COVID-19 Update: Blood Test, Lingering Symptoms, Bypassing CDC

COVID-19 Update: Blood Test, Lingering Symptoms, Bypassing CDC
Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:

Blood Test Signals Risk?

A low lymphocyte count in people presenting to the hospital with COVID-19 could help physicians identify those at higher risk for intensive care unit (ICU) admission, suggests new evidence from a retrospective cohort study of 57 patients.

Lymphocytopenia was associated with more than a threefold increased risk for requiring ICU care compared with people with normal lymphocyte results at time of admission. Acute kidney injury also was more common among people with low absolute lymphocyte counts.  

Lingering Symptoms 

Some recovered COVID-19 patients discharged from acute care need continued monitoring for long-lasting effects, according to new research. In a study of previously hospitalized COVID-19 patients, nearly 90% of 143 patients had at least one persistent symptom 2 months or longer after initial onset and at more than a month after discharge.

About half of patients still had fatigue, 40% had dyspnea, 30% had joint pain, and 20% chest pain — none had fever or other signs and symptoms of acute illness. Thirty-two percent of patients had one or two symptoms and 55% had three or more.

Change to Government Data Reporting

The Trump administration has issued new instructions for hospitals to report COVID-19 patient information to the US Department of Health and Human Services (HHS) for a central database, rather than through the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network. 

The New York Times, which first reported the change, also reported that public health experts expressed concern that the CDC would no longer be collecting the data, while officials said the change would streamline data gathering and assist the White House coronavirus task force in allocating personal protective equipment and the antiviral drug remdesivir.

Too Many Trials?

There has been an explosion of research into COVID-19, from its underlying biology to its potential treatments. Researchers recently quantified just how much: 674 specific randomized trials of COVID-19 interventions. Nearly a quarter of the treatment trials were testing chloroquine. 

“This could be a problem,” F. Perry Wilson, MD, MSCE, says in a commentary for Medscape. One issue is that, with enough randomized trials of an intervention that doesn’t actually work, some individual trials will nevertheless return positive results, and those results will be publicized. 

Second, more researchers should work together, Wilson says. “We need to foster collaboration across medical centers and research institutions, get these teams working together, do 20 really amazing trials instead of 120 mediocre ones.” 

Few Claims for Uninsured COVID Care

HHS has received far fewer claims than expected from clinicians and hospitals for COVID-19–related testing and treatment for uninsured patients, a senior official said during a media briefing.

The official said that, so far, HHS has paid out some $340 million in claims, which is “less than we had expected to distribute.” HHS has not put any limit or cap on how much it will reimburse for the claims, which are paid at the Medicare rate. The agency probably has an additional $40 billion to $50 billion in spending flexibility for the uninsured, the official said.

“Broken Heart” Syndrome

The incidence of stress cardiomyopathy, also known as Takotsubo, or “broken heart” syndrome, was higher among patients presenting to two Ohio hospitals with acute coronary syndromes during the COVID-19 pandemic compared with other time periods, according to a new analysis.

Twenty of 258 patients (7.75%) who presented in a 2-month period during the pandemic were diagnosed with stress cardiomyopathy compared with five to 12 patients (1.5% to 1.8%) during other comparative 2-month periods from 2018 to 2020.

Those differences, plus the finding that COVID-19 test results were negative in all patients diagnosed with stress cardiomyopathy in the pandemic period, suggests that “the psychological, social, and economic distress accompanying the pandemic, rather than direct viral involvement and sequelae of the infection, are more likely factors associated with the increase in stress cardiomyopathy cases,” the authors write.

Elective Surgery Halt Likely Had Minor Effect on ICU Capacity 

Canceling elective surgeries in an attempt to free up ICU beds for COVID-19 patients may have had a limited effect on expanding ICU capacity, according to a researcher who reviewed 5 years of New York State hospital data with colleagues. They found that elective surgery accounted for about 13% of ICU admissions, while 28% were emergent or urgent admissions such as trauma surgery cases and 59% were medical admissions. 

Even though one of the study authors estimated that the biggest increase in ICU bed capacity in New York during the pandemic likely came from reductions in trauma and medical admissions due to stay-at-home orders, he also said that stopping elective surgery was “necessary to free up much needed resources.” 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1700 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form. 

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Ellie Kincaid is Medscape’s associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine. She can be reached at ekincaid@medscape.net or on Twitter @ellie_kincaid .

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