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COVID-19 Intelligence Report: Hospitalist and Medical Care

Hospitalist & Medical Care

April 27, 2020

Title:  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients

Hospitalized With COVID-19 in the New York City Area

Publisher: JAMA Network

Publication: April 22, 2020

URL: https://jamanetwork.com/journals/jama/fullarticle/2765184

Key Takeaway: 

  • Among patients who were discharged or died (n=2,634), 14.2% required ICU care,

12.2% received invasive mechanical ventilation, 3.2% needed renal replacement therapy, and 21% died. 

  • Among patients who received mechanical ventilation (n=320), mortality was 76.4% for ages 18-65 and 97.2% for those aged >65. Among patients who did not receive mechanical ventilation, mortality was 19.8% and 26.6%, respectively.  

 

 

April 20, 2020

Title: COVID-19 Clinical Guidance Repository, Assoc. American Medical Colleges (AAMC)

URL: https://www.aamc.org/covid-19-clinical-guidance-repository?utm_source=sfmc&utm_medium=email&utm_campaign=GIR&utm_content=newsletter

Key Takeaway: Summary of up-to-date management guidelines from leading academic centers.

 

Title: Absence of 2019 Novel Coronavirus in Semen and Testes of COVID-19 Patients

URL: https://pubmed.ncbi.nlm.nih.gov/32297920/

Publication: Biology of Reproduction, April 16, 2020

Key Takeaway: This small case series demonstrates that the Covid-19 virus is absent from the semen and testes in men infected by COVID-19 at both acute and recovery phases making it highly unlikely that the 2019-nCov can be sexually transmitted by men. However other adjacent activities (e.g. kissing and close contact) can still result in transmission.

 

Title: Nature Article - Temporal dynamics in viral shedding and transmissibility of COVID-19

Publication: Nature, April 15, 2020

URL: https://www.nature.com/articles/s41591-020-0869-5

Key Takeaway: In 94 COVID-19 positive patients, the authors observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. They estimated that 44% (95% confidence interval, 25–69%) of secondary cases were infected during the index cases’ presymptomatic stage. The highest risk was in clustered household settings, and non-compliance with quarantine.

 

Title: How does Coronavirus Kill?  Clinicians trace a ferocious rampage through the body from brain to toes

Publication: Science Magazine, April 17, 2009

URL: https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes?utm_campaign=news_daily_2020-04-17&et_rid=79789788&et_cid=3290441#

Key Takeaway: This non-technical, “big picture” piece highlights the multi-system implications of clinical disease with novel coronavirus. COVID pathology is not limited to the lungs.  While the pulmonary system is certainly ground zero, its reach can extend to many organs including the heart and blood vessels, kidneys, gut, and brain.

 

March 31, 2013

Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province

  • https://annalsofintensivecare.springeropen.com/track/pdf/10.1186/s13613-020-00650-2
  • Note from submitter: Model of early recognition of patients most likely to clinically deteriorate; model for early detection of high-risk and potential critically ill patients.  Patients were screened twice every day and respiratory rate (RR), heart rate (HR), SpO2 (room air) were monitored regularly. Once SpO2 < 93%, RR > 30/min, HR > 120/min or any signs of organ failure were observed, patients would be transferred to intensive care unit (ICU).  Model for awake prone position in patients which showed significant effects in improving oxygenation and pulmonary heterogeneity.

Care Recommendations for Home-Based Ventilation Patient

GW COVID-19 Inpatient Care Algorithm

Post-Acute Care

  • https://www.ncbi.nlm.nih.gov/pubmed/32211831
  • Viewpoint article on preparing for care for patients who recover from Covid-19 infection
  • Grabowski DC, Joynt Maddox KE. Postacute Care Preparedness for COVID-19: Thinking Ahead. JAMA. Published online March 25, 2020. doi:10.1001/jama.2020.4686  
  • Note from submitter: Viewpoint article on preparing for care for patients who recover from Covid-19 infection.

Cardiology and Covid-19

  • https://youtu.be/CjEhV68GcD8  or https://www.acc.org/COVID19 
  • American College of Cardiology Guidelines related to Covid-19 cardiovascular injury
  • Note from submitter: ACC webinar held in partnership with the Chinese Cardiovascular Association on March 18 addressing myocardial injury with Coronavirus (COVID-19) and the latest guideline published by the Chinese College of Cardiovascular Physicians.

Educational Resources

Title: Covid 19 Primer: Virtual Patient Simulation 

Publisher: New England Journal of Medicine

Publication Date: April 2020

URL: https://interactives.nejm.org/external/covid_simulation/index.html 

Key Takeaway: Resource for Internal Medicine interns – COVID patient simulator.

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