COVID-19 Daily: Practices Turn to GoFundMe; 'COVID Toes,' Rashes

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MAY 10, 2020 -- Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Medical Practices Use GoFundMe to Survive

The crowdfunding site GoFundMe has hosted numerous campaigns for individuals unable to pay their medical bills, and now private medical practices themselves are using the site to get financial help, Undark reports. The loss of patient revenue due to the COVID-19 pandemic has forced some practices to seek financial assistance in order to pay staff and to cover care provided to patients who have lost jobs and medical insurance.

One policy expert said the situation highlights problems with the US healthcare system. "It's broken if patients have to use it, and it's broken if doctors have to use it," said Stephanie Woolhandler, from City University of New York, Hunter College. 

Other public health experts expressed concern that crowdfunding tends to benefit those who are more socially connected, which could exacerbate healthcare disparities by rewarding practices who serve wealthier clients while isolating those serving lower-income people.

Fauci, Redfield, Hahn Self-Isolate

After two staff members at the White House tested positive for COVID-19, three top health officials have decided to quarantine themselves because they were exposed, reports the New York Times. All three are members of the White House's coronavirus task force: Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases; Robert Redfield, MD, director of the Centers for Disease Control and Prevention; and Stephen Hahn, MD, commissioner of the US Food and Drug Administration. All three officials said they would continue to work from home.

'COVID Toes' and Other Dermatologic Manifestations

Rashes associated with COVID-19 infection are numerous and difficult to pin down, but five patterns emerged from a study of 375 cases in Spain. Vesicular eruptions similar to chickenpox lesions were the earliest to appear, even before other symptoms; other manifestations were "pseudo-chilblains," maculopapular eruptions, urticaria, and livedo or necrosis.

Pseudo-chilblains have garnered media attention as "COVID toes," and are associated with milder disease course, whereas livedo and necrosis were associated with more severe illness and a poorer prognosis.

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Other studies reported cases of children in the UK and Spain presenting with rashes related to an inflammatory condition with features of toxic shock syndrome and Kawasaki disease. Similar symptoms were also reported more recently in children in New York.

Nurse Struggles 8 Weeks With Infection

"How long can a heart last like this?" asks Darlene Krawetz, whose heart rate is 140 at rest. The 30-year nurse in Syracuse, New York, chronicled her struggle in the Washington Post, including a 10-day hospital stay where she was treated with a malaria drug, an antibiotic, vitamin C, blood thinners, baby aspirin, and cough syrup with codeine

She managed to avoid intubation, but even after discharge she was on oxygen and was plagued by heart palpitations, headaches, insomnia. Her story concludes with a readmission to the hospital on May 7. Doctors have told her she has blood clots on her lungs. "When will this damn thing let me alone?" she asks.

How Clinicians Prep for a Day on the Front Lines 

Seven healthcare professionals shared with Medscape Medical News their emotional highs and lows in preparing — both mentally and physically — for their shifts taking care of COVID-19 patients.

"I do 100 sit-ups every day before I go to work,” said a critical care nurse from Stony Brook University Hospital in New York. I have the local news on in the background, to hear what the statistics are, not that I pay that much attention to them. Then, my mantra is, 'Be the best nurse you can be.' "

Study of COVID-19 and Psychosis

Two researchers at Johns Hopkins University in Baltimore are planning a study to look for a potential link between exposure to coronaviruses — including SARS-CoV-2 — and neuropsychiatric disease.

"It's an esoteric area of the literature, but it really has a lot of evidence to support a connection between the infectious disease process and the development of psychiatric disorders," said one of the researchers. The scientists plan to examine adult case-control comparisons of the four less severe coronaviruses (229E, NL63, OC43, HKU1) and quantify the seroprevalence of the more severe forms of the virus, MERS, SARS-CoV-1, and SARS-CoV-2, in patients with psychiatric disorders vs controls.

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Case Report: COVID-19 in a Third-Trimester Pregnancy

Obstetricians at Yale-New Haven Hospital in Connecticut report a successful vaginal delivery of a woman with COVID-19. The woman was separated from the newborn during her two-day hospital stay, but was able to bond with the baby and to breast-feed after they went home. The infant was not tested and did not develop any symptoms related to the coronavirus. 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1000 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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