September 1, 2020

On today's episode we discuss: —Epidemiology: Investigators affiliated with the Laboratorio de Investigacao Medica em Envelhecimento at Universidade de Sao Paulo performed a longitudinal, observational study on 707 COVID-19 patients admitted to a tertiary university hospital in Sao Paulo, Brazil and found that 33% (n=234) of patients had descriptors of delirium (confusional state, disorientation, hallucinations, etc;). Additionally, delirium was independently associated with length of hospital stay, ICU admission, and in-hospital deaths in adults older than the age of 50. Based on these findings, the authors suggest that healthcare workers should assess for delirium among COVID-19 patients, which may help monitor the severity and prognosis of these patients. —Transmission & Prevention: Authors affiliated with several institutions in China performed a cross-sectional study on the daily COVID-19 cases, air quality, and meteorological factors in 33 locations in China. Among their findings, the authors note an association between relative risk of COVID-19 spread and air quality index (AQI) that was greater between 10 degrees Celsius and 20 degrees Celsius and a possibly stronger AQI impact on confirmed COVID-19 cases between the range of 10% to 20% relative humidity, respectively, suggesting that AQI may play a role in COVID-19 transmission in both low temperatures and low humidity, although further investigation is needed. —Management: A literature review was conducted by pharmacists from Yale, Cleveland Clinic, and University of Pittsburgh regarding alternative drugs for managing analgesia, sedation, and paralysis in COVID-19 patients requiring mechanical ventilation in the event of drug shortages, as detailed in the summary section below. These conservative and alternative management strategies for mechanically ventilated ICU patients can ensure sustainability of optimum critical care in the near future as the COVID-19 pandemic wears on. —R&D: Diagnosis & Treatments:A case-control validation study including 50 SARS-CoV-2 positive specimens and 300 SARS-CoV-2 negative specimens combined into various sized pooled samples was conducted in South Korea by physicians and infectious disease researchers, and found that less than or equal to 6 specimens was the ideal specimen number for a pooled testing strategy to avoid decreasing sensitivity. Limitations of the study were as follows: the cutoff cycle threshold (Ct) number in the PCR kit was Ct value <35 within 40 amplification cycles, in addition to cost effectiveness not being analyzed. These findings help inform the upper limit threshold of number of specimens to process for COVID-19 pooled testing strategies to ensure high sensitivity.