome in Children in New York State

The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

Childhood Multisystem Inflammatory Syndrome — A New Challenge in the Pandemic

The recognition and description of new diseases often resemble the parable of the blind men and the elephant, with each declaring that the part of the beast they have touched fully defines it. As the coronavirus disease 2019 (Covid-19) pandemic has evolved, case reports have appeared describing children with unusual febrile illnesses that have features of Kawasaki’s disease, toxic shock syndrome, acute abdominal conditions, and encephalopathy, along with other reports of children with fever, elevated inflammatory markers, and multisystem involvement. It is now apparent that these reports were describing different clinical presentations of a new childhood inflammatory disorder.

Cognitive Bias and Public Health Policy During the COVID-19 Pandemic

As the coronavirus disease 2019 (COVID-19) pandemic abates in many countries worldwide, and a new normal phase arrives, critically assessing policy responses to this public health crisis may promote better preparedness for the next wave or the next pandemic. A key lesson is revealed by one of the earliest and most sizeable US federal responses to the pandemic: the investment of $3 billion to build more ventilators. These extra ventilators, even had they been needed, would likely have done little to improve population survival because of the high mortality among patients with COVID-19 who require mechanical ventilation and diversion of clinicians away from more health-promoting endeavors.

Taking a Closer Look at COVID-19, Health Inequities, and Racism

Meanwhile, the COVID-19 crisis also revealed the nation’s eroding public health readiness, according to Murray, an adjunct assistant professor at the University of Illinois at Chicago School of Public Health and a past president of the American Public Health Association.

June 26, 2020

Infectability of human BrainSphere neurons suggests neurotropism of SARS-CoV-2

Reports from Wuhan suggest that 36% of COVID-19 patients show neurological symptoms, and cases of viral encephalitis have been reported, suggesting that the virus is neurotropic under unknown circumstances. This is well established for other coronaviruses.

Editorial Evaluation and Peer Review During a Pandemic

Concerns have been raised about how journals maintain their standards during the current coronavirus disease 2019 (COVID-19) pandemic, given the rapid pace and unprecedented volume of research being conducted in such a short time, and the large number of reports submitted to journals.

June 25, 2020

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Covid-19 and the Need for Health Care Reform

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. Although all aspects of U.S. health care will face incredible challenges in the coming months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.

June 24, 2020

COVID-19 Outbreak Among College Students After a Spring Break Trip to Mexico — Austin, Texas, March 26–April 5, 2020

A coordinated response with contact tracing and testing of all contacts, including those who are asymptomatic, is important in controlling future COVID-19 outbreaks that might occur as schools and universities consider reopening.

Mortality, Admissions, and Patient Census at SNFs in 3 US Cities During the COVID-19 Pandemic

Mortality from coronavirus disease 2019 (COVID-19) is disproportionately concentrated in skilled nursing facilities (SNFs). As of June 18, 2020, 50 185 residents died of COVID-19 in the 41 states reporting deaths at SNFs, accounting for 45% of their total COVID-19 deaths statewide.

A Proposed Lottery System to Allocate Scarce COVID-19 Medications

These problems are not specific to remdesivir or to the current pandemic: governments and health systems will predictably encounter situations during pandemics in which novel therapeutics are in short supply and knowledge about their harms and benefits is limited.

Missed Opportunities on Emergency Remdesivir Use

In the case of remdesivir, the decision to grant an EUA followed the release of a summary interim finding of shorter time to recovery among patients treated with the drug in a National Institute of Allergy and Infectious Diseases (NIAID)–funded phase 3 placebo-controlled clinical trial.

June 23, 2020

A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2

Despite various levels of preventive measures, in 2020 many countries have suffered severely from the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. We show that population heterogeneity can significantly impact disease-induced immunity as the proportion infected in groups with the highest contact rates is greater than in groups with low contact rates.

Plans and Pandemics

It was the first week of my oncology fellowship, and Dr. E., a senior fellow, was handing his patients over to me, as he was shifting from clinical work to research. He had emailed signout the night before, but this in-person meeting communicated all the nuance that a spreadsheet lacked — how Mr. R., for example, liked his chemotherapy scheduled around calving season. Having been a medicine resident just a week earlier, I knew minimal oncology. But this meeting was not about the science. It was about the stories.

June 22, 2020

Using influenza surveillance networks to estimate state-specific prevalence of SARS-CoV-2 in the United States

Detection of SARS-CoV-2 infections to date has relied heavily on RT-PCR testing. However, limited test availability, high false-negative rates, and the existence of asymptomatic or sub-clinical infections have resulted in an under-counting of the true prevalence of SARS-CoV-2.

Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions — United States, January–May 2020

In the 10 weeks following declaration of the COVID-19 national emergency, ED visits declined 23% for heart attack, 20% for stroke, and 10% for hyperglycemic crisis.

June 18, 2020

Challenges of “Return to Work” in an Ongoing Pandemic

As economic and political pressure has built to relax “shelter in place” public health orders for control of coronavirus disease 2019 (Covid-19), industry, professional service firms, retail and service establishments, and educational institutions seek to establish norms that protect workers, customers, clients, students, and visitors. A public health order represents a minimum disease-prevention standard, adherence to which is not elective, but may not satisfy all legal requirements with respect to the personal safety of workers and others.

Association between high serum total cortisol concentrations and mortality from COVID-19

Physiological stress from critical illness and elective surgery increases serum cortisol concentrations and bioavailability by activation of the hypothalamic–pituitary–adrenal axis, decreased metabolism of cortisol, and a reduction in the amount of binding proteins (eg, cortisol-binding globulin).

Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections

These data suggest that asymptomatic individuals had a weaker immune response to SARS-CoV-2 infection. The reduction in IgG and neutralizing antibody levels in the early convalescent phase might have implications for immunity strategy and serological surveys.

June 17, 2020

Genomewide Association Study of Severe Covid-19 with Respiratory Failure

We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.)

June 15, 2020

Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020

As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.

Hospital-Wide SARS-CoV-2 Antibody Screening in 3056 Staff in a Tertiary Center in Belgium

Belgium has a high burden of coronavirus disease 2019 (COVID-19), especially the region surrounding the Hospital East-Limburg, a tertiary care center.1 Infection prevention measures were instituted in the hospital beginning March 4, 2020, including testing and contact tracing of all symptomatic patients and staff, changes in hospital operations, and provision of personal protective equipment (PPE). The first case was detected March 13 (Figure 1). We investigated the prevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among hospital staff.

Monoclonal Antibodies for Prevention and Treatment of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has created a worldwide crisis and inspired an urgent search for prevention and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Attention has focused on the development of vaccines, new antiviral agents, and convalescent plasma infusions. Monoclonal antibodies have received less attention even though neutralizing antibodies are a key component of protective immunity for most viral diseases. Neutralizing monoclonal antibodies to SARS-CoV-2 have the potential for both therapeutic and prophylactic applications, and can help to guide vaccine design and development.

June 13, 2020

COVID-19 vaccines for all?

The   third   replenishment   meeting   for   Gavi,   the   Vaccine   Alliance,   on  June  4,  which  raised  a  record  US$8·8  billion  for  the  next  5  years,  was overshadowed by the COVID-19 global  pandemic  and  the  burning  question  of  how  to  ensure  equita-ble   access   to   any   vaccines   that   become   available.  

June 11, 2020

The Dual Epidemics of COVID-19 and Influenza

The health system, and wider society, must prepare for the likelihood of co-epidemics of COVID-19 and influenza. What are the most effective strategies for increasing influenza vaccine coverage across the population and particularly in schools, businesses, and hospitals? Should states or businesses require vaccinations? Influenza vaccination, moreover, could offer valuable lessons for ensuring vaccine acceptance and uptake when COVID-19 vaccines become available.

June 10, 2020

The Importance of Proper Death Certification During the COVID-19 Pandemic

Death certificate data are used to monitor local, regional, and national mortality trends to improve public health and public safety. Accurate death certification related to coronavirus disease 2019 (COVID-19) is vital to understand the extent and progression of the pandemic.

Sustaining Rural Hospitals After COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is a financial stress test for US hospitals.1,2 Revenues have declined from the suspension of elective procedures and nonessential services, and many hospitals have experienced a surge of critically ill patients.

June 8, 2020

Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City

Severe coronavirus disease 2019 (COVID-19) has been reported rarely in children.1,2 International data suggest the development of a proinflammatory syndrome with features of Kawasaki disease (KD) or toxic shock syndrome (TSS) in children, possibly related to COVID-19.

Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain

Data from China found severe complications in 8% of pregnant women with coronavirus disease 2019 (COVID-19).1 However, the high rate of cesarean deliveries (>90%) in Chinese reports is concerning,2 and whether mode of delivery is associated with maternal complications or neonatal transmission is unknown.3 We assessed births to women with COVID-19 by mode of delivery.

Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

These findings help characterize the clinical features of hospitalized, seriously ill children with PIMS-TS and provide insights into this apparently novel syndrome.

June 5, 2020

False Negative Tests for SARS-CoV-2 Infection — Challenges and Implications

There is broad consensus that widespread SARS-CoV-2 testing is essential to safely reopening the United States. A big concern has been test availability, but test accuracy may prove a larger long-term problem.

Waiting for Certainty on Covid-19 Antibody Tests — At What Cost?

Governments around the world and throughout the United States are beginning to “reopen their economies” in stages. Some have been considering the use of serologic antibody testing to screen for possible immunity and to identify people who could return to the workplace with less severe mitigation measures or be assigned to higher-exposure tasks. Although availability of antibody tests is lagging and successful mitigation has kept seroprevalence too low to rely fully on positive test results, at some point in the near future antibody testing will become a viable option. This idea is not without its critics.

June 4, 2020

Retraction: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2007621.

Because all the authors were not granted access to the raw data and the raw data could not be made available to a third-party auditor, we are unable to validate the primary data sources underlying our article, “Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19.”

June 3, 2020

Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

June 1, 2020

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection

Although clear evidence of person-to-person airborne transmission of SARS-CoV-2 has not been published, an airborne component of transmission is likely based on other respiratory viruses such as SARS, Middle East respiratory syndrome, and influenza. While air sampling for SARS-CoV-2, in a clinical setting, has demonstrated detectable viral RNA, the extent of transmission resulting from airborne particles relative to large respiratory droplets, directly and on surfaces, is not yet known.

The Urgency and Challenge of Opening K-12 Schools in the Fall of 2020

Reopening schools this fall is an urgent national priority. To achieve this goal as safely as possible and reduce the chances that schools are required to close again, policy makers at every level should consider embracing a framework with these 6 components.

May 29, 2020

A COVID-19 vaccine has passed its first human trial. But is it the frontrunner?

A promising coronavirus vaccine candidate cleared a key hurdle this week, when Moderna Therapeutics entered phase two of clinical trials. The move signals that the company’s mRNA vaccine has passed its initial safety checks and has met an important milestone in bringing this drug closer to the public and commercial markets.

May 28, 2020

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.

COVID-19: in the footsteps of Ernest Shackleton

We describe what we believe is the first instance of complete COVID-19 testing of all passengers and crew on an isolated cruise ship during the current COVID-19 pandemic. Of the 217 passengers and crew on board, 128 tested positive for COVID-19 on reverse transcription–PCR (59%). Of the COVID-19-positive patients, 19% (24) were symptomatic; 6.2% (8) required medical evacuation; 3.1% (4) were intubated and ventilated; and the mortality was 0.8% (1). The majority of COVID-19-positive patients were asymptomatic (81%, 104 patients). We conclude that the prevalence of COVID-19 on affected cruise ships is likely to be significantly underestimated, and strategies are needed to assess and monitor all passengers to prevent community transmission after disembarkation.

May 27, 2020

Reducing transmission of SARS-CoV-2

Respiratory infections occur through the transmission of virus-containing droplets (>5 to 10 μm) and aerosols (≤5 μm) exhaled from infected individuals during breathing, speaking, coughing, and sneezing. Traditional respiratory disease control measures are designed to reduce transmission by droplets produced in the sneezes and coughs of infected individuals. However, a large proportion of the spread of coronavirus disease 2019 (COVID-19) appears to be occurring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking.

How can airborne transmission of COVID-19 indoors be minimised?

Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans

Important findings include the presence of thrombosis and microangiopathy in the small vessels and capillaries of the lungs, with associated haemorrhage, that significantly contributed to death. Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. Cardiac findings included individual cell necrosis without lymphocytic myocarditis. There was no evidence of secondary pulmonary infection by microorganisms.

Comparison of Clinical Characteristics of Patients with Asymptomatic vs Symptomatic Coronavirus Disease 2019 in Wuhan, China

Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China.1,2 To control the spread of COVID-19 and isolate patients as early as possible, the Chinese government requested that close contacts of individuals with COVID-19 must be screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During the screening process, we found some patients whose test results were positive for SARS-CoV-2 but who had no symptoms or signs throughout the course of the disease.

May 26, 2020

One Key Factor in whether COVID-19 Will Wane This Summer

So far, scientists have identified at least nine distinct viruses that can cause respiratory tract infection and that express seasonality in their outbreak pattern in temperate regions. Of these, three viruses—influenza, human coronavirus and human respiratory syncytial virus (RSV) – clearly peak during winter months.

Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut

Developing an approach to care for pregnancy and childbirth during the coronavirus disease 2019 (COVID-19) crisis is a priority to (1) provide safe care to pregnant women and newborns; and (2) protect health care workers from infection. A study conducted in New York City reported a 13.5% prevalence of asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in women presenting for childbirth.1 On March 30, 2020, an initially asymptomatic woman admitted to the Yale New Haven Health system developed cough and fever soon after childbirth; testing confirmed SARS-CoV-2 infection. This event prompted the development of a SARS-CoV-2 screening and testing program of patients presenting for childbirth; we report the prevalence detected in the first weeks of the program.

Adverse Consequences of Rushing a SARS-CoV-2 Vaccine

As the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic persists across the US and the world, the spotlight on vaccine science has never been more intense. Researchers across the globe are working rapidly to produce a potential vaccine, and 7 candidates are already in clinical trials. Operation Warp Speed, the vaccine development project announced by President Trump, has advocated for a vaccine to be made available in the US by the beginning of 2021. But for scientists and physicians, the term “warp speed” should trigger concern. Good science requires rigor, discipline, and deliberate caution. Any medical therapy approved for public use in the absence of extensive safeguards has the potential to cause harm, not only for COVID-19 prevention efforts and vaccine recipients, but also for public trust in vaccination efforts worldwide.

May 25, 2020

COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia?

Reports of thrombotic complications in patients with COVID-19 are increasingly prominent, and these reports include patients receiving therapeutic anticoagulation.At our institution, multiple occurrences of anticoagulation failure prompted us to search for alternative aetiologies contributing to refractory hypercoagulability.

May 22, 2020

Remdesivir for the Treatment of Covid-19 — Preliminary Report

Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (Covid-19), none have yet been shown to be efficacious.

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach

Physical distancing, hand hygiene, and disinfection of surfaces are the cornerstones of infection control during the coronavirus disease 2019 (COVID-19) pandemic. At the same time, governments, international agencies, policymakers, and public health officials have been debating the validity of recommending use of nonmedical masks by the general public to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We believe that these decisions should be informed by evidence.

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial

A vaccine to protect against COVID-19 is urgently needed. We aimed to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain.

Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans — Los Angeles, California, 2020

After identification of two cases of COVID-19 in an SNF in Los Angeles, universal, serial reverse transcription–polymerase chain reaction (RT-PCR) testing of residents and staff members aided in rapid identification of additional cases and isolation and cohorting of these residents and interruption of transmission in the facility.

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) . Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders.

High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020

Faith-based organizations should work with local health officials to determine how to implement the U.S. Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities.

May 21, 2020

Enlisting Monoclonal Antibodies in the Fight Against COVID-19

We now know that the immune system of nearly everyone who recovers from COVID-19 produces antibodies against SARS-CoV-2, the novel coronavirus that causes this easily transmitted respiratory disease [1]. The presence of such antibodies has spurred hope that people exposed to SARS-CoV-2 may be protected, at least for a time, from getting COVID-19 again. But, in this post, I want to examine another potential use of antibodies: their promise for being developed as therapeutics for people who are sick with COVID-19.

Postmortem Examination of Patients With COVID-19

Approximately 15% of individuals affected by coronavirus disease 2019 (COVID-19) develop severe disease, and 5% to 6% are critically ill (respiratory failure and/or multiple organ dysfunction or failure).1,2 Severely ill and critically ill patients have a high mortality rate, especially with older age and coexisting medical conditions. Because there are still insufficient data on cause of death, we describe postmortem examinations in a case series of patients with COVID-19.

Coronavirus Antibody Tests—What They Tell Us

Video

Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.

Covid-19, Angiogenesis, and ARDS Endotypes

The SARS-CoV-2 pandemic has inspired new interest in understanding the fundamental pathology of acute respiratory distress syndrome (ARDS), which has been associated with severe coronavirus disease 2019 (Covid-19). ARDS has long been recognized to be remarkably heterogeneous, with not only a wide range of causes but also a broad spectrum of severity, abnormalities on imaging, and gas-exchange impairment. The form of ARDS that is associated with Covid-19 is no different.

May 20, 2020

Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults

Children account for less than 2% of identified cases of coronavirus disease 2019 (COVID-19).1,2 It is hypothesized that the lower risk among children is due to differential expression of angiotensin-converting enzyme 2 (ACE2),3 the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for host entry.4 We investigated ACE2 gene expression in the nasal epithelium of children and adults.

May 19, 2020

Personal Protective Equipment and Covid-19

Given the threat of coronavirus disease 2019, or Covid-19, it is important to emphasize the use of proper precautions for infection control in health care settings. Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, is the virus that causes Covid-19.

The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction

During the Covid-19 pandemic, reports have suggested a decrease in the number of patients presenting to hospitals because of emergency conditions such as acute myocardial infarction.

Renin–Angiotensin–Aldosterone System Inhibitors in Covid-19

In their Special Report, Vaduganathan and colleagues (April 23 issue)1 describe the use of renin–angiotensin–aldosterone system (RAAS) inhibitors in patients with coronavirus disease 2019 (Covid-19).

May 18, 2020

Silent COVID-19: what your skin can reveal

Clinical manifestations of coronavirus disease 2019 (COVID-19) are rare or absent in children and adolescents hence, early clinical detection is fundamental to prevent further spreading. We report three young patients presenting with chilblain-like lesions who were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Seroprevalence of SARS-CoV-2–Specific Antibodies Among Adults in Los Angeles County, California, on April 10-11, 2020

Inadequate knowledge about the extent of the coronavirus disease 2019 (COVID-19) epidemic challenges public health response and planning. Most reports of confirmed cases rely on polymerase chain reaction–based testing of symptomatic patients.1 These estimates of confirmed cases miss individuals who have recovered from infection, with mild or no symptoms, and individuals with symptoms who have not been tested due to limited availability of tests.

Planning for a COVID-19 Vaccination Program

The long-term solution to the coronavirus disease 2019 (COVID-19) pandemic, hopefully, will be a globally implemented, safe vaccination program that has broad clinical and socioeconomic benefits. Dozens of vaccines are in development, with 8 currently in phase 1 trials. Some scenarios predict the earliest, widespread availability of a COVID-19 vaccine to be in 2021.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)

It has been more than a century since the world has encountered a pandemic like coronavirus disease 2019 (COVID-19), and the rate of spread of COVID-19 around the globe and the associated morbidity and mortality have been staggering.

Implications for Telehealth in a Postpandemic Future

The coronavirus disease 2019 (COVID-19) pandemic has required health care systems to radically and rapidly rethink the delivery of care. One of the most remarkable ongoing changes has been the unprecedented accelerated expansion of telehealth. T

COVID-19 and the Need for a National Health Information Technology Infrastructure

The need for timely, accurate, and reliable data about the health of the US population has never been greater. Critical questions include the following: (1) how many individuals test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how many are affected by the disease it causes—novel coronavirus disease 2019 (COVID-19) in a given geographic area; (2) what are the age and race of these individuals; (3) how many people sought care at a health care facility; (4) how many were hospitalized; (5) within individual hospitals, how many patients required intensive care, received ventilator support, or died; and (6) what was the length of stay in the hospital and in the intensive care unit for patients who survived and for those who died.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)

It has been more than a century since the world has encountered a pandemic like coronavirus disease 2019 (COVID-19), and the rate of spread of COVID-19 around the globe and the associated morbidity and mortality have been staggering.

May 17, 2020

Factors associated with duration of viral shedding in adults with COVID-19 outside of Wuhan, China: A retrospective cohort study

This is the study with relatively large sample size that mainly focused on the duration of viral shedding and relevant factors in patients with COVID-19 outside of Wuhan, China. Potential risk factors were identified and should be taken into consideration for the strategy of quarantine of infected patients.

May 16, 2020

Reviving the US CDC

The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

May 15, 2020

Severe Covid-19

The most common initial symptoms of coronavirus disease 2019 (Covid-19) are fever, cough, fatigue, anorexia, myalgias, and diarrhea.1 Severe illness usually begins approximately 1 week after the onset of symptoms. Dyspnea is the most common symptom of severe disease and is often accompanied by hypoxemia2,3 (Figure 1).

Pandemic Could Add Noise to Clinical Trial Data

Investigational ChAdOx1 nCoV-19 vaccine protects monkeys against COVID-19 pneumonia

A single dose of ChAdOx1 nCoV-19, an investigational vaccine against SARS-CoV-2, has protected six rhesus macaques from pneumonia caused by the virus, according to National Institutes of Health scientists and University of Oxford collaborators. SARS-CoV-2 is the virus that causes COVID-19.

May 14, 2020

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.

Asymptomatic Seroconversion of Immunoglobulins to SARS-CoV-2 in a Pediatric Dialysis Unit

Dialysis units are at especially high risk of infectious disease transmission, and concern exists about spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Dialysis units in Wuhan, China, have reported high coronavirus disease 2019 (COVID-19) prevalence, due in part to unique exposure challenges that limit social distancing efforts, including open bay formats and rotating/multiple nursing assignments.1,2 This study describes SARS-CoV-2 seroconversion in patients and health care workers in a pediatric dialysis unit.

Emergency Use Authorization of Remdesivir

The Need for a Transparent Distribution Process

On February 4, 2020, the Secretary of the US Department of Health and Human Services (DHHS) determined that there was a public health emergency due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 27, 2020, the DHHS secretary declared that circumstances existed to justify the authorization of emergency use of drugs and biologics during the coronavirus disease 2019 (COVID-19) outbreak, pursuant to section 564 of the Federal Food, Drug, and Cosmetic Act

May 13, 2020

Multiorgan and Renal Tropism of SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preferentially infects cells in the respiratory tract,1,2 but its direct affinity for organs other than the lungs remains poorly defined. Here, we present data from an autopsy series of 27 patients (see the clinical data in Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org) that show that SARS-CoV-2 can be detected in multiple organs, including the lungs, pharynx, heart, liver, brain, and kidneys.

Treatment of COVID-19 Patients with Convalescent Plasma in Houston, Texas

Background: COVID-19 disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally, and no proven treatments are available. Convalescent plasma therapy has been used with varying degrees of success to treat severe microbial infections for more than 100 years.

The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission

Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 μm diameter, or 12- to 21-μm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.

Kawasaki-like disease: emerging complication during the COVID-19 pandemic

Children have to date borne a minimal medical burden in the global COVID-19 pandemic. Epidemiological data from many countries show that children are a small minority of those who test positive. Children younger than 18 years have made up only 1·7% of national cases in the USA, 1% of cases in the Netherlands, and 2·0% of a large observational cohort in the UK. Whether these proportions reflect lower susceptibility among children versus adults, or similar infection rates, but much higher proportions with asymptomatic disease, is unclear.

May 12, 2020

Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody

SARS-CoV-2 is a newly emerged coronavirus responsible for the current COVID-19 pandemic that has resulted in more than 3.7 million infections and 260,000 deaths as of 6 May 20201,2. Vaccine and therapeutic discovery efforts are paramount to curb the pandemic spread of this zoonotic virus.

High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020

The potential for superspreader events underscores the importance of physical distancing, including avoiding gathering in large groups, to control spread of COVID-19. Enhancing community awareness can encourage symptomatic persons and contacts of ill persons to isolate or self-quarantine to prevent ongoing transmission.

May 11, 2020

Real-time tracking of self-reported symptoms to predict potential COVID-19

A total of 2,618,862 participants reported their potential symptoms of COVID-19 on a smartphone-based app. Among the 18,401 who had undergone a SARS-CoV-2 test, the proportion of participants who reported loss of smell and taste was higher in those with a positive test result (4,668 of 7,178 individuals; 65.03%) than in those with a negative test result (2,436 of 11,223 participants; 21.71%) (odds ratio = 6.74; 95% confidence interval = 6.31–7.21). A model combining symptoms to predict probable infection was applied to the data from all app users who reported symptoms (805,753) and predicted that 140,312 (17.42%) participants are likely to have COVID-19.

Virus impact on Louisiana state finances pegged at $1B

Louisiana's forecasting panel Monday slashed the state's income projections by $1 billion because of the coronavirus outbreak, blowing a hole in next year's budget as the virus's economic fallout threatens deep cuts across state services.

Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State

Among patients hospitalized with COVID-19, treatment with hydroxychloroquine, azithromycin, or both was not associated with significantly lower in-hospital mortality.

Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 — California, February 3–March 17, 2020

Monitoring travelers was labor-intensive and limited by incomplete information, volume of travelers, and potential for asymptomatic transmission. Health departments need to weigh the resources needed for monitoring against those needed for implementing mitigation activities during the COVID-19 pandemic.

Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak — New York City, March 11–May 2, 2020

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and has since spread worldwide. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic (1). That same day, the first confirmed COVID-19–associated fatality occurred in New York City (NYC). To identify confirmed COVID-19–associated deaths, defined as those occurring in persons with laboratory-confirmed SARS-CoV-2 infection, on March 13, 2020, the New York City Department of Health and Mental Hygiene (DOHMH) initiated a daily match between all deaths reported to the DOHMH electronic vital registry system (eVital) (2) and laboratory-confirmed cases of COVID-19.

COVID-19 and Postinfection Immunity Limited Evidence, Many Remaining Questions

In summary, existing limited data on antibody responses to SARS-CoV-2 and related coronaviruses, as well as one small animal model study, suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily. However, the immune response to COVID-19 is not yet fully understood and definitive data on postinfection immunity are lacking. Amidst the uncertainty of this public health crisis, thoughtful and rigorous science will be essential to inform public health policy, planning, and practice.

COVID-19 and Racial/Ethnic Disparities

The novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has led to a global pandemic manifested as coronavirus disease 2019 (COVID-19), with its most severe presentation being acute respiratory distress syndrome leading to severe complications and death.

COVID-19 and Health Equity—A New Kind of “Herd Immunity”

Three articles recently published in JAMA provide insight into the large racial/ethnic differences associated with coronavirus disease 2019 (COVID-19) and highlight the need for, and potential opportunity to, redouble efforts in the US to develop strategies that would enable society to slow and ultimately eliminate the spread of inequities in health.

May 10, 2020

Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin–angiotensin–aldosterone inhibitors

In two independent cohorts of patients with heart failure, plasma concentrations of ACE2 were higher in men than in women, but use of neither an ACE inhibitor nor an ARB was associated with higher plasma ACE2 concentrations. These data might explain the higher incidence and fatality rate of COVID-19 in men, but do not support previous reports suggesting that ACE inhibitors or ARBs increase the vulnerability for COVID-19 through increased plasma ACE2 concentrations.

May 8, 2020

Triple combination of interferon beta-1b, lopinavir–ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial

Effective antiviral therapy is important for tackling the coronavirus disease 2019 (COVID-19) pandemic. We  assessed  the  efficacy  and  safety  of  combined  interferon  beta-1b,  lopinavir–ritonavir, and  ribavirin  for  treating  patients with COVID-19.Methods

Changes in SARS-CoV-2 Positivity Rate in Outpatients in Seattle and Washington State, March 1-April 16, 2020

The first reported case of coronavirus disease 2019 (COVID-19) in the US occurred on January 20, 2020, in Snohomish County, Washington.1 The University of Washington (UW) Virology Division was among the first US laboratories to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and since March 1, 2020, has tested samples from more than 73 000 patients. More than 90% of the samples are from the UW health system and outpatient clinics in Washington State.

The positivity rates for SARS-CoV-2 in outpatient settings in Washington State and in emergency departments (EDs) in Seattle were analyzed to identify temporal trends that may reflect the local dynamics of the pandemic and the effect of mitigation strategies such as physical distancing.

When Should Clinicians Act on Non–Statistically Significant Results from Clinical Trials?

Understanding whether the results of a randomized clinical trial (RCT) are clinically actionable is challenging. Reporting standards adopted by JAMA and other leading journals lead to relative uniformity of presentation of RCT findings that help simplify critical appraisal.

Association between Angiotensin Blockade and Incidence of Influenza in the United Kingdom

Some researchers have hypothesized that drugs that interfere with the renin–angiotensin–aldosterone system (RAAS), including angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), may increase susceptibility to coronaviruses. This hypothesis is based on the observation that coronaviruses engage ACE2 for cell entry1 and that altered expression of ACE2 is influenced by the use of ACE inhibitors and ARBs, an action that has been shown in animal models.2 Influenza A (H7N9, H1N1, and H5N1) has been shown to use the ACE2 receptor to mediate lung damage, similar to that seen in severe acute respiratory syndrome (SARS).3 Understanding the shared mechanism between SARS and influenza may help to address the question as to how ACE inhibitors and ARBs may modulate the manifestations of certain viral respiratory infections.

Collateral Effect of Covid-19 on Stroke Evaluation in the United States

The effect of the Covid-19 pandemic on medical care for conditions other than Covid-19 has been difficult to quantify.1 Any decrease in care for patients with acute conditions such as ischemic stroke may be consequential because timely treatment may decrease the incidence of disability.

Suppressing the Epidemic in New South Wales

Facing the coronavirus pandemic, Australia has achieved national consensus on policies that were unprecedented for the past century. New South Wales (which has 8 million residents) and other jurisdictions appear to have successfully suppressed Covid-19 transmission after a rapid escalation of cases in March 2020.

May 7, 2020

Clinical Characteristics and Results of Semen Tests Among Men with Coronavirus Disease 2019

In December 2019, an outbreak of pneumonia associated with coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, and rapidly spread to other parts of China and overseas.1 It has been confirmed that COVID-19 has the characteristic of human-to-human transmission, mainly through respiratory droplets and contact. Other routes require further verification. The virus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in stool, gastrointestinal tract, saliva, and urine samples.2 However, little is known about SARS-CoV-2 in semen.

Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19

In this observational study involving patients with Covid-19 who had been admitted to the hospital, hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. Randomized, controlled trials of hydroxychloroquine in patients with Covid-19 are needed.

The Urgency of Care during the Covid-19 Pandemic — Learning as We Go

Chloroquine and hydroxychloroquine, alone or in combination with azithromycin, have been highly touted as potential therapies for Covid-19. The claims of efficacy are based largely on anecdotes and case series that have been described as being so persuasive that it would be unethical to perform studies with placebo controls.1 On the basis of this “evidence,” these therapies have been recommended in many guidelines, including some national policies, and have been widely implemented.

May 6, 2020

Interpreting Diagnostic Tests for SARS-CoV-2

The pandemic of coronavirus disease 2019 (COVID-19) continues to affect much of the world. Knowledge of diagnostic tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still evolving, and a clear understanding of the nature of the tests and interpretation of their findings is important. This Viewpoint describes how to interpret 2 types of diagnostic tests commonly in use for SARS-CoV-2 infections—reverse transcriptase–polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time

May 5, 2020

Adaptations and Lessons in the Province of Bergamo

Lombardy, and particularly the province of Bergamo, has been the area of Italy most affected by Covid-19. As of April 26, 2020, the province had 11,113 confirmed cases and 2932 deaths from Covid-19. Delays in recognizing SARS-CoV-2 in the few infected patients admitted to the small hospital in Alzano Lombardo — and delays in activating measures to protect other patients, hospital personnel, and visitors, as well as in implementing adequate containment measures in patients’ villages — allowed the virus to spread rapidly and into the city of Bergamo.

Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19

Patients with coronavirus disease 2019 (Covid-19) have a profound hypercoagulable state, and complicating venous thrombotic events are common.1-3 Abnormalities in coagulation screening measures, including a prolonged activated partial-thromboplastin time (aPTT), have been reported in patients with Covid-19.4 This finding could be seen as a reason to avoid the use of anticoagulation at both therapeutic and prophylactic doses.

A Trial of Lopinavir–Ritonavir in Covid-19

After a review of the findings of Cao et al. (published in the Journal online on March 18),1 many clinicians are abandoning the use of lopinavir–ritonavir for the treatment of Covid-19. We consider this action to be premature. It is crucial to realize that although this trial did not show that the time until clinical improvement was meaningfully better than standard care among patients with severe Covid-19 who received lopinavir–ritonavir, the trial was statistically underpowered to show this outcome.

May 4, 2020

Obesity could shift severe COVID-19 disease to younger ages

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 was first reported in China in late December, 2019, and has since evolved into a global pandemic. As of April 29, 2020, COVID-19 has been confirmed in more than 3 million individuals in 185 countries and regions, with an overall mortality rate of more than 6%.1Severe disease involves bilateral interstitial pneumonia requiring intensive care unit (ICU) ventilatory support and can evolve into adult respiratory distress syndrome with high mortality. The largest study of 1591 ICU patients from Italy reported a median age of 63 years, with only 203 patients (13%) younger than 51 years.Common comorbidities are hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (42 [4%] of 1043), obstructive pulmonary disease. Similar data have been reported from China.

Profile of a killer: the complex biology powering the coronavirus pandemic

In 1912, German veterinarians puzzled over the case of a feverish cat with an enormously swollen belly. That is now thought to be the first reported example of the debilitating power of a coronavirus. Veterinarians didn’t know it at the time, but coronaviruses were also giving chickens bronchitis, and pigs an intestinal disease that killed almost every piglet under two weeks old.

A human monoclonal antibody blocking SARS-CoV-2 infection

The emergence of the novel human coronavirus SARS-CoV-2 in Wuhan, China has caused a worldwide epidemic of respiratory disease (COVID-19). Vaccines and targeted therapeutics for treatment of this disease are currently lacking. Here we report a human monoclonal antibody that neutralizes SARS-CoV-2 (and SARS-CoV) in cell culture.

Randomized Clinical Trials and COVID-19Managing Expectations

Despite the millions of cases and hundreds of thousands of deaths that have occurred in this devastating coronavirus disease 2019 (COVID-19) pandemic, no peer-reviewed studies of specific therapies proven to be effective in reducing mortality have been published and a vaccine is many months to years away. To date, more than 1000 studies addressing various aspects of COVID-19 are registered on ClinicalTrials.gov, including more than 600 interventional studies and randomized clinical trials (RCTs).

May 1, 2020

Contact Tracing Assessment of COVID-19 Transmission Dynamics in Taiwan and Risk at Different Exposure Periods Before and After Symptom Onset

High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.

Production of the First Batch of Proposed COVID-19 Vaccines in the US Expected in July

Moderna, Inc. and Lonza Group AG announced a global agreement to manufacture one billion doses of Moderna's proposed vaccine every year, to be produced in the United States in July.

Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context.

Public Health Response to the Initiation and Spread of Pandemic COVID-19 in the United States, February 24–April 21, 2020

Various factors contributed to accelerated spread during February–March 2020, including continued travel-associated importations, large gatherings, introductions into high-risk workplaces and densely populated areas, and cryptic transmission resulting from limited testing and asymptomatic and presymptomatic spread. Targeted and communitywide mitigation efforts were needed to slow transmission.

COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States, April 2020

COVID-19 cases among U.S. workers in 115 meat and poultry processing facilities were reported by 19 states. Among approximately 130,000 workers at these facilities, 4,913 cases and 20 deaths occurred. Factors potentially affecting risk for infection include difficulties with workplace physical distancing and hygiene and crowded living and transportation conditions.

Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19

Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context.

Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19

In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.

Inhibitors of the Renin–Angiotensin–Aldosterone System and Covid-19

SARS-CoV-2, the coronavirus that causes Covid-19, enters human cells by binding of its viral spike protein to the membrane-bound form of the aminopeptidase angiotensin-converting enzyme 2 (ACE2).1

 From the viewpoint of human physiology, ACE2 plays an important regulatory role in the renin–angiotensin–aldosterone system (RAAS), metabolizing angiotensin II (a potent vasoconstrictor) to generate angiotensin-(1–7) (a vasodilator).2 Studies in animals have suggested that angiotensin-converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) may up-regulate ACE2 expression,3 thus increasing the availability of target molecules for SARS-CoV-2.

Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three).

COVID-19 Outbreak Among Three Affiliated Homeless Service Sites — King County, Washington, 2020

On March 30, 2020, Public Health – Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A’s day center services.

April 30, 2020

A SARS-CoV-2 protein interaction map reveals targets for drug repurposing

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19 respiratory disease, has infected over 2.3 million people, killed over 160,000, and caused worldwide social and economic disruption1,2. There are currently no antiviral drugs with proven clinical efficacy, nor are there vaccines for its prevention, and these efforts are hampered by limited knowledge of the molecular details of SARS-CoV-2 infection.

Clinical Characteristics of Coronavirus Disease 2019 in China

During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

Responding to Covid-19 — A Once-in-a-Century Pandemic?

In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

History in a Crisis — Lessons for Covid-19

Writing in the heady days of new antibiotics and immunizations, esteemed microbiologists Macfarlane Burnet and David White predicted in 1972 that “the most likely forecast about the future of infectious diseases is that it will be very dull.”1 They acknowledged that there was always a risk of “some wholly unexpected emergence of a new and dangerous infectious disease, but nothing of the sort has marked the last fifty years.” Epidemics, it seemed, were of interest only to historians.

Virtually Perfect? Telemedicine for Covid-19

Recognizing that patients prioritize convenient and inexpensive care, Duffy and Lee recently asked whether in-person visits should become the second, third, or even last option for meeting patient needs.1 Previous work has specifically described the potential for using telemedicine in disasters and public health emergencies.2 No telemedicine program can be created overnight, but U.S. health systems that have already implemented telemedical innovations can leverage them for the response to Covid-19.

Second-Trimester Miscarriage in a Pregnant Woman With SARS-CoV-2 Infection

No data exist regarding the effect on fetuses of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the first or second trimester of pregnancy, and data are limited regarding infections that occur during the third trimester. However, reports of newborns with fetal distress or requiring admission to the intensive care unit1,2 and a stillbirth after maternal coronavirus disease 2019 (COVID-19)3 in the third trimester suggest the possibility of COVID-19–induced placental pathology.

Mental Health in the Coronavirus Disease 2019 Emergency—The Italian Response

This article briefly reports the experience of mental health services and the lessons learned during the coronavirus disease 2019 (COVID-19) crisis. In particular, this report offers opportunities to build on experience gained in managing the COVID-19 emergency in the Departments of Mental Health and Addiction (DMHAs) in Lombardy, the wealthiest Italian region, which has approximately 10 million inhabitants.

Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

The coronavirus disease 2019 (COVID-19) pandemic is filling the headlines these days. Although it is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be associated with skin manifestations, a limited number of images are available in the literature at this time. This observation reports dermatologic findings associated with a confirmed case of COVID-19.

April 29, 2020

Responding to the hidden pandemic for healthcare workers: stress

Healthcare workers are having to work under incredibly stressful conditions. Videoconferencing can be harnessed to provide mental-health support, but some report ‘tele-health’ fatigue. To protect public health, prepare for the mental-health surge among healthcare workers.

Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York

Data on Covid-19 in patients with immune-mediated inflammatory disease who have received anticytokine biologics, other immunomodulatory therapies, or both on a long-term basis are scarce. Trials to assess the efficacy of antirheumatic therapies such as hydroxychloroquine1 and anticytokine therapies such as interleukin-6 inhibitors2 to improve outcomes in patients with Covid-19 are ongoing.

Characteristics and Clinical Outcomes of Adult Patients Hospitalized with COVID-19 — Georgia, March 2020

In a cohort of 305 hospitalized adults with COVID-19 in Georgia (primarily metropolitan Atlanta), black patients were overrepresented, and their clinical outcomes were similar to those of nonblack patients. One in four hospitalized patients had no recognized risk factors for severe COVID-19.

April 28, 2020

The race for coronavirus vaccines: a graphical guide

More than 90 vaccines are being developed against SARS-CoV-2 by research teams in companies and universities across the world. Researchers are trialling different technologies, some of which haven’t been used in a licensed vaccine before.

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

We report five cases of large-vessel stroke in patients younger than 50 years of age who presented to our health system in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all five patients.

Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Because of the high virulence of the novel coronavirus responsible for causing COVID-19, many patients infected with the virus become critically ill, requiring prolonged intubation, and may ultimately require tracheostomy. Mucosal surfaces have been shown to be reservoirs for high concentrations of the virus, which can become aerosolized for up to 3 hours following manipulation.1,2 Surgeons performing tracheostomies are at high risk for exposure, and recently published guidelines recommend against elective, non–time-sensitive procedures.3 In the event that a tracheostomy is indicated in a patient with confirmed or suspected COVID-19, interventions that limit the spread of aerosols are critical to reducing exposure.4,5 Here we present the creation of a novel negative-pressure aerosol cover made out of readily available operating room materials as an additional barrier to limit the spread of aerosols during tracheostomy.

April 27, 2020

Epidemiological characteristics and incubation period of 7,015 confirmed cases with Coronavirus Disease 2019 outside Hubei Province in China

Rapidly transmitting COVID-19 has a short incubation period. The onset mainly occurs among young to middle-aged adults. Traffic restrictions played an important role in the decreased number of imported cases outside Hubei.

Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals

Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.

Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study

Rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, prompted heightened surveillance in Shenzhen, China. The resulting data provide a rare opportunity to measure key metrics of disease course, transmission, and the impact of control measures.

Q&A: AAP president concerned about pandemic-related drop in vaccination rates

According to data from PCC, an independent firm that provides pediatric electronic health records software, pediatric vaccinations are down as a result of the COVID-19 pandemic.

Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment

Despite personal protective equipment, fluorescent markers were found on the uncovered skin, hair, and shoes of participants after simulations of emergency department management of patients experiencing respiratory distress. The findings suggest that the current recommendations for personal protective equipment may not fully prevent exposures in emergency department settings. Clothing that covers all skin may further diminish exposure risk.

COVID-19 and Risks Posed to Personnel During Endotracheal Intubation

Fundamental research is needed to better inform PPE recommendations. For example, it would be useful to know how long SARS-CoV-2 can remain infective on surfaces such as the skin, hair, and clothing, and the potential for contact transmission from those sites to guide recommendations for barrier protection. A better understanding of the duration of infectivity and level of risk posed by airborne SARS-CoV-2 would help to guide recommendations for respiratory protection. Much can be done to protect health care personnel performing endotracheal intubations from procedure-related transmission of COVID-19. Individuals who perform this life-saving procedure must be able to do it as safely as possible.

Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston

Universal SARS-CoV-2 PCR testing of an adult homeless shelter population in Boston shortly after the identification of a COVID-19 case cluster yielded a 36% positivity rate. The majority of individuals with newly identified infections had no symptoms and no fever at the time of diagnosis, suggesting that symptom screening in homeless shelters2 may not adequately capture the extent of disease transmission in this high-risk setting.

The Potential Effects of Coronavirus on National Health Expenditures

The first step in projecting how COVID-19 may affect the health share of the GDP is to estimate how COVID-19 will affect health care spending. This will depend on the future extent, timing, and composition of the pandemic, so it is highly uncertain.

April 25, 2020

Travel restrictions hampering COVID-19 response

The coronavirus disease 2019 (COVID-19) pandemic has sparked an unprecedented shutdown of borders and airlines, which is severely restricting the movement of essential medical personnel and supplies that are vital to stem the spread of the virus and save lives.

April 24, 2020

"Immunity passports" in the context of COVID-19

WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an “immunity passport” or “risk-free certificate” that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

Clarification of Mortality Rate and Data in Abstract, Results, and Table 2

In the Original Investigation titled “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area” published online April 22, 2020, in JAMA,1 clarification and correction of data were required.

Mild or Moderate Covid-19

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations.

Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California

Coronavirus disease 2019 (COVID-19) has resulted in increased hospital and intensive care unit (ICU) use. In the United States, few reports have characterized patients treated outside of the ICU.1 Northern California was an early epicenter of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) community transmission in the United States. We report hospitalization and ICU admissions from Kaiser Permanente Northern California (KPNC), a regional integrated health care system serving 4.4 million members, constituting 30% of the area’s insured population.

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

In this phase IIb randomized clinical trial of 81 patients with COVID-19, an unplanned interim analysis recommended by an independent data safety and monitoring board found that a higher dosage of chloroquine diphosphate for 10 days was associated with more toxic effects and lethality, particularly affecting QTc interval prolongation. The limited sample size did not allow the study to show any benefit overall regarding treatment efficacy.

A real-time dashboard of clinical trials for COVID-19

As trial findings are communicated, these data must be centralised and meta-analysed in real-time. Syntheses of these trials are urgently needed to assist clinicians, researchers, and policy makers to make evidence-informed decisions to minimise the morbidity and mortality due to COVID-19.

April 23, 2020

Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19

The renin–angiotensin–aldosterone system (RAAS) is an elegant cascade of vasoactive peptides that orchestrate key processes in human physiology. Severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and SARS-CoV-2, which have been responsible for the SARS epidemic in 2002 to 2004 and for the more recent coronavirus disease 2019 (Covid-19) pandemic, respectively, interface with the RAAS through angiotensin-converting enzyme 2 (ACE2), an enzyme that physiologically counters RAAS activation but also functions as a receptor for both SARS viruses.

Epidemiological Assessment of Imported Coronavirus Disease 2019 (COVID-19) Cases in the Most Affected City Outside of Hubei Province, Wenzhou, China

The coronavirus disease 2019 (COVID-19) outbreak was first identified in Wuhan, the capital of Hubei Province, China, in December 2019.1 The disease spread rapidly from Wuhan to other cities. To contain this epidemic, Wuhan was locked down on January 23, 2020. Wenzhou, which has a population of 9.3 million and is located in southeastern China approximately 600 miles from Wuhan, is the most affected Chinese city outside of Hubei.

Information Technology–Based Tracing Strategy in Response to COVID-19 in South Korea—Privacy Controversies

South Korea extensively utilized the country’s advanced information technology (IT) system for tracing individuals suspected to be infected or who had been in contact with an infected person. Such measures helped flatten the curve of newly confirmed cases and deaths around mid-March.1,2(pp4-5) As of April 21, 2020, there had been 10 683 confirmed cases of COVID-19 in South Korea, with a total of 2233 patients who are in isolation because of hospitalization or quarantine, and a total of 237 deaths.3 However, important concerns have been raised over privacy involving the tracing strategy.

April 22, 2020

Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs

When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.

Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection

Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally.1 A spectrum of disease severity has been reported, with main symptoms that include fever, fatigue, dry cough, myalgia, and dyspnea.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and AdolescentsA Systematic Review

In this systematic review of 18 studies with 1065 participants, most pediatric patients with SARS-CoV-2 infection presented with fever, dry cough, and fatigue or were asymptomatic; 1 infant presented with pneumonia, complicated by shock and kidney failure, and was successfully treated with intensive care. Most pediatric patients were hospitalized, and symptomatic children received mainly supportive care; no deaths were reported in the age range of 0 to 9 years.

Timely antiviral therapy may slow COVID-19 progression; more study needed

Researchers in China found that hospitalized patients with milder cases of COVID-19 were treated earlier with an assortment of antivirals compared with patients who experienced more severe disease, suggesting that the timing of antiviral therapy may significantly slow COVID-19 progression.

Timeline reset: CDC confirms weeks-earlier California deaths

Health officials say two people died with the coronavirus in California weeks before the first reported death from the disease.

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

In this case series that included 5700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died (n = 2634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died.

April 21, 2020

Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study

Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed.

Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study

Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed.

April 20, 2020

Health Care Heroes of the COVID-19 Pandemic

The COVID-19 pandemic has accounted for tens of thousands of deaths and ultimately will affect millions more people who will survive. There will be time to mourn the victims and care for the survivors. But it is also time to recognize and thank some of the heroes who have emerged so far.

Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020

On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2 (1). As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories (2). CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2 (3).

April 19,2020

Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients

A novel coronavirus (COVID-19) pandemic threatens the world. Here, we first studied the dynamics profile of SARS-CoV-2 from 56 recovered COVID-19 patients. We found virus shedding was up to 6 weeks after onset of symptoms. Prolonged observation period is necessary for older patients.

April 18, 2020

Will antibody tests for the coronavirus really change everything?

British Prime Minister Boris Johnson called them a ‘game changer’. Antibody tests have captured the world’s attention for their potential to help life return to normal by revealing who has been exposed, and might now be immune, to the new coronavirus.

Will antibody tests for the coronavirus really change everything?

Dozens of biotech companies and research laboratories have rushed to produce the blood tests. And governments around the world have bought millions of kits, in the hope that they could guide decisions on when to relax social-distancing measures and get people back to work. Some have even suggested that the tests could be used as an ‘immunity passport’, giving the owner clearance to interact with others again.

Flooded by the torrent: the COVID-19 drug pipeline

The coronavirus disease 2019 (COVID-19) drug pipeline is not growing at quite the same speed as the pandemic. But its rate of expansion is nevertheless cause for pause. In the months since COVID-19 has spread, researchers have launched more than 180 clinical trials of everything from repurposed antivirals and immunomodulators to unproven cell therapies and vitamin C. A further 150 trials are preparing to recruit patients.

COVID-19 exacerbating inequalities in the US

COVID-19 does not affect everyone equally. In the US, it is exposing inequities in the health system. Aaron van Dorn, Rebecca E Cooney, and Miriam L Sabin report from New York.

April 17, 2020

SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection

We found that ocular fluids from SARS-CoV-2-infected patients may contain infectious virus, and hence may be a potential source of infection. These findings highlight the importance of control measures, such as avoiding touching the nose, mouth, and eyes and frequent hand washing. A related implication is the importance of appropriate use of personal protective equipment for ophthalmologists during clinical examination, because ocular mucosa may be not only a site of virus entry but also a source of contagion. Furthermore, we observed that ocular involvement of SARS-CoV-2 may occur early in the COVID-19 course, suggesting that measures to prevent transmission via this route must be implemented as early as possible.

Masks and Coronavirus Disease 2019 (COVID-19)

Recent studies suggest that coronavirus disease 2019 (COVID-19) may be transmitted by infected persons even in the absence of symptoms of disease. While social distancing and good hand hygiene are the most important methods to prevent virus transmission, new guidelines state that healthy individuals can consider wearing masks in public settings, particularly when physical distancing is difficult (like in grocery stores or pharmacies). Primary benefits of wearing a mask include limiting the spread of the virus from someone who knows or does not know they have an infection to others.

Symptom Screening at Illness Onset of Health Care Personnel With SARS-CoV-2 Infection in King County, Washington

In this cohort, screening only for fever, cough, shortness of breath, or sore throat might have missed 17% of symptomatic HCP at the time of illness onset; expanding criteria for symptoms screening to include myalgias and chills may still have missed 10%. The data indicate that HCP worked for several days while symptomatic, when, according to a growing body of evidence, they may transmit SARS-CoV-2 to vulnerable patients and other HCP.1 Interventions to prevent transmission from HCP include expanding symptoms-based screening criteria,2 furloughing symptomatic HCP,2 facilitating testing of symptomatic HCP,4 and creating sick leave policies that are nonpunitive, flexible, and consistent with public health guidance.5

From Mitigation to Containment of the COVID-19 Pandemic

Putting the SARS-CoV-2 Genie Back in the Bottle

The COVID-19 pandemic will one day be in the rearview mirror. US history will inevitably recount an early phase of the crisis plagued with denial, flawed testing, a patchwork response, and inadequate supplies that resulted in thousands of excess infections and deaths. Therefore, before the US “reopens,” the country must ensure that this chapter will end with a course-corrected public health strategy that promises widespread testing, resources for those affected, and a profound appreciation for an impressive, inspired, and tireless health care workforce that helped the US deal with this pandemic.

COVID-19—Looking Beyond Tomorrow for Health Care and Society

While acknowledging that there will be uncertainty in addressing the topics in the “COVID-19: Beyond Tomorrow” series, the insights from these Viewpoints should serve to help inform physicians, other health care professionals, administrators, and policy makers about what the future may hold with COVID-19 for health care and society. Perhaps these Viewpoints could also serve to provide suggestions to galvanize efforts about what will need to be done beyond tomorrow.

April 16, 2020

Project IDentif.AI: Harnessing Artificial Intelligence to Rapidly Optimize Combination Therapy Development for Infectious Disease Intervention

This platform is disease indication and disease mechanism‐agnostic, and potentially applicable to the systematic N‐of‐1 and population‐wide design of highly efficacious and tolerable clinical regimens. This work also discusses key factors ranging from healthcare economics to global health policy that may serve to drive the broader deployment of this platform to address COVID‐19 and future pandemics.

April 15, 2020

COVID-19 and African Americans

Public health is complicated and social reengineering is complex, but change of this magnitude does not happen without a new resolve. The US has needed a trigger to fully address health care disparities; COVID-19 may be that bellwether event. Certainly, within the broad and powerful economic and legislative engines of the US, there is room to definitively address a scourge even worse than COVID-19: health care disparities. It only takes will. It is time to end the refrain.

Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens

These results suggest higher rates of co-infection between SARS-CoV-2 and other respiratory pathogens than previously reported, with no significant difference in rates of SARS-CoV-2 infection in patients with and without other pathogens. The presence of a non–SARS-CoV-2 pathogen may not provide reassurance that a patient does not also have SARS-CoV-2.

April 14, 2020

Stay 6 Feet Apart, We’re Told. But How Far Can Air Carry Coronavirus?

And scientists agree that six feet is a sensible and useful minimum distance, but, some say, farther away would be better.

FDA authorizes process it says could decontaminate 4 million masks daily

Amid widespread shortages of personal protective equipment and masks during the COVID-19 pandemic, the FDA has granted several emergency use authorizations, or EUAs, for the decontamination and reuse of N95 or N95-equivilent masks.

IDSA publishes ‘living guidelines’ on treatment of COVID-19

The Infectious Diseases Society of America published rapid guidelines on the treatment and management of patients with COVID-19 that mostly recommend recruiting patients into ongoing trials for investigational therapies.

CMS waiver on telehealth amid COVID-19 represents a ‘sea change’

CMS recently announced that video and chat apps that normally do not comply with HIPAA security and privacy regulations can be used to facilitate patient care during the COVID-19 public health emergency.

Weathering the cytokine storm in COVID-19: Telltale signs, therapeutic hope on the horizon

Good news about COVID-19 is at a premium these days. Encouraging reports about therapeutic options or vaccine development usually are either overly optimistic or entirely spurious. But scientific advancement is as relentless as the virus itself, and this is exemplified by a growing body of research into a potential association between cytokine storm syndrome and COVID-19.

Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020

Health care personnel (HCP) are at heightened risk of acquiring COVID-19 infection, but limited information exists about transmission in health care settings.

Spread of SARS-CoV-2 in the Icelandic Population

In a population-based study in Iceland, children under 10 years of age and females had a lower incidence of SARS-CoV-2 infection than adolescents or adults and males. The proportion of infected persons identified through population screening did not change substantially during the screening period, which was consistent with a beneficial effect of containment efforts.

Drug Evaluation during the Covid-19 Pandemic

The pandemic will inevitably leave considerable morbidity, mortality, and loss in its wake. Damage to the country’s medication-assessment process — and the public’s respect for it — should not be part of its legacy.

Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic

There may be no way for families to hold patients’ hands or hug them while they’re dying, but with the care and compassion of frontline health care workers, maybe we can harness creative solutions to help them feel some connection, while still keeping everyone safe.

April 13, 2020

Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)A Review

The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given the rapid pace of scientific discovery and clinical data generated by the large number of people rapidly infected by SARS-CoV-2, clinicians need accurate evidence regarding effective medical treatments for this infection.

Who Is Immune to the Coronavirus?

Among the many uncertainties that remain about Covid-19 is how the human immune system responds to infection and what that means for the spread of the disease. Immunity after any infection can range from lifelong and complete to nearly nonexistent. So far, however, only the first glimmers of data are available about immunity to SARS-CoV-2, the coronavirus that causes Covid-19.

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

The potential benefits of a universal testing approach include the ability to use Covid-19 status to determine hospital isolation practices and bed assignments, inform neonatal care, and guide the use of personal protective equipment. Access to such clinical data provides an important opportunity to protect mothers, babies, and health care teams during these challenging times.

Mental Health and the Covid-19 Pandemic

The Covid-19 pandemic has alarming implications for individual and collective health and emotional and social functioning. In addition to providing medical care, already stretched health care providers have an important role in monitoring psychosocial needs and delivering psychosocial support to their patients, health care providers, and the public — activities that should be integrated into general pandemic health care.

They Call Us and We Go

And I also know something about myself that I didn’t know even a few weeks ago: that as averse to risk as I am by nature, I would take on more if called to do so. The sentiments expressed by a character in The Plague, a novel by Albert Camus that I first read in high school, are no longer abstract to me: “I have no idea what’s awaiting me, or what will happen when this all ends,” says Dr. Rieux. “For the moment I know this: there are sick people and they need curing.”

Staying Ahead of the Wave

For clinicians in areas that have not yet been hard hit, the pandemic wave will surely come. Persons under investigation for Covid-19 should be treated as if they are infected. These patients often have a progression of disease severity, with approximately 15% of admitted patients requiring upgrades in care. We hope that lessons from our center will help prepare other physicians and hospitals for what is likely to come so they can stay ahead of the wave.

April 6, 2020

Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients

In conclusion, both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.

Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020

Pediatric COVID-19 patients might not have fever or cough. Social distancing and everyday preventive behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.

Sample Pooling as a Strategy to Detect Community Transmission of SARS-CoV-2

Strategies such as pooled screening may facilitate detection of early community transmission of SARS-CoV-2 and enable timely implementation of appropriate infection control measures to reduce spread.

April 3, 2020

Detection of SARS-CoV-2 Among Residents and Staff Members of an Independent and Assisted Living Community for Older Adults — Seattle, Washington, 2020

Following identification of two COVID-19 cases in a Seattle independent and assisted living facility, stringent preventive measures were implemented. Testing of all residents and staff members found few cases of COVID-19. Three of four residents who had positive test results were asymptomatic.

Lessons from Covid-19 Hotspots
Eric J. Rubin, Lindsey R. Baden, and Stephen Morrissey

In this audio interview conducted April 1, the editors draw lessons from the early Covid-19 outbreak in Seattle and the growing crisis in New York City. Listen to the interview.

Barrier Enclosure during Endotracheal Intubation

Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation. We describe one such barrier that is easily fabricated and may help protect clinicians during this procedure.

Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness

The coronavirus disease 2019 (COVID-19) pandemic will present an unprecedented stressor to patients and health care systems across the globe. Because there is currently no vaccine or treatment for the underlying infection, current health efforts are focused on providing prevention and screening, maintaining continuity of treatment for other chronic conditions, and ensuring access to appropriately intensive services for those with the most severe symptoms.

April 2, 2020

Audio Interview: Lessons from Covid-19 Hotspots

The rapid spread of SARS-CoV-2, a novel coronavirus that emerged in late 2019, and the resulting Covid-19 disease has been labeled a Public Health Emergency of International Concern by the World Health Organization. What physicians need to know about transmission, diagnosis, and treatment is the subject of ongoing updates from infectious disease experts at the Journal.

Governmental Public Health Powers During the COVID-19 Pandemic

The president and all 50 governors have declared health emergencies to counteract the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). While researchers race to develop vaccines, officials are implementing physical distancing, including orders to stay at home, restricting travel, and closing nonessential businesses.

April 1, 2020

Virological assessment of hospitalized patients with COVID-2019

Altogether, this suggests active virus replication in upper respiratory tract tissues, where SARS-CoV is not thought to replicate in spite of detectable ACE-2 expression19,20 . At the same time, the concurrent use of ACE-2 as a receptor by SARS-CoV and SARS-CoV-2 corresponds to a highly similar excretion kinetic in sputum, with active replication in the lung.

An Uncomplicated Delivery in a Patient with Covid-19 in the United States

This case describes uncomplicated labor and vaginal delivery in a woman with Covid-19. Care was taken to avoid infecting hospital staff, and 7 days after the delivery, no caregivers appeared to be infected.

Detection of Covid-19 in Children in Early January 2020 in Wuhan, China

A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children,1,2 and our understanding of the spectrum of illness is limited.3 We conducted a retrospective analysis involving hospitalized children in Wuhan, China.

Ten Weeks to Crush the Curve

Rather than stumble through a series of starts and stops and half-measures on both the health and the economic fronts, we should forge a strategy to defeat the coronavirus and open the way to economic revival. If we act immediately, we can make the anniversary of D-Day on June 6, 2020, the day America declares victory over the coronavirus.

Universal Masking in Hospitals in the Covid-19 Era

As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. An increasing number of frontline providers are wondering whether this effort should include universal use of masks by all health care workers. Universal masking is already standard practice in Hong Kong, Singapore, and other parts of Asia and has recently been adopted by a handful of U.S. hospitals.

March 31, 2020

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020

Based on preliminary U.S. data, persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions.

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

Health care workers who come in close contact with a patient’s head and neck are particularly at risk for developing coronavirus disease 2019 (COVID-19) because of the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) through respiratory droplets. This article provides safety recommendations for these health care workers regarding exams and surgical procedures based on a review of the literature and the experiences of physicians with firsthand knowledge of safety procedures during this pandemic.

Surgical Considerations for Tracheostomy During COVID-19 Pandemic

Lessons learned from the 2003 severe acute respiratory syndrome (SARS) epidemic may help reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), the cause of coronavirus disease 2019 (COVID-19), to health care workers performing open tracheostomies, a surgical procedure to open an airway that may be required for many patients with COVID-19.

Ocular Findings of Patients With COVID-19

One-third of COVID-19 patients from Hubei, China, had ocular manifestations, occurring frequently in patients with more severe physical conditions.

Measures for Care of Cancer Patients During COVID-19 Outbreak in China

The authors describe measures taken to reduce the risk of transmitting severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) to medical staff and cancer patients seeking treatment during the COVID-19 outbreak in China.

Perspectives on COVID-19 Control Measures for Ophthalmology Clinics

This article describes treatment initiatives being undertaken for novel coronavirus 2019 at an ophthalmology center in Singapore.

March 30, 2020

SARS-CoV-2–Positive Sputum and Feces After Conversion of Pharyngeal Samples in Patients With COVID-19

Pharyngeal swabs are widely used to determine the appropriateness of a patient's discharge from the hospital and whether isolation continues to be required. We observed 22 patients who had positive RT-qPCR results for SARS–CoV-2 in the sputum or feces after pharyngeal swabs became negative. These finding raise concern about whether patients with negative pharyngeal swabs are truly virus-free, or sampling of additional body sites is needed.

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high.

Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19)

The recent report of 2 critically ill emergency physicians infected by the novel coronavirus disease 2019 (COVID-19) is a sobering reminder of the vulnerability of the nation’s health care workforce.1 While all members of the health care workforce are vital as the health care system faces perhaps its greatest challenge in memory, physicians and nurses are the caregivers who typically have the most direct contact with patients, whether through advising, triaging, or treating those who require hospitalization.

Optimizing the Trade-off Between Learning and Doing in a Pandemic

The world is united regarding the goal of ending the coronavirus disease 2019 (COVID-19) pandemic but not the strategy to achieve that goal. One stark example is the debate over whether to prescribe available therapies, such as quinine-based antimalarial drugs (eg, chloroquine or hydroxychloroquine), or test these drugs in randomized clinical trials (RCTs). At the heart of the problem is one of the oldest dilemmas in human organizations: the “exploitation-exploration” trade-off.

March 27, 2020

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

In this uncontrolled case series of 5 critically ill patients with COVID-19 and acute respiratory distress syndrome (ARDS), administration of convalescent plasma containing neutralizing antibody was followed by an improvement in clinical status.

Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington

In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.

March 26, 2020

Cutaneous manifestations in COVID‐19: a first perspective

From the collected data (88 patients), 18 patients (20.4%) developed cutaneous manifestations. 8 patients developed cutaneous involvement at the onset, 10 patients after the hospitalization. Cutaneous manifestations were erythematous rash (14 patients), widespread urticaria (3 patients) and chickenpox-like vesicles (1 patient). Trunk was the main involved region. Itching was low or absent and usually lesions healed in few days. Apparently there was not any correlation with disease’s severity.

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

Although 2 recent studies1,2 have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort. Therefore, it is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.

Tracking COVID-19 responsibly

As of  March  25,  2020, WHO’s  online  coronavirus  disease  2019  (COVID-19)  situation  dashboard  reveals  that  the  pandemic  spans  195  countries  and  territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public  health  authorities,  researchers,  and the wider public.

March 25, 2020

The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study

Our projections show that physical distancing measures were most effective if the staggered return to work was at the beginning of April; this reduced the median number of infections by more than 92% (IQR 66–97) and 24% (13–90) in mid-2020 and end-2020, respectively.

Novel Coronavirus and Old Lessons — Preparing the Health System for the Pandemic

How sad that the people who remember the last major pandemic — influenza in 1968 — are the primary victims of today’s. How sad that despite the many medical advances that have been made since then — critical care, extracorporeal membrane oxygenation (ECMO), emergency medicine, and emergency medical services, to name a few — the treatments offered to many patients in areas where Covid-19 has exploded are the same ones they might have received in that era. Perhaps the lessons they remember, those of quarantine, isolation, and social distancing, are the ones that will save us again.

March 24, 2020

Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics

Although many drugs have in vitro activity against different coronaviruses, no clinical evidence currently supports the efficacy and safety of any drug against any coronavirus in humans, including SARS-CoV-2. Numerous drugs that have been highly promising in vitro for other infectious diseases have failed in clinical studies.

Novel 2019 coronavirus SARS-CoV-2 (COVID-19): An updated overview for emergency clinicians

This overview analyzes the best information from the early research, including epidemiologic and demographic features from SARS-CoV-1 and MERS-CoV viruses; lessons learned from the experience of an emergency physician in Northern Italy, where the outbreak has devastated the healthcare system

Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease

Among those with COVID-19, there is a higher prevalence of cardiovascular disease and more than 7% of patients suffer myocardial injury from the infection (22% of the critically ill). 

COVID-19: Abnormal Clotting Common in More Severe Disease

Endothelial damage and subsequent clotting is common in severe and critical COVID-19 coronavirus, which may have implications for treatment, Chinese clinicians said at a webinar co-sponsored by the Chinese Cardiovascular Association and American College of Cardiology.

Psychiatrists Anticipate Mental Health Needs With COVID-19

Psychiatric appointments across the country have been going virtual as mental health professionals try to limit potential exposures by moving to home offices and keeping outpatient visits to a minimum.

COVID-19 Update: 17 Days on Surfaces; U.S. 'New Epicenter'? Fatal Chloroquine

March 23, 2020

COVID-19: Melatonin as a potential adjuvant treatment.

This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology.

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.

Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections.

Coronavirus in New York - Report From The Front Lines (Video)

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

New Guidelines on CPR When COVID-19 Is Known or Suspected

Ethics Committee Reviews of Applications for Research Studies at 1 Hospital in China During the 2019 Novel Coronavirus Epidemic

The Toughest Triage — Allocating Ventilators in a Pandemic

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020

March 22, 2020

Chloroquine for Coronavirus? Not So Fast

Chloroquine, the old malaria drug, is making news as a potential therapy for coronavirus. Does it belong in the headlines for its antiviral properties, or is it just hype and bluster? Will it become a drug? Let's find out.

Point-of-Care RNA-Based Diagnostic Device for COVID-19

A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing

March 21, 2020

Loss of sense of smell as marker of COVID-19 infection

March 20, 2020

Lianhuaqingwen exerts anti-viral and anti-inflammatory activity against novel coronavirus (SARS-CoV-2)

LH significantly inhibits the SARS-COV-2 replication, affects virus morphology and exerts anti-inflammatory activity in vitro. These findings indicate that LH protects against the virus attack, making its use a novel strategy for controlling the COVID-19 disease.

People who are at higher risk for severe illness

Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19)

Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

Hypothesis for potential pathogenesis of SARS-CoV-2 infection--a review of immune changes in patients with viral pneumonia

Treatment for severe acute respiratory distress syndrome from COVID-19

Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

COVID-19 and the liver: little cause for concern

Rational use of face masks in the COVID-19 pandemic

COVID-19: protecting health-care workers

Is COVID-19 A Bigger Threat than Flu?

March 19, 2020

A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence

Systematically summarizes the epidemiology, clinical characteristics, diagnosis, treatment and prevention of knowledge surrounding COVID-19.

Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State

Probable Pangolin Origin of SARS-CoV-2 Associated with the COVID-19 Outbreak

Partha Kar: Covid-19-we must keep faith in our experts

CT appearance of severe, laboratory-proven coronavirus disease 2019 (COVID-19) in a Caucasian patient in Berlin, Germany

Securing the Safety Net and Protecting Public Health During a Pandemic

Use of antiviral drugs to reduce COVID-19 transmission

Estimation of COVID-19 outbreak size in Italy

Viral dynamics in mild and severe cases of COVID-19

March 18, 2020

Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19

A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

Presidential Powers and Response to COVID-19

March 17, 2020

Updated: WHO Now Doesn't Recommend Avoiding Ibuprofen For COVID-19 Symptoms

Aminoquinolines Against Coronavirus Disease 2019 (COVID-19): Chloroquine or Hydroxychloroquine

Coronavirus Disease 2019 (COVID-19) in Italy

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

CDC Expert Answers Top COVID-19 Questions

Clinical course and mortality risk of severe COVID-19

Prevention of SARS-CoV-2 infection in patients with decompensated cirrhosis

COVID-19 in pregnant women – Authors' reply

Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review

March 16, 2020

On the front lines of coronavirus: the Italian response to covid-19

Coronavirus Testing – March 16 Q&A with the CDC’s Jay Butler, MD

COVID-19 in Seattle: Clinical Features and Managing the Outbreak

Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures

COVID-19: consider cytokine storm syndromes and immunosuppression

COVID-19: the need for continuous medical education and training

A Sequence Homology and Bioinformatic Approach Can Predict Candidate Targets for Immune Responses to SARS-CoV-2

March 13, 2020

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA

From Containment to Mitigation of COVID-19 in the US

Coronavirus in Italy – March 13 Q&A with ICU Physician Maurizio Cecconi of Humanitas University  JAMA Video Interview

COVID-19, ECMO, and lymphopenia: a word of caution

From Containment to Mitigation of COVID-19 in the US

The Effect of the COVID-19 Pandemic on Clinic Operations

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response

March 12, 2020

Supporting the Health Care Workforce During the COVID-19 Global Epidemic

A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias

March 11, 2020

Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

Early dynamics of transmission and control of COVID-19: a mathematical modelling study

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Detection of SARS-CoV-2 in Different Types of Clinical Specimens

March 4, 2020

Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient

March 3, 2020

Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing

Journal Pre Proof

Don't overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19)

Over  the  course  of  the  current pandemic,   it   became   apparent   that   some   patients   can   present   with   abdominal symptoms  without  fever  or  respiratory  manifestations,  and  could  be  overlooked  by health care providers. 

SARS-CoV-2 turned positive in a discharged patient with COVID-19 arouses concern regarding the present standard for discharge

LSU Healthcare Network
 

See important LSU Healthcare Network COVID-19 information and updates, as well as how to request a patient appointment at the buttons below.

COVID-19 Updates Request an Appointment
 

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General Information and Guidance

Louisiana Coronavirus (COVID-19) Case Count
lacovidmap

Louisiana Department of Health

Directives

Allowable Medical, Surgical and Dental Procedures (4/24/20)

AMENDED AND UPDATED NOTICE: (4/20/20)
Medical and Surgical Procedures
Dental Visits, Procedures and Surgeries
Other Healthcare Services

Elective Procedures

Routine, Non-essential Dental Procedures

Louisiana Department of Health COVID-19 Information Updates

Bulletins

Informational Bulletin 20-6: COVID-19 – LMHP Telemedicine/Telehealth

Informational Bulletin 20-5: COVID-19 Provider Update

Informational Bulletin 20-4: COVID-19 – MHR Telemedicine/Telehealth

Press Releases

Gov. Edwards Announces Louisiana's Roadmap to Resilience Will Start Phase 2 on Friday, June 5

LDH Blog: How one hard-hit state is rallying to support those with addiction amidst COVID-19

Louisiana Department of Health Updates for 5/25/2020

Neighborhood-based COVID-19 testing coming to Northshore parishes

Crisis counseling text line now available to Louisiana residents

Louisiana Department of Health Updates for 5/21/2020

Louisiana Department of Health Updates for 5/18/2020

EMERGENCY ORDER: Continuation of LDH Notices and Orders Due to COVID-19 – May 15, 2020

Louisiana Department of Health Updates for 5/14/2020

Louisiana Department of Health Updates for 5/11/2020

State of Louisiana Will Hire Hundreds of Louisianans as Contact Tracers to Fight the Spread of COVID-19 - May 8, 2020

Louisiana Department of Health Updates for 5/7/2020

Louisiana Department of Health Updates for 5/6/2020

Louisiana Department of Health Updates for 5/4/2020

Department of Health shares regional data informing decision to extend Stay at Home order -5-1-20

Louisiana Department of Health Updates for 5/1/2020

Louisiana Department of Health Updates for 4/29/2020

EMERGENCY ORDER: Continuation of LDH Notices and Orders Due to COVID-19 – April 28, 2020

Gov. Edwards Will Extend Stay at Home Order Until May 15 to Continue Flattening the Curve and Slowing the Spread of COVID-19 – April 27, 2020

Health Department launches pilot in Baton Rouge to connect healthcare workers with facilities in need April 23, 2020

Louisiana Department of Health Updates for 4/22/2020

Louisiana Department of Health Updates for 4/20/2020 – April 20, 2020

Dr. Courtney N. Phillips joins Louisiana Department of Health as Secretary – April 17, 2020

Regional projections show Louisiana could be grappling with COVID-19 until the end of the year – April 16, 2020

Louisiana Department of Health Updates for 4/15/2020

Gov. Edwards Issues Statement as Louisiana Surpasses 1,000 COVID-19 Deaths

Louisiana Department of Health Updates for 4/13/2020

Louisiana Department of Health Updates for 4/11/2020

LDH Blog: Public health workers deserve our thanks

Louisiana Department of Health Updates for 4/8/2020

The Department of Health has extended all guidance to April 30, 2020

Louisiana Department of Health Updates for 4/7/2020

Louisiana Department of Health Updates for 4/6/2020

State of Louisiana COVID-19 Data Models Show Thousands of New Hospitalizations Daily Without Effective Social Distancing Measures - 4/3/2020

Department of Health Reports More than 2,500 Additional COVID-19 Cases, Most from Commercial Labs – 4/2/2020

Louisiana Department of Health Updates for 4/1/2020

Louisiana Department of Health Updates for 3/31/2020

Louisiana Department of Health Updates for 3/30/2020

Louisiana Department of Health Updates for 3/29/2020

Louisiana Department of Health Updates for 3/28/2020

Louisiana Department of Health Updates for 3/27/2020

Louisiana Department of Health Updates for 3/26/2020

Louisiana Department of Health Updates for 3/25/2020

Louisiana Department of Health Updates for 3/24/2020

Louisiana Department of Health Updates for 3/23/2020

Louisiana Department of Health Updates for 3/22/2020

Gov. Edwards Issues Statewide Stay at Home Order to Further Fight the Spread of COVID-19 in Louisiana

Emergency Order: Tattoo/Body Art Closures COVID-19

Gov. Edwards Thanks Healthcare Workers and Releases New PSA Urging Louisianans to Help Slow the Spread of COVID-19


IEE COMMITTEE CORONAVIRUS RESOURCES
 


COVID ACT NOW

CovidActNow.org was created by a team of data scientists, engineers, and designers in partnership with epidemiologists, public health officials, and political leaders to help understand how the COVID-19 pandemic will affect their region. This tool is built to enable political leaders to quickly make decisions in their Coronavirus response informed by best available data and modeling.

Bill Gates is spending billions to ‘save months’ on a coronavirus vaccine

Protect the Heroes Launches Direct Support to Local Hospitals, Health Systems and Frontline Healthcare Workers Across Nation in Fight Against COVID-19

The Creative Coalition, Association for Healthcare Philanthropy, and the American Hospital Association have united to launch the “Protect the Heroes” campaign, which allows the general public to make direct impact donations to America’s hospital and health systems. Every dollar raised from Protect the Heroes goes directly to the donor’s choice of local hospital to purchase personal protective equipment (PPE) and other support for their local healthcare workers to fight the ravages of COVID-19.

Convalescent plasma transfusion shows promise for severely ill patients with COVID-19

Preliminary research has shown the potential of convalescent plasma therapy to improve clinical outcomes of patients with severe disease related to COVID-19.

Endocrinologists warn of increased COVID-19 complication risks with glucocorticoid use

Adults who are prescribed glucocorticoid therapy for common conditions, such as asthma, allergies and arthritis, as well as individuals with adrenal insufficiency, are at high risk for developing serious complications from COVID-19 due to an inability to mount a normal stress response, according to an editorial published in the Journal of Clinical Endocrinology & Metabolism.\

Medical Companies Win Approval for Rapid Coronavirus Tests

Starting this week, Abbott Laboratories ABT +1.46% plans to make a rapid test available for use in physicians’ offices, urgent-care clinics and other settings through an Abbott device. The test can detect the virus in a patient sample in as few as five minutes and return negative results in 13 minutes.

FDA approved 3 additional kits today (2 PCR, 1 RAPID), 31 March 2020. Total registered COVID-19 Test Kits for commercial use is now 26.

FDA approved 3 additional kits today (2 PCR, 1 RAPID), 31 March 2020. Total registered COVID-19 Test Kits for commercial use is now 26. Click this link for details.

Johnson & Johnson announces lead COVID-19 vaccine candidate

Johnson & Johnson today announced the selection of a lead COVID-19 vaccine candidate from constructs it had been working on since January 2020, with expected initiation of human clinical studies by September 2020 at the latest.

Q&A: Telepsychiatry plays vital role in combating mental health effects of COVID-19

The novel coronavirus pandemic has led to numerous quarantine and social isolation measures throughout the United States and the world. Thus, psychiatric patients may be unable to attend an in-person appointment with their clinician.

CMS eases requirements for transferring non-COVID-19 infected patients

During a White House Rose Garden event, CMS Administrator Seema Verma unveiled the hospitals without walls program.

"Under the CMS's temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. For example, a healthcare system can use a hotel to take care of patients needing less intensive care while using its inpatient beds for COVID-19 patients," CMS noted in a press release.

Limited testing poses challenges to mapping COVID-19 spread

But how to accurately display and project the spread of the disease has proven difficult, particularly given the limited number of tests available to confirm where cases of COVID-19 actually are.

Coronavirus outbreak: NYU, Chinese researchers develop AI tool to predict severe COVID-19 cases

Researchers have created an artificial intelligence tool that may help physicians predict which patients will develop severe lung disease, even if they initially have a mild case of the novel coronavirus.

In a study published in Computers, Materials & Continua, NYU and Chinese researchers used data from a small group of COVID-19 patients in two Chinese hospitals.They found that patients with mildly elevated liver enzymes and body aches were most likely to develop acute respiratory distress syndrome.

Coronavirus Test Tracker: Commercially Available COVID-19 Diagnostic Tests

As labs and diagnostic developers race to meet demand for assays to detect the SARS-CoV-2 coronavirus, 360Dx is updating this tracker on a regular basis in order to provide readers with up-to-date and accurate information on the regulatory status of these tests in the US, European, and Asian markets.

The tracker includes only those tests that are available for diagnostic use. Links to primary regulatory decisions are provided where available.

AHA launches “100 Million Mask Challenge” to aid front line health professionals

The American Hospital Association (AHA) today announced a national initiative to secure millions of masks for the physicians, nurses and caregivers who are treating coronavirus patients and at greater risk due to a nationwide shortage of personal protective equipment. The effort will facilitate private sector partnerships to address these shortages in the fight against COVID-19. 

AHA Urges HHS to Clarify EMTALA, HIPAA Waivers

The AHA March 24 urged the Department of Health and Human Services to clarify the Emergency Medical Treatment and Labor Act and Health Insurance Portability and Accountability Act waivers issued under the public health and national emergency declarations.

AHA Comments to Department of Labor on the Families First Coronavirus Response Act

The AHA has asked the Department of Labor to accurately define "health care provider" as it promulgates regulations implementing key sections of the recently-enacted Families First Coronavirus Response Act and clarify how this policy will be operationalized, including how it interacts with state law.

COVID-19 Drug Therapy –Potential Options

NETEC: Personal Protective Equipment for 2019 Novel Coronavirus (COVID-19)

Information from LabCorp about Coronavirus Disease 2019 (COVID-19)

Quest Diagnostics Testing for COVID-19

Coronavirus 2019-nCoV Global Cases by Johns Hopkins CSSE

Coronavirus (COVID-19)

National Institutes of Health Coronavirus

World Health Organization, Coronavirus

 

Health Articles

Doctors keep discovering new ways the coronavirus attacks the body

Today, there is widespread recognition the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many doctors are focused on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.

As States Rush to Reopen, Scientists Fear a Coronavirus Comeback

Most have not met even minimal criteria for doing so safely, and some are reopening even as coronavirus cases rise, inviting disaster. The much-feared “second wave” of infection may not wait until fall, many scientists say, and instead may become a storm of wavelets breaking unpredictably across the country.

Pharmaceutical giant Pfizer begins testing coronavirus vaccine in people

Pharmaceutical giant Pfizer began testing multiple versions of an experimental coronavirus vaccine in healthy young people in the United States this week, a first step toward establishing the safety, dosage and most promising candidate to take into larger trials that will test effectiveness.

Anti-vaccination leaders seize on coronavirus to push resistance to inoculation

As scientists around the world race to develop a vaccine for the coronavirus, the pandemic is also stoking a surge of activity among activists who argue that such a vaccine must be resisted.

Coronavirus Q&A: Update from the CDC

Anne Schuchat, MD, Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), discusses evolution of CDC guidance and latest developments in the COVID-19 pandemic.  Recorded on Friday May 1, 2020.

COVID-19: Anticoagulation Recommended Even After Discharge

Of COVID-19's hallmark symptoms, clotting may not rank high in the national consciousness. But it has made quite an impression in-hospital.

U.S. Coronavirus Death Toll Is Far Higher Than Reported, C.D.C. Data Suggests

Total deaths in seven states that have been hard hit by the coronavirus pandemic are nearly 50 percent higher than normal for the five weeks from March 8 through April 11, according to new death statistics from the Centers for Disease Control and Prevention. That is 9,000 more deaths than were reported as of April 11 in official counts of deaths from the coronavirus.

Young and middle-aged people, barely sick with covid-19, are dying from strokes

Reports of strokes in the young and middle-aged — not just at Mount Sinai, but also in many other hospitals in communities hit hard by the novel coronavirus — are the latest twist in our evolving understanding of the disease it causes. The numbers of those affected are small but nonetheless remarkable because they challenge how doctors understand the virus. Even as it has infected nearly 2.8 million people worldwide and killed about 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe — impacting nearly every major organ system in the body.

In New York’s largest hospital system, many coronavirus patients on ventilators didn’t make it

One other surprising finding from the study was that 70 percent of the patients sick enough to be admitted to the hospital did not have a fever. Fever is listed as the top symptom of covid-19 by the CDC, and for weeks, many testing centers for the virus turned away patients if they did not have one.

A mysterious blood-clotting complication is killing coronavirus patients

One doctor replied that one of his patients had a strange blood problem. Despite being put on anticoagulants, the patient was still developing clots. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.

Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate to Prevent and Treat Coronavirus Disease 2019 (COVID-19)

Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound hydroxychloroquine, should be used only under the supervision of a healthcare provider as prescribed medications.