The Count

Region	Cases	Deaths
World	6,203,612	371,855
US	1,819,807	105,634

Research News

After testing negative, SARS-COV-2 reappeared in 11 of 69 Chinese COVID-patients an average of 2 weeks after discharge from the hospital. Given that this has been found in other studies, it questions our assumptions about the clinical course of this infection and the potential for occult viral persistence in a subset of patients.

Both comorbidity** and exposure to environmental factors** can alter the expression of the ACE2 receptor, which is the binding site for the SARS-CoV-2 virus. Investigators in these two studies found that cancer, asthma, hypertension, Type I diabetes, heart disease, kidney disease, chronic lung disease, a history of smoking, and exposure to fine particulate air pollution all unregulated this receptor. Type II diabetes down regulated the receptor. These findings could help explain differences in disease severity among individuals and regions.

Past exposure to coronaviruses** including the 2003 SARS virus, conveyed enhanced T-cell based immunity to the original virus as well as enhanced response to the SARS-CoV-2 virus. This would be consistent both with the potential to have long lasting immunity to the novel virus as well as the possibility that past exposure to other coronaviruses could convey some level of immunity to SARS-CoV-2.

A clinical trial comparing five and ten day courses of Remdesivir found that the longer treatment course did not convey a significant advantage over five days of treatment. There was no placebo control, so the study could not provide additional information into the efficacy of Remdesivir.

An index to estimate the seriousness of a hypothetical SARS-CoV-2 infection** was developed based on data from based on 43,061 patients in six countries. The index, referred to by the authors as the COVID-19 estimated risk (COVER), used individual data on history of cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, hyperlipidemia, and kidney disease to estimate the risk of hospitalization, need for intensive care, and death. The area under the curve, which would be 1.0 for an ideal index, ranged from 0.73 to 0.91 depending on outcome. An index such as this can and should be used and refined as an instrument for identifying groups that require higher levels of protection in the post-lockdown, pre-vaccine world.

An indicator of the risk of death from COVID-19 among hospitalized patients** based on Lymphopenia, Oxygen saturation, White blood cell characteristics, Hypertension, Age, Renal injury, and Myocardial injury (the LOW HARM index) had an area under the curve of 0.95 (a perfect indicator would have an AUC of 1.0). These results suggest this index could be a valuable tool for triage and planning in a clinical setting.

A comparison of 2020 mortality rates to historic rates during March and April** in the United States estimated that only about 2/3 of the excess deaths during the pandemic period had been specifically attributed to COVID-19 in the death records (95% confidence bounds 56-78%). The additional deaths can be presumed to include a combination of undiagnosed cases of COVID-19 and fatalities related to an overburdened health care system. It is important to include their impact when assessing the effects of the pandemic.

The percent of out of hospital deaths that were unexplained in Paris rose during the COVID-19 outbreak to 79% (as compared to 21% in 2019). Pulmonary embolisms and deep venous thrombosis (Clots to the lung and in the veins) were far more common than in previous years. This suggests both that there were unrecognized deaths from SARS-CoV-2 and that thromboembolism may be a more important part of COVID-19 than than previously recognized.

Nearly half of Italian health care workers (HCWs) are experiencing symptoms of Post Traumatic Stress Syndrome. HCW's had elevated rates of depression, anxiety and insomnia in the face of the pandemic. Being younger, female, and a frontline HCW were all associated with elevated risk. The mental health consequences of COVID-19 on HCW's is extremely high, may have lasting consequences, and will require proactive intervention.

Washington State Department of Health found rising rates of SARS-CoV-2 infections among younger age groups over the course of the pandemic,** but there is also a marked rise in testing among younger age groups. It is not entirely clear from the paper, how much of the rise in cases is related to changes in testing, but the fact that, in mid-April, 39% of all cases were occurring in people under 40 makes it clear that younger age groups can and do become infected at high rates.

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*Preprint **Not peer reviewed.

Covid19- Ahead of the Curve.

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