By Christian Hoffmann &
Bernd S. Kamps
Epidemiology
Gudbjartsson DF, Helgason A, Jonsson H, et al. Spread of SARS-CoV-2 in the Icelandic Population. N Engl J Med. 2020 Apr 14. PubMed: https://pubmed.gov/32289214. Full-text: https://doi.org/10.1056/NEJMoa2006100
SARS-CoV-2 in Iceland. As of April 4, a total of 1,221 of 9,199 tested persons (13.3%) were positive. Why is this of interest? Because the country serves as a perfect epidemiological model. Key findings: The percentage of participants who tested positive in population screening remained stable (0.8%) in March, and the infection rates in two screening groups (recruited through open invitation and through random sampling) were not substantially different. Notably, 43% of the participants who tested positive reported having no symptoms.
Stone TE, Kunaviktikul W, Omura M, Petrini M. Editorial: Facemasks and the Covid 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks? Nurs Health Sci. 2020 Apr 12. PubMed: https://pubmed.gov/32279450. Full-text: https://doi.org/10.1111/nhs.12724
Bottom line of this editorial (addressed to nurses): surgical facemasks by the general public is not recommended unless you are looking after a sick person in a household setting or are suffering an illness. Far more effective is handwashing and maintaining a safe distance from other people.
Perc M, Miksić NG, Slavinec M et al. Forecasting COVID-19. Front. Phys., 08 April 2020 | https://doi.org/10.3389/fphy.2020.00127
Forecasts obtained with a simple iteration method that needs only the daily values of confirmed cases as input. The method takes into account expected recoveries and deaths, and it determines maximally allowed daily growth rates that lead away from exponential increase toward stable and declining numbers. Keeping the daily growth rates at least below 5% is an important target for a promising outlook.
Diagnostic
Cheng MP, Papenburg J, Desjardins M, et al. Diagnostic Testing for Severe Acute Respiratory Syndrome-Related Coronavirus-2: A Narrative Review. Ann Intern Med. 2020 Apr 13. pii: 2764737. PubMed: https://pubmed.gov/32282894. Full-text: https://doi.org/10.7326/M20-1301
Comprehensive review of the current array of tests for SARS-CoV-2, highlighting gaps in current diagnostic capacity, and proposing potential solutions.
Wang X, Yao H, Xu X, et al. Limits of Detection of Six Approved RT-PCR Kits for the Novel SARS-coronavirus-2 (SARS-CoV-2). Clin Chem. 2020 Apr 13. pii: 5819547. PubMed: https://pubmed.gov/32282874. Full-text: https://doi.org/10.1093/clinchem/hvaa099
Limits of detection of six commercial kits differed substantially (up to 16-fold difference), with the poorest limits likely leading to false-negative results when RT–PCR were used to detect SARS-CoV-2 infection. According to the authors, manufacturers should analyze the existing problems according to the clinical application and further improve their products.
Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020 Apr 14. PubMed: https://pubmed.gov/32286675. Full-text: https://doi.org/10.2340/16501977-2677
One aftershock of the pandemic will be huge number of post-intensive care survivors who have been mechanically ventilated and will likely experience short- and medium-term consequences. These patients will require not only adequate screening but early rehabilitation and other interventions.
Comorbidities
Daniels MJ, Cohen MG, Bavry AA, Kumbhani DJ. Reperfusion of STEMI in the COVID-19 Era – Business as Usual? Circulation. 2020 Apr 13. PubMed: https://pubmed.gov/32282225. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047122
In the current crisis with limited resources to protect the work force, fibrinolytic therapy (FT) may be considered for patients with myocardial infarction (STEMI). FT may even be preferred over primary percutaneous coronary intervention. Arguments for this strategy are summarized.
Zhong Z, Zhang Q, Xia H, et al. Clinical characteristics and immunosuppressants management of coronavirus disease 2019 in solid organ transplant recipients. Am J Transplant. 2020 Apr 13. PubMed: https://pubmed.gov/32282986. Full-text: https://doi.org/10.1111/ajt.15928
COVID-19 was observed in two transplant recipients (liver and kidney), with different treatments and prognoses. Both patients recovered.
Treatment
Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020 Apr 13. pii: 2764727. PubMed: https://pubmed.gov/32282022. Full-text: https://doi.org/10.1001/jama.2020.6019
Phantastic review on current knowledge on potential therapies (as of April 5).
Rome BN, Avorn J. Drug Evaluation during the Covid-19 Pandemic. N Engl J Med. 2020 Apr 14. PubMed: https://pubmed.gov/32289216. Full-text: https://doi.org/10.1056/NEJMp2009457
Thoughts on how clinical trials should be performed during the current pandemic. And how the processes for evaluating and approving drugs can go awry during a public health crisis.