December 9, 2020

In today's episode we discuss: —Epidemiology: A systematic review of 39 articles (30 retrospective and 9 prospective) on venous thromboembolic events (VTE) in COVID-19 by a team of cardiologists and molecular biologists from the Central South University in Hunan, China found that D-dimer, fibrinogen, and APTT may be useful in predicting thromboembolic events in patients with severe COVID-19. —Understanding the Pathology: Physicians at the Icahn School of Medicine used enzyme-linked immunosorbent assay (ELISA) to screen patients (n=72,401) at Mount Sinai Health System for the SARS-CoV-2 spike protein antibody and found that 30,082 patients tested positive (titer 1:80 or higher) with quantitative microneutralization assay demonstrating that spike protein titer level positively correlated to neutralization titer (Spearman r: 0.87, p<0.000). A subgroup (n=121) had titers drawn at multiple timepoints (30, 82, and 148 days after symptom onset), and their ELISA titers still positively correlated with the neutralization titers after 148 days (r: 0.79; p=0.0001), suggesting that patients infected with SARS-CoV-2 form long lasting neutralizing antibodies and that understanding the kinetics of these antibodies could aid in the vaccine development. —Management: Infectious disease physicians at the Imperial College London reviewed publications about bacterial and fungal coinfection with human coronaviruses and found that in the nine studies, 62/806 patients (8%) experienced coinfections during hospital admission. Because most patients across all studies received broad spectrum antibiotics (1450/2010; 72%), authors suggest the seemingly low occurrence of coinfection may be attributable to empiric antibiotic use and recommend conducting prospective studies to inform antibiotic stewardship during the COVID-19 pandemic. · Members of the World Association of Perinatal Medicine propose consensus statements regarding SARS-CoV-2 infection in pregnant patients based on their review of the literature. They comment on diagnosis, screening in laboring patients, maternal and fetal complications, vertical transmission, delivery mode, breastfeeding, appropriate setting of care, and use of antiviral medications.