With regular inputs from Dr Monica Vasudev

790: Social distancing reduces COVID-19 infection: Evidence from China

Intensive non-pharmaceutical interventions were introduced in China to stop transmission of the novel coronavirus disease. As transmission increases in other countries, the link between age, contact patterns, social distancing, susceptibility to infection, and COVID-19 dynamics remains unclear. To answer some of these questions, researchers assessed contact surveys data for Wuhan and Shanghai prior to and during the outbreak and contact tracing information from Hunan Province.

Daily contacts were decreased about 7-8-fold during the COVID-19 social distancing period, with most interactions restricted to the household.Investigators noted that children 0-14 years are less prone to SARS-CoV-2 infection as compared to adults 15-64 years of age (odd ratio 0.34, 95%CI 0.24-0.49), while individuals over 65 years are more susceptible to infection (odd ratio 1.47, 95%CI: 1.12-1.92). Based on these data, a transmission model was designed to study the impact of social distancing and school closure on transmission.It was noted that social distancing alone, as implemented in China during the outbreak, is sufficient to control COVID-19.Proactive school closures cannot interrupt transmission on their own, but they can diminish peak incidence by 40-60% and delay the epidemic.[Juanjuan Zhang J , Maria Litvinova, Yuxia Liang , et al. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. J. Zhang et al., Science 10.1126/science.abb8001 (2020).https://science.sciencemag.org/content/sci/early/2020/04/28/science.abb8001.full.pdf]

791: Rare inflammatory syndrome seen in US child with COVID-19(CNN): US doctors have stated that they may have seen a possible complication of coronavirus infection in a young child - a rare inflammatory condition known as Kawasaki disease.National Health Service England has sent an alert to doctors and the Paediatric Intensive Care Society also tweeted it out to members. It cautioned about a small rise in cases of critically ill children with "common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters" with some children testing positive for COVID-19.Some reports have also been there in Italy and Spain.Kawasaki disease leads to inflammation in the walls of the arteries and can limit blood flow to the heart. It is a treatable condition and most children recover without serious problems, but it can be fatal. It is not known what causes Kawasaki disease, but some studies have suggested a link between viruses or a bacterial infection. [Hospital Pediatrics].

792: In the first three weeks after symptom onset, the majority of RT-PCR results were positive for SARS-CoV-2.It has been noted in a study in Clinical Infectious Diseases that over the first three weeks after symptom onset, the majority of RT-PCR results were positive for SARS-CoV-2. From week three onward, negative results increased. All tests were negative at week six after symptom onset.The rate of positive results was highest at week one (100%), followed by 89.3%, 66.1%, 32.1%, 5.4% and 0% at weeks two, three, four, five and six, respectively.Patients were divided into non-prolonged and prolonged shedding groups based on nucleic acid conversion time (up to or more than 24 days). Patients with longer viral shedding were older and more likely to have comorbidities such as diabetes and hypertension. [Medscape]

793: Protect yourself and your pets: CDC says keep animals 6 feet apartWhile the principal way of virus spread is from person to person, transmission between animals and humans cant be ruled out until more testing is done. While taking your dog on a walk, dont let the social distancing guard down. The same applies to your indoor/outdoor cat. The Centers for Disease Control and Prevention says that its best to take precautions and keep your pets away from other people and animals presently. Not only should you maintain a physical distance of at least 6 feet from others, the CDC says your animals should also maintain that distance.

794: In the U.S. multiple animals, including a familys pug in North Carolina, two pet cats, and five tigers and three lions at the Bronx Zoo in New York have tested positive for COVID-19. Two pet dogs and a pet cat in Hong Kong also tested positive.The CDC says that theres no evidence that animals have a significant role in spreading SARS-CoV-2. The principal way the virus spreads is from person to person, but transmission between animals and humans cant be ignored until more testing is done. Dr. McCarthy, President of the Oregon Veterinary Medical Association, says that during the COVID-19 outbreak, people should not let their pets interact with anyone - two-legged or four-legged - outside of the household. You should also avoid petting other peoples dogs. Restrain from bringing your pups to dog parks and letting them run around off leash. Wash your hands and maintain good hygiene, around people and around animals.

795: Two rare neurologic conditions in patients hospitalized with COVID-19A 50-year-old man developed Miller Fisher syndrome and a 39-year-old man developed polyneuritis cranialis. Both these conditions are variants of Guillain-Barré syndrome (GBS), which physicians in China and Italy have also linked to COVID-19 infection [Medscape]

760: Remdesivir now‘standard of care’for COVID-19Hospitalized patients with advanced COVID-19 with lung involvement and who received the antiviral agent remdesivir (Gilead Sciences) were found to recover faster than similar patients who received placebo, revealed a preliminary data analysis from a U.S.-led randomized, controlled trial.The interim results, discussed in a NIAID press release, revealed that time to recovery (i.e., being well enough for hospital discharge or to return to normal activity level) was 31% faster for patients who received remdesivir compared to those who received placebo (P < .001).The median time to recovery was 11 days for patients treated with remdesivir, compared to 15 days for those given placebo. There was a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir and 11.6% for the patients who received placebo (P = .059).The study - the Adaptive COVID-19 Treatment Trial (ACTT) - is the first clinical trial launched in the United States to assess an experimental treatment for COVID-19. It is underway at 68 sites – 47 in the United States and 21 in countries in Europe and Asia.

761: The Infectious Disease Society of America has released new guidelines on the use and reuse of personal protective equipmentThe guidelines recommend the following for encounters with suspected or confirmed COVID-19 patients:Either a surgical mask or N95 (or N99 or PAPR [powered & supplied air respiratory protection]) respirator for routine patient care in a conventional setting.Either a surgical mask or reprocessed respirator over no mask for routine care in a contingency or crisis setting.No recommendation on the use of double gloves vs. single gloves.No recommendation on the use of shoe covers for any setting.An N95 (or N99 or PAPR) respirator for aerosol-generating procedures in a conventional setting.A reprocessed N95 respirator over a surgical mask for aerosol-generating procedures in a contingency or crisis setting.Adding a face shield or surgical mask as a cover for an N95 respirator to facilitate extended use during respirator shortages when performing aerosol-generating procedures in a contingency or crisis setting. This recommendation carries a caveat: It assumes correct doffing sequence and hand hygiene before and after taking off the face shield or surgical mask cover.Adding a face shield or surgical mask over the N95 respirator so it can be reused, again assuming the correct sequence for hand hygiene.

762: SGLT2 and COVIDA recently-launched study of the type 2 diabetes agent dapagliflozin in patients with mild-moderate COVID-19 is raising concerns, provided that several expert groups have advised that drugs in this class, i.e., the sodium-glucose cotransporter 2 (SGLT2) inhibitors, be stopped in all patients hospitalized with COVID-19 due to the increased risk for diabetic ketoacidosis (DKA).

763: A Third of COVID-19 Hospital Patients May DieA third of patients in hospital with COVID-19 may be dying, suggests to preliminary UK research. The preprint also noted that being male or obese decreased the odds of survival from the disease. Over half of patients mechanically ventilated are dying, stated the authors. The prospective observational cohort study, which has not been peer reviewed, was conducted by a consortium of researchers, known as ISARIC4C, and was led by the University of Liverpool, University of Edinburgh, and Imperial College London (ICL).

764: Increase in out-of-hospital cardiac arrests in Italy linked to COVID-19 A study published in The New England Journal of Medicine showed a correlation between out-of-hospital cardiac arrests and COVID-19 in Lombardy, Italy. Using the Lombardia Cardiac Arrest Registry, Enrico Baldi, MD, University of Pavia, Pavia, Italy, and colleagues compared out-of-hospital cardiac arrests that occurred in the provinces of Lodi, Cremona, Pavia, and Mantua during the first 40 days of the COVID-19 outbreak (February 21-March 31, 2020) with those that occurred during the same period in 2019 (February 21-April 1, 2019 to account for the leap year). During the 2020 study period, 9,806 cases of COVID-19 were reported. During this period, 362 cases of out-of-hospital cardiac arrest were identified, compared with 229 cases during the same period in 2019, reflecting a 58% increase. Increases of various magnitudes in the numbers of cases of out-of-hospital cardiac arrest were noted in all 4 provinces. Of the 362 cases of out-of-hospital cardiac arrest in 2020, 103 were suspected to have or had received a diagnosis of COVID-19 (87 and 16 patients, respectively). These numbers account for 77.4% of the increase in cases of out-of-hospital cardiac arrest observed in these provinces in 2020.The authors stated that the cumulative incidence of out-of-hospital cardiac arrest in 2020 had a robust associated with the cumulative incidence of COVID-19 (Spearman rank correlation coefficient, 0.87; 95% confidence interval, 0.83-0.91; P< 0.001), and that the rise in the number of cases of out-of-hospital cardiac arrest over the number in 2019 followed the time course of the COVID-19 outbreak.

765: COVID-19: Anticoagulation Recommended Even After Discharge"I have never, ever, ever seen such high levels of D-dimer in any of the hundreds of other patients with venous thrombosis that Ive seen over the past 15 years," said Behnood Bikdeli, MD, of NewYork-Presbyterian Hospital/Columbia University Irving Medical Center in New York City. "Its just mind-blowing." [Medpage Today]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA