With input from Dr Monica Vasudev

1547:  The US FDA has authorized Moderna to add more vaccine doses into its COVID-19 vaccine vials, with the range now being between 11 and 15 doses that can be extracted. The FDA cleared new vials from Moderna that can contain up to 15 doses. The agency further stated that the presently used 10-dose vials can safely extract up to 11 doses. The move may further increase vaccine supply in in US in the weeks to come and could also hasten Modernas delivery timeline, as per The New York Times. The company intends to deliver 200 million doses by the end of May and 300 million by the end of July. (WebMD)

1548: Researchers at Stanford University detected a case of a new coronavirus variant with two mutations, which was first seen in India last month. The variant has been identified in a patient in the San Francisco Bay Area.

It carries two mutations in the spike protein of the virus. The double mutation could be of concern if the variant turns out to be more transmissible or deadly; however, the health officials have not yet called it a "variant of concern."

Dean Winslow, MD, an infectious disease specialist at Stanford University, stated that there is lack of any definitive evidence that the double variant is more virulent or causes more severe disease. (WebMD)

1549: Three COVID-19 phenotypes of patients who present to ER

Investigators have described three COVID-19 phenotypes of patients who present to the ER in an article published online in PLOS ONE.

1. Researchers looked into the electronic health records from 14 hospitals in the midwestern United States and from 60 primary care clinics in Minnesota. Data were obtained for 7538 patients with confirmed COVID-19 from March 7 through August 25, 2020. Of these, about 14% (1022) required hospitalization and were included in the study. Data were obtained on comorbidities, medications, lab results, clinic visits, hospital admission information, and patient demographics.
2. Most patients (n=613 or 60%) in the study presented to emergency rooms with "phenotype II."  
3. Patients presenting with phenotype II less frequently had a history of hepatic disease compared to those with phenotype I or III. They had more moderate disease and nearly 10% mortality.
4. A total of 236 patients (23%) had "phenotype I," or the "adverse phenotype." This was tied to the worst outcomes. These patients appeared to have the most hematologic, renal, and cardiac comorbidities (P < .001). These patients were more likely to be non-White (38.8% vs 45.6% vs 60.7%, respectively, P = .002) and non-English speakers (47.9% vs 39.2% vs 23.7%, respectively, P < .001).
5. Phenotype I patients were older than patients in phenotypes II and III (67.2 [52.9, 79.0] years vs 60.9 [45.9, 75.4] years and 58.6 [34.8, 71.3] years, respectively, P < .001).
6. "Phenotype III," or the favorable phenotype, formed the smallest group, with 173 patients (16.9%); they had the best outcomes. Those in phenotype III had the highest rate of respiratory comorbidities (P = .002) despite lowest complication and mortality rates. They had higher odds of having had a history of smoking, alcohol abuse, and neutropenia.
7. Most patients with chronic lung diseases were on inhalers and this finding might suggest that inhalers are more protective.
8. Phenotype III patients had a 10% greater risk of hospital readmission compared to the other two phenotypes.
9. Phenotype III patients were also more often female compared to patients with phenotype I or II (57.6% vs 41.6% and 53.4%, respectively,P = .002).
10. Phenotypes I and II were associated with 7.3-fold and 2.57-fold increases, respectively, in hazard of death compared with phenotype III.

(Medscape)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA