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Management of chronic respiratory diseases during viral pandemics: A concise review of guidance and recommendations

Author/s: 
Sharma, P., Mishra, M., Dua, R., Saini, L. K., Sindhwani, G.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute respiratory disease that can lead to respiratory failure and death. Although anticipated that patients with chronic respiratory diseases would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19, it is striking that these diseases appear to be underrepresented in the comorbidities reported for patients with COVID-19. The first wave of COVID-19 has taught us important lessons concerning the enormous burden on the hospitals, shortage of beds, cross infections and transmissions, which we coped together. However, with the subsequent waves of COVID-19 or any other viral pandemic, to ensure that patients with respiratory illnesses receive adequate management for their diseases while minimizing their hospital visits for their own safety. Hence, we prepared an evidence-based summary to manage outpatients and inpatients suspected or diagnosed with COPD, asthma and ILD based on the experience of the first wave of COVID-19 and recommendations by expert societies and organizations.

Keywords 
asthma interstitial lung disease management recommendations copd COVID-19

Covid-19 Vaccines — Immunity, Variants, Boosters

Author/s: 
Barouch, D. H.

The coronavirus disease 2019 (Covid-19) pandemic has claimed an estimated 15 million lives, including more than 1 million lives in the United States alone. The rapid development of multiple Covid-19 vaccines has been a triumph of biomedical research, and billions of vaccine doses have been administered worldwide. Challenges facing the Covid-19 vaccine field include inequitable vaccine distribution, vaccine hesitancy, waning immunity, and the emergence of highly transmissible viral variants that partially escape antibodies. This review summarizes the current state of knowledge about immune responses to Covid-19 vaccines and the importance of both humoral and cellular immunity for durable protection against severe disease.

Keywords 
United States Biomedical Research vaccines Pandemics Immunity

Care of Patients With New, Continuing, or Recurring Symptoms After Acute SARS-CoV-2 Infection

Author/s: 
Laine, C., Cotton, D.

As the pandemic of acute SARS-CoV-2 infection continues, there is another pandemic that shadows it—the growing population of people who have new, continuing, or recurring symptoms long after initial infection. Many refer to this condition as “long COVID,” and the National Institutes of Health's (NIH) official name for the condition is postacute sequelae of SARS-CoV-2 (PASC). Whatever we call it, the current limited understanding of the pathophysiology, epidemiology, and course of this condition makes caring for these patients a vexing challenge.

Keywords 
COVID-19 SARS-CoV-2 Infection symptoms pandemic Long COVID

Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2

Author/s: 
Brooks, J. T., Butler, J. C.

Prior to the coronavirus disease 2019 (COVID-19) pandemic, the efficacy of community mask wearing to reduce the spread of respiratory infections was controversial because there were no solid relevant data to support their use. During the pandemic, the scientific evidence has increased. Compelling data now demonstrate that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection, especially as source control to prevent spread from infected persons, but also as protection to reduce wearers’ exposure to infection.

Keywords 
Mask Wearing COVID-19 SARS-CoV-2 Community Spread

Cervical cancer screening guideline for individuals at average risk

Author/s: 
Chor, J., Davis, A. M., Rusiecki, J. M.

Major recommendations

Begin screening at age 25 years regardless of sexual history or HPV vaccination status (strong recommendation)

Primary HPV testing every 5 years through age 65 years (strong recommendation)

If primary HPV testing is not available use cotesting (HPV+ cytology) every 5 years or every 3 years if cytology only (strong recommendation)

Discontinue screening at age 65 years if no history of cervical intraepithelial neoplasia grade 2 or more severe diagnosis in last 25 years and adequate negative prior screening in last 10 years (qualified recommendation)

Clinical Outcomes for Patients With Anosmia 1 Year After COVID-19 Diagnosis

Author/s: 
Renaud, Marion, Thibault, Claire, Normand, F. L., Mcdonald, E. G., Gallix, B., Debry, C., Venkatasamy, A.

Since the pandemic was declared in early 2020, COVID-19–related anosmia quickly emerged as a telltale sign of infection.1,2 However, the time course and reversibility of COVID-19–related olfactory disorders, which may persist and negatively affect patients’ lives, require further study. To clarify the clinical course and prognosis, we followed a cohort of patients with COVID-19–related anosmia for 1 year and performed repeated olfactory function evaluations for a subset of patients.

Keywords 
COVID-19 Anosmia diagnosis Infection clinical outcomes

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Author/s: 
Young, Trevor K., Shaw, Katharina S., Shah, Jinal K., Noor, Asif, Alperin, Risa A., Ratner, Adam J., Orlow, Seth J., Betensky, Rebecca A., Shust, Gail F., Kahn, Philip J., Oza, Vikash S.

Importance: To date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms.

Objective: To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020.

Design, setting, and participants: A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C.

Main outcomes and measures: Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists.

Results: Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity.

Conclusions and relevance: In this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.

Keywords 
COVID-19 coronavirus children Multisystem Inflammatory Syndrome
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