Case Counts Scrutinized, Surgeon Sings for Relief

What your doctor is reading on Medscape.com:

APRIL 19, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Experts Skeptical of “Fast-Track” Prevalence Studies

After two preprints were released suggesting the number of coronavirus cases is much higher than previously thought — which would make the death rate significantly lower — experts spent the weekend conducting their own “peer reviews” of the studies and found them seriously lacking. “The only thing they did well was to try to answer a question, but they miserably failed in every aspect of it,” said Eric Topol, MD, Medscape’s editor in chief.

The authors of one of the preprints already revised their estimates from 28 million to 8.7 million to account for data discrepancies. Twitter critics described the papers as “misleading” and focused on flaws with the antibody test used to generate the data in one study, as well as selection bias. While they acknowledged that such studies will be important to help the world resume normal activities again, they cautioned that these conclusions could downplay the seriousness of the epidemic and give false hope about its progression.

Accuracy of Antibody Tests Questioned

Some experts believe that the key to “reopening” the country is widespread antibody testing to determine immunity to the COVID-19 virus, but many of the currently available tests are raising alarms about their accuracy, reports the New York Times. The FDA has allowed about 90 companies to sell tests that were not vetted by the agency, the newspaper reports; most tests are made in China and some are described as “deeply flawed,” giving false positive reports of immunity. 

Chaos and Grief Rattle Medical Trainees

For medical students and residents, there’s no handbook for how to deal with the disruption in education or the illness of teachers and peers caused by COVID-19, writes Jillian Horton, MD, an internist at the University of Manitoba in Winnipeg, Canada. She experienced a similar situation as a resident during the outbreak of severe acute respiratory syndrome, and she shares lessons she learned from that difficult time.

“You may wonder if you have a ‘right’ to grieve for the doctors, nurses, and other healthcare providers who are dying in this terrible crisis,” she writes. “You do. You see yourself in them, and rightly so. If you are questioning your right to grieve for them because you have not ‘earned’ it, trust that your conflict is entirely normal. But make no mistake, this is your community.”

Singing Surgeon Records Songs for COVID-19 Relief

He’s been a viral sensation on YouTube, Spotify and other social channels, and now the orthopedic surgery resident — whose first name happens to be Elvis — has recorded an album, and the proceeds will go to the Center for Disaster Philanthropy’s COVID-19 Response Fund. Elvis Francois, MD, who is finishing his residency at Mayo Clinic in Rochester, Minnesota, will then enter a fellowship in spine surgery at Beth Israel Deaconess Medical Center in Boston.

For now, he is enjoying his day in the spotlight. “I’ve had to pinch myself, ‘Is this actually real?'” he told the Associated Press. Fellow resident William Robinson accompanies the singer on piano for his renditions of “Imagine,” “Lean on Me,” “Rise Up,” and “Alright.”

New Hospital Designs Emerge From Pandemic

Hospitals lately have focused on being lean and efficient, but they now must add “adaptability” to their goals, say architects studying current and future needs. The ability to expand and contract will be more important than building permanent wards to address future epidemics, they say. Current strategies include setting up temporary facilities in parks or auditoriums — dubbed “Nightingale wards” after the famed nurse who first called for placing beds 6 feet apart — but hospitals can also design parking garages or similar facilities that can be converted to hospital wards when needed.

Other design features of future hospitals may include touch-free controls for lighting and other building functions, to reduce the spread of disease on surfaces. Using materials that are less hospitable to microbes, such as copper, also may reduce infections. And window curtains could be replaced with “smart glass” that can switch between see-through and opaque.

Blood Donations Needed to Maintain Essential Supply

A variety of factors are converging to strain the nation’s blood supply, and some clinicians are concerned that patients who need regular transfusions are at risk. Donations are down as many people follow stay-home orders, and even healthcare workers who are a usual source are too busy to give blood,
experts say.

Hematologists became concerned in early March when blood banks urged them to think twice about order routine transfusions because the blood likely would be needed to treat coronavirus patients, Ify Osunkwo, MD, told MDedge. The FDA has revised recommendations to make more people eligible to donate blood, including easing restrictions around potential HIV transmission, malaria transmission, and spread of Creutzfeldt-Jakob disease from previous travel to Europe.

Can You Solve This Challenging Case?

A 45-year-old man with a history of HIV infection presents to the ED with shortness of breath, dyspnea, a productive cough, and a fever of 101°F (38.3°C). Is it tuberculosis, Kaposi sarcoma, Pneumocystis jirovecii pneumonia? Check out the x-ray and chest CT images to make the call.

UK Vaccine Trial “Close to Getting Underway”

The lead researcher of the vaccine development program at the University of Oxford told The Lancet that she hopes to have vaccinated 500 volunteers by mid-May. That vaccine is based on an adenovirus vaccine vector and the virus spike protein. Prof Sarah Gilbert has said previously that she was 80% confident the vaccine will work. “We can never be certain these vaccines are going to work,” she told Medscape UK. But, she added, she has a high degree of confidence. “I’ve worked with this technology a lot…and I’ve seen what that can do.”

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 of 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.