Tulane Outbreak Daily | May 19, 2020

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Featured Headlines

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

WHO SITREP #115 ECDC Johns Hopkins
Confirmed Cases 4,248,389 4,766,468 4,836,329
Deaths 292,046 318,201 319,213

 

NEW:
Total cases: 1,480,349
Total deaths: 89,407
(Numbers close out at 4 p.m. the day before reporting.)

Surveillance Headlines

USA

Texas: Coronavirus Cases Surge In Texas Panhandle As State Continues To Reopen – NPR

Navajo Nation: Surpasses New York state for the highest Covid-19 infection rate in the US – CNN

CANADA

Montreal: Why is coronavirus so deadly in Montreal? CTV

EUROPE

Sweden: What’s going wrong in Sweden’s care homes? – BBC

LATIN AMERICA

MIDDLE EAST

Iran: Iran Sees New Surge in Virus Cases After Reopening Country – NYT

Science and Tech

Coronavirus in charts: are virtual conferences here to stay? – Nature

More than 80% of respondents to a Nature reader poll said that they would be in favour of some scientific conferences remaining virtual even after the coronavirus pandemic ends. Many meetings have been pushed online since March as a result of the global COVID-19 outbreak — including large, flagship conferences that usually attract thousands of attendees.

How the Coronavirus Got Its Close-Up, Thanks to Electrons – Wired

This teeny, tiny particle doesn’t just expose what the pathogen looks like—it’s already helped scientists design a vaccine now in trials.

Therapeutics

A ‘Coronavirus Inhaler’ Sounds Weird. Here’s Why It Makes Sense – Forbes

Scientists have isolated a special antibody from llamas that could prevent or treat COVID-19 and be delivered via an inhaler. [Related study]

Antivirals

New Pharma Company Lands $354 Million Government Contract To Produce Coronavirus Drugs In The U.S. – Forbes

Monday evening, the U.S. government signed a $354 million four-year contract with new pharmaceutical company Phlow Corp. to increase American production of medications that may help treat Covid-19 in a bid to avoid potential supply chain shortages, with the potential to extend the contract to $812 million for the next ten years, according to the New York Times.

Vaccine

Vaccine Developer Reports Early Results – NPR

[6 min audio at the link] The number of COVID-19 cases and deaths in the U.S. is still on the rise, but there are glimmers of hope. A vaccine developer has reported some encouraging, though early results.


Infection Prevention

The need to go is a big barrier to going out. Why public bathrooms are a stumbling block for reopening. – Washington Post

Whether it’s the mall, restaurants, concerts, ballparks or even drive-in movie theaters, Americans are making it clear: They won’t be ready to go out to their favorite destinations until they feel confident about being able to go. To the bathroom, that is.

‘No offense, but is this a joke?’ Inside the underground market for face masks. – Washington Post

Navigating a ‘sea of sleaze’ to get protective gear for U.S. health workers

 


Published Research

Cigarette smoke exposure and inflammatory signaling increase the expression of the SARS-CoV-2 receptor ACE2 in the respiratory tract – Cell

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic – Lancet

Cross-neutralization of SARS-CoV-2 by a human monoclonal SARS-CoV antibody – Nature

Right Ventricular Dilation in Hospitalized Patients with COVID-19 Infection – Journal of Cardiology Imaging

Factors associated with duration of viral shedding in adults with COVID-19 outside of Wuhan, China: A retrospective cohort study – Journal of Infectious Diseases

Structural Basis for Potent Neutralization of Betacoronaviruses by Single-Domain Camelid Antibodies – Cell

Severe Covid-19 – NEJM

Diffuse Myocardial Inflammation in COVID-19 Associated Myocarditis Detected by Multiparametric Cardiac Magnetic Resonance Imaging – Cardiovascular Imaging

A spike with which to beat COVID-19? – Nature

Asymptomatic COVID-19: What the Neuroradiologist Needs to Know about Pulmonary Manifestations – American Journal of Neuroradiology

Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)

None today


Coping in Quarantine

The Journey To College In The Age Of COVID-19 – Forbes

COVID-19 has turned the world, and the journey to college, upside down. High school instruction is now online. Grades have moved to pass/fail in many districts. Standardized test administrations have been cancelled, extra-curricular activities put on hold, and summer plans suspended—not to mention that virtual proms aren’t exactly the stuff high school memories are made of.

We have a graduating High School student headed for college (maybe?) in the Fall. She’s a top notch athlete, straight-A student, and has a sense of adventure like her dad. There will be no big graduation ceremony, no prom, no parties… it’s a rough year to be a graduating senior. Shelby, may I suggest Baguetting? How about a DIY haircut?