In this issue: Effects of COVID-19 on mental health, False Positive rates in testing, Using ultrasound to diagnose DVT in COVID patients, and COVID-19 affects on health disparities

Effects of quarantine on mental health of populations affected by COVID-19

Lately, it seems that there has been a large discussion on the effects of quarantine on mental health. This article, discusses the psychological effects of the quarantine related to COVID-19. Citizens in a confined state feel constraint and expressed fixation on the state of the virus. Rapid infection spread and death rates have been increased anxiety, depression, and stress in the public and in the medical community. Those who were involved in this study report symptoms consistent with PTSD, confusion, and anger. In addition, unexpected interruption of work and professional activities has caused financial loss leading to increased anxiety and stress. The authors noted increased psychological damage that may continue for months after the end of the quarantine period and stress that public health agencies allocate resources to the support of mental health during this time.

COVID-19 Testing Updates:

During the COVID-19 pandemic, the gold standard for testing has been via the RT-PCR method. Many articles have been published recently that examine the validity of these tests when diagnosing SARS-CoV-2. A few articles discuss the use of this method:

Discrimination of false negative results in RT-PCR detection of SARS-CoV-2 in RNA

In this article, one study seeks to determine the principle cause of false-negative results when using RT-PCR testing of respiratory tract specimens. The study examined 161 COVID-19 positive patients and took multiple sputum and throat swabs to evaluate a total of 1052 samples. Using a retroactive analysis, the authors identified Ct cutoff values for RPP30 RT-PCR which predicted false-negative results for COVID-19 with high sensitivity (95.03-95.26%) and specificity (83.72%-98.55%) for respective combination of specimen type and amplification reaction to identify false negative results using these cut-off values. The study outcome determined that the presence of cellular materials (infected host cells) are essential for detection of SARS-CoV-2 in patient specimens when using RT-PCR testing.

Laboratory verification of an RT-PCR assay for SARS-CoV-2

In this article, the authors evaluate the characteristic performance of RT-PCR testing in a clinical laboratory. Using a commercial SARS-CoV-2 RNA RT-PCR kit commonly used in a lab setting, a multiple real-time RT-PCR assay for the RdRP, N, and E genes in SARS-CoV-2 is verified. The verification of the RNA test was consistent with the product requirements and the study confirmed that the kit met the detection performance criteria stated in the kit. However, the study did have some limitations noted in the article. Discussion of possible “false-positives” are noted, and that further RNA comparisons could be useful.

Using bedside ultrasound to diagnose DVT in COVID patients

This study evaluates the applicability of bedside ultrasonography for the diagnosis of DVT in patients with COVID-19, with and without low molecular weight heparin therapy. Using a retrospective approach, the authors reviewed medical records of deceased and surviving patients who detected (or not) a DVT and in whom LMWH was or wasn’t prescribed. The results show that the incidence of DVT was higher in deceased patients (33 of 35) than in survivors (22 of 46). Analysis also showed that LMWH had been administered in a larger proportion of survivors when compared to the deceased. Results indicate that DVT was found in higher concentrations of patients who were fatally affected by COVID-19, and that bedside ultrasound technique can and should be used to detect DVT as early as possible to allow for reasonable use of LMWH.

Is COVID causing delays in cancer diagnosis?

In this letter to the editor, printed in the Sao Paulo Medical Journal, the author references a special report published in the American Society of Clinical Oncology which recommended delaying visits for cancer screening and staging-related procedures in May 2020. While the author supports delaying diagnostic and staging procedures when clinically indicated, they expressed concern that delaying all screening and procedures would lead to an unprecedented elevation of cancer diagnoses in time. The author proposes that new screening strategies should be implemented during the pandemic to ensure cancer diagnoses are not delayed. He suggests: incorporating alternatives such as self-collection of fecal occult blood tests and/or HPV tests, having facilities set up specific days/locations for preventive procedures (mammography and colonoscopy), requests for imaging should be sent to the diagnostic center directly, etc. Many facilities have returned to seeing patients as normal, however, should a future quarantine occur, these methods could be utilized to reduce the delay in cancer screening and diagnosis.

The impact of COVID-19 on health disparities in the African American Community

The pandemic has greatly magnified social and health disparities in the United States. Perhaps the greatest impact has been on the African American community. Healthcare providers must be aware of the social and medical factors that lend to disproportionate cases of COVID-19 among populations at risk. Addressing these factors is critical in reducing health disparities and improving care.

This article discusses the unfortunate effects that COVID-19 has had on vulnerable populations, specifically, in the African American community. African Americans are being diagnosed with and dying from COVID-19 at disproportionate rates. This is especially so in Chicago, Illinois, Michigan, and Louisiana who have high mortality rates. Minorities represent a large number in the service industry, early care and education, restaurant workers and food processors where public interaction is high and physical distancing is difficult. In addition, socioeconomic status is an indicator that is most consistent with early onset of chronic medical conditions which occur on average, 10-15 years sooner which may contribute to the higher COVID-19 numbers within the African American community. Lack of health insurance may delay diagnosis and treatment options, lack of public testing, high rates of chronic illness, and individual and structural healthcare system bias all create a perfect storm lending to higher incidence of COVID-19 cases and deaths in the African American population. The dire need for improvement in care is discussed.