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Work from home was never part of your job description. Here are coronavirus pearls for those on the frontlines.
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Numbers don't lie: age, high SOFA scores, and high d-dimer (above 1 ug / mL) on admission were linked to a greater risk of mortality in a cohort of 190 COVID-19 patients hospitalized in China during January and February 2020. Key labs like LDH and high-sensitivity troponin trended in opposite directions for survivors and non-survivors, and more than half of admitted patients met criteria for sepsis despite the absence of a bacterial source.
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The same study found a median viral shedding period (measured via respiratory specimen collection) of 20 days in survivors. The max was almost twice as long at 37 days.
Lancet
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A pooled analysis of 180 confirmed COVID-19 cases found that symptoms were apparent in 98% of patients after 11.5 days. After a few extrapolation assumptions, the authors estimated that 101 out of 10,000 cases, or ~99%, will develop symptoms during a quarantine period of 14 days. Hence, 2 weeks of self-isolation for anyone who chose the wrong spot to vacation.
Annals
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COVID-19 makes adults of all ages sick, says a preliminary epidemiological report from the CDC. Almost 40% of hospitalized patients in the United States were between age 20 – 54, and almost half of ICU admissions were for patients younger than age 64. Here's a breakdown of hospitalization, ICU admission, and fatality by age as of mid-March.
MMWR
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A worldwide map of cases. A point-of-care management guide. A centralized hub for all new COVID-19 literature. An early guide to emerging drug therapy. Stay safe.
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When you're newly terrified of the subway
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A study of 230,000 UK commuters found that those who cycled had more short-term injuries but fewer long-term health complications than non-active commuters. Per estimates, a switch to biking from driving for 10 years would cause 26 more injuries per 1,000 people (though only 3 would result in hospital stays 1 week or longer) but 15 fewer first cancer diagnoses, 4 fewer cardiovascular events, and 3 fewer deaths.
BMJ
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Screen all adults (ages 18 - 79) for hepatitis C virus (HCV) once, says the USPSTF. The task force updated their previous 2013 statement calling for 1-time screening of adults born between 1945 and 1965. HCV is on the rise in young adults (ages 20 – 39), and about one-third of persons who inject drugs (PWID) ages 18 – 30 are infected. That number rises to 70 – 90% of older PWID. Consider screening for HCV more than once in this high-risk population.
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Behind universal screening? The 2013 USPSTF recommendation was made in the era of interferon, and direct-acting antiviral (DAA) agents have changed the game. There's little direct evidence supporting screening, but the agency's large meta-analysis confirmed that DAA reduced all-cause mortality and hepatocellular carcinoma among HCV-positive patients who achieved a sustained virologic response (SVR) on therapy.
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What's the average turnaround time for COVID-19 testing at your hospital?
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Thanks to the 1,000+ readers who chimed in on our survey on health policy in the 2020 presidential election! Check out our tweetorial on the results.
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