COVID-19: CSF Leak After COVID-19 Test / Vaccine Investigation / No Cruise Ship Travel

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Here are some of the latest developments in COVID-19:

CSF leak after COVID-19 test: Researchers report the first known case of a cerebrospinal fluid (CSF) leak after a patient was tested for COVID-19. The patient presented for testing before undergoing elective hernia surgery. Soon after, she developed unilateral rhinorrhea, vomiting, and headache. Computed tomography scans revealed a previously undiagnosed skull base defect at the fovea ethmoidalis. The nasal swab test likely caused trauma to the patient's preexisting encephalocele. The authors write in JAMA Otolaryngology—Head & Neck Surgery: "This case of iatrogenic CSF leak from nasal swab testing for COVID-19 illustrates that prior surgical intervention, or pathology that distorts normal nasal anatomy, may increase the risk of adverse events associated with nasal testing for respiratory pathogens, including COVID-19." They recommend considering alternatives to nasal testing in such patients.

Vaccine investigation: The FDA has expanded the scope of its examination of AstraZeneca's investigational SARS-CoV-2 vaccine to include data from prior trials of similar vaccines created by the same scientists, Reuters reports. The company put its vaccine trial on hold in early September after one patient developedtransverse myelitis. The broader investigation will likely mean delays for the vaccine. The FDA was expected to receive additional data this week.

No cruise ship travel: The CDC has extended the No Sail Order for passenger cruise ships through the end of October. From March through September, the CDC received reports of nearly 3700 COVID-19 or COVID-like illnesses on cruise ships within U.S. jurisdiction, and these are likely an underestimate. At least 41 of these people died.