COVID-19 Daily: Reusing Masks, Imaging Guidance

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APRIL 17, 2020 -- Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Data on Sanitizing N95s for Reuse

Researchers from the National Institute of Allergy and Infectious Diseases in Hamilton, Montana, tested four methods of decontaminating N95 respirators for reuse and found that vaporized hydrogen peroxide and ultraviolet light appeared to eliminate the SARS-CoV-2 virus from the material and preserve the integrity of the masks' fit for up to three uses. 

The research has been published as a preprint and is not yet peer-reviewed, so it shouldn’t be used to guide clinical practice, according to a note on the webpage. 

Imaging Recommendations

A professional society's consensus statement on the role of imaging during the acute workup of COVID-19 patients calls for liberal use in patients with moderate-to-severe clinical features indicative of infection, regardless of their COVID-19 test results, but limited use in patients who present with mild symptoms or are asymptomatic. 

For patients with moderate-to-severe clinical features of COVID-19 whose pretest probability is high, the specialists write that a diagnosis "may be presumed when imaging findings are strongly suggestive of COVID-19" — even if the patient's test is negative. 

Infectious Disease Experts Advise on Reopening

The ability to conduct mass testing is critical to begin easing physical-distancing measures, according to new recommendations from the Infectious Diseases Society of America. In order to fully lift physical-distancing restrictions, the recommendations call for effective treatments for COVID-19 and a protective vaccine that can be deployed to key at-risk populations.

Sleep in the Time of COVID-19

The current reality of most people's lives during the COVID-19 pandemic has the potential to induce or exacerbate sleep problems, though it may also present some with an opportunity to sleep better, according to experts. "In terms of sleep or other effects on worsening of psychiatric problems, it is still not clear what the overall effects [of the pandemic] are going to be," said one.

Oxygen Targets in COVID-19 With ARDS

A few randomized clinical trials and a large retrospective study published in the past few years have yielded seemingly conflicting information about the optimal oxygen targets for patients in critical care units with acute respiratory distress syndrome (ARDS). Aaron B. Holley, MD, program director of pulmonary and critical care medicine at Walter Reed National Military Medical Center, synthesizes what the available research means for treating COVID-19 patients with ARDS. 


Auranofin Tested In Vitro

Here's the latest repurposed drug that killed SARS-CoV-2 in an in vitro study: the gold compound auranofin, approved for rheumatoid arthritis. Researchers at Georgia State University added auranofin to cells infected with SARS-CoV-2 and found that the treated cells had 95% less intracellular viral RNA after 48 hours than cells that served as a control. 

Besides the usual caution needed when considering the implications of in vitro research, it's worth keeping in mind that this study was published to the preprint server bioRxiv and has not been peer-reviewed. bioRxiv adds this reminder about preprints: "They should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information."

Epidemiologists Critique Influential Model

In press briefings about the COVID-19 response, Trump administration officials have cited a model of hospital resource use and deaths from COVID-19 published by the Institute for Health Metrics and Evaluation at the University of Washington. But other experts have critiqued the model, STAT reports, as not well suited for long-term predictions about the course of the pandemic. 

"That [the model] is being used for policy decisions and its results interpreted wrongly is a travesty unfolding before our eyes," one epidemiologist said. 

Pulmonary Management Reference

A Medscape review article summarizes the pulmonary impact and management of COVID-19, including a look at noninvasive and mechanical ventilation.

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for 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

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