Report

Date, Article

Helpful Learning

Read July 2020

“COVID-19 and Imaging: Why CT Scans and X-Rays Are Not Recommended for Diagnosing Coronavirus”

See: https://blog.radiology.virginia.edu/covid-19-and-imaging

Arun Krishnaraj, MD, MPH, and Alan Matsumoto, MD. Last updated 4/6/2020.

April 3rd, 2020

Health care providers have tried to use chest CT scans or x-rays to find out if patients have COVID-19.  But current evidence suggests that CT scans and x-rays are NOT specific enough to either diagnose or rule out COVID-19.

Care providers have tried to use imaging tests to diagnose COVID-19 with CT scan or chest x-ray. While patients with COVID-19 can show abnormality on a chest x-ray or CT scan, many other lung problems can look similar. Additionally, the absence of an abnormality on either a chest x-ray or CT scan does not necessarily exclude COVID-19. Yet, a significant percentage of patients with COVID-19 have normal chest CTs or x-rays. For those patients, a normal imaging result could falsely convince them that they are healthy. If they believe they are healthy, they are at greater risk of spreading the virus to others.

Read July 2020

Here’s the Damage Coronavirus (COVID-19) Can Do to Your Lungs How the coronavirus causes acute respiratory distress syndrome

Cleveland Clinic 20 March 2020

Many people with COVID-19 have no symptoms or only mild symptoms, a subset of patients develop severe respiratory illness and may need intensive care.

Lung pathologist Sanjay Mukhopadhyay lays out in detail how the lungs are affected in these severe cases. The 15-minute video walks through how COVID-19 causes a “dangerous and potentially fatal” condition known as ARDS that underscore the severity of the damage that condition can cause to your lungs.

Dr. Mukhopadhyay explains, Chinese researchers have linked COVID-19 to ARDS. They examined risk factors for 191 confirmed coronavirus patients who died while being treated in two hospitals in Wuhan, China. The researchers found 50 of the 54 patients who died had developed ARDS while only nine of the 137 survivors had ARDS.  “It’s a really, really significant contribution to death in these patients,” says Dr. Mukhopadhyay.  If you have ARDS, you have symptoms like sudden breathlessness, rapid breathing, dizziness, rapid heart rate and excessive sweating.  Patients suffering from ARDS end up having damage to the walls of the air sacs in their lungs — the ones that help oxygen pass through into our red blood cells.

Read July 2020

From lung scarring to heart damage, COVID-19 may leave lingering marks

By Kara Manke| JULY 8, 2020

John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology in UC Berkeley-UCSF Joint Medical Program

See:

From lung scarring to heart damage, COVID-19 may leave lingering marks

A preventive medicine specialist receives Saccharin spray during contamination suit testing at the Coronavirus Surge Facility in Philadelphia. (Public Domain photo)

Virus may inflict long-lasting damage to lungs, heart and nervous system, and researchers are closely watching to see if kidneys, liver and gastrointestinal tract may face persistent damage. Some patients report symptoms that remain weeks after becoming infected, leading some to suspect the virus may spark conditions like chronic fatigue syndrome.

Doctors did not anticipate the virus seems to accelerate a great deal of scarring in the lungs. And if lung tissue is replaced with scar tissue, it is no longer functional as regular pulmonary tissue, which translates to poor gas exchange. What we really fear is long-term shortness of breath that could extend anywhere from being very mild to severely limiting. CT scans of asymptomatic people found they left with some scar tissue

Researchers who scanned the hearts and lungs of people who test positive for COVID-19, have seen telltale signs of distress.

Read August 2020

COVID-19 then and now: Six reasons why death rates are improving

Since the terrifying early days of the pandemic, more people are surviving

●        MOUNTAIN VIEW, CALIFORNIA – SEPTEMBER 18: Dr. Alan Chausow, a pulmonologist at El Camino Hospital in Mountain View, Calif., stands by an unused ventilator inside the CCU, Friday, Sept. 18, 2020. (Karl Mondon/Bay Area News Group)

New data reveals that while patients are still being rushed to intensive care units, a greater proportion are coming out alive. Since the pandemic began, the death rate for Californians fell 5.87% to 2.14%.

There are improvements in how we prepare and care for sickest patients, according to interviews with top medical experts.

six major reasons why the death rate is falling:

More testing, younger patients

Better preparation – Hospitals cite “four S’s” needed for effective ‘surge’ planning: staff, supplies, space and systems. Managing a patient on a ventilator is a labor-intensive and delicate task.

During a surge of cases, hospitals in California fell short on all four of these metrics, nearly hitting capacity. Some patients were intubated in emergency rooms instead of the intensive care units. Hospitals were forced to use older equipment, as well as doctors and nurses from outside hospitals who were less familiar with procedures and life-saving devices.

In the San Francisco Bay Area, hospitals were better prepared. And this planning has improved, over time.

Improved use of ventilators – Doctors now have a better understanding of how to manage breathing in severely ill patients, better fine-tuning ventilation, understanding optimal amount of oxygen, pressure and time between breaths, she said. We’ve learned to be very gentle on the lungs.

Other interventions – Clinicians are also more skilled at deploying other tactics including “proning,” caregivers gently roll a patient from their back onto their abdomen to help lungs to expand.

Read August 2020

Seven months later, what we know about Covid-19 — and the pressing questions that remain

By ANDREW JOSEPH @DrewQJoseph, HELEN BRANSWELL @HelenBranswell, and ELIZABETH COONEY @cooney_liz

AUGUST 17, 2020

Since scientists confirmed the rapidly spreading disease in Wuhan was caused by a new coronavirus and posted its genetic sequence on line, an extraordinary amount has been learned about the virus, SARS-CoV-2, the disease it causes, Covid-19, and how they affect us.

younger children and teenagers shouldn’t be lumped together – Teens seem to shed virus — emit it from their throats and nasal passages — at the same rates as adults. Kids under 5 have high levels of virus in their respiratory tracts, but not clear how much they spread it or why they don’t develop symptoms as often as adults do. A published report from a Georgia sleep-away camp shows virus can spread among kids. The camp had to be closed within 10 days of starting its orientation for camp staffers, because within days of children arriving, kids and staff started getting sick. The camp did not require campers to wear face masks.

A recent report on Covid infections in children from the Centers for Disease Control and Prevention showed that while they remain low, U.S. hospitalization rates for Covid-19 in children have risen since the pandemic started. And one in three children hospitalized with the disease ends up in intensive care. The highest rate of hospitalizations in children was among those under 2 years of age. Black and Latino children hospitalized at higher rates than white children. And like adults, children with other health conditions — obesity, chronic lung diseases, or infants who were born premature — are at higher risk than otherwise healthy children.

A small proportion of children infected with Covid-19 go on to develop a condition where multiple organs come under attack from their own immune system. Called multisystem inflammatory syndrome in children or MIS-C, this condition seems to occur about two to four weeks after Covid-19 infection. Most children who develop this syndrome recover.

Read in September 2020

Largest COVID-19 contact tracing study to date finds children key to spread, evidence of superspreaders

Morgan Kelly, Princeton Environmental Institute

The paper is the largest COVID-19 contact tracing study to date.

Sept. 30, 2020 10:40 a.m.

This Princeton-led study of 500,000 people in India who are exposed to novel coronavirus suggests that virus’ continued spread is driven by only a small percentage of those who become infected, known as superspreaders.

Children and young adults found to be potentially much more important to transmitting the virus — especially within households — than previous studies have identified. Researchers from Princeton Environmental Institute (PEI), Johns Hopkins University and the University of California, Berkeley, worked with public health officials in the southeast Indian states of Tamil Nadu and Andhra Pradesh to track the infection pathways and mortality rate of 575,071 individuals who were exposed to 84,965 confirmed cases of COVID-19, the disease caused by SARS-CoV-2. It is the largest contact tracing study — which is process of identifying people who came into contact with an infected person. Paper states “SARS-CoV-2 hinges on “superspreading,” in which a small percentage of the infected population passes the virus on to more people.” Researchers found 71% of infected individuals did not infect any of their contacts, while 8 % of infected individuals accounted for 60% of new infections. Study presents the largest empirical demonstration of superspreading that we are aware of in any infectious disease, as “Superspreading events” are the rule rather than the exception when one is looking at the spread of COVID-19, both in India and likely in all affected places.

Read in September 2020

U.S. Public Now Divided Over Whether To Get COVID-19 Vaccine

ALEC TYSON, COURTNEY JOHNSON AND CARY FUNK

National survey by Pew Research Center, conducted Sept. 8-13 among 10,093 U.S. adults, finds intent to get a COVID-19 vaccine has declined across all major political and demographic groups.

Efforts to develop and test COVID-19 vaccines spur debate around release of federally approved vaccine, Americans who say they would get vaccine has declined sharply since earlier this year. About half of U.S. adults now say they would definitely or probably get a vaccine if available today and 49% say they definitely or probably would not get vaccinated, falling from 72% in May. There are public concerns about the vaccine development process. On the heels of a pledge from nine pharmaceutical companies to ensure that a potential vaccine would meet rigorous standards, the Center survey finds three-quarters of Americans (77%) think it’s very or somewhat likely a COVID-19 vaccine will be approved in the United States before its safety fully understood.

Read in October 2020

Patients who had more severe COVID-19 may be the best donors for convalescent plasma therapy

Carly Kempler

Oct. 22, 2020

JHU researchers believe that studying Sex, age, and severity of disease may be useful in identifying COVID-19 survivors who are likely to have high levels of antibodies that can protect against disease, according to  new study co-led by researchers at JHU Bloomberg School of Public Health. Findings suggest older males who have recovered from COVID-19 after having been hospitalized are strong candidates for donating plasma for treating COVID-19 patients. Doctors using infusions of plasma—part of blood that contains antibodies—from recovered COVID-19 patients to treat other patients and possible prophylaxis for prevention. Doctors use convalescent plasma to treat patients or immunize persons at high risk of virus exposure during outbreaks of measles, mumps, polio, Ebola, and even 1918 pandemic flu.

Clinical trials of convalescent plasma treatment against COVID-19 are ongoing, and doctors until now haven’t had guidance for selecting COVID-19 survivors who are likeliest to have strong antibody responses.

Read in October 2020

Johns Hopkins launches center for COVID-19 immunity research

Carly Kempler Published Oct 28

 part of an emergency $300 million NIH initiative to understand the causes of severe COVID-19 and develop an effective vaccination program

Johns Hopkins Bloomberg School of Public Health and JHU School of Medicine awarded a major grant from the National Cancer Institute, part of the National Institutes of Health, to set up a center for research on human serological immune response to SARS-CoV-2 that causes COVID-19.

The five-year grant will provide funding of more than $2 million per year to support studies—commencing immediately—of the immune elements that determine whether people get mild or severe COVID-19 illness following exposure to the virus. A better understanding of these immunological underpinnings of COVID-19 is expected to lead to effective treatments and vaccines.

The project, Johns Hopkins Excellence in Pathogenesis and Immunity Center for SARS-CoV-2, or JH-EPICS, will be jointly led by Sabra Klein, professor of Molecular Microbiology and Immunology at the Bloomberg School, and Andrea Cox, professor of Medicine at Johns Hopkins Medicine. Center’s goal is to combine expertise in immunology, virology, and biostatistics to map out complexity of immune response as it develops after infection—and to understand why that response can differ so greatly depending on age, gender, race, comorbidities such as obesity, and other factors. Klein has expertise in antibody immunity, while Cox’s research has focused on T-cell-mediated immunity and older “innate immunity” provided by other cells and molecules.

Screening the healthy population for covid-19 is of unknown value, but is being introduced nationwide

BMJ Online

November 9, 2020

 UK’s Operation Moonshot will conduct regular screenings of households, cities, and the entire UK population for SARS-CoV-2, at a reported cost of over £100 billion. People on blog assert this is “most unethical proposals for use of public funds, or for screening.”  UK National Screening Committee (NSC) had played no part in the decision-making process, and legality of  procurement processes have been questioned. 

UK government had abandoned plans for Operation Moonshot. Yet, on Tuesday 3 November it was reported Moonshot Phase 1 began in Liverpool. According to City Council’s website “everyone who lives or works in the city” is eligible for regular and repeat testing from 6 November by attending one of 14 army-run test over the course of two weeks. [3] The website says this is the beginning of national roll out and “will help to demonstrate that massive asymptomatic testing can identify far more cases and break the transmission of coronavirus.” Army testing 11 t-18 year-olds in schools.

Covid stress taking a toll on children’s mental health, CDC finds

The findings “highlight the importance of continued monitoring of children’s mental health throughout the pandemic.”

Nov. 12, 2020, 12:13 PM

By Daniel Arkin

Disruptions to daily life during pandemic, anxiety about Covid and social isolation take toll on mental health, per CDC. From March to October, emergency room visits related to children’s mental health rose for school-aged children and adolescents compared to previous year. The findings provide insight into children’s mental health in context of pandemic and highlight importance monitoring children throughout pandemic, ensuring access to care during public health crises, and improving healthy coping strategies and resiliency among children. CDC studied data from national emergency room database from January to Oct. and compared to data during 2019. Losing milestones like graduations, birthday parties, athletics felt deeply. From March to October, emergency visits related to mental health increased 24% for children aged 5-11 and spiked 31% for adolescents (adolescents made up highest% mental health visits in 2019 and 2020.