September 4, 2020

On today's episode we discuss: —Climate: An online survey of gay, bisexual and other men who have sex with men assessed changes in sexual behavior, prophylaxis use, and disease testing during the COVID-19 lockdown. Findings included a mean increase of 2.3 sexual partners during lockdown, HIV and other STI screenings were decreased in about a third of respondents, and lockdown prevented 8.9% of respondents from accessing HIV PrEP. This study suggests the need to help ensure that populations needing these services will have access to them, especially during the pandemic. —Epidemiology: Post-discharge surveillance of 285 adult patients with COVID-19 in China showed that RT-PCR retested positive (RP) events occurred in 10% of cases within 15 days of discharge and were unlikely due to reinfection. The RP incidence, as well as clinical features and risk factors for RP patients found in this study, can inform COVID-19 post-discharge management in other developing countries. —Management: Intensivists in Italy describe two COVID-19 patients admitted to the ICU who developed acute liver failure secondary to herpes simplex virus 1 (HSV-1). During their clinical course, both patients received hydroxychloroquine and tocilizumab, required ventilation assistance, developed signs of confusion or delirium, and succumbed to death. Based on these two cases, the authors suggest that "unbalanced use" of immunosuppressive agents in COVID-19 could contribute to secondary infections and argue for research into COVID-19 and its typical therapies in HSV-1 infection or reactivation. —Adjusting Practice During COVID-19: A survey of 277 neonatal intensive care units (NICUs) globally found that the number of NICUs allowing 24-hour parental presence declined from 83% pre-COVID-19 to 53% during COVID-19 and 43% of NICUs reported a decrease in services for therapy, lactation, and/or social work. The authors warn against limiting parental presence, which can adversely impact the well-being and health of infants and their families. —R&D: Diagnosis & Treatments: Medical researchers in Thailand conducted a study to explore the viability of saliva pooling as a cost-effective, less invasive alternative SARS-CoV-2 specimen for RT-PCR. The authors analyzed 40 pools of 5 samples and 20 pools of 10 samples. Their findings suggest that saliva pools are able to detect SARS-CoV-2 and, thus, may be an effective testing option in low prevalence areas. The authors note, however, that saliva pooling may be limited by viral RNA breakdown during storage protocol and freeze-thawing, leading to possible false-negative results. · Investigators affiliated with Mayo Clinic working in collaboration with the United States Food and Drug Administration provide a safety update of the US Convalescent Plasma Expanded Access Program after transfusing 20,000 hospitalized patients with severe or life-threatening COVID-19 with convalescent plasma. Based on the results of these 20,000 patients, the authors suggest that the use of convalescent plasma is safe and carries no excess risk of complications. The authors also share that a future report will describe the efficacy of COVID-19 convalescent plasma therapy.