COVID-19 Scan for Jun 04, 2020

COVID-19 in kids having surgery
N95 respirator decontamination

Study: COVID-19 rate in US pediatric surgical patients low but varies by region

A study published today in JAMA Surgery has found a 0.93% overall incidence of COVID-19 among pediatric patients undergoing urgent surgery in three US hospitals, but with wide regional variations.

Overall, 1,295 patients younger than 19 years were tested for the novel coronavirus as part of universal preoperative screening at Children's Hospital of Philadelphia, Texas Children's Hospital in Houston, and Seattle Children's Hospital from Mar 26 to Apr 22.

Twelve of 1,295 (0.93%) tested positive, but the incidence ranged from 1 of 456 (0.22%) in Houston to 9 of 339 (2.65%) in Philadelphia. Incidence in Seattle was 2 of 500 (0.40%).

Mean age of all surgical patients was 7 years. The authors noted that five of the nine coronavirus-positive patients in Philadelphia were from a single township with a positive risk rate of 55.6%, versus 1.5% (5 of 330) in all other patients (risk ratio, 36.7; P = .001).

Of the 12 total patients with COVID-19, 6 had preoperative symptoms; 3 had fever, and 2 had nasal discharge. Because reported symptoms could have been attributed to unrelated conditions (eg, appendicitis), and many children are asymptomatic or only mildly ill, symptoms are unreliable indicators of infection, the authors said.

Accordingly, of 41 pediatric hospitals responding to a recent Pediatric Anesthesia Leadership Council survey, 56% reported implementing universal preoperative screening, they noted.

"The value of universal screening is greatest in areas with higher prevalence," the authors wrote. "As elective surgery resumes across the country, it is important to consider universal testing in the context of regional prevalence, local testing capability, and availability of personal protective equipment."
Jun 4 JAMA Surg research letter

Researchers: N95 respirators can be decontaminated successfully

A research letter yesterday in Emerging Infectious Diseases describes four methods of decontaminating N95 respirators and finds that, while all can be effective, the integrity of respirator fit and seal must be maintained.

Healthcare workers around the world rely on N95 respirators to protect themselves from aerosolized pathogens, and typically the respirators are discarded after a single use. But the COVID-19 pandemic has caused massive shortages and forced clinics and hospitals to reuse N95s for entire shifts. Decontaminating the respirators before reuse has become a new area of interest.

The authors looked at four methods to decontaminate N95s: ultraviolet (UV) light (260 to 285 nm), 70ºC (158ºF) dry heat, 70% ethanol, and vaporized hydrogen peroxide (VHP). For each decontamination method, the authors compared the normal inactivation rate of SARS-CoV-2 virus on N95 filter fabric to that on stainless steel. They also measured the filtration performance of N95 respirators after each decontamination run and 2 hours of wear, for 3 consecutive decontamination and wear sessions.

After a single decontamination method, filtration performance was not reduced. But, they write, "Subsequent rounds of decontamination caused sharp drops in filtration performance of the ethanol-treated masks and, to a slightly lesser degree, the heat-treated masks." They add, "Our results indicate that, in times of shortage, N95 respirators can be decontaminated and reused up to 3 times by using UV light and [VHP] and 1–2 times by using dry heat."
Jun 3 Emerg Infect Dis study

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