COVID-19 Vaccines & Distribution Strategies
As the nation prepare for the Phase 1a of the COVID-19 vaccine distribution plan, there is much conversation regarding who, when, and how this will be accomplished. In this early release article, the CDC states that demand will likely exceed supply in the first months of the national vaccination program. The Advisory Committee on Immunization Practices (ACIP) has recommended that health care personnel and residents of long term care facilities be offered the vaccine during Phase 1 of the vaccine distribution plan. The ACIP advises the CDC on groups and circumstances for vaccine usage and convened on December 1, 2020 to discuss the FDA’s Emergency Use Authorization and provided interim guidance to the approach for the initial rounds of immunization. Healthcare settings and long term care facilities are extremely high-risk settings for COVID-19 exposure. Early protection of these individuals is crucial to preserve working capacity to care for patients with COVID and other illnesses. Further planning beyond Phase 1a will be considered once the FDA approval is complete.
Clinical Differences Among COVID-19 Patients Related to Age
This retrospective study aimed to identify distinctive clinical characteristics of older adults with COVID-19 when compared to those of younger patients, and also aimed to identify risk factors for mortality. Of the 340 patients studied, 44.6% were >70 years and most had multiple comorbidities when compared to the younger group. Symptoms in this group include confusion, decreased oxygen saturation <93%, neutrophilia, elevated D-dimer, creatinine, and lactate dehydrogenase were all elevated in the older population. In addition, complications such as acute respiratory failure, acute kidney injury, and mortality were reported higher among this group. Younger patients presented with more typical symptoms such as cough, fever, myalgia, etc. In conclusion, older adults with COVID-19 have a more atypical presentation, higher risk for complication, and increased mortality when compared with younger patients. Oxygen saturation at or below 93% on room air on admission was determined to be a predictive factor for death in this study.
Impact of Liver Injury on COVID-19 Severity
In this systematic review with meta-analysis, authors aim to analyze the impact of baseline liver function on COVID-19 outcomes. Authors used a systematic review of relevant studies and determined that patients with pre-existing liver injury had significant risk for development of severe COVID-19 infection when compared to those patients with normal liver function at admission. This study concludes that assessment of AST, ALT, and total bilirubin should be routinely tested in patients who are affected by COVID-19 in order to predict outcomes and anticipate risk of complications.
Convalescent Plasma Treatment
This retrospective study out of Wuhan, China aimed to examine the effects of convalescent plasma therapy in 24 patients who were diagnosed with SARS-CoV-2. The authors of the study evaluated the clinical data and test reports of patients diagnosed with severe COVID-19 pneumonia who also received a convalescent plasma transfusion during treatment. Results show a clinical outcome in those who received the transfusion in 14 of 24 patients (58.3%) with no patients having an adverse reaction to the transfusion process. Lymphocyte counts after treatment returned to normal levels, while white blood cells, CRP, procalcitonin, ALT and AST also showed decreasing trends after treatment. Recent clinical guidelines have been developed to support the collection and implementation of convalescent plasma and hyperimmune immunoglobulin in COVID positive patients and may offer a promising treatment plan at this time.
Source and Symptoms of COVID-19 Positive Healthcare Workers
Healthcare workers (HCW’s) are among the most vulnerable populations facing COVID-19 infection. As we look toward the future it is important to realize what specific risks are increasing rates among HCW’s and work to mitigate those risks. This case study out of Milan examines 172 COVID positive hospital workers during the peak of the pandemic. Interestingly, the study concluded that the most common sources of infection were other positive healthcare workers, with medical doctors and nursing assistants among those most frequently infected. Internal medicine, surgical, ICU, and emergency departments were more affected than COVID units. Symptoms most reported included mild cough, loss of smell and taste (30-40%), and recovery time averaged 23 days while it took 41 days for 95% of healthcare workers to become free of the virus.