Tulane Outbreak Daily | May 5, 2020

Featured Headlines

15 Children Are Hospitalized With Mysterious Illness Possibly Tied to Covid-19 – New York Times

The health authorities in New York City issued an alert saying that the children had a syndrome that doctors do not yet fully understand.


The FLARE team discusses the need to use low tidal volume ventilation in COVID-19 patients.

  1. Low tidal volume ventilation is a cornerstone of therapy for ARDS and has a well-demonstrated mortality benefit.
  2. Low tidal volume ventilation has also been associated with improved outcomes in non-ARDS patients.
  3. Implementation of low tidal volume ventilation has costs in the form of increased sedation and even paralysis. These costs must be balanced against the benefits of achieving low tidal volume ventilation in a particular patient.
  4. Given demonstrated benefits of low tidal volume ventilation in both ARDS and non-ARDS respiratory failure, it should not be assumed that protocolized use of higher tidal volumes, as has been advocated, is ever without harm.

The groundbreaking way to search lungs for signs of Covid-19 – BBC

The algorithm in question, developed by Axial AI, analyses CT imagery in seconds. It declares, for example, whether a patient has a high risk of viral pneumonia from coronavirus or not. A consortium of firms developed the AI in response to the coronavirus outbreak. They say it can show whether a patient’s lungs have improved or worsened over time, when more CT scans are done for comparison. [Related article with video on the technology]

COVID-19 deaths deemed likely to climb even as states reopen – CIDRAP

Over the weekend and through today, dozens of states reopened parts of their economy, many with extensive social distancing measures in place. But new leaked documents from the White House show that the US daily death toll from COVID-19 will likely climb throughout the month of May, reaching 3,000 deaths per day by Jun 1.

Why the Coronavirus Is So Confusing – The Atlantic

A guide to making sense of a problem that is now too big for any one person to fully comprehend

More than 50 dead as coronavirus ravages Massachusetts nursing home – Washington Post

In the past four weeks, 54 residents at a nursing home in Massachusetts have died after contracting the novel coronavirus and more than 100 others have tested positive as the number of elder-care facilities reporting cases of the deadly virus continues to rise nationwide.

The Grim Post-COVID-19 Future For Nursing Homes – Forbes

The deaths of more than 16,000 of their residents from COVID-19 has profoundly disrupted senior living facilities—especially nursing homes— and will drive historic change in the industry. Robert Kramer, president of the consulting firm Nexus Insights and a long-time observer of nursing home finances, told me, “There never will come a time when we will return to the old normal.”

More than ‘covid toes’: Numerous reports of skin rashes tied to COVID-19 – LiveScience

Numerous reports of skin rashes in patients with COVID-19 are cropping up around the world. The rashes can take many forms — some appear as tiny red spots, while others appear as larger flat or raised lesions. Some have a hive-like appearance, while others look like frostbitten toes.

U.K. Report Backs Stroke as COVID-19 Complication – Medical Page Today

Acute ischemic strokes were seen in six British COVID-19 patients, including two who had breakthrough strokes despite therapeutic anticoagulation, researchers reported. [Related Study]

Why You Shouldn’t Treat COVID-19 ARDS Like HAPE – Medical Page Today

Don’t treat COVID-19 acute respiratory distress syndrome (ARDS) as if it were high altitude pulmonary edema (HAPE), you might kill your patient. [Related Study]

Coronavirus SARS-CoV-2 Infects Cells of the Intestine and Multiplies There – Sci Tech Daily

Researchers from the Hubrecht Institute in Utrecht, Erasmus MC University Medical Center Rotterdam, and Maastricht University in the Netherlands have found that the coronavirus SARS-CoV-2, which causes COVID-19, can infect cells of the intestine and multiply there. Using state-of-the-art cell culture models of the human intestine, the researchers have successfully propagated the virus in vitro, and monitored the response of the cells to the virus, providing a new cell culture model for the study of COVID-19. These findings could explain the observation that approximately one third of COVID-19 patients experience gastrointestinal symptoms such as diarrhea, and the fact that the virus often can be detected in stool samples. The results of this study were published in the scientific journal Science on the 1st of May 2020. [Related Study]

AHA guidance directs resuscitation in kids amid COVID-19 – CIDRAP

Guidance from the American Heart Association (AHA) and other groups on resuscitating newborns and children with COVID-19 was published today in Pediatrics to bridge the gap between current practice and the need for healthcare workers to protect themselves amid worldwide shortages of personal protective equipment (PPE) during the pandemic. [Interim Guidance Document]

Coronavirus by air: The spread of Covid-19 in the Middle East – BBC

An investigation by BBC News Arabic has analysed flight tracking data and open source footage which shows how Iran’s largest airline – Mahan Air – continued to fly while government flight bans were in place, and contributed to the spread of Covid-19 in the Middle East.

Editor’s note: Regarding the case counts below, please consider due to limited testing capabilities in some locations, the real number of cases could be considerably higher.

Official Reporting for May 5, 2020

WHO SITREP #105 ECDC | Country Data Johns Hopkins
Confirmed Cases 3,435,894 3,544,222 3,618,325
Deaths 238,628 250,977 253,381


Total cases: 1,152,372
Total deaths: 67,456
(Numbers close out at 4 p.m. the day before reporting.)

Surveillance Headlines


Michigan: Reports 196 New Coronavirus Cases, 86 COVID-19 Deaths – Local news

Texas: 70% of Texas prisoners tested have the coronavirus. . – Texas Tribune


Spain: Coronavirus Map and Case Count – NYT

France: First known case ‘was in December’ – BBC

UK: UK coronavirus death toll surpasses Italy to become the highest in Europe – NBC





Science and Tech

[Editorial] Randomized Clinical Trials and COVID-19Managing Expectations – JAMA

espite the millions of cases and hundreds of thousands of deaths that have occurred in this devastating coronavirus disease 2019 (COVID-19) pandemic, no peer-reviewed studies of specific therapies proven to be effective in reducing mortality have been published and a vaccine is many months to years away.


The race towards a coronavirus vaccine: What’s the latest? – DW

Vaccine developers are pursuing a number of different approaches: inactivated vaccines, live vaccines and DNA vaccines. What’s the difference between them? And when will one finally be ready?

Pfizer Begins Human Trials of Possible Coronavirus Vaccine – NYT

The drug company, along with a German partner, is running tests in healthy volunteers. It’s one of several companies on an accelerated timetable to try to find a safe, effective vaccine.


Study Sheds New Light on Remdesivir’s Mechanism of Action against SARS-CoV-2 – Science

A team of researchers from China reports the structure of the antiviral drug remdesivir bound to both a molecule of RNA and to the SARS-CoV-2 viral polymerase. The study illuminates the mechanism that remdesivir uses to interrupt RNA replication and shut down viral reproduction — and may inform efforts to develop new and more potent therapies that employ a similar mechanism. [Related Study]


This Drug May Cause Birth Defects. Japan’s Pushing It for Coronavirus. – NYT

Prime Minister Shinzo Abe is urging the world to fight the epidemic using a Japanese-made medication, though there is little evidence that it works.


What COVID-19 Antibody Tests Can and Cannot Tell Us – Scientific American

Assays that detect prior novel coronavirus infections could reveal the extent of outbreaks. But they may give individuals false security

Published Research

Characteristics of ischaemic stroke associated with COVID-19 – BMJ

SARS-CoV-2 productively infects human gut enterocytes – Science

Effect of non-pharmaceutical interventions to contain COVID-19 in China – Nature

Platelets in Coronavirus Disease 2019 – Thieme

Anticoagulation in COVID-19 – European Heart Journal

ST-Elevation Myocardial Infarction in Patients with COVID-19: Clinical and Angiographic Outcomes – American Heart Assn

Impaired interferon signature in severe COVID-19 – Nature

Advanced Pulmonary and Cardiac Support of COVID-19 Patients – American Heart Assn

Clinical characteristics and radiological features of children infected with the 2019 novel Q6 coronavirus – Clinical Radiology

Imaging findings of critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia: a case series – Hong Kong Medical Journal

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

Preventing cytokine storm syndrome in COVID-19 using alpha-1 adrenergic receptor antagonists

Supply Chain Impact

Tyson expects to keep slowing meat production as coronavirus sickens workers and tanks income – NBC

The meat producer warned of continued “slowdowns and temporary idling” of plants during the coronavirus pandemic.

COVID-19 Is Causing Food Shortages. Here’s How to Manage – Healthline

The COVID-19 outbreak has caused some notable shifts in how we approach food, from what we consume and where we consume it to how it’s being produced and made available to us. Certainly in the United States, the pandemic has played a major role in reshaping our interactions with food.

Infection Prevention



Coping in Quarantine

You’re Stronger Than Your Quarantine Fatigue – NYT

Exhaustion and waning discipline surrounding the restrictions to daily life needed to prevent the spread of the coronavirus — is entirely understandable.

The evolution of home fitness – BBC

Covid-19 has forced us to exercise indoors. But home fitness has been shaping our lives for decades. [Related horrible 80’s workout video]