July 17, 2020

On today's episode we discuss: — Understanding the Pathology: · Highlights from a literature review conducted by a Japanese cardiologist: - SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) receptors for cellular invasion. - Renin-Angiotensin-Aldosterone System (RAAS) inhibitor drugs are not associated with a higher risk of mortality from COVID-19. - An increased number of ACE receptors found in male and diabetic subjects may contribute to an increased susceptibility to the SARS-CoV-2 virus. In conclusion, the author urges more research on ACE2 and SARS-CoV-2 infectivity and whether medications for cardiovascular disease may affect disease severity and mortality. — Transmission and Prevention: This survey conducted at 26 Detroit skilled nursing facilities (SNF) found that after two repeated point prevalence surveys (testing all healthcare workers regardless of symptoms), separated by a median time interval of 15 days (IQR=14-17 days), the percentage of positive test results for SARS-CoV-2 decreased from 35% (n=373/1063 residents, 26 SNF) to 18% (n=115/637 residents, 12 SNF). The findings suggest that repeated point prevalence surveys may reduce SARS-CoV-2 transmission rates by initiating infection prevention and control activities and the authors recommend frequent surveys of healthcare workers as testing availability increases. — Management: · A case series of 5 COVID-19-positive patients in Italy found neurological manifestations (namely polyradiculoneuritis and cranial polyneuritis), clinical neurophysiology indications (conduction block, absence of F waves, etc.), and albuminocytological dissociation (in 3/5 patients) suggestive of Guillain Barré syndrome (GBS). Intravenous immunoglobulin (IVIG) therapy at 0.4 g/kg for 5 days partially resolved neurological symptoms in 4/5 patients. These observations suggest that clinicians should be aware of neurologic signs similar to GBS in COVID-19 patients and may consider the use of clinical neurophysiology and IVIG therapy in the management of these patients — Adjusting Practice: A narrative review conducted by the Department of Emergency Medicine at Singapore General Hospital discusses how Singapore's largest hospital turned a multi-story car park (MSCP) into a flu screening area (FSA) during the COVID-19 pandemic. The authors label this FSA as a physical component of Singapore General Hospital's surge capability, highlighting its use as a means to confront the recent COVID-19 outbreak. This operation is yet another example of efforts to repurpose facilities to accommodate growing COVID-19 infection rates.