August 24, 2020

On today's episode we discuss: —Climate: Physicians affiliated with the Icahn School of Medicine at Mount Sinai, Harvard School of Medicine, and Duke University Medical Center consider the downside of "pressurized research" in the context of previous healthcare crises and reflect on the shortcomings of poor research that have occurred during previous calamities, including the secondary pneumonias that followed trials of immunotherapies during the 1918 influenza epidemic and cases of Guillain–Barre syndrome following swine flu vaccination in 1976. The authors recognize the challenges to meet demands for effective therapies and vaccine development, however, they urge for caution and humility in research during the current pandemic to avoid such shortcomings. —Epidemiology: Researchers from the Brown University Department of Epidemiology and Department of Medicine examined data from the COVID-19 Data Repository at Johns Hopkins University to determine the relationship between United States state stay-at-home orders and SARS-CoV-2 doubling time in each state and found that stay-at-home mandates correlated with virus doubling times from 2.68 days prior to mitigation efforts to 15 days after. Additionally, states without stay-at-home orders saw an increase in doubling time of 34% whereas states with stay-at-home orders saw a increase of 72%. Although limited by surveillance data, these findings support that present efforts at social distancing help control COVID-19 spread within communities. A team of global health and computational biology experts from Stanford University discuss how artificial intelligence (AI) has contributed to racial disparities during the COVID-19 pandemic. —Management: A retrospective cohort study using Electronic Health Record (EHR) data from the Mayo Clinic Health System in Rochester, Minnesota found 246 COVID-19 positive patients had higher plasma fibrinogen levels and lower platelet counts than COVID-19 negative patients (n=13,666) at time of testing but as the infection progressed COVID-19 positive patients showed declining fibrinogen and increased platelet counts, while 31% (n=76/246) developed at least one clot diagnosis . Authors suggest that understanding the evolution and range of COVID-19 associated coagulopathy (CAC) may provide insight for advancement in thrombophylaxis therapy. —Adjusting Practice During COVID-19: Members of the Neuroscience Section at the University of Milan in Italy propose guidelines for care of patients with neuromuscular disorders (NMD) during the SARS-CoV-2 pandemic recommending outpatient care, minimizing immune-compromising medications and in-person interactions, and maintenance of regular follow-up by utilizing telehealth. Additionally, they suggest providers caring for NMD patients admitted to the hospital with SARS-CoV-2 consider which medications have NMD side effects and consult neurologists for all such patients., suggesting that these measures can optimize outcomes for this group at increased risk for severe disease course. —R&D: Diagnosis & Treatments: A meta-analysis of 40 studies conducted across 31 provinces in China of severe and critically-ill COVID-19 patients (n=5,872) found severe disease was associated with older age.