Tulane Outbreak Daily | May 19, 2020

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Smokers more likely to express ACE2 protein that SARS-COV-2 uses to enter human cells – Medical Express

Previous data from COVID-19 patients suggests that cigarette smokers are more likely to have health complications. One possible reason, researchers report May 15 in the journal Developmental Cell, is that smoking increases the gene expression of ACE2—the protein that binds SARS-CoV-2—which may promote COVID-19 infection. The study suggests that prolonged smoking could cause an increase of the ACE2 protein in the lungs, possibly resulting in a higher rate of morbidity in patients. [Related Study]

From Headaches to ‘COVID Toes,’ Coronavirus Symptoms Are a Bizarre Mix – Scientific American

Blood clots and inflammation may underlie many of these complications. The new coronavirus that has infected millions of people around the globe can wreak havoc far beyond the lungs. Some of the symptoms of the disease it causes, COVID-19, are predictable enough: cough, fever, chills, headache. But the pathogen’s effects by no means stop there. The virus can cause problems in almost every organ, including the brain, heart, kidneys, gastrointestinal tract and skin.

COVID-19 Will Be ‘Constant Threat’ Until Vaccine Found, WHO Envoy Says – VOA

The World Health Organization’s (WHO) special envoy on COVID-19 said Tuesday that the coronavirus will ”be a constant threat” until a vaccine or reliable treatment is found.

In an interview with British broadcaster Sky News, Dr. David Nabarro (Tulane Outbreak Daily subscriber) said this means the world will need to learn how to live with it. The coronavirus causes the COVID-19 disease.

What causes hypoxemia in COVID-19? (Part I) – FLARE Team

The canonical presentation of severe COVID-19 is hypoxemia and, often, ARDS (April 10 FLARE). Early studies of gas exchange in ARDS emphasized the predominant contribution of shunt, which is thought to be secondary to continued perfusion of collapsed and/or fluid-filled alveolar units (Albert and Jobe, 2012). The observation of severe hypoxemia in COVID-19 despite only mild parenchymal involvement (Gattinoni et al., 2020) has led some to speculate (Leisman et al., 2020) that novel mechanisms must underlie the hypoxemia. These speculations have been the subject of intense debate both in the scientific literature (Leisman et al., 2020) and in non-peer reviewed forums. Proposed novel mechanisms of hypoxemia include endothelitiis, failure of hypoxic pulmonary vasoconstriction (Archer et al., 2020; Lang et al., 2020) and/or macro- or microvascular thrombosis (Klok et al., 2020).

Prolonged COVID-19 virus shedding noted in China – CIDRAP

Patients with COVID-19 outside of Wuhan, China, shed the virus for a median of 17 days, according to a retrospective cohort study published yesterday in the International Journal of Infectious Diseases. [Related Study]

Silent COVID-19: what your skin can reveal – Lancet

Clinical manifestations of coronavirus disease 2019 (COVID-19) are rare or absent in children and adolescents hence, early clinical detection is fundamental to prevent further spreading. We report three young patients presenting with chilblain-like lesions who were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Rethinking Covid-19 in Children – NYT

There is new evidence that some children may become very sick, and we are beginning to learn more about who may be most at risk and what parents need to watch for.

Mental Health Challenges after COVID-19 Recovery – Med Page Today

Short- and long-term depression, anxiety, PTSD may be an issue post-ICU. This is particularly true for the sickest of the sick who required time in the ICU and intubation. These patients may experience “post-intensive care syndrome” (PICS) that could manifest as a combination of physical, cognitive, and mental health impairments following an ICU stay for a critical illness. [Related Study/Lancet]

Where Chronic Health Conditions and Coronavirus Could Collide – NYT

Large parts of the South and Appalachia are especially vulnerable, according to a health-risk index created for The New York Times by PolicyMap, a company that analyzes local health data. The index for the first time identifies counties with high rates of the underlying conditions that increase residents’ risk of becoming severely ill if they are infected with the coronavirus.

With Postmortem Testing, ‘Last Responders’ Shed Light On Pandemic’s Spread – NPR

As efforts to test for the coronavirus and trace cases continues, medical examiners and coroners play a vital — if often unsung ― role. These “last responders” are typically called on to investigate and determine the causes of deaths that are unexpected or unnatural, including deaths that occur at home.

Right Heart Problems Spell Trouble for COVID-19 Patients – Med Page Today

Portable echocardiography may help identify patients at highest risk. Right ventricular (RV) dilation was linked to in-hospital mortality among COVID-19 patients at one New York City hospital, researchers reported. [Related Study]

Study reports ‘staggering’ death rate in US among those infected who show symptoms – Medical Express

s COVID-19 more deadly than the flu? It’s a lot more deadly, concludes a new study by the University of Washington published May 7 in the journal Health Affairs. The study’s results also project a grim future if the U.S. doesn’t put up a strong fight against the spread of the virus. The national rate of death among people infected with the novel coronavirus—SARS-CoV-2—that causes COVID-19 and who show symptoms is 1.3%, the study found. The comparable rate of death for the seasonal flu is 0.1%.[Related Study]

The Grim History of Counting the Dead During Plagues – Wired

In the spring of 1665, an Englishman named Samuel Pepys noted in his diary that he’d been “to the coffee-house, where all the news is of … the plague growing upon us in this town; and some of the remedies against it: some saying one thing and some another.” The plague had swept through much of England and Europe repeatedly that century. News of the latest wave would have reached Londoners through the running tallies of plague deaths featured in the earliest newspapers and in government documents known as “mortality bills.”

Learning from a Choir’s SARS-CoV-2 Exposure Cluster – Contagionlive

As the SARS-CoV-2/COVID-19 pandemic continues across the globe, researchers and epidemiologists are working tirelessly to understand clusters that shed new insight into transmission dynamics. From healthcare exposures to household contacts, there is a varying degree of risk based upon the environment and the interaction. [Related Paper CDC]

Official Reporting for May 19, 2020