August 25, 2020

On today's episode we discuss: —Epidemiology: Australian systematic review and meta-analysis further confirm that patients with chronic disease are at higher risk for worse outcomes with COVID-19. The most common comorbidities were hypertension (22%), diabetes (14%), and cardiovascular diseases (13%). Crude case fatality rate (CFR) was 7% overall but increased significantly with an increasing number of comorbidities. —Understanding the Pathology: A retrospective cross-sectional study by Chest Diseases specialists in Turkey enrolled 123 adult COVID-19 pneumonia patients with pulmonary infiltrates on CT chest (34 mild, 89 severe), comparing 91 BCG-vaccinated and 32 unvaccinated patients and found increased age (p<0.001) and low income (p<0.001) to be predictors for severe pneumonia, whereas BCG vaccination was not found to be associated with severe COVID-19 pneumonia. —Management: A prospective study, conducted by fungal experts from the Center of Expertise in Mycology in the Netherlands, of 108 mechanically ventilated COVID-19 patients with ARDS to assess for the prevalence of pulmonary aspergillosis found a 27.7% incidence of COVID-19 associated pulmonary aspergillosis (CAPA), with a 25% lower survival rate among this population than in the non-CAPA patients (19% vs 44%). A correlation between bronchoalveolar lavage (BAL) Galactomannan-index (GM) and odds of death was observed, justified by lower mortality, and reduced GM-index in 11/19 CAPA patients receiving voriconazole and indicated the importance of early identification of clinical and host risk factors for CAPA in critically-ill COVID-19 patients. —Adjusting Practice During COVID-19: Cardiologists conducted a prospective cohort study at two referral centers (n=1,372 heart failure [HF] patients) in London, England from January 7th, 2020 to June 14th, 2020 and found HF hospitalizations decreased during the COVID-19 pandemic as compared to 2019 (p<0.001) but in-hospital HF mortality significantly increased (p=0.015) and hospitalization for HF in 2020 was independently associated with worse outcomes (hazard ratio: 2.25, p=0.002). Authors suggest patients hospitalized for HF may be at higher risk for adverse outcomes during the COVID-19 pandemic and further investigation of prognosis predictors is needed to inform on management within this population. —R&D: Diagnosis & Treatments: A retrospective observational study conducted at Third Hospital in Wuhan, China involving 191 COVID-19 patients and 50 healthy controls investigated the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) discrepancies among the infected patients and controls. —Mental Health & Resilience Needs: A survey study conducted by special education and child development experts from California and Oregon interviewed 77 primarily Hispanic parents of children aged 3-5 who have intellectual and developmental disabilities (IDD) to determine the impact of and challenges that the COVID-19 pandemic has brought upon their families.