Stroke in Young Adults, Test Safety Issues

What your doctor is reading on Medscape.com:

APRIL 25, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Stroke in Young Adults

Investigators from Mount Sinai Health System in New York City report five cases of large-vessel stroke over a 2-week period in COVID-19 patients under age 50 years — a sevenfold increase over the norm.

The cases, which involved only mild or no COVID-19 symptoms, are described in a rapid communication to be published online April 29 in the New England Journal of Medicine.

“It’s been surprising to learn that the virus appears to cause disease through a process of blood clotting,” lead investigator Thomas Oxley, MD, PhD, told Medscape Medical News, adding that the message for neurologists and other physicians is “we’re learning that this can disproportionally affect large vessels more than small vessels in terms of presentation of stroke.”

Abbott Test Safety Issues?

Lab workers at Abbott Laboratories are raising alarm bells about the safety of a widely distributed rapid coronavirus test touted repeatedly by President Donald Trump. They are concerned in particular about the risk of infection of those handling the test, saying the test requires more than the usual protection for those who administer it.

Kaiser Health News reports on this and other “hiccups” with respect to the test, as well as plans to develop safety recommendations to address the issues.

Bud Rose

Burton “Bud” Rose, MD, renowned kidney specialist, entrepreneur, and creator of the popular online medical education resource UpToDate, died Friday from complications of COVID-19 at age 77. You can read more about his achievements and invaluable contributions in this moving tribute to “the Steve Jobs of medicine” on Stat News.

VTE vs Bleeding Risk

Clinicians have been sounding the alarm about unusually high rates of thrombosis among COVID-19 patients, and news this week that Broadway star Nick Cordera had one of his legs amputated as a result of thrombotic complications of COVID-19 brought the issue center stage.

Now a panel of 36 international experts has published a report summarizing the evidence on the thrombotic disease pathogenesis, diagnosis, and management in patients with COVID-19 as well as the management of thrombotic disease in patients without COVID-19. The panel also addresses concerns about balancing the need for thromboprophylaxis against the risk for bleeding.

“There’s so much confusion, so much heterogeneity in the way people are practicing — and granted, the evidence is not perfect — but I thought it’s about time to provide a thorough assessment of the known literature but also some consensus-based recommendations,” Behnood Bikdeli, MD, New York–Presbyterian Hospital/Columbia University Irving Medical Center and Yale University’s Center for Outcomes Research and Evaluation, New Haven, Connecticut told theheart.org | Medscape Cardiology.

Immunity Passports?

As part of efforts to enable people to travel or return to work, some governments have floated the idea of providing “immunity passports” indicating an individual is COVID-19 risk-free.

Not so fast, says the World Health Organization (WHO), which has published guidance on adjusting public health and social measures for the next phase of the pandemic response. The WHO states there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a subsequent infection.

In a scientific brief published online April 24, the WHO states that study on this matter is ongoing, but at this point evidence is lacking about the effectiveness of antibody-mediated immunity to ensure that an individual is risk-free, and that the use of such classifications could increase the risks of continued virus transmission.

US WHO?

The United States will have no official role in a new WHO initiative involving several world leaders and designed to accelerate the development of tests, drugs, and vaccines against the coronavirus.

The Access to COVID-19 Tools Accelerator initiative, a “landmark collaboration” that aims to speed tool development and ensure equal access worldwide, was announced Friday in the wake of a decision by President Trump to suspend US contributions to the global health body, as reported by The Hill. A spokesman for the US mission in Geneva said there will be no official US participation.

Managing Hypoxia

In hypoxic patients with COVID-19 and an indication for endotracheal intubation, an airway expert should perform intubation, an N-95/FFP-2 or equivalent respirator mask should be used, and other PPE and infection control precautions should be taken, according to new guidelines from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.

Staff presence in the room should be minimized and use of videolaryngoscopy should be considered if available, the authors note.

Medscape Drugs and Diseases has provided a quick summary of the guidelines, which also address patients in whom endotracheal intubation is not indicated and who are not tolerating supplemental oxygen or high-flow nasal cannula use.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and put themselves at risk of infection. More than 500 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.