COVID-19: Social Distancing Effects / Multisystem Inflammatory Syndrome / Pulmonary Arterial Thrombosis / Point-of-Care Test / Allocating Scarce Meds

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

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

Social distancing effects: Each of three social distancing measures enacted in Germany led to a decline in COVID-19 cases that became detectable 2 weeks after its implementation, according to a short-term modeling study in Science. Of the three measures — in sequence: canceling large events, school closures, and, lastly, contact banning and closure of nonessential stores — only the third stopped exponential growth of the epidemic. The authors write, "Lifting restrictions too much will quickly lead to renewed exponential growth and ... we would be effectively blind to this worsened situation for nearly two weeks in which ... transmission will be uninhibited."

Multisystem inflammatory syndrome: The World Health Organization has issued a preliminary case definition for multisystem inflammatory syndrome in children related to COVID-19. Linked below, it differs slightly from the definition the CDC issued late last week (also linked below). In a Saturday tweet, WHO Director-General Dr. Tedros Adhanom Ghebreyesus called "on all clinicians worldwide to work with your national authorities and WHO to be on the alert and better understand this syndrome in children." As of Sunday, some 200 cases had been identified in the U.S. and Europe, with several associated fatalities, the New York Times reports.

Pulmonary arterial thrombosis: In an autopsy study of 11 COVID-19 patients in Austria, "the most striking and unexpected finding was the obstruction of pulmonary arteries by thrombotic material present at both the macroscopic and microscopic level in all cases," researchers report in the Annals of Internal Medicine. These thromboses were frequently associated with pulmonary infarction and bronchopneumonia. Of note, 10 of the 11 patients had received prophylactic anticoagulation (although venous thromboembolism had not been suspected in any of them).

Concerns about point-of-care test: The Abbott ID NOW point-of-care test for SARS-CoV-2 may deliver false-negative results, possibly due to the type of swabs or virus transport media used, the FDA said in a news release. The agency has received 15 adverse event reports about the test. The manufacturer will be conducting postmarketing studies to help identify the cause of any inaccuracies. In the meantime, an FDA official said, "This test can still be used and can correctly identify many positive cases in minutes. Negative results may need to be confirmed with a high-sensitivity authorized molecular test." For example, a negative result should be confirmed if it's inconsistent with a patient's signs and symptoms.

Allocating scarce inpatient therapies: The authors of a viewpoint in JAMA offer an ethical framework for making decisions about distributing parenteral medications that are in short supply (e.g., remdesivir, monoclonal antibodies) to hospitalized COVID-19 patients. It's worth a read (see link below).