This is a brief report from JAMA Cardiology. It is an observational study from Wuhan. In hypertension patients admitted with COVID-19, a history of ACEi/ARB use was not associated with an increase in disease severity or death when compared to anti-hypertensive drugs. It is a small study and absence of evidence of an effect is not the same thing as evidence of absence of an effect. There may be residual confounding. The conclusion is that the authors feel that their data support current societal recommendations not to discontinue ACEi/ARB in COVID-19 patients.
– Paul Bridgman
Computational epidemiology was used to develop simulation of the ongoing COVID-19 pandemic in Australia. Once the model was calibrated for key variables, it then evaluated potential effects of several interventions strategies: case isolation; international travel restrictions; social distancing at different population compliance levels; and school closures independent of social distancing.
A key finding is the best effect comes from combining all restrictions with high social distancing compliance. There is a clear trade-off between duration vs compliance, a shorter period of social distancing implementation for a duration at 80% (18-19 weeks) and 90% (13-14 weeks) compliance. Importantly, this model confirms that social distancing compliance of 70% or less results in no benefit to epidemic control. School closures were found to not bring decisive benefits, unless coupled with high level of social distancing compliance. Increasing compliance is important to significantly reduce incidence and prevalence, and effectively control the spread of COVID-19 in Australia (during the suppression period).
– Louise Hickman
Barrier Enclosure during Endotracheal Intubation (7 April, 2020)
A picture is worth a thousand words. Wear your PPE.
This NEJM picture of fluorescent dye coughed on a face shield is a solid reminder to wear your PPE and follow recommended procedures for taking it off. No need to read the article just look at the image.
– Paul Bridgman
This is a lab based study published in the NEJM on 17 March. The COVID -19 virus has similar duration of viability in the air and on surfaces to the closely related coronavirus that caused the SARS outbreak. The inference is that the epidemiology of COVID 19 is very different to SARS because of the higher loads of virus are shed from the upper respiratory tract and because of a higher potential for asymptomatic people to spread the virus.
– Paul Bridgman
ACC position paper on COVID-19 and troponins (1 April, 2020)
- Troponin commonly elevated in Covid
- Clinicians are advised to only measure troponin if the diagnosis of acute MI is being considered on clinical grounds and an abnormal troponin should not be considered evidence for an acute MI without corroborating evidence.
- Use of echocardiography or coronary angiography for COVID-19 patients with myocardial injury or elevated natriuretic peptide should be restricted to those patients in whom these procedures would be expected to meaningfully affect outcome.
- No data exist to suggest benefit from anti-platelet or anticoagulant therapy for those with acute myocardial injury with the exception of those with Type 1 MI.
– Ian Crozier
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