First10EM Journal Club : CoV2-SARS edition

We will open this episode with a disclaimer:

In this edition of the research roundup we acknowledge that we are making many decisions based on very weak science. I generally don’t include that many really weak studies, unless they are really entertaining, but when searching for scientific answers to my questions about COVID, that was often the best I could find. I will also say that new publications are coming out at an astounding rate, and even with the amount of time I spend reading every day, I cannot keep up. Some of this information could be out of date by the time you read it. That being said, this is a collection of studies that I found interesting and helped answer some of my many questions about COVID-19.

I am not going to include any of the papers that describe the basic clinical course or management of this disease.  We highly recommend  the summaries on REBEL EM or The Internet Book of Critical Care.

Some infection control stuff

COVID will cover all room surfaces, but cleaning works

Ong SWX, Tan YK, Chia PY, et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient JAMA. 2020; [article]

COVID will survive on surfaces

van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 [published online ahead of print, 2020 Mar 17]. N Engl J Med. 2020;10.1056/NEJMc2004973. PMID: 32182409

What exactly are aerosol generating procedures?

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797. PMID: 22563403

doi:10.1371/journal.pone.0035797

Hui DS, Chan MT, Chow B. Aerosol dispersion during various respiratory therapies: a risk assessment model of nosocomial infection to health care workers. Hong Kong Med J. 2014;20 Suppl 4:9–13. PMID: 25224111 

https://www.youtube.com/watch?v=_80EtxfAmIE

Bourouiba L. Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19 [published online ahead of print, 2020 Mar 26]. JAMA. 2020;10.1001/jama.2020.4756. doi:10.1001/jama.2020.4756 PMID: 32215590

In the meantime, there is a very interesting episode of the Epidemic podcast with Dr Celine Gounder (an ID doc and journalist) entitled “A False Dichotomy: Airborne versus Droplet”.

Clinical Assessment

The Roth Score

Chorin E, Padegimas A, Havakuk O, et al. Assessment of Respiratory Distress by the Roth Score. Clin Cardiol. 2016;39(11):636–639. doi:10.1002/clc.22586 PMID: 27701750

Some treatment stuff

Chloroquine is probably not a miracle cure

Gautret P, Lagier J, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. 2020; [article]

Paper #2: Gautret P, Lagier J, Parola P, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study. Prepublished online

Neither is Lopinavir-Ritonavir

Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 [published online ahead of print, 2020 Mar 18]. N Engl J Med. 2020;10.1056/NEJMoa2001282. PMID: 32187464 [open access article]

You can read more about this study on REBELEM and PulmCrit

I wanted to include a trial on remdesivir, because everyone is talking about it, and people are clamouring to get it from Gilead, but there is not a single clinical trial looking at this drug in humans. There is no evidence that it works. You can read about the lack of evidence for all the antivirals in this post.

The current trial design is available here: Clinical Trials Registry

Kalil AC. Treating COVID-19-Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics [published online ahead of print, 2020 Mar 24]. JAMA. 2020;10.1001/jama.2020.4742. doi:10.1001/jama.2020.4742 PMID: 32092748

Some PPE stuff

The big question: N95 or surgical mask?

Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta‐analysis J Evid Based Med.. 2020; [article]

But we are running out of masks. Can we make our own?

MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015;5(4):e006577. Published 2015 Apr 22. doi:10.1136/bmjopen-2014-006577 PMID: 25903751 [free full text]

Ibuprofen – there is no actual data… so here is a trial that might explain the phenomenon

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? [published online ahead of print, 2020 Mar 11]. Lancet Respir Med. 2020;S2213-2600(20)30116-8. doi:10.1016/S2213-2600(20)30116-8 PMID: 32171062

Palliative Care

Hendin A, La Rivière CG, Williscroft DM, O’Connor E, Hughes J, Fischer LM. End-of-life care in the Emergency Department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19) [published online ahead of print, 2020 Mar 26]. CJEM. 2020;1–5. doi:10.1017/cem.2020.352 PMID: 32213224

There is a nice infographic that summaries this paper from the great EMOttawaBlog:

Finally a meme to lighten the mood.  There are so many flying around the Web but I liked this one as it speaks to the absurdity of the situation in many places.

Vincent van Cough:

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