COVID-19 Update: Cardiac Considerations with Antimalarials & Azithro / Family Gatherings / Coagulopathy & Antiphospholipid Antibodies / Loss of Smell

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Here are some of the latest developments in novel coronavirus disease (COVID-19):

Antimalarials, azithromycin & QT prolongation: The American Heart Association, American College of Cardiology, and Heart Rhythm Society have issued recommendations on using hydroxychloroquine and azithromycin to treat COVID-19 in patients with preexisting cardiovascular disease. Complications may include severe arrhythmia, polymorphic ventricular tachycardia, long QT syndrome, and increased risk for sudden death. One recommendation: the drugs should be withheld in patients with baseline QT prolongation. Additionally, the effects of these two drugs in combination on QT prolongation and arrhythmia have not been studied.

Family gatherings: In MMWR, U.S. researchers describe a cluster of 15 probable or confirmed COVID-19 cases that occurred after an infected patient — with only mild respiratory symptoms — attended a funeral and then a birthday party 3 days later. Three of the 15 patients died. The researchers write, "These data illustrate the importance of social distancing for preventing SARS-CoV-2 transmission, even within families."

Coagulopathy & antiphospholipid antibodies: An older man in China with a history of hypertension, diabetes, and stroke was diagnosed with COVID-19 that ultimately required invasive mechanical ventilation. Testing revealed coagulopathy, antiphospholipid antibodies, and cerebral infarcts in multiple vascular territories. Two other patients in the ICU had similar findings. Writing in the New England Journal of Medicine, physicians note that antiphospholipid antibodies can occur in critically ill patients, and they "may rarely lead to thrombotic events that are difficult to differentiate from other causes of multifocal thrombosis."

Loss of smell: In JAMA Otolaryngology—Head & Neck Surgery, researchers describe a woman in her 40s who presented with sudden loss of olfactory function, without dysgeusia. There was no nasal obstruction, rhinorrhea, or fever. Several days earlier, she'd had a dry cough, headache, and muscle aches. Imaging showed bilateral inflammatory obstruction of the olfactory clefts. She ultimately tested positive for SARS-CoV-2. The researchers conclude that "a sudden and complete olfactory function loss, without nasal obstruction in a patient with other symptoms, such as cough or fever, should alert the clinician to suspect SARS-CoV-2 infection."

SARS-CoV-2 in Pets: Researchers in China investigated how susceptible certain domesticated animals are to SARS-CoV-2. Writing in Science, they conclude that "ferrets and cats are highly susceptible ... dogs have low susceptibility, and livestock including pigs, chickens, and ducks are not susceptible to the virus." In particular, SARS-CoV-2 replicates in the upper respiratory tract of ferrets; it also replicates efficiently in cats, and experiments suggest cats may be susceptible to airborne transmission.