COVID-19: Expert Responses to Key Questions

These documents were prepared by teams of research librarians and faculty experts in response to specific questions posed by individuals involved in Indiana’s frontline COVID-19 response. They summarize information that frontline responders may find useful. Please note that information is current for the dates specified. New studies, priorities and literature are being published daily, and best practices are rapidly evolving. These documents do not represent clinical guidelines, standard operating procedures, or the opinions or positions of Indiana FSSA or Indiana CTSI.

• What is known about pediatric multi-system inflammatory syndrome as is related to COVID-19?
• What evidence is necessary to inform the potential easing of social distancing in the context of childcare, summer programming, and out-of-school learning in Indiana?
• What is the national incidence of MIS-C requiring hospitalizations among various pediatric age groups? How long are these children hospitalized and what are their overall outcomes?
• What is the national incidence of long COVID among various pediatric age groups? What do we know about the duration of symptoms and return to regular activities including school?
• Are there any specific recommendations (specifically for cardiac work up but in general) for children and/or adults for returning to activity after COVID-19 infection?
• What is known about the epidemiology of COVID-19 infection among children?
• What are best practices for communicating COVID-specific infection control measures to children, families and group setting caregivers?

• What is the literature on best practices for targeted communication, engagement and inclusion of minority populations in COVID-19 testing, adherence to masking/social distancing mitigation orders, and the development of vaccine allocation plans?
• What are best practices to communicate COVID-19 contact tracing to the public?
• What evidence is necessary to inform the potential easing of social distancing in the context of childcare, summer programming, and out-of-school learning in Indiana?
• Is there evidence that vaccine incentives work to increase COVID-19 vaccination rates (especially among vulnerable populations), and if so – which incentives work best?
• What are best practices for communicating COVID-specific infection control measures to children, families and group setting caregivers?

• Based on data compiled by the Kaiser Family Foundation, have stated social distancing measures (stay at home orders/closures/gathering limitations in particular) made a difference in terms of resurgence in those states?
• What symptoms are associated with SARS CoV-2? What is the prevalence of those symptoms among people who test positive? How frequently do people experience 1 symptom, 2 symptoms, 3 symptoms, more than 3 symptoms?
• What is the demonstrated lag time between the implementation of a mitigation scale-back measure (eg, the date non-essential work resumes, the date restaurants open, etc.) and evidence of uptick in rates of infection/ED admissions/ICU bed usage/vent usage? What are the intermediary measures like time from implementation to evidence of behavior change (eg, per mobility tracking data).
• What is the evidence base for viral testing of wastewater to inform COVID-19 mitigation and containment efforts?
• Modeling inputs specific to US populations.
• What are survival rates for ICU vented patients stratified by age? What are survival rates for ECMO patients stratified by age?
• What is the best model for managing health care surge for COVID patients?
• What are co-infection rates for COVID-19 with flu and other respiratory viruses?
• What is the national incidence of long COVID among various pediatric age groups? What do we know about the duration of symptoms and return to regular activities including school?
• What information is available about COVID-19 fatality stratified by gender, age and co-morbidity?
• What is known about the epidemiology of COVID-19 infection among children?

• What mental health resources are available for providers?
• Based on data compiled by the Kaiser Family Foundation, have stated social distancing measures (stay at home orders/closures/gathering limitations in particular) made a difference in terms of resurgence in those states?
• What is the demonstrated lag time between the implementation of a mitigation scale-back measure (eg, the date non-essential work resumes, the date restaurants open, etc.) and evidence of uptick in rates of infection/ED admissions/ICU bed usage/vent usage? What are the intermediary measures like time from implementation to evidence of behavior change (eg, per mobility tracking data).
• What evidence is necessary to inform the potential easing of social distancing in the context of childcare, summer programming, and out-of-school learning in Indiana?
• What are some approaches to scaling back COVID-19 mitigation measures, such as social distancing, on a population scale?
• I have read (CDC) that we need to wait 3 hours after discharge prior to doing a terminal clean in the room of a patient diagnosed with COVID-19. Would the use of UV or increased air changes per hour decrease this time?
• Are severe restrictions on movement (e.g., lockdowns, shelter in place orders) effective in mitigating the spread of the novel coronavirus? 
• What are current recommendations regarding air flow and the prevention of droplet spread in both medical and non-medical settings?

• What is the impact of government mask mandates on mask-wearing behaviors?
• Have other states put protections in place for employers who are sued by employees who contract COVID-19, alleging a workplace exposure? What are the key points, or specific language, of those protections?
• I have read (CDC) that we need to wait 3 hours after discharge prior to doing a terminal clean in the room of a patient diagnosed with COVID-19. Would the use of UV or increased air changes per hour decrease this time?
• Are severe restrictions on movement (e.g., lockdowns, shelter in place orders) effective in mitigating the spread of the novel coronavirus? 
• Are there any specific recommendations (specifically for cardiac work up but in general) for children and/or adults for returning to activity after COVID-19 infection?
• What are current recommendations regarding air flow and the prevention of droplet spread in both medical and non-medical settings?
• What are best practices for communicating COVID-specific infection control measures to children, families and group setting caregivers?

• Among asymptomatic people who test positive for COVID-19, how many ultimately become symptomatic?
• What symptoms are associated with SARS CoV-2? What is the prevalence of those symptoms among people who test positive? How frequently do people experience 1 symptom, 2 symptoms, 3 symptoms, more than 3 symptoms?
• Is there any evidence to support the presence of a hyper-coagulant state associated with COVID-19 and the use of systemic therapeutic anti-coagulation for COVID-19 treatment?
• What is known about pediatric multi-system inflammatory syndrome as is related to COVID-19?
• For how long are infected individuals (symptomatic or asymptomatic) contagious?
• What is currently known about the transmissibility of SARS CoV-2from asymptomatic/pre-symptomatic infected individuals?
• What proportion of infected individuals may be asymptomatic (including pre-symptomatic) at any given point in time?
• Is there any evidence of a correlation between false negative RT-PCR test results for COVID-19 and patient symptoms?
• What definitions of “recovery” from COVID-19 are being used?
• What are co-infection rates for COVID-19 with flu and other respiratory viruses?
• What is the national incidence of long COVID among various pediatric age groups? What do we know about the duration of symptoms and return to regular activities including school?
• What is known about long-term health effects of COVID-19 infection?
• What is the current evidence base regarding COVID-19 re-infection?

• What are the best practices for SARS-Cov-2 testing in long term care facilities? Please include surveillance, screening, and symptom-based testing.
• What is the utility of workplaces testing all employees or a random sample of employees for COVID-19?
• What is the evidence base for viral testing of wastewater to inform COVID-19 mitigation and containment efforts?
• What are best practices to communicate COVID-19 contact tracing to the public?
• Is there any evidence to support screening pregnant patients for COVID-19 prior to labor? Have any formal guidance documents or recommendations been issued?
• What information is out there about the availability, use and sensitivity of lingual (salivary) point of care diagnostic tests?
• What are specimen storage and stability considerations as they relate to COVID-19 antibody detection?
• What is known about the sensitivity of different methods of specimen collection (e.g., nasopharyngeal, anterior nares, nasal mid-turbinate, or oropharyngeal) for COVID-19 RT-PCR diagnostic testing?
• Is there evidence as to the equivalency of people collecting their own specimens (e.g., at drive-thru testing sites) to provider-collected specimens?
• What is the evidence base for using serologic tests to diagnose COVID-19? What is the evidence base for using serologic tests to understand the full scope of the COVID-19 pandemic at a population level?
• What point-of-care (POC) diagnostic tests for COVID-19 are FDA-approved and available for purchase? What states, if any, are using POC testing or preparing to use POC testing? Is any information about sensitivity available for these tests?
• Is there any evidence of a correlation between false negative RT-PCR test results for COVID-19 and patient symptoms?
• What do we know about the rapid point of care test (Cepheid) – particularly in regard to sensitivity/specificity – and is it available to order?
• Is there any evidence to support the use of thermal scanners in work environments to promote safety in the context of COVID-19?

• What is the evidence base for electrostatic spray technology killing SARS-CoV-2 on surfaces?
• Are plastic/plexiglass barriers effective in reducing the transmission of SARS-CoV-2?
• To what extent does maintaining three feet of distance between individuals reduce the transmission of SARS-CoV-2?
• What sources are specifically tracking COVID-19 cases in congregant settings (e.g., nursing homes) by state? AND Have there been any studies comparing transmission in congregant settings to identify effective mitigation methods? AND Are there any Indiana-specific thought pieces out there regarding our rates of transmission (which are lower than neighboring states)?
• What is known about the risk of COVID-19 transmission from surfaces (i.e., contact transmission)?
• What are best practices to communicate COVID-19 contact tracing to the public?
• What evidence of COVID-19 transmission via singing is available, and what are best practices (PPE and social distancing) for mitigating potential transmission?
• What is known about how temperature impacts the transmission of COVID-19?
• For how long are infected individuals (symptomatic or asymptomatic) contagious?
• What is currently known about the transmissibility of SARS CoV-2 from asymptomatic/pre-symptomatic infected individuals?
• What are some approaches to scaling back COVID-19 mitigation measures, such as social distancing, on a population scale?
• Is there a documented rate of transmission for lab workers who are doing viral extractions?
• Are severe restrictions on movement (e.g., lockdowns, shelter in place orders) effective in mitigating the spread of the novel coronavirus? 
• Are there any documented cases of airborne transmission of COVID-19?
• What is the latest evidence regarding the effectiveness of mask use in preventing COVID-19 transmission?
• What are current recommendations regarding air flow and the prevention of droplet spread in both medical and non-medical settings?

• What updates are there for the phase 3 clinical trials for a COVID-19 vaccine?
• What is known about the safety and efficacy of using Seraph 100 Blood Filter for COVID-19 treatment?
• What is the evidence base for using chloroquine and hydroxychloroquine with or without azithromycin for COVID-19 treatment and prevention? 
• What is the most ethical and evidence-based way to allocate a limited supply of Remdesivir?
• Is there any evidence to support the presence of a hyper-coagulant state associated with COVID-19 and the use of systemic therapeutic anti-coagulation for COVID-19 treatment?
• Is there any evidence to support the use of aspirin as prophylaxis for COVID-19?
• Is there any evidence to support the use of Tissue Plasminogen Activator (TPA) for COVID-19 treatment?
• Is there evidence to support the use of vitamin D to prevent and/or treat COVID-19?
• Is there evidence to support ECMO plus hemodialysis for COVID-19 patients?
• Assuming that ventilators are running low, is the prone position with supplemental oxygen a feasible option for COVID-19 patients even with profound hypoxia? Can CPAP and BiPAP be re-configured (e.g., through the use of hoods) to minimize aerosols?
• What is known about the use of Oseltamivir to treat COVID-19?
• What is known about the use of Kaletra to treat COVID-19?
• What is known about the use of IVIG to treat COVID-19?
• What are survival rates for ICU vented patients stratified by age? What are survival rates for ECMO patients stratified by age?
• What is known about using plasma for the treatment of COVID-19 patients (i.e., using the plasma of people who have recovered from COVID-19 to treat those who are infected)?
• What are best practices for treating ARDS (acute respiratory distress syndrome)? What are best practices for use of steroids to treat ARDS? Have other states adopted specific best practices for treating COVID-19 patients with ARDS?
• Vaccination post prophylactic monoclonal antibodies
• Is there evidence that vaccine incentives work to increase COVID-19 vaccination rates (especially among vulnerable populations), and if so – which incentives work best?
• Vaccination Recommendations for Pregnant Individuals
• Pfizer Summary of Vaccine Characteristics and Progress
• Moderna Summary of Vaccine Characteristics and Progress
• Johnson & Johnson Summary of Vaccine Characteristics and Progress
• Adverse Events of Varying COVID-19 Vaccines

• Which SARS-CoV-2 vaccines have been approved for use in the US or are likely to be approved for use within the next three months, and what are their defining characteristics?
• What is the literature on best practices for targeted communication, engagement and inclusion of minority populations in COVID-19 testing, adherence to masking/social distancing mitigation orders, and the development of vaccine allocation plans?
• What updates are there for the phase 3 clinical trials for a COVID-19 vaccine?
• Vaccination post prophylactic monoclonal antibodies
• Is there evidence that vaccine incentives work to increase COVID-19 vaccination rates (especially among vulnerable populations), and if so – which incentives work best?
• Who is most at risk for COVID-19 Delta variant infection even if fully vaccinated?
• Vaccination Recommendations for Pregnant Individuals
• Pfizer Summary of Vaccine Characteristics and Progress
• Moderna Summary of Vaccine Characteristics and Progress
• Johnson & Johnson Summary of Vaccine Characteristics and Progress
• Adverse Events of Varying COVID-19 Vaccines

• What symptoms are associated with SARS CoV-2? What is the prevalence of those symptoms among people who test positive? How frequently do people experience 1 symptom, 2 symptoms, 3 symptoms, more than 3 symptoms?
• What is known about pediatric multi-system inflammatory syndrome as is related to COVID-19?
• For how long are infected individuals (symptomatic or asymptomatic) contagious?
• What is currently known about the transmissibility of SARS CoV-2from asymptomatic/pre-symptomatic infected individuals?
• Are there any documented cases of airborne transmission of COVID-19?
• What definitions of “recovery” from COVID-19 are being used?
• What are co-infection rates for COVID-19 with flu and other respiratory viruses?
• Who is most at risk for COVID-19 Delta variant infection even if fully vaccinated?
• What is known about whether and how the SARS-CoV-2 virus may mutate?
• What is the current evidence base regarding COVID-19 re-infection?

• What is the literature on best practices for targeted communication, engagement and inclusion of minority populations in COVID-19 testing, adherence to masking/social distancing mitigation orders, and the development of vaccine allocation plans?
• What are the best practices for SARS-Cov-2 testing in long term care facilities? Please include surveillance, screening, and symptom-based testing.
• Comorbidities and COVID-19
• Is there any evidence to support screening pregnant patients for COVID-19 prior to labor? Have any formal guidance documents or recommendations been issued?
• Is there a documented rate of transmission for lab workers who are doing viral extractions?
• Assuming that ventilators are running low, is the prone position with supplemental oxygen a feasible option for COVID-19 patients even with profound hypoxia? Can CPAP and BiPAP be re-configured (e.g., through the use of hoods) to minimize aerosols?
• What are survival rates for ICU vented patients stratified by age? What are survival rates for ECMO patients stratified by age?
• In relation to the healthcare workforce and COVID-19, what is the standard of care for determining when infected providers can discontinue isolation and return to work? Have other states adopted specific timelines?
• In relation to the healthcare workforce and COVID-19, the CDC recommends that exposed providers be excluded from work (quarantined) for 14 days. Some states are releasing providers to work 9 days post-exposure. What is the evidence base for this (if any)?
• Vaccination post prophylactic monoclonal antibodies
• What is the national incidence of MIS-C requiring hospitalizations among various pediatric age groups? How long are these children hospitalized and what are their overall outcomes?
• What is the national incidence of long COVID among various pediatric age groups? What do we know about the duration of symptoms and return to regular activities including school?
• Is there evidence that vaccine incentives work to increase COVID-19 vaccination rates (especially among vulnerable populations), and if so – which incentives work best?
• Who is most at risk for COVID-19 Delta variant infection even if fully vaccinated?
• Vaccination Recommendations for Pregnant Individuals
• What information is available about COVID-19 fatality stratified by gender, age and co-morbidity?
• What is known about the epidemiology of COVID-19 infection among children?

• Are plastic/plexiglass barriers effective in reducing the transmission of SARS-CoV-2?
• What is the utility of workplaces testing all employees or a random sample of employees for COVID-19?
• Have other states put protections in place for employers who are sued by employees who contract COVID-19, alleging a workplace exposure? What are the key points, or specific language, of those protections?
• What evidence is necessary to inform the potential easing of social distancing in the context of childcare, summer programming, and out-of-school learning in Indiana?
• In relation to the healthcare workforce and COVID-19, what is the standard of care for determining when infected providers can discontinue isolation and return to work? Have other states adopted specific timelines?
• In relation to the healthcare workforce and COVID-19, the CDC recommends that exposed providers be excluded from work (quarantined) for 14 days. Some states are releasing providers to work 9 days post-exposure. What is the evidence base for this (if any)?
• What is the national incidence of long COVID among various pediatric age groups? What do we know about the duration of symptoms and return to regular activities including school?
• What are current recommendations regarding air flow and the prevention of droplet spread in both medical and non-medical settings?
• What are best practices for communicating COVID-specific infection control measures to children, families and group setting caregivers?