By Christian Hoffmann &
Bernd S. Kamps
Fauci AS, Lane HC, Redfield RR. Covid-19 – Navigating the Uncharted. N Engl J Med. 2020 Mar 26;382(13):1268-1269. PubMed: https://pubmed.gov/32109011. Full-text: https://doi.org/10.1056/NEJMe2002387
Brief overview of current research topics, given by opinion leaders.
Hospital
Sorbello M, El-Boghdadly K, Di Giacinto I, et al. The Italian COVID-19 outbreak: experiences and recommendations from clinical practice. Anaesthesia. 2020 Mar 27. PubMed: https://pubmed.gov/32221973. Full-text: https://doi.org/10.1111/anae.15049
Detailed practical recommendations, based on experiences made during the Italian outbreak. Key elements of clinical management, airway management, personal protective equipment and non-technical aspects are described.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia. 2020 Mar 27. PubMed: https://pubmed.gov/32221970. Full-text: https://doi.org/10.1111/anae.15054
Consented principles from the UK Association of Anaesthetists for airway management, including emergency tracheal intubation, predicted or unexpected difficult tracheal intubation, cardiac arrest, anaesthetic care and tracheal extubation.
Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020 Mar 20. pii: S2213-2600(20)30127-2. PubMed: https://pubmed.gov/32203709. Full-text: https://doi.org/10.1016/S2213-2600(20)30127-2
Brief overview of therapeutic options for severe acute respiratory distress syndrome.
Clinical
Chen G, Wu D, Guo W, et al. Clinical and immunologic features in severe and moderate Coronavirus Disease 2019. J Clin Invest. 2020 Mar 27. pii: 137244. PubMed: https://pubmed.gov/32217835. Full-text: https://doi.org/137244
First study on immunologic characteristics of 21 patients (retrospective). Total lymphocytes but also CD4+ and CD8+T cells decreased in nearly all patients, and were markedly lower in severe cases (294, 178 and 89 x 106/L) than moderate cases (641, 382 and 254 x 106/L). Immunological markers may be of importance due to their correlation with disease severity in COVID-19.
Risk factors, comorbidities
McMichael TM, Currie DW, Clark S, et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020 Mar 27. PubMed: https://pubmed.gov/32220208. Full-text: https://doi.org/10.1056/NEJMoa2005412
Important paper that highlights the severity of COVID-19 in older people. A total of 167 confirmed cases affecting 101 residents in a long-term care facility, 50 health care personnel (HCP), and 16 visitors. The case fatality rate for residents was 33.7% (34 of 101) and 0 % among HCP.
Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J. 2020 Mar 26. pii: 13993003.00547-2020. PubMed: https://pubmed.gov/32217650. Full-text: https://doi.org/10.1183/13993003.00547-2020
More on the role of comorbidities. 1,590 hospitalised patients from 575 hospitals across mainland China. After adjusting for age and smoking status, COPD [hazards ratio (HR) 2.681, 95% confidence interval (95%CI) 1.424-5.048], diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were risk factors of reaching endpoints.
Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Mar 27. pii: 2763843. PubMed: https://pubmed.gov/32219357. Full-text: https://doi.org/10.1001/jamacardio.2020.1096
Interesting case report on myopericarditis with systolic dysfunction which highlights cardiac involvement as a complication, even without symptoms and signs of interstitial pneumonia.
Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI. A War on Two Fronts: Cancer Care in the Time of COVID-19. Ann Intern Med. 2020 Mar 27. pii: 2764022. PubMed: https://pubmed.gov/32219410. Full-text: https://doi.org/10.7326/M20-1133
Inspiring thoughts on treatment and care for patients with cancer. No new data.
Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091. PubMed: https://pubmed.gov/32217556. Full-text: https://doi.org/10.1136/bmj.m1091
Retrospective case series of 113 deceased patients. The median time from disease onset to death was 16 (IQR 12.0-20.0) days. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (100%), type I respiratory failure (51%), sepsis (100%), acute cardiac injury (77%), heart failure (49%), alkalosis (40%), hyperkalaemia (37%), acute kidney injury (25%), and hypoxic encephalopathy (20%).
Little P. Non-steroidal anti-inflammatory drugs and covid-19. BMJ. 2020 Mar 27;368:m1185. PubMed: https://pubmed.gov/32220865. Full-text: https://doi.org/10.1136/bmj.m1185
Discussion of a possible link between NSAIDs and both respiratory and cardiovascular adverse effects in COVID-19. Recommends pragmatic approach: regular NSAID use should probably not be recommended first line.
Pregnancy, pediatric patients
Wang SS, Zhou X, Lin XG, et al. Experience of Clinical Management for Pregnant Women and Newborns with Novel Coronavirus Pneumonia in Tongji Hospital, China. Curr Med Sci. 2020 Mar 26. pii: 10.1007/s11596-020-2174-4. PubMed: https://pubmed.gov/32219626. Full-text: https://doi.org/10.1007/s11596-020-2174-4
Updated and very detailed recommendations for the clinical management for pregnant women and their newborns with SARS-CoV-2. Experience from Wuhan. No data.
Zeng H, Xu C, Fan J, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020 Mar 26. pii: 2763854. PubMed: https://pubmed.gov/32215589. Full-text: https://doi.org/10.1001/jama.2020.4861
Among 6 mothers with confirmed COVID-19, SARS-CoV-19 was not detected in the serum or throat swab by RT-PCR in any of their newborns. However, virus-specific antibodies (IgG) were detected in 5 neonatal blood sera samples.