With input from Dr Monica Vasudev

1443: Israel is leading the world in COVID-19 vaccinations, with 55% of its population having received one dose of the Pfizer-BioNTech vaccine and over 41% of the individuals having received two doses. (thenewsnow.live)

1444: COVID-19 patients with severe disease have increased level of sustained platelet activation that may contribute to the thrombotic issues associated with the infection, suggests new evidence. 

COVID-19 patients are known to have an increased thrombotic risk, despite getting treatment with heparin. The new study, published online in JACC: Basic to Translational Science, noted that there was considerable platelet activation in patients hospitalized with COVID-19, suggesting that antiplatelet agents and anticoagulants should be considered in their treatment.

Treating thrombotic complications in COVID-19 with anticoagulants is associated with increased risk of bleeding if doses are too high. The new data suggest that antiplatelet agents should be given.

The findings are in line with autopsy studies which noted platelet-rich thrombi in the microvessels of the lungs. Doctors may consider treating patients with worsening COVID infection with an antiplatelet drug. Low-dose aspirin (the dose used for cardiovascular prevention) could be sufficient. The risk would be low as the drug would be taken only for a few weeks. 

It is well known that severe COVID-19 predisposes patients to develop thrombotic disease, which may develop in spite of giving standard pharmacologic prophylaxis with heparin.

The low platelet count usually seen in COVID-19 patients points to increased consumption due to platelet activation and thrombus formation. Activated platelets express a functionally active tissue factor, and can themselves trigger the coagulation cascade. (Medscape)

1445: Researchers at the Centers for Disease Control and Prevention (CDC) have noted that when restrictions on dining on premises at restaurants were lifted, rates of daily COVID-19 infections increased 41 to 100 days later. Deaths related to COVID-19 also increased significantly after 60 days. The report also stated that mask mandates decreased the spread of SARS-CoV-2 virus within a few weeks. The study was published online in the CDC Morbidity and Mortality Weekly Report. 

The report does not differentiate between outdoor and indoor restaurant dining. However, the researchers did compare COVID-19 case and death rates prior to and after most states banned restaurants from serving on-premises in March and April 2020.

It was noted that daily cases rose by 0.9% at 41 to 60 days after dining was permitted on premises. The rates rose by 1.2% at 61 to 80 days, and 1.1% at 81 to 100 days after the restrictions were lifted. Death rates did not increase significantly initially, but showed an increase of 2.2% at 61 to 80 days after on-premises dining was permitted. Deaths increased by 3% at 81 to 100 days. (Medscape)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA