Mental Health, Substance Abuse, and Suicide During COVID-19 Pandemic
This publication from the CDC discusses that communities are facing mental health challenges. From June 24-June 30, 2020, US adults reported elevated mental health conditions associated with the pandemic. Young adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers reported having disproportionate adverse mental health outcomes, increased substance abuse, and elevated suicidal ideation. In late June, 40% of U.S. adults reported struggling with mental health or substance abuse issues. Public health practices should increase interventions and prevention strategies to address these issues. The groups mentioned in the publication should be given priority when discussing and implementing community-level intervention strategies.
Face Masks in the General Population and Optimal Allocation of Resources
Efforts to control the SARS-CoV-2 virus have led to travel restrictions, social distancing, mask mandates, and more to mitigate the spread. Without a vaccine and/or reliable treatments, we have relied on prevention methods to reduce the spread of the virus. There have been great debates in the public on the use of face masks and whether they are efficient. This study examines the epidemiological impact of face masks using a mathematical model. There is also discussion of resource allocation when supply is less than demand. Resource limitations are discussed as well. The authors argue that random distribution of masks is sub-optimal, and priority should be given to the elderly whenever resources are limited. Global guidance surrounding the use of face masks varies widely with multiple European and North American countries mandating facial coverings. When examining provisions for resource allocation of masks, the authors studied policies and compared eight differing policies for different levels of masks. The results in this case show that surgical masks were assumed to be 3 times more effective that face coverings, both in terms of protection and containment.
Vaccine News
As the race continues for the world’s first COVID-19 vaccine, there has been great discussion and debate over the safety and efficacy of a vaccine which will have been produced in such a short period of time. The global struggle against COVID-19 is now in its 8th month. The RNA sequence of the SARS-COV-2 genome was publicized on January 10, 2020. Vaccine candidates quickly emerged and interim reports show candidate vaccines are safe and produce immune responses that may be effective. Long term vaccine safety and duration of vaccine induced immunity has yet to be determined. At this point in time, there are vaccine efficacy trials entering phase 3.
This editorial reports results from an interim analysis of data for a SARS-COV-2 inactivated virus vaccine plus adjuvant, the first protein immunogen vaccine candidate for COVID-19 to be reported. The authors discuss preliminary findings in which healthy participants aged 18-59 years were enrolled and trials conducted. In this particular discussion, the preliminary report indicates that the inactivated whole-virus vaccine candidate was tolerated, safe, and produced neutralizing antibodies at day 14 after vaccination, which indicates that a promising vaccine may be on the horizon. As countries and scientists rush to get the first approved vaccine on to the market, we should anticipate many new studies being released that discuss the safety and efficacy of the COVID-19 vaccine.
Clinical Characteristics in Asymptomatic COVID-19 Patients
It has been noted that many patients with COVID-19 display no symptoms during their infection. Throughout the pandemic, this factor has created a major challenge when asymptomatic cases have been as high as 80% in some studies. This article discusses a study that was performed in South Korea and examine 10,237 patients who were positive for COVID-19. Of those, 62% were asymptomatic while 38% were symptomatic. The authors attempt to correlate other characteristics that may indicate infection for those who are asymptomatic. The study observed a U-shaped association between age group and the proportion of asymptomatic individuals but did not identify other factors to indicate the possibility of infection in those who are asymptomatic. The results indicate that symptom-based screening may fail to identify those in need of testing/treatment because many individuals are indeed positive during their asymptomatic stage. The article suggests expanding criteria for contact tracing and testing to capture potential transmission before symptom onset.
Screening for COVID-19 prior to surgical procedures
This article evaluates the results of screening for patients who are planning a surgical or diagnostic procedure. The study included all patients who were screened for COVID-19 before procedures that required general, regional anesthesia, or sedation and included symptom questionnaires by phone, PCR and HRCT chest testing. 398 screenings were performed on 386 patients, with the questionnaire being completed in 72% of screenings. In 371 screenings, PCR testing was performed and negative. High resolution chest CT found 18 cases where COVID-19 could not be excluded with negative PCR tests. Of these cases, three patients postponed surgery due to inconclusive results and additional measures were used in three different patients. Incidental findings were indicated in 14% of HRCT scans. This study indicates that screening of patients prior to surgical procedures is necessary. Symptom questionnaires are useful to exclude symptoms related to COVID-19 and should lead to further screening using PCR testing in certain risk groups. However, with a low prevalence of COVID-19, pre-procedure HRCT added no additional value.
Frequency of Main Red Flags in Patients with Atypical Headache and COVID-19
In this article, the authors used a cross-sectional of confirmed COVID-19 patients to evaluate the frequency of the main red flags in patients with atypical headache. One of the most frequent neurologic symptoms of COVID-19 is headache, diagnosis of secondary headache disorders is still based on the presence of “red flags.” The study included those who had a confirmed diagnosis of COVID-19, were hospitalized, and who reported headache as a symptom during their evaluation. The results show that 22.6% of participants reported headache during their time of infection, and 26% of patients reported headache as their first symptom. In the clinical setting, diagnosis of secondary headache disorders is still based on the presence of red flags (systemic symptoms, older age, new onset of headache, etc). However, this study concludes that with COVID-19 patients, systemic symptoms such as fever, sneezing, coughing, and/or recent change in headache pattern were frequently experienced when headaches were related to COVID-19 and not related to other areas of concern.
Cerebrovascular Complications of COVID-19
In this retrospective case study, the authors report the largest case study to date of cerebrovascular complications of COVID-19 when compared to stroke patients who are not infected with the virus. The method includes the comparison of imaging from confirmed-stroke patients from 11 New York hospitals in March 2020. The results show that 86 COVID-19 positive stroke cases were identified (mean age 67.4 years, 44.2% women); ischemic (83.7%) and nonfocal nerologic presentations (67.4%) were most predominant. Most involved multivascular distributions and associated hemorrhage. When compared with controls, COVID-19 was associated with in-hospital stroke onset and was among the strongest independent risk factor for inpatient hospital stroke. In addition, COVID-19 infection, age, and intracranial hemorrhage independently predicted mortality resulting in the confirmation that COVID-19 is an independent risk factor for stroke in hospitalized patients. The study also discusses the atypical presentations of stroke patients and mortality when COVID-19 is present.
