August 3, 2020

CLIMATE: · This review, composed of a literature review and anecdotes from the authors' students, highlights that the fact that a greater percentage of African Americans have succumbed to COVID-19 than other racial and ethnic groups, and discusses economic and social challenges faced by the Black community during the pandemic. The authors advocate for further analysis now and post-pandemic to determine the impact of structural racism and identify strategies to mitigate these disparities (including access to care, improving the education system, and voting rights). EPIDEMIOLOGY: · A case report and case series of COVID-19 patients who had concomitant co-infection with Dengue and Tuberculosis highlight the need to avoid both availability bias and premature closure when diagnosing respiratory disease during the pandemic. This will be especially crucial as cold/flu season approaches. ADJUSTING PRACTICE: · A group of pulmonologists discuss the effects of COVID-19 on patient care and propose recommendations to restructure clinical practices and workflow in order to avoid delays in patient care and decrease transmission during the pandemic. They recommend the following structural changes before, during, and after clinic visits: o Before the visit - Implement systems for telephone screening for COVID symptoms and triaging by acuity. - Allow “high-risk” staff to work virtually. - Asymptomatic testing for all patients prior to any potentially aerosolizing procedure. o During the visit: - Ensure staff have adequate PPE. - Stagger clinic appointments to avoid crowding of lobby and waiting room. - Disinfect all rooms and equipment between patients. o After the visit: - Transition to virtual appointments if possible. - Develop a robust system for follow-up and continuity of care R&D DIAGNOSIS AND TREATMENT: · Emergency physicians from multiple California medical centers present a framework for point-of-care ultrasound (POCUS) integration into the clinical management of COVID-19 patients. These include utilizing POCUS to improve diagnosis, prognosis, and evaluation of cardiopulmonary complications. The authors stress the need for more research studies on COVID-19 that "progress beyond diagnostic accuracy" and begin to incorporate more patient-centered outcomes. Examples include performing serial POCUS exams to monitor clinical progression of cardiac dysfunction, the development of pulmonary edema, and distinguishing between the H-type (high elastance, low compliance) phenotype seen earlier in disease and the L-type (low elastance, high compliance) form of ARDS seen later in the disease.