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Featured Headlines
Mortality among hospitalized COVID-19 patients in New York City reached a whopping 88% for those requiring ventilators. Among all patients who received mechanical ventilation, the mortality rate was 76.4% for adults ages 18 to 65, and nearly all patients over age 65 died (97.2%). By contrast, mortality rates among these age groups who did not receive mechanical ventilation were 19.8% and 26.6%, respectively. [Related Study JAMA]
APRV and HFOV in COVID-19: It’s time to revive outdated modes of ventilation such as APRV and HFOV for COVID-19 associated ARDS- FLARE
High frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV) are non-conventional modes of ventilation for ARDS that are designed to achieve recruitment and avoid atelectrauma. It has been suggested that these non-traditional modes are better suited to COVID-19 associated ARDS than traditional lung protective ventilation. Unlike traditional lung protective ventilation, neither HFOV nor APRV has ever been shown to reduce mortality in ARDS. One large trial of HFOV actually suggested an increase in mortality. Traditional lung protective ventilation, by which we mean low tidal volume and minimal driving pressure, remains the best approach to mechanical ventilation in COVID-19 and in ARDS more generally.
The other COVID-19 risk factors: How race, income, ZIP code can influence life and death – Kaiser Health
Doctors know that people with underlying health conditions ― such as the 40% of Americans who live with diabetes, hypertension, asthma and other chronic diseases ― are more vulnerable to COVID-19. So are patients without access to intensive care or mechanical ventilators.
Coronavirus at meatpacking plants worse than first thought – USA Today
Coronavirus closed Smithfield and JBS meatpacking plants. Many more are at risk. Operators may have to choose between worker health or meat in stores.
One Hundred USDA Meat Inspectors Have Contracted Covid-19 – Bloomberg
One hundred U.S. Department of Agriculture inspectors have tested positive for the coronavirus as the illness ravages the nation’s meat processing plants. The workers are part of the Food Safety and Inspection Service, which employs about 6,500 inspectors, a spokesperson for the agency confirmed Thursday. USDA is taking measures to supply masks to workers, though they currently may need to find them on their own.
A light at the end of the coronavirus pandemic tunnel? 6 signs to look for – ABC News/John Brownstein
There are encouraging signs that the most intensive phase of our battle against the novel coronavirus is succeeding. The number of new COVID-19 cases nationally is tapering downward and some initial studies have shown that far more people were infected but had mild or no symptoms at all.That doesn’t mean we can – or should — declare victory and go home. We’re far from being able to return to “normal.” But it’s nice to see what appear to be a few green shoots of encouraging data. [Related Study]
A mysterious blood-clotting complication is killing coronavirus patients – Washington Post
Once thought a relatively straightforward respiratory virus, covid-19 is proving to be much more frightening. Craig Coopersmith was up early that morning as usual and typed his daily inquiry into his phone. “Good morning, Team Covid,” he wrote, asking for updates from the ICU team leaders working across 10 hospitals in the Emory University health system in Atlanta. 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.
Newly confirmed coronavirus deaths might not be nation’s first – Politico
Officials late Tuesday revealed the finding that the first death to occur in the county from Covid-19 happened on Feb. 6 — three weeks before Washington state reported its Feb. 29 death, which at the time was believed to have been the first in the nation. The three earlier Santa Clara County deaths were not associated with travel to highly infected areas, indicating the virus was spreading in the U.S. much earlier than previously thought.
The Fear of Coronavirus and Flu Colliding in the Fall – New York Times
Could the United States face two epidemics at the same time next fall, flu and the coronavirus? A new surge in coronavirus cases could coincide with the next flu season, causing an even more difficult crisis than the one the nation is facing now.
COVID-19 Arrived in Seattle, Where it Went from There Stunned Scientists – NYT
Jan. 15, at the international airport south of Seattle, a 35-year-old man returned from a visit to his family in the Wuhan region. He grabbed his luggage and booked a ride-share to his home north of the city.
U.S. Pressures China To Close Wet Markets Thought To Be Source Of COVID-19 – NPR
The U.S. is calling on China to permanently shut down the country’s wet markets, where the deadly coronavirus is thought to have first emerged late last year, as Australia urged an international scientific investigation of the health risks associated with them.
WHO warns of long road ahead with COVID-19 – CIDRAP
The head of the World Health Organization (WHO) today said global COVID-19 activity is at different stages in different parts of the world and warned of a long road ahead with the virus.
States rushing to reopen are likely making a deadly error – Washington Post
By the end of the week, residents in Georgia will be able to get their hair permed and nails done. By Monday, they will be cleared for action flicks at the cineplex and burgers at their favorite greasy spoon. And it will almost certainly lead to more novel coronavirus infections and deaths.
Surveillance
Official Reporting for April 23, 2020
| WHO SITREP #93 | ECDC | Country Data | Johns Hopkins | |
| Confirmed Cases | 2,471,136 | 2,588,068 | 2,671,024 |
| Deaths | 169,006 | 182,808 | 186,131 |
Total deaths: 44,575
Surveillance Headlines
USA
Wisconsin: Wisconsin reports largest one-day jump in COVID-19 cases; 147 cases linked to JBS Meat Packing plant in Green Bay – WBAY
Washingto State: Washington State Builds Coronavirus Contact Tracing ‘Fire Brigade’ – NPR
Idaho: Crush the Curve Idaho announces first wave of coronavirus antibody test results – KTVB
Hawaii: Antibody tests show COVID-19 was in Hawaii before first positive test – KHON
New York: Antibody study estimates 13.9% of residents have had the coronavirus – CNBC
EUROPE
Coronavirus Is Leading to Europe’s Highest Deaths in Decades – Bloomberg
ASIA
China: Inside the Dystopian, Post-Lockdown World of Wuhan – Bloomberg
Science and Tech
NIH Panel Recommends Against Drug Combination For COVID-19 – NPR
A panel of experts convened by the National Institute of Allergy and Infectious Diseases recommends against doctors using a combination of hydroxychloroquine and azithromycin for the treatment of COVID-19 patients because of potential toxicities.
How South Korea flattened the coronavirus curve with technology – The Conversation
As countries around the world consider how best to reopen their countries, it’s worth considering how South Korea has been able to “flatten the curve” and even hold parliamentary elections without resorting to lockdowns.
Vaccine
Approaches to Covid-19 Vaccines and Antivirals – NEJM [Audio Interview Download]
Diagnostics
Kaiser is building a $14M COVID-19 lab in Berkeley to process 10,000 tests a day – Berkleyside
Kaiser Permanente is converting an existing Berkeley warehouse into a $14 million testing site that will be able to process 70,000 tests for COVID-19 each week. The new lab, at 1795 Second St., will be fully operational by June 1 and will serve as Kaiser’s main testing site in Northern California, according to Dr. Brian Missett, associate executive director of The Permanente Medical Group. It’s separate from a new medical office project on San Pablo Avenue south of Parker Street set to open in 2021.
Which States Are Doing Enough Testing? This Benchmark Helps Settle The Debate – NPR
When it comes to testing for COVID-19, there are two competing narratives. The Trump administration claims the U.S. has been doing well and has enough testing capacity, for states to begin to enter the first phase of the White House plan for reopening.
Published Research
Late-Onset Neonatal Sepsis in a Patient with Covid-19 – NEJM
Serologic Evidence of Pancreatic Injury in COVID-19 – NEJM
Therapeutic strategies for critically ill patients with COVID-19 – Annals of Intensive Care
Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)
Neutrophil Involvement in Covid-19 – Immunology/PrePrints
Coping in Quarantine
Entertainment keeps you sane… try some of these for something new
Pop Culture Happy Hour is a fun and freewheeling chat about the latest movies, television, books, and music.
If You’re Going to Grow a Quarantine Mustache… Bloomberg Business
Of all the worthy projects to tackle during quarantine, the one with the least chance of resulting in real self-improvement is the introduction of a new mustache.