Lung transplantation as therapeutic option in acute respiratory distress syndrome for COVID-19-related pulmonary fibrosis
The authors present a case series of 3 post-COVID-19 patients who underwent urgent lung transplantation as a result of end-stage pulmonary fibrosis. The patients all had COVID-19 for over 1 month and extremely high sequential organ failure assessment (SOFA) scores. 2 of the 3 survived following transplantation, and their transplant course is described.
Yellow - The case series demonstrates that lung transplantation (LT) can be successfully performed in patients with end-stage respiratory failure caused by COVID-19 related pulmonary fibrosis, but the small sample size (n=3) limits the study’s validity and impact.
Loss of smell and taste possibly linked to COVID-19
Anecdotal evidence suggests that loss of smell and/or taste could be an early symptom of COVID-19 infection, even without other symptoms. Though no peer-reviewed studies have yet been released, British and American ENT associations recommend that anyone experiencing these symptoms self-quarantine for seven days and that any health care provider with such patients use personal protective equipment (PPE).
1. Roni Caryn Robin, New York Times. 2. Erin Brodwin, STAT News. 3. Billy Perrigo, TIME. 4. Emily Kwong, Allison Aubrey, and Maria Godoy, NPR. 5. American Academy of Otolaryngology - Head and Neck Surgery
1. New York Times. 2. STAT News. 3...
Prisons and Jails Respond to COVID-19 Popular Press Summary
Growing concerns over the risk of COVID-19 spreading through prisons and jails have prompted state, federal and local policy measures to reduce transmission by halting new arrests in specific cases or releasing some prisoners. However, there are concerns that the current response is not unified or equitable, and that incarcerated populations remain vulnerable to exposure.
1. Jimmy Jenkins, NPR. 2. Katie Benner, New York Times. 3. Eli Hager, Marshall Project. 4. James Hill and Luke Barr, abc News. 5. Prison Policy Initiative
1. NPR. 2. New York Times. 3. Mars...
Mitigating Risk of COVID-19 in Dialysis Facilities
Given that patients receiving dialysis treatment are at high risk for severe illness and death from COVID-19, special precautions should be taken to decrease the likelihood of transmission in dialysis centers. The American Society of Nephrology (ASN) partnered with the CDC to produce specific guidelines for dialysis centers.
Yellow - This paper was published in a reputable journal based on joint advice from the CDC and the ASN.
Corticosteroid treatment and 2019-nCoV lung injury
The acute lung injury and respiratory distress syndrome seen in patients with COVID-19 is likely partly caused by the immune system as it attacks both virus and healthy tissue. Therefore, corticosteroid treatment could theoretically assist in suppressing lung inflammation. Data on corticosteroid use in other viral pneumonias (RSV, influenza, SARS-CoV, and MERS-CoV) suggest that their use can increase mortality, impair viral clearance, and result in secondary complications. However, studies thus far have been primarily observational, and some have contradictory results, suggesting corticosteroids can reduce mortality and shorten hospital stays in patients with SARS and H1N1 influenza. Ultimately, thorough clinical trials must be done to determine whether even this use is efficacious.
Russell et al: Yellow – The letter was published in the Lancet as a high-level review of many studies. However, the evidence is primarily observational, mostly without controls, and un-randomized.
Shang et al: Yellow – The letter was published in the Lancet and summarizes the Chinese Thoracic Society expert consensus statement. However, the evidence is primarily observational, mostly without controls, and un-randomized.
Zhou et al: Red – The letter was published in a peer-reviewed Nature Group Journal, but the comparisons due to small sample size and lack of a control group.
Myths in Africa and Asia and COVID-19 Popular Press Summary
One of the greatest threats to vulnerable populations during this pandemic is lack of access to accurate information about COVID-19. The WHO has called this phenomenon an “infodemic.” Myths could endanger people with less access to technology and information, particularly in certain regions within Africa and Asia, where — despite a WHO advisory on myths about COVID-19 — influential figures and local beliefs may pose an elevated risk.
1. Amber Milne, Thomas Reuters Foundation. 2. Edward Lempinen, Berkeley News. 3. BBC News Reality Check Team, BBC News. 4. World Health Organization
1. Thomas Reuters Foundation. 2. B...
Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19
This special report discussed the uncertain concern that using RAAS inhibitors can have deleterious effects on COVID-19 patients given that ACE2 functions as the receptor of the virus. The authors proposed an alternative hypothesis that ACE2 may be beneficial rather than harmful in patients with lung injury, and warned that withdrawal of RAAS inhibitors in certain high-risk patients with suspected or known COVID-19 may be harmful.
Yellow - A thorough review of the physiology and rationale for Angiotensin-converting enzyme inhibitors (ACEi) use in COVID patients and published in the reputable NEJM. However, one cannot put too much stake in a clinical recommendation not based on clinical evidence
Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation
This study reports the structure of the 2019-nCoV spike (S) protein, which is necessary for viral entry into a host cell. The structure is highly similar to the SARS-CoV S protein and has higher affinity to angiotensin-converting enzyme 2 (ACE2). Importantly, 2019-nCoV S does not interact with previously tested antibodies against the SARS-CoV receptor-binding domain. More work is needed to improve targeting of 2019-nCoV S and this structure provides a good starting point for rational design of antigens and drugs.
Green – a thorough protein structural analysis of SARS-CoV-2 S protein, helpful to design antigens to develop new vaccines and antibodies against the virus
Nicole A. Perry-Hauser, PhD, edited by Andreacarola Urso and Andrew Ressler
Biopharmaceutical companies, backed by funding from The Gates Foundation and the NIH, are beginning human trials for a COVID-19 vaccine. Following Moderna Therapeutics’ first vaccine, which began human trials mid-March, the second vaccine created by Inovio Pharmaceuticals also began trials on April 6. Meanwhile, mass antibody testing assays are also being examined and distributed in the U.S. to understand the immunity of recovered cases.
1. Darrell Etherington, TechCrunch. 2. Knvul Sheikh and Katie Thomas, New York Times. 3. Apoorva Mandavilli and Katie Thomas, New York Times. 4. Denise Grady, New York Times.
1. TechCrunch. 2. New York Times....
Compassionate Use of Remdesivir for Patients with Severe Covid-19
This nonrandomized study describes the effect of compassionate use of a 10-day remdesivir course in COVID-19 patients with severe respiratory distress. Reduction in oxygen support occured in 68% of patients, and the mortality rate was 13%. The lack of a control arm limits how to interpret these findings. Additionally, 23% of patients reported serious events, such as multiple-organ dysfunction syndrome and septic shock.
Yellow - A well-known study published in NEJM with some of the first positive results for treating COVID-19, but the study is limited in its validity and generalizability.