What your doctor is reading on Medscape.com:
APRIL 22, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:
New Treatment Guidelines From NIH Panel
The National Institutes of Health (NIH) has issued “living” treatment guidelines for COVID-19, which will be updated online as new data from peer-reviewed publications and other authoritative information become available.
“We have to face the reality that we don’t yet have the controlled clinical data we need in order to say whether something works,” said a guidelines panel cochair. “But we asked ourselves whether guidelines were needed now, and we decided that we do need to provide guidance for clinicians facing critical patients and wanting to do something to help them.”
Observational Data on ACEI/ARBs
In an observational study, hospitalized COVID-19 patients with hypertension who were taking a renin-angiotensin system-inhibiting drug had significantly better survival when compared with similar hypertensive patients not on these drugs, researchers from China report.
“While the investigators used standard techniques to attempt to reduce bias in this observational study via propensity matching, it is not a randomized study and the residual confounding inherent to this approach renders the conclusions hypothesis generating at best,” experts write in an accompanying editorial.
While triage of critical care resources should be a rare event during the COVID-19 crisis, recent reports in academic journals urge hospitals and communities to prepare for surges in demand that might require triaging resources, and offer advice on how to do so.
“The ethical burden this places on hospitals, health systems, and society is enormous,” one of the report authors said. “Our hope is that a triage system can help us identify those patients with the greatest likelihood of benefiting from scarce critical care resources, including but not limited to mechanical ventilation, while still remembering our obligations to care for all patients as best we can under difficult circumstances.”
At present, with questions about the reliability of antibody tests — and uncertainty about whether they indicate a person’s future immunity to SARS-CoV-2 — the information from antibody testing is largely unhelpful to individuals, Medscape Medical News reports. But it still could be valuable to epidemiologists and policy makers.
“There is enormous demand for serologic testing,” said the president of Mayo Clinic Laboratories, which has developed a test. “At this time, serology testing needs to be prioritized for efforts to identify individuals in areas where potential immunity is key ― supporting healthcare workers, screening for potential plasma donors, and helping advance the most promising vaccine candidates.”
Pay Cuts May Violate Contracts
Just in the past few weeks, as the pandemic intensified, employed physicians have started to see massive changes in their payment arrangements. They have had to take large pay cuts, give up bonuses, go on leave, and have even been terminated.
In many cases, these actions violate the employed physicians’ contracts, one physician contract attorney said. “In my 11 years of work on physician contracts, I have never seen changes as drastic as these,” said another.
First US Deaths Earlier in February
The Bay Area county of Santa Clara announced that its medical examiner has identified two individuals who died at home on February 6 and February 17 whose tissue samples have since tested positive for SARS-CoV-2. Previously, the first known COVID-19 fatality in the United States was a person who died in the Seattle, Washington, area on February 29.
A Medscape reference article highlights characteristic findings on chest CT scans and radiographs, with accompanying images.
As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Hundreds 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.