COVID-19 Scan for Apr 29, 2020

Stroke and COVID-19 in younger adults
Internet searches for COVID-19 drugs
Workplace exposures to infection

Study associates stroke with COVID-19 in adults younger than 50

Five COVID-19 patients in their 30s and 40s had large-vessel ischemic strokes from Mar 23 to Apr 7 in a New York City health system, more than five times what the system had been seeing every 2 weeks in the past year, according to a research letter published yesterday in the New England Journal of Medicine.

When admitted, the patients' mean National Institutes of Health Stroke Scale (NIHSS) score was 17 (scores range from 0 to 42, with higher numbers indicating more severe stroke). One patient had previously had a stroke. Over the past year, the health system had seen only 0.73 patients in that age-group with large-vessel stroke every 2 weeks.

Two patients delayed calling an ambulance after developing stroke symptoms because they were worried about hospital exposure to the novel coronavirus. One, a previously healthy 33-year-old woman who had a cough, headache, and chills for a week, waited 28 hours after she began having trouble speaking and weakness in her left arm and leg before seeking treatment.

On hospital arrival, she had an NIHSS score of 19. Computed tomography (CT) and CT angiography demonstrated a partial blockage in the right middle cerebral artery, a blood clot partially blocking the right carotid artery, and fluid buildup in the lungs characteristic of COVID-19 infection. She tested positive for the virus and was released to a rehabilitation facility after 10 days.

The authors noted that retrospective data from Wuhan, China, showed a 5% incidence of stroke among hospitalized COVID-19 patients, but with the youngest stroke patient being 55 years old.

Stroke was also associated with the SARS (severe acute respiratory syndrome) outbreak in Singapore, and abnormal clotting and damage to the lining of blood vessels are thought to be complications of COVID-19.

"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes," the authors said.
Apr 28 NEJM research letter


Trump's enthusiasm for antimalarials tied to spike in Internet search

A new study published today in JAMA Internal Medicine shows that Internet search for hydroxychloroquine and chloroquine spiked after endorsements from President Donald Trump and billionaire entrepreneur Elon Musk.

The study, conducted by researchers at Oxford University, Harvard University, Johns Hopkins University, and the University of California San Diego, used Google Trends to record searches originating from the United States from Feb 1 to Mar 29 that were related to the antimalarial drugs touted as potential therapeutics for COVID-19 after some success was seen in small clinical settings in China and France.

Google searches for buying chloroquine (which included words such as "buy," "order," and "Amazon") were 442% higher, and searches for hydroxychloroquine were 1,389% higher following endorsements from Trump, the study authors found.

President Trump first endorsed the drugs on Mar 19, and even following public news reports on Mar 22 of chloroquine-related deaths and poisonings, searches to buy chloroquine or hydroxychloroquine remained substantially above expected levels at 212% (95% confidence interval [CI], 66% to 1098%) and 1,167% (95% CI, 628% to 1741%) higher, respectively, the authors said.

"The present analysis suggests that in times of public health crises, demand for unproven and potentially hazardous COVID-19 treatments is massively increased by endorsements. Public health leaders, regulatory agencies, media, and retailers must amplify accurate information," the authors concluded.
Apr 29 JAMA Intern Med study


Many US employees regularly exposed to infection at work, study finds

About 10% of US workers have jobs in which they are exposed to disease or infection at least once a week, while 18% are exposed at least monthly, making workplaces an important focus for public health interventions, a study published yesterday in PLOS One has found.

Using national employment and survey exposure data, University of Washington researchers showed that more than 90% of healthcare workers providing patient care or support are exposed more than once a month, while 75% are exposed more than once a week.

While healthcare workers are likely to have workplace infectious disease prevention plans, other sectors have high levels of exposure and may not have such plans in place, such as administrative support professionals, daycare and preschool teachers, social workers, and plumbers. For instance, 52% of police officers, airport screeners, firefighters, childcare workers, and personal attendants are exposed at least once a month.

The authors pointed out that, of the first 25 COVID-19 patients in Singapore, 17 had probable occupational exposure, including retail and casino workers, taxi drivers, domestic workers, and security guards.

The authors noted that quantifying how many people are at risk for infection can help guide the public health response to infectious disease outbreaks such as the COVID-19 pandemic as well as the risk response and communications plans of governments and individual businesses.  Measures could include holding workplace infectious disease training, increasing access to paid sick leave, cross-training, ensuring flexible working conditions and temp workers to fill in when workers are ill, and offering hazard pay for workers exposed during a pandemic.

"Occupational characteristics, such as interfacing with the public and being in close quarters with other workers, not only put workers at high risk for disease, but also make them a nexus of disease transmission to the community," they wrote. "This can further be exacerbated through presenteeism, the term used to describe the act of coming to work despite being symptomatic for disease."
Apr 28 PLOS One study

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