August 12, 2020

On today's episode we discuss: — Epidemiology: A comparison of outcomes among COVID-19 patients with (n=21) and without (n=236) chronic hepatitis B virus (HBV) infection found that a similar proportion of patients in both groups progressed to severe disease and exhibited at least one transaminase elevation, suggesting that chronic HBV infection does not appear to affect COVID-19 outcomes. · A systematic review and meta-analysis including 5829 COVID-19 pediatric patients found that in general, nonspecific symptoms such as fever and cough were very common in these patients as were normal white blood cell counts. Additionally, among children younger than 1 year, there was a relatively high incidence of vomiting (33%) as well as critical illness (14%). — Understanding the Pathology: A genomic analysis using samples from 18 COVID-19 patients with no comorbidities (10 mild, 8 severe) found genome deletions near the Spike S1 and S2 cleavage sites in all of the mild cases and half of the severe cases. The authors propose that these deletions may result in free S1 protein which could compete with viral particles or act as a decoy to weaken the disease and modulate the virus’s virulence. — Management: Seven critically ill patients diagnosed with COVID-19 underwent successful treatment consisting of early noninvasive-invasive sequential ventilation, prone positioning, and pharmacotherapy consisting of antivirals, anti-inflammatory drugs, immune-enhancing medications, and complication prophylaxis agents. All 7 patients were extubated following a median ICU stay of 12.9 days and discharged home, suggesting that this protocol may contribute to successful outcomes in critically ill patients with COVID-19. — Adjusting Practice During COVID-19: The Irish College of General Practitioners discuss a remote care model they developed to facilitate patient access to opioid agonist treatment in Ireland during the pandemic and enable continued care for this vulnerable population while mitigating exposure and transmission of the virus. — R&D: Diagnosis & Treatments: A case-control study at Johns Hopkins evaluated the clinical validity of serum antibodies to SARS-CoV-2 in 11,066 patients by using IgG/IgA assays. 60 patients tested positive for COVID-19 and shortly after an infection developed IgG that was sustained for up to 58 days. Furthermore, for every 2-fold increase in IgG, there was a 62% increase in the predicted odds of developing acute respiratory distress syndrome.