Mitigation Measures in Delaware Lead to Decline in New COVID-19 Cases, Hospitalization, and Deaths

In this Morbidity and Mortality Weekly Report, lab and case investigation studies investigated mitigation measures such as stay-at-home orders, public mask mandates, contact tracing and investigation, and prompt isolation/quarantine. The study found that these measures contributed to an 82% reduction in COVID-19 incidence, 88% reduction in hospitalizations, and 100% reduction in mortality in Delaware from late April-June. This early release article implies that combination, state-mandated community mitigation efforts and routine public health interventions can reduce new cases, hospitalizations, and deaths related to COVID-19.

Assessment of Asymptomatic and Pre-symptomatic Patients with Early SARS-CoV-2

In this retrospective study, authors aim to investigate characteristics of pre-symptomatic and asymptomatic COVID-19 patients by analyzing associations between clinical features, laboratory findings, and imaging results. COVID-19 CT infiltrates pre-dated symptoms in two-thirds of patients. The most commonly occurring infiltrates were ground glass opacities (94%) and consolidation (46%). Body temperature, CRP, and KL-6 (a serum marker for interstitial pneumonia expressed on type 2 pneumocytes), were associated with the presence of CT infiltrates. Infiltrate volume, percent lung involvement, and consolidation were associated with subsequent development of COVID-19 symptoms. Sixty-five percent of pre-selected asymptomatic patients with SARS-CoV-2 had abnormal chest CT findings, with CT infiltrates pre-dating symptoms onset by 3.8 days.

Effects of COVID-19 on Liver Dysfunction

In this meta-analysis, authors discuss the levels of liver injury or dysfunction in patients diagnosed with COVID-19. The aim of this study was to explore clinical severity and mortality of COVID-19 patients and their liver dysfunction. This study found a significant correlation between liver dysfunction and mortality related to COVID-19 infection. The mortality and severity of COVID-19 patients are associated significantly with liver dysfunction, and the deceased had higher serum AST levels than survivors, and non-severe cases.

Characteristics of Pulmonary Auscultation in COVID-19 Patients

In this cross-sectional, observational study, authors aimed to determine clinical features and significance of pulmonary auscultation among patients with COVID-19 pneumonia using an electronic stethoscope in isolation wards. After studying fifty-seven patients (average age 60.6 years), the findings indicated that most had cough during auscultation. As many as 96.4% had bilateral lesions, such as multiple-ground glass opacities and fibrous stripes. High quality recordings of breath sounds revealed coarse crackles, wheezing, fine crackles, Velcro crackles, and overall coarse lungs. Most patients had normal breath sounds in the upper lobes, but abnormal sounds were most often discovered in the basal fields of the posterior chest. This study concluded that abnormal breath sounds among COVID-19 pneumonia had some consistencies in distribution and correlated, to some extent, with radiologic findings.

Frequency of VTE in Patients with COVID-19

In this retrospective study, discuss the increased risk for venous thromboembolism among critically ill COVID-19 patients. The study evaluated patients who were admitted or treated by a New Orleans-based health system who had confirmed SARS-CoV-2 infection and who also had a confirmed VTE during their hospitalization or after the hospital encounter. Of the 6253 patients who were identified as being COVID-19 positive, 2,748 were admitted, while 3,405 were treated and discharged through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Among the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 of these patients. The findings of this study support previous publications that suggest VTE rates, and prophylaxis failure in hospitalized COVID-19 patients may be higher than expected. The authors encourage further studies into this topic and support a traditional approach to VTE prophylaxis for COVID-19 positive patients during and after hospitalization.