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CMAAO Coronavirus Facts and Myth Buster: COVID Update

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Dr KK Aggarwal    02 January 2021

With input from Dr Monica Vasudev

 

1265: Children have a greater risk of contracting the coronavirus at a social gathering compared to a classroom or childcare setting, reported a study released by the University of Mississippi Medical Center, conducted in association with U.S. CDC, appearing in Dec. 18 Morbidity and Mortality Weekly Report.

 

A survey was conducted among patients below 18 years of age who had tested positive for the coronavirus in emergency departments and outpatient health facilities during September, October and November. In comparison with children who tested negative, those who tested positive were more likely to have attended gatherings and have had visitors at home. There were lesser odds of parents or guardians of infected children to report wearing masks at the gatherings.

 

Household contacts versus a contact at school appeared to play a more important role in a childs risk for being infected. (Medscape)

 

1266: There is some degree of immunity following the first dose of the COVID-19 vaccines; however, it is not optimal and it is not known how long it will last. It is known that immunity increases dramatically after the second dose and lasts considerably longer. (Medscape)

 

1267: A "bridging study" in children is likely to begin in mid-January to ensure that the COVID-19 vaccines efficacy and safety data are comparable to those of the successful adult vaccine trials. (Medscape)

 

1268: April could be open season for the general public to start receiving vaccines against COVID-19 in the US. There could be "umbrella protection" across the country, establishing herd immunity, by the end of summer of 2021. (Medscape)

 

1269: Like all RNA viruses, this coronavirus has been undergoing mutation, and a new variant that has emerged in the United Kingdom may be more contagious. However, there is no evidence to suggest that it is more virulent or that current vaccines will not be effective against it. (Medscape)

 

1270:   A large study provides additional evidence that individuals with type O or Rh−negative blood may have a slightly lower risk from the new coronavirus. Of 225,556 Canadians tested for the virus, the risk for a COVID-19 diagnosis was found to be 12% lower and the risk for severe COVID-19 or death was 13% lower in people with blood group O compared to those with A, AB, or B, reported researchers in Annals of Internal Medicine. People in any blood group who were Rh-negative also appeared to be protected, particularly if they had O-negative blood.

 

Individuals with type O blood, and those who are Rh negative, may have developed antibodies able to recognize some aspect of the new coronavirus and therefore might, in part, protect them against it. (Medscape)

 

 

1271: Abnormal Clotting Common in More Severe COVID-19

 

Endothelial damage and subsequent clotting appear to be common in severe and critical COVID-19, which may have implications for treatment. Clots in the small vessels of all organs, not only the lungs but also the heart, the liver, and the kidney, have been described by Bin Cao, MD, of the National Clinical Research Center for Respiratory Diseases in Beijing. The investigators had reported March 11 in The Lancet that D-dimer levels >1 μg/L at admission were predictive of 18-fold increased odds of dying before discharge among 191 COVID-19 patients seen at two hospitals in Wuhan. D-dimer can exceed 70 or 80 μg/L.

 

Acute cardiac injury was reported in 12% of COVID-19 cases in a small case series in the Lancet which was cited by Cao. Another study reported a rate of 7.2% among 138 patients from another hospital in Wuhan.

Comorbid cardiovascular disease is a distinct risk factor for COVID-19, associated with a mortality rate of up to 10.5% among over 70,000 patients in one study. The virus can potentially bind to the endothelial cells and damage the blood vessels, especially the microcirculation of the small blood vessels, leading to platelet aggregation. It is not a myocardial infection, not a stroke, but it is the clots all over the body. Hence, the high D-dimer. It is because of the wide spread of abnormal coagulation all over the body.

 

Besides endothelial shedding and thrombosis in vessels, autopsies have shown inflammatory changes in the heart with fine interstitial mononuclear inflammatory infiltrates, but no viral inclusions in the heart. Other potential mechanisms for cardiac damage include hypoxia-induced myocardial injury, cardiac microvascular damage, and systemic inflammatory response syndrome. In the majority of mild and moderate cases, the only cardiac impact was some tachycardia and slightly higher troponin.

 

Investigators highlighted the case of a COVID-19-infected man with apparent STEMI by ECG, troponin T >10,000 ng/L, and CK-MB 113 ng/L, but coronary angiography showing no stenosis. After treatment with steroids, immunoglobulin, norepinephrine, diuretic, a vasodilator, and antibiotics, the mans ejection fraction recovered from 27% to 66% and his enlarged heart normalized. (Medpage Today)

 

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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