New born babies with COVID-19 tend to have mild disease

Medibulletin Desk
-
0
New born babies with COVID-19 tend to have mild disease

Infants under 90 days of age who tested positive for COVID-19 tend to be well, with little or no respiratory involvement

Infants under 90 days of age who tested positive for COVID-19 tend to be well, with little or no respiratory involvement, finds a new study. Fever was often found to be the primary or only symptom. Findings were published in The Journal of Pediatrics.

“While there is limited data on infants with COVID-19 from the United States, our findings suggest that these babies mostly have mild illness and may not be at higher risk of severe disease as initially reported from China.” said lead author Leena B. Mithal, MD, MSCI, pediatric infectious diseases expert from Lurie Children’s and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

“Most of the infants in our study had fever, which suggests that for young infants being evaluated because of fever, COVID-19 may be an important cause, particularly in a region with widespread community activity. However, evaluation for bacterial infection in young infants with fever remains important.”

Young infants also had notably high viral loads in their nasal specimens despite mild clinical illness

The study included 18 infants, none with a significant medical history. Of the 50 percent of these infants who were admitted to the hospital’s general inpatient service, none required oxygen, respiratory support, or intensive care. Indications for admission were mainly clinical observation, monitoring of feeding tolerance, and ruling-out bacterial infection with empiric intravenous antibiotics in infants younger than 60 days. Of the infants admitted to the hospital, six out of nine had gastrointestinal (GI) symptoms (poor feeding, vomiting and diarrhea). Upper respiratory tract symptoms of cough and congestion preceded onset of GI symptoms. Young infants also had notably high viral loads in their nasal specimens despite mild clinical illness.

“It is unclear whether young infants with fever and a positive test for SARS-CoV-2 require hospital admission,” said Dr. Mithal. “The decision to admit to the hospital is based on age, need for preemptive treatment of bacterial infection, clinical assessment, feeding tolerance, and adequacy of follow-up.” There may be opportunities to utilize rapid SARS-CoV-2 testing to determine disposition of clinically well infants with fever.”

 

Heart rhythm disorders common in critically ill COVID-19 patients

Medibulletin Desk
-
0
Heart rhythm disorders common in critically ill COVID-19 patients

Critically ill COVID-19 patients are 10 times more likely to develop cardiac arrhythmias

Patients with COVID-19 who were admitted to an intensive care unit were 10 times more likely than other hospitalized COVID-19 patients to suffer cardiac arrest or heart rhythm disorders, according to a new study published in the Heart Rhythm Journal, the official journal of the Heart Rhythm Society.

The study suggests cardiac arrests and arrhythmias are likely triggered by systemic illness, not solely due to the viral infection itself.

Arrhythmia or heart rhythm problems occur when electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow, or irregularly. If left untreated, cardiac arrhythmias can lead to serious medical conditions, including stroke and cardiac arrest – the abrupt loss of heart function.These include irregular heart rate (atrial fibrillation), slow heart rhythms (bradyarrhythmia) or rapid heart rate that stops by itself within 30 seconds (non-sustained ventricular tachycardia).

The study suggests cardiac arrests and arrhythmias are likely triggered by systemic illness, not solely due to the viral infection itself

“In order to best protect and treat patients who develop COVID-19, it’s critical for us to improve our understanding of how the disease affects various organs and pathways within our body – including our heart rhythm abnormalities,” said the study’s senior and corresponding author Rajat Deo, MD, MTR, a cardiac electrophysiologist and an associate professor of Cardiovascular Medicine at Penn. “Our findings suggest that non-cardiac causes such as systemic infection, inflammation and illness are likely to contribute more to the occurrence of cardiac arrest and arrhythmias than damaged or infected heart cells due to the viral infection.”

Recent studies from China have suggested that COVID-19 is associated with a high incidence of cardiac arrhythmias, particularly among critically ill patients – early reports showed 44 percent of patients admitted to the ICU suffered arrhythmias. 

Patients in the study had a mean age of 50 years, with Black patients accounting for more than 70 percent of the population. Researchers identified a total of 53 arrhythmic events: nine patients who suffered cardiac arrest, 25 patients with atrial fibrillation who required treatment, nine patients with clinically significant bradyarrhythmias and 10 non-sustained ventricular tachycardia events. The team did not identify any cases of heart block, sustained ventricular tachycardia or ventricular fibrillation.

Of the 700 patients hospitalized with COVID-19 to the Hospital of the University of Pennsylvania, about 11 percent were admitted to the ICU. None of the other hospitalized patients suffered a cardiac arrest. After adjusting for confounding factors, researchers found cardiac arrest and arrhythmias were more likely to occur among patients in an ICU compared to the other hospitalized patients.

Two sisters – and the first liver transplant from a recovered COVID19 patient

Dr. Rajesh Dey
-
0
Two sisters – and the first liver transplant from a recovered COVID19 patient

How a transplant team in Delhi operated during lockdown on a girl, the donor was the sister who had just beaten COVID19

A thrilling medical crisis worthy of an episode in  ‘Grey’s Anatomy’ played out in a prominent liver transplant unit in the capital while Covid19, lockdown and the associated scare spread like wildfire across the country.

Lisa (name changed), a 12 yr girl from a remote village in West Bengal was suffering from Caroli’s disease – a rare condition where a person’s liver is replaced with sacs of bile. To add to her woes, those sacs got repeatedly infected and she had recurrent episodes if fever, yellow eyes (jaundice). Things came to such a pass that antibiotics were of no use as the bacteria developed resistance.

Her only hope was a liver transplant.

In the middle of lockdown, the team decided to go ahead with a liver transplant.
This was  the first liver transplant performed on a donor who had recovered from covid.

Lisa was admitted in one of the premier liver transplant units of the country in the middle of March 2020, just before India went into a lockdown. Living donor liver transplant is the main way a liver transplant is performed in India, where a person donates a part of his liver to the patient with a diseased liver. Unfortunately, both of Lisa’s parents were unsuitable for donation. Her elder sister Misa, a biology honours student and only 19 yrs of age was the only eligible donor in the family.

By the time she was ready to donate, the lockdown was enforced, and the family was left with little social and financial support. Adding to the family’s woes, Misa was found to be Covid positive on testing and though she did not have any symptoms, she was sent to a quarantine center following prevalent guidelines. Her father was kept in isolation and Lisa and her mother stayed in the hospital.

To make things worse, Lisa deteriorated clinically and needed constant ICU care.
Only aftet repeated testing did Misa turn out to be covid negative and was released from the quarantine center after 3 weeks.

The family had meanwhile used up all resources and depended on crowdfunding for treatment. In the middle of lockdown, the team decided to go ahead with a liver transplant.
This was  the first liver transplant performed on a donor who had recovered from covid.

Both the donor and the recipient made a gradual recovery and were finally discharged.
One fallout of the covid pandemic has been the relative lack of attention to other medical illnesses. Indeed, illnesses like cancers, liver disease progress relentlessly, but care has suffered because of the raging pandemic.

Lisa’s case is a proof of that phenomenon.

Covid and the associated lockdown did create impediment in her treatment pathway, however she did manage to make it through.

MMR vaccine shot could protect against COVID-19

Medibulletin Desk
-
0
MMR vaccine shot could protect against COVID-19

Administering the MMR (measles, mumps, rubella) vaccine could prevent severe symptoms of COVID-19

Administering the MMR (measles, mumps, rubella) vaccine could serve as a preventive measure to dampen lung inflammation and sepsis associated with COVID-19 infection, said a team of experts in this week’s mBio, a journal of the American Society for Microbiology. 

Live attenuated vaccines like MMR, which are made using weakened strains of a disease causing pathogen, provide nonspecific protection against lethal infections.

Vaccination with MMR in immunocompetent individuals has no contraindications and may be especially effective for health care workers who can easily be exposed to COVID-19, said the researchers.

“Live attenuated vaccines seemingly have some nonspecific benefits as well as immunity to the target pathogen. A clinical trial with MMR in high-risk populations may provide a low-risk-high-reward preventive measure in saving lives during the COVID-19 pandemic,” said author Dr. Paul Fidel, Jr., Associate Dean for Research, Louisiana State University Health School of Dentistry. 

The protection was mediated by long-lived myeloid-derived suppressor cells (MDSCs) previously reported inhibiting septic inflammation and mortality in several experimental models. Mortality in COVID-19 cases is strongly associated with progressive lung inflammation and eventual sepsis.

experts suggest that all adults, especially health care workers and individuals in nursing homes get the MMR vaccine

The milder symptoms seen in the 955 sailors on the U.S.S Roosevelt who tested positive for COVID-19 (only one hospitalization) may have been a consequence of the fact that the MMR vaccinations are given to all U.S. Navy recruits emphasized the researchers.

In addition, epidemiological data suggest a correlation between people in geographical locations who routinely receive the MMR vaccine and reduced COVID-19 death rates. COVID-19 has not had a big impact on children, and the researchers hypothesize that one reason children are protected against viral infections that induce sepsis is their more recent and more frequent exposures to live attenuated vaccines including MMR.

A clinical trial is proposed to test whether the MMR vaccine can protect against COVID-19, but in the meantime, the experts suggest that all adults, especially health care workers and individuals in nursing homes get the MMR vaccine. 

If adults got the MMR as a child then they should get a booster MMR shot to enhance the antibodies to measles, mumps, and rubella and reinitiate the MDSCs. 

 

Chasing SARS-CoV2 in Dharavi: how Asia’s largest slum became a COVID19 showcase

Medibulletin Desk
-
0
Chasing SARS-CoV2 in Dharavi: how Asia’s largest slum became a COVID19 showcase

Mumbai’s Dharavi, the largest slum in Asia has managed to being down COVID19 infection rates drastically by some proactive measures

From being the problem child to being a model to be showcased – Dharavi in Mumbai has travelled the distance.

On Sunday, as total COVID19 cases in the country touched 4,10,461 including 306 new deaths and  15413 overall deaths, the government of India issued a laudatory note on the management of the disease in Asia’s largest slum.

“Being densely populated (2,27,136 persons/ sq. km), Dharavi had 491 cases in April 2020 with a 12% growth rate and a case doubling period of 18 days. The proactive measures adopted by BMC reduced the COVID-19 growth rate to 4.3% in May 2020 and further to 1.02% in June. These measures also ensured an improved case doubling time to 43 days in May 2020 and 78 days in June 2020,” the statement reads.

COVID-19 growth rate reduced to 4.3% in May 2020 and further to 1.02 % in June. These measures also ensured an improved case doubling time to 43 days in May 2020 and 78 days in June 2020

Several challenges presented themselves to BMC in Dharavi where 80% population depends on community toilets. About 8-10 people live in households/hutment which measures about 10ft x 10ft coupled with existence of narrow lanes with 2-3 storied houses where often the ground floor is a house and other floors are used as factories. Hence, there were severe limitations of physical distancing with no possibility of effective ‘Home Quarantine’.

BMC adopted a model of actively following four T’s – Tracing, Tracking, Testing and Treating. This approach included activities like proactive screening. While 47,500 people were covered by doctors and private clinics in house-to-house screening, about 14,970 people were screened with the help of Mobile Vans, and 4,76,775 were surveyed by BMC health workers. Fever clinics were set up for screening high risk category such as elderly/senior citizens. This helped to screen 3.6 lakh people. Also, around 8246 Senior Citizens were surveyed and as part of its policy of ‘Timely Separation’, they were separated from the other community to effectively limit the transmission of the disease. In all, 5,48,270 people have been screened in Dharavi.

The suspected cases were shifted to well organized COVID Care Centres and Quarantine Centres. To tackle the issue of manpower to carry out proactive screening in high risk zones, BMC forged strategic public private partnerships in containment measures and all available ‘private’ practitioners were mobilized. BMC provided the private doctors with PPE Kits, thermal scanners, pulse Oxymeters, masks and gloves and started Door-to-Door screening in high risk zones and all suspects were identified. BMC encouraged all practitioners to open their clinics to attend to the patients and communicate to BMC in case any COVID1-9 suspects were found.

BMC sanitised the clinics of the private practitioners and provided them all necessary support. To augment health infrastructure in the city, all private hospitals were brought onboard and acquired for treatment.

 

Brain injury markers raised in patients with severe COVID-19

Medibulletin Desk
-
0
Brain injury markers raised in patients with severe COVID-19

Highly sensitive biomarkers for brain injury were found elevated in patients with severe COVID-19

Certain blood-based biomarkers which indicate injury to the brain were found raised in moderate to severe COVID-19 patients, according to a new study. Findings were published in the journal Neurology.

Some people infected with the coronavirus SARS-CoV-2 get only mild, cold-like symptoms, while others become severely ill and require hospital treatment. 

Although the neurological symptoms associated with COVID-19 have received much less attention than the lung symptoms, most studies suggest that they are common among people with severe illness.  Most common neurological symptoms include headache, dizziness, altered levels of consciousness, uncoordinated muscle movements, seizures, and strokes.

Confusion and an inability to wake up or stay awake, has been listed by CDC as a warning sign of emergency in COVID-19 patients.

NfL (neurofilament light chain protein), which is also seen in brain injury was found elevated in most of the patients who required ventilator treatment

In this study, researchers collected blood samples from 47 patients with mild, moderate and severe COVID-19 in the course of their hospital stay. These samples were analyzed by means of highly sensitive biomarkers for brain injury. The results were compared with those from a healthy control group comprising 33 people matched by age and sex.

A biomarker, known as GFAP (glial fibrillary acidic protein), which is normally present in brain cells called astrocytes, but leaks out in the event of astrocytic injury or overactivation, was raised even in moderate COVID-19 – that is, in patients admitted to hospital but not in need of ventilator support. 

The second biomarker investigated was NfL (neurofilament light chain protein), which is also seen in brain injury was found elevated in most of the patients who required ventilator treatment, and there was a marked correlation between how much they rose and the severity of the disease.

“The increase in NfL levels, in particular, over time is greater than we’ve seen previously in studies connected with intensive care, and this suggests that COVID-19 can in fact directly bring about a brain injury. Whether it’s the virus or the immune system that’s causing this is unclear at present, and more research is needed, added the authors.

“Blood tests for biomarkers associated with brain injury could be used for monitoring patients with moderate to severe COVID-19, to reduce the risk of brain injury. It would be highly interesting to see whether the NfL increase can be slowed down with new therapies, such as the new dexamethasone treatment that’s now been proposed,” said Magnus Gisslén, Professor   of Infectious Diseases at Sahlgrenska Academy.

 

Chest CT can differentiate negative from positive COVID-19 results

MediBulletin Bureau
-
0
Chest CT can differentiate negative from positive COVID-19 results

Chest CT can differentiate between negative and positive lab results for COVID-19 based on presence of pulmonary consolidation 

Presence of pulmonary consolidation in chest CT scan of suspected COVID-19 patients can help separate negative initial lab test results from positive cases, according to a new study published in the American Journal of Roentgenology (AJR).

Researchers exploring the diagnostic value of chest CT for coronavirus disease (COVID-19) pneumonia, especially for patients with negative initial results, found that the less pulmonary consolidation on chest CT, the greater the possibility of negative initial RT-PCR results. RT-PCR testing, also known as reverse transcription-polymerase chain reaction, is the most reliable test for detection of COVID-19 infection in the nasal or throat swab of suspected patients.

Data of 21 patients (nine men, 12 women; age range, 26-90 years) with confirmed COVID-19 pneumonia from five non-specialized infectious disease hospitals across Guangzhou were analyzed.

After undergoing chest CT and swab RT-PCR tests within 3 days, patients were divided into two groups: seven patients with negative initial results (who were found to have positive results after a second RT-PCR test 2 days later) and 14 patients with initial positive results.

Compared with the positive initial RT-PCR results group, CT of the group with negative initial RT-PCR results was less likely to indicate pulmonary consolidation (p < 0.05)

“Most of the COVID-19 lesions were located in multiple lobes (67%) in both lungs (72%) in our study,” said lead investigator Dandan Chen of Guangzhou First People’s Hospital in China. Authors also added that the CT findings observed most frequently were ground-glass opacities (95%) and consolidation (72%) with subpleural distribution (100%) and 33% of patients had other lesions around the bronchovascular bundle.

Additional chest CT findings identified by researchers were air bronchogram (57%), vascular enlargement (67%), interlobular septal thickening (62%), and pleural effusions (19%).

Compared with the positive initial RT-PCR results group, CT of the group with negative initial RT-PCR results was less likely to indicate pulmonary consolidation (p < 0.05).

Acknowledging that RT-PCR detection can be affected by laboratory reagents, test method, and subjective operability, authors noted that, theoretically, the multicenter nature of this study should have reduced interference by such factors.

“When patients with suspected COVID-19 pneumonia who have an epidemiologic history and typical CT features have negative initial RT-PCR results,” the authors of this study concluded, “repeated RT-PCR tests and patient isolation should be considered.”

Mobile COVID19 testing laboratory to take tests to remote corners

Medibulletin Desk
-
0
Mobile COVID19 testing laboratory to take tests to remote corners

In a presentation the health ministry has said that India brought down COVOD19 growth rate by a huge margin by the lockdown

 

India on Thursday got its first mobile I-Lab (Infectious disease diagnostic lab) for COVID-19 testing for last mile testing access. It will be deployed in remote, interior and inaccessible parts of the country and have capability to perform 25 COVID-19 RT-PCR tests/Day, 300 ELISA tests/day, additional tests for TB, HIV etc. as per CGHS rates.

Union Minister of Health & Family Welfare Dr. Harsh Vardhan launched the I-LAB. It is supported by the Department of Biotechnology, Ministry of Science & Technology, under the Covid Command strategy. In the last 24 hours there were 334 deaths and 12,880 cases reported, taking the total to 3,66,945. During that time, 7390 COVID-19 patients were cured. A total of 1,94,324 patients, so far, have been cured of COVID-19. The recovery rate rises to 52.96%. Currently, 1,60,384 active cases are under medical supervision. 

At the beginning of Lockdown 1.0 on March 25, the growth rate stood at 24.3%, on April 14, it came down to 13%, which was more than halved to 6.1% by the end of Lockdown 2.0 on May 3

The number of government labs has been increased to 699 and private labs has been increased to 254 (A total of 953). The break-up is given as:

Real-Time RT PCR based testing labs: 540 (Govt: 349 + Private: 191)​

TrueNat based testing labs: 340 (Govt: 325 + Private: 15)​

CBNAAT based testing labs: 73 (Govt: 25 + Private: 48)​

In the last 24 hours, 1,65,412 samples were tested. The total number of samples tested thus far is 62,49,668.

In a two meetings with chief ministers over the last two days, the prime minister had told them to concentrate on increasing testing and contact tracing. The health ministry in a presentation said that India managed to bring down the growth rate of COVID cases from 24.3% pre-lockdown to 3.8% during the current Unlock 1.0. At the beginning of Lockdown 1.0 on March 25, the growth rate stood at 24.3%, on April 14, it came down to 13%, which was more than halved to 6.1% by the end of Lockdown 2.0 on May 3. It came down to 5.3% at the end of Lockdown 3.0 on May 17. At the end of Lockdown 4.0 on May 31 it stood at 4.7%.

Home monitoring of COVID-19 patients effective in reducing burden on healthcare

Medibulletin Desk
-
0
Home monitoring of COVID-19 patients effective in reducing burden on healthcare

Home monitoring program for patients presumed positive for COVID-19 could reduce need of large healthcare workforce

Alarming reports of an increasing number of COVID-19 patients finding it difficult to get a hospital bed has put many countries around the world in a fix. Home monitoring programs for patients who have COVID-19 symptoms may be the only way forward, especially for countries who have a poor healthcare infrastructure. 

A home-monitoring program of 7604 patients presumed positive for COVID-19 was accomplished with the assistance of nurses, nurse practitioners, a large number of medical students and physicians’ assistants from the Northwestern University Feinberg School of Medicine. Patients filled an online questionnaire daily and a monitoring team member called the individual to follow up on any concerning symptoms they report, such as shortness of breath, chest pain or confusion. Results showed that only 500 patients needed to be shifted to the emergency department. 

Early results of the study were published in the New England Journal of Medicine Catalyst.

“We were able to catch these patients before their condition dangerously deteriorated, which improved our ability to treat them,” said Dr. Jeffrey Linder, Northwestern Medicine chief of general internal medicine and geriatrics.

The program proactively reached out to patients to ensure they are safe in their homes rather than waiting for them to identify a worsening of their condition

“We started the program to address the needs of the 80% of patients who would spend their entire course of COVID-19 at home,” Linder said. “We knew from early COVID-19 experience patients could deteriorate quickly. We also suspected they may have a lot of questions about quarantine, the course of the disease and lots of social needs.”

Patients reported that the program healed them both physically and emotionally.

The program proactively reached out to patients to ensure they are safe in their homes rather than waiting for them to identify a worsening of their condition. Team members also called any individuals who do not report symptoms via the patient portal or who simply don’t use it. On the call, health care providers assess and triage individuals for urgent medical care if they reported any severe symptoms like confusion, trouble breathing or bluish lips or face. They also refer patients to social work for non-medical challenges, such as difficulty with finances or accessing food.

 

Isolation and contact tracing vital to COVID-19 pandemic control : The Lancet

Medibulletin Desk
-
0
Isolation and contact tracing vital to COVID-19 pandemic control : The Lancet

Testing, self-isolation and contact tracing with physical distancing measures, could control the COVID-19 pandemic

In the absence of a vaccine or highly effective treatments for COVID-19, combining isolation and intensive contact tracing with physical distancing measures – such as limits on daily social or workplace contacts – might be the most effective and efficient way to achieve and maintain epidemic control, according to a new research published in The Lancet Infectious Diseases journal.

Using social-contact data on more than 40,000 individuals from the BBC Pandemic database to simulate SARS-CoV-2 transmission in different settings and under different combinations of control measures, the researchers estimate that a high incidence of COVID-19 would require a considerable number of individuals to be quarantined to control infection. For example, a scenario in which 5,000 new symptomatic cases were diagnosed each day would likely require 150,000-200,000 contacts to be quarantined every day if no physical distancing was in place.

The study is the first time researchers have used social contact data to quantify the potential impact of control measures on reducing individual-level transmission of SARS-CoV-2 in specific settings. 

Researchers modelled the rate at which the virus is transmitted, known as the reproductive number (R), or the average number of people each individual with the virus is likely to infect at a given moment under different strategies. To keep the COVID-19 epidemic declining, R needs to be less than 1.

Successful strategies will likely include intensive testing and contact tracing supplemented with moderate forms of physical distancing

In the model, the secondary attack rate (the probability that a close contact of a confirmed case will be infected) was assumed to be 20% among household contacts and 6% among other contacts. The researchers calculated that, had no control measures been implemented, R would be 2.6 – meaning that one infected person would infect, on average, 2-3 more people.

The model suggested that mass testing alone, with 5% of the population undergoing random testing each week (i.e. 460,000 tests per day in UK), would lower R to just 2.5, because so many infections would either be missed or detected too late.

Compared with no control measures, self-isolation of symptomatic cases (at home) alone reduced transmission by an estimated 29% (lowering R to 1.8); whilst combining self-isolation, household quarantine, and tracing strategies could potentially lower transmission by as much as 47% (R 1.4) when using app-based contact tracing (assuming the app is adopted by 53% of the population), and by 64% with manual tracing of all contacts (R 0.94).

Limiting daily contacts outside home, school, and work to four people (e.g. by restricting mass gatherings) along with manual tracing of acquaintances only (i.e. people they have met before) and app-based tracing, would have the greatest impact, reducing disease spread by 66%, and lowering R to 0.87. However, they note that the effectiveness of manual contact tracing strategies is highly dependent on how many contacts are successfully traced.

“Our findings reinforce the growing body of evidence which suggests that we can’t rely on one single public health measure to achieve epidemic control”, said Dr Adam Kucharski from the London School of Hygiene & Tropical Medicine, UK. “Successful strategies will likely include intensive testing and contact tracing supplemented with moderate forms of physical distancing, such as limiting the size of social gatherings and remote working, which can both reduce transmission and the number of contacts that need to be traced.”

He added: “The huge scale of testing and contact tracing that is needed to reduce COVID-19 from spreading is resource intensive, and new app-based tracing, if adopted widely alongside traditional contact tracing, could enhance the effectiveness of identifying contacts, particularly those that would otherwise be missed.”

1...232425...234Page 24 of 234