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From the New England Journal of Medicine
A randomized trial of hydroxychloroquine as postexposure prophylaxis for COVID-19: “After high-risk or moderate-risk exposure to COVID-19, hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMoa2016638
Remdesivir for 5 or 10 days in patients with severe COVID-19: “In patients with severe COVID-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMoa2015301
Swabs collected by patients or health care workers for SARS-CoV-2 testing: “Our study shows the clinical usefulness of tongue, nasal, or mid-turbinate samples collected by patients as compared with nasopharyngeal samples collected by health care workers for the diagnosis of COVID-19. Adoption of techniques for sampling by patients can reduce [personal protective equipment] use and provide a more comfortable patient experience. Our analysis was cross-sectional, performed in a single geographic region, and limited to single comparisons with the results of nasopharyngeal sampling, which is not a perfect standard test. Despite these limitations, we think that patient collection of samples for SARS-CoV-2 testing from sites other than the nasopharynx is a useful approach during the COVID-19 pandemic.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMc2016321
From JAMA
Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial: “In this randomized clinical trial that included 103 patients and was terminated early, the hazard ratio for time to clinical improvement within 28 days in the convalescent plasma group vs the standard treatment group was 1.40 and was not statistically significant. Meaning: Among patients with severe or life-threatening COVID-19, convalescent plasma therapy added to standard treatment did not significantly improve the time to clinical improvement within 28 days, although the trial was terminated early and may have been underpowered to detect a clinically important difference.” OPEN ACCESS at https://jamanetwork.com/journals/jama/fullarticle/2766943
Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York: “In this case series of 50 children and adolescents hospitalized with COVID-19 infection, respiratory symptoms, while common, were not always present. Children hospitalized with COVID-19 commonly had comorbidities, infants had less severe disease, those with obesity were likely to receive mechanical ventilation, and elevated markers of inflammation at admission and during hospitalization were associated with severe disease. Meaning: Expanded testing, maintaining a high suspicion for severe acute respiratory syndrome coronavirus 2 infection given the variable presentation of COVID-19, risk stratification, and recognition of findings suggestive of immune dysregulation are crucial to effective COVID-19 management in children.” OPEN ACCESS at https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766920
Airborne spread of SARS-CoV-2 and a potential role for air disinfection: “Given the ongoing risks of SARS-CoV-2 infection among health care workers, some hospitals are considering deployment of commercially available upper-room GUV air disinfection, although no published studies have demonstrated efficacy and GUV systems are not currently recommended in the infection prevention guidelines from the CDC [Centers for Disease Control and Prevention] or the World Health Organization. Upper-room GUV [germicidal UV] systems must be installed and maintained following evidence-based guidelines. Priority areas for air disinfection might be waiting rooms, emergency departments, intensive care units, bronchoscopy and endoscopy rooms, and other sites where aerosol is generated. COVID-19 will not likely be the last pandemic. Management of the current crisis and preparation for future respiratory viral pathogens should include consideration of the use of upper-room GUV to help mitigate airborne transmission.” OPEN ACCESS at https://jamanetwork.com/journals/jama/fullarticle/2766821
Venous thrombosis among critically ill patients with coronavirus disease 2019 (COVID-19): “Mortality of patients with COVID-19 admitted to ICUs has been reported to be high, at 50%. Frequent venous and arterial thrombotic events have been reported, with rates from 27% to 69% of peripheral venous thromboembolism and up to 23% of pulmonary embolism. The main limitations of this study were its monocentric nature and the relatively small size of our cohort. In view of the high rate (ie, 79%) of deep vein thrombosis reported in this study, prognosis might be improved with early detection and a prompt start of anticoagulant therapy. Despite anticoagulant prophylaxis, 15% of our patients developed deep vein thrombosis only 2 days after ICU admission. Systematic anticoagulant therapy for all ICU patients with COVID-19 should be assessed.” OPEN ACCESS at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766543
From The BMJ
Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study: “The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m2094
Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series: “Patients admitted to hospital with COVID-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m1996
From The Lancet
The impact of ethnicity on clinical outcomes in COVID-19: A systematic review: “Data on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggest BAME [black, Asian, and minority ethnic] individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance.” OPEN ACCESS at https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30148-6/fulltext
Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study: “The characteristics of SARS-CoV-2 mean that extreme measures are probably required to bring the epidemic under control and to prevent very large numbers of deaths and an excess of demand on hospital beds, especially those in ICUs.” OPEN ACCESS at https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30133-X/fulltext
Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis: “Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m; protection was increased as distance was lengthened. Face mask use could result in a large reduction in risk of infection (low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar. Eye protection also was associated with less infection.” OPEN ACCESS at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
From the MJA
Live streamed ward rounds – a tool for clinical teaching during the COVID-19 pandemic: “We have trialled live-streamed rounds at John Hunter Hospital (NSW) in obstetrics and gynaecology with great success. This teaching strategy can be applied to all areas of medicine and many clinical scenarios, including ward rounds and clinical handover rounds in areas of acute medical care. This strategy is one of the many that the [University of Newcastle] plans to utilise to provide ongoing clinical teaching during the COVID-19 pandemic. Being adaptable and flexible, cognisant of costs, and driven by evidence are critical features of delivering medical education and contemporary medical practice.” OPEN ACCESS at https://www.mja.com.au/journal/2020/live-streamed-ward-rounds-tool-clinical-teaching-during-covid-19-pandemic
Pandemic printing: Evaluation of a novel 3D printed swab for detection of SARS-CoV-2: “3D-printed swabs were non-inferior to two commercially available swabs when recovering SARS-CoV-2 in vitro. 3D-printed swabs were able to capture the same quantity of human cellular material in a clinical validation study. The implications: Our work provides evidence supporting the use of 3D-printed swabs for the diagnosis of SARS-CoV-2.” OPEN ACCESS at https://www.mja.com.au/journal/2020/pandemic-printing-evaluation-novel-3d-printed-swab-detection-sars-cov-2
At the time of the pandemic cancer survivors are getting lost in transition: “Monitoring morbidity and mortality data now and over forthcoming months will shed the light on whether follow-up of cancer survivors makes much difference. We have opportunities for global data collection where outcomes can be compared across different health care settings. Population based data from the global financial crisis of 2008 had shown that economic downturn closely correlated with mortality for curable cancers presumably due to lack of uptake of treatment. To date, there is little knowledge as to impact of such major disruptions on the outcomes of cancer survivors. At this unprecedented time, as we all experience the feelings so familiar to cancer survivors – the fear for the future and the lack of control – let’s channel these feeling to address some of the most pressing challenges of survivorship care so no person with cancer is ever lost in transition.” OPEN ACCESS at https://www.mja.com.au/journal/2020/time-pandemic-cancer-survivors-are-getting-lost-transition
Telehealth in cancer during COVID-19 pandemic: “This letter outlines the uptake of telehealth in cancer services across health institutions in Victoria and Tasmania during the COVID-19 pandemic from a survey of clinical directors and heads of units through the Victorian COVID-19 Cancer Network in early April 2020. The network was established in late March as a collaborative initiative between the Victorian Comprehensive Cancer Centre (VCCC) and Monash Partners Comprehensive Cancer Consortium (MPCCC). We aim to highlight the key challenges facing clinicians, patients and health services in the use of telehealth in Victoria and believe that this can help inform both government and health services to address these barriers as appropriate during and beyond the pandemic.” OPEN ACCESS at https://www.mja.com.au/journal/2020/telehealth-cancer-during-covid-19-pandemic
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