COVID-19 Daily: Skin Manifestations, HCQ Heart Rhythm Risks

What your doctor is reading on Medscape.com:

MAY 05, 2020 -- Here are the coronavirus stories Medscape's editors around the globe think you need to know about today:

Skin Manifestations

It is not yet clear whether skin symptoms, which were identified in 20% of COVID-19 patients in one Italian series, are directly caused by the virus. Two new case reports illustrate the heterogeneity of the rashes physicians are observing. The American Academy of Dermatology has set up a registry to which any healthcare professional can submit cases of COVID-19-associated dermatoses. 

Hydroxychloroquine-triggered QTc-Interval Prolongations

Two new studies further document the potential for serious arrhythmias from hydroxychloroquine treatment of COVID-19 patients. A report on 90 confirmed COVID-19 patients treated with hydroxychloroquine at one Boston hospital identified a notably prolonged, corrected QT (QTc) interval in a total of 21 patients (23%), and a report on 40 COVID-19 patients in France who received hydroxychloroquine found that 37 (93%) had some increase in the QTc interval. 

One of the Boston patients developed torsades de pointes following treatment with hydroxychloroquine and azithromycin, "which to our knowledge has yet to be reported elsewhere in the literature," the report said.

New Angiotensin Studies

Four recent studies of the relationship of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) with COVID-19 — all observational and with confounding factors — offer reassurance. The results do not suggest that continued use of ACE inhibitors and ARBs causes harm, but there are some contradictory findings in secondary analyses regarding possible differences in the effects of the two drug classes.

COVID Data Dives

Medscape has asked top experts to weigh in on the most pressing scientific questions about COVID-19, starting with serology studies. "We should expect many more SARS-CoV-2 serosurveys in our future," writes Natalie Dean, PhD, an assistant professor of biostatistics at the University of Florida in Gainesville, in an article explaining her thoughts on best practices for the design of serosurveys. 

"Be cautious about interpreting serologic studies from places where we don't think there has been a lot of disease," advises William Hanage, PhD, an associate professor at the Center for Communicable Disease Dynamics in the Department of Epidemiology at the Harvard T. H. Chan School of Public Health. "What they find could easily be false positives, which give a faulty impression of the actual amount of disease — and bad advice to the people tested."

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Inflammatory Syndrome in Children

The New York City Health Department issued an alert for physicians to look for and report cases of a pediatric multisystem inflammatory syndrome associated with COVID-19, following a similar alert recently issued in the United Kingdom. The NYC Health Department said it had identified 15 patients aged 2 to 15 years who had been hospitalized from April 17 to May 1, 2020, with illnesses compatible with this syndrome. Some, but not all, of the children had positive tests for SARS-CoV-2. 

Michigan Furloughs and Layoffs

Michigan Medicine announced plans for organizational restructuring, furloughs, and layoffs affecting approximately 1400 full-time employees. The health system said it's projecting financial losses of up to $230 million in its fiscal year ending June 30, 2020. 

Marschall S. Runge, chief executive officer of Michigan Medicine and dean of the U-M Medical School said in the announcement that he will reduce his compensation by 20% and that he has asked his direct reports, department chairs, and other leaders to voluntarily reduce their compensation on a scale between 5% and 15%. Additional plans to cut expenses include a hiring freeze, suspending merit raises and employer retirement match, and delaying construction of a new inpatient facility. 

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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