COVID-19 Headervisual

COVID-19: Resources & Updates

By gathering externally published information from trusted sources, our editorial team aims to provide useful information for healthcare providers fighting the virus worldwide.

The content covers clinical studies, the latest data, webinars, and clinicians’ experiences. We’ll update the page regularly, so check it often for the latest information. Stay safe!

  • Latest information of the World Health Organization can be found here: World Health Organization
  • The World Health Summit offers a list of links to their academic partners across the globe: World Health Summit
  • The Johns Hopkins University is a reliable resource for infection numbers, but also offers a wealth of additional information on their dedicated Website: Johns Hopkins University
  • JAMA Network’s COVID-19 collection includes Q&A’s and publications on vaccine development, infection control, and public health preparedness: JAMA Q&A’s & Publications
  • The Lancet has created a Coronavirus Resource Centre that brings together COVID-19 content from across The Lancet journals as it is published. Access is free of charge: Publications Lancet
  • With a focus on imaging, RSNA Journals has created a dedicated COVID-19 page which includes research articles, case studies, editorials, and podcasts: Publications RSNA
  • The American College of Radiology ACR has collected radiology-specific materials on COVID-19: ACR
  • On their Website, the European Society of Radiology offers a comprehensive list of publications and links: European Society of Radiology
  • In addition to their Website, the ESR also offers a dedicated playlist on YouTube with several lectures and talks on COVID-19: ESR
  • The Society of Nuclear Medicine and Molecular Imaging shares COVID-19 strategies and experiences: SNMMI
  • Wiley offers free access to the COVID-19 section of its online library: Wiley
  • Focusing on laboratory diagnostics, the American Association for Clinical Chemistry has gathered information to help laboratories prepare for COVID-19: AACC Resources
  • The International Federation of Clinical Chemistry and Laboratory Medicine regularly updates their information guide: IFCC Information Guide on COVID-19
  • With a focus on cardiac patients, the American Heart Association provides helpful resources for health systems, clinics, care providers, patients and the public. American Heart Association
  • The Centers for Disease Control and Prevention’s Emerging Infectious Disease journal also features a dedicated section on COVID-19: Emerging Infectious Disease

Cardiology 

Exploring the risk of COVID-19 mortality in the context of hypertension and antihypertensive treatment

It is still unclear whether antihypertensive treatments affect COVID-19 mortality. To help shed light on the question, researchers in China conducted a retrospective observational study of patients admitted to a Wuhan hospital. The authors compare the association of hypertensive status and antihypertensive treatment class with mortality in COVID-19 patients.

Cardiac arrhythmias associated with COVID-19 infection and treatment

Given the lack of information on the type and severity of arrhythmias associated with COVID-19, this paper from New York presents four such cases to highlight the spectrum of arrhythmias observed in patients with the disease: high-grade atrioventricular block, atrial fibrillation, polymorphic ventricular tachycardia, and cardiogenic shock and PEA arrest.

Study examines relationship of cardiovascular disease and drug therapy with in-hospital death among COVID-19 patients

This study addresses concerns and uncertainty about possible harmful effects of ACE inhibitors and ARBs in COVID-19 patients. Using an observational database from hospitals on three continents, researchers studied patients who were hospitalized between December 2019 and March 2020, and who either died in hospital or survived to discharge as of late March.

Study addresses concerns that renin-angiotensin-aldosterone system inhibitors could increase risk of COVID-19

Conflicting theories about the effect of RAAS inhibitors on COVID-19 infection and severity led these researchers to investigate the association between antihypertensive drugs and the chance of testing positive for COVID-19 or experiencing severe disease (ICU, mechanical ventilation, or death). The cohort was drawn from a healthcare network in New York City.

Researchers examine characteristics and outcomes of heart-transplant recipients who contract COVID-19

This single-center case series from New York describes the presentation, disease course, outcomes, and immunosuppression management in HT recipients with COVID-19. At 25%, the case fatality rate was far higher than in other populations. Given the complexity of managing the disease in HT recipients, the authors recommend treating them in transplant centers.

Consensus statement by cardiologists and emergency physicians on managing acute myocardial infarction during COVID-19 in the U.S.

Three U.S. medical societies have published recommendations for a systematic approach to treating AMI patients during the pandemic. The paper builds on the fact that most patients with ischemic heart disease may not have COVID-19, and focuses on topics such as clinical presentations, suitable PPE, and the role of emergency departments and cardiac cath labs.

Study investigating links between fatal COVID-19 outcomes and underlying CVD and myocardial injury

To shed light on the cardiovascular implications of fatal outcomes in COVID-19, researchers conducted a retrospective study at a hospital in Wuhan. They analyzed 187 patients, of whom 27.8% had myocardial injuries. The results provide insights into the links between COVID-19 deaths and CVD and myocardial injury, and offer guidance for triage and treatment.

Immediate and long-term cardiovascular implications of coronaviruses

This Viewpoint article addresses the shortage of published data on cardiovascular presentations in the wake of viral epidemics. The authors examine the acute and long-term cardiovascular implications of respiratory virus infections caused by influenza viruses and coronaviruses, and stress the need for serial follow-up studies of survivors of acute infection. 

Report on patient treated with glucocorticoid and human immunoglobulin for coronavirus fulminant myocarditis

Researchers in China report on a man diagnosed with coronavirus fulminant myocarditis with cardiogenic shock and pulmonary infection. Imaging showed significant enlargement of the heart. After treatment, which included methylprednisolone and immunoglobulin, the patient’s symptoms improved markedly and cardiac chamber dimensions quickly returned to normal.

How robotics could potentially reduce exposure to virus patients during interventional procedures in a pandemic

In this interview, Jon George of Einstein Medical Center in Philadelphia, USA, talks about whether robotics could help protect physicians during interventions on virus patients. He explains the benefits of robotics and how it differs from remote PCI. He also discusses his own successful experience of performing robotic PCI in a suspected COVID-19 case.

Interim guidance for healthcare providers caring for pediatric patients with known or suspected COVID-19

The American Heart Association and the American Academy of Pediatrics have issued guidelines designed to help pediatric healthcare providers – as well as EMS and other first responders – reduce the risk of SARS-CoV-2 transmission. A particular focus is on resuscitation care, and the information is drawn primarily from the U.S. Centers for Disease Control.

European Society of Cardiology publishes dedicated page for COVID-19 resources

As the ESC says, learning from each other is now more important than ever. With this in mind, it has created a dedicated page that aims to provide an array of useful resources about COVID-19. Updated regularly, it features special editions of ESC TV, insights from the front lines, recommended reading, and resources for both patients and professionals.

ACC Interventional Council and SCAI discuss issues facing catheterization personnel during the COVID-19 pandemic

COVID-19 will require cath labs to modify their practice for standard cardiac patients, those with suspected or confirmed COVID-19, and those with unrelated cardiac conditions or cardiac manifestations associated with the disease. This joint statement discusses solutions for various patient scenarios and for resource allocation and protection of workers.

Statement on continuing ACE-I and ARBs in patients who contract COVID-19

The AHA, the HFSA, and the ACC recommend continuing ACE-i or ARB medications for all patients already receiving them for indications such as heart failure, hypertension, or ischemic heart disease. CVD patients with COVID-19 should be evaluated before adding or removing any treatments. Any changes to their treatment should be based on the latest evidence.

Preparing patients, providers, and health systems for cardiovascular care during COVID-19

The American College of Cardiology reports on a recent article that outlines considerations for patients, providers, and health systems during the COVID-19 pandemic, and reviews what is currently known about this disease and its cardiovascular impacts. The authors also look at aspects such as personal protective equipment, telehealth, and staff education.

Review of literature on cardiovascular considerations for patients, healthcare workers, and health systems during the COVID-19 pandemic

COVID-19 has major implications for the cardiovascular care of patients. Pre-existing conditions, infection, side effects from treatment, triage times, and staff exposure can all affect outcomes. The authors review peer-reviewed and preprint literature about cardiovascular care and COVID-19, and highlight gaps in knowledge that require further research.

Clinicians’ Experience

Guidance on managing COVID-19 for resource-limited countries

In this article, the authors give their view on how low- and middle-income countries can prepare for local outbreaks of COVID-19. After reporting on Africa’s preparations for managing the disease, the paper discusses issues such as critical care, minimum requirements for infection prevention and control, refugees, and media support for public health efforts.

Video Q&A with a critical care expert on the front line of the pandemic in New York

Speaking in an interview for JN LearningTM, Michelle N. Gong, Chief of Critical Care Medicine at Montefiore Medical Center in the Bronx, talks to the editor-in-chief of JAMA about planning for the surge in COVID-19 patients. She discusses issues such as managing ARDS, encountering surprising aspects of COVID-19, and procuring diagnostic tests and PPE.

Leading Chinese epidemiologist talks about COVID-19 in China in early 2020

Zunyou Wu, Chief Epidemiologist at the China CDC, joined the editor-in-chief of JAMA in February to review the development and spread of COVID-19 in China. Their conversation covers multiple topics, including confirmed and suspected cases, the challenges of achieving large-scale diagnostic testing, case fatality rates, and asymptomatic spread of the disease.

Leading experts from the University of Washington discuss what they have learned from COVID-19 so far

In this conversation with Diagnostic Imaging, two leading physicians talk about their radiology department’s response to COVID-19. They report on changes in imaging volumes, financial steps taken in light of declining revenues, further planning for the pandemic, and strategies for returning to normal, processing postponed studies, and re-engaging patients.

Free webinar About Italy’s Experience With COVID-19 and Preparing for the Virus

In this webinar endorsed by the Viennese Doctors’ Chamber, physicians from Italy and Austria discuss preparatory and precautionary measures, clinical symptoms, and CT and ultrasound diagnostics for COVID-19 patients.

UK Radiologists are Moving to “Clean” and “Covid” CT Scanners

Four UK-based chest radiologists explain their approach to scanning patients with or without suspected COVID-19 and no PCR results yet available. CRP and lymphopenia are the bedrock of triage, while CT scans for stable patients should be delayed until lab results are available so that radiologists know whether to use the “clean” or the “covid” scanner.

The Key role of Radiology in the COVID-19 Crisis

Carolyn Meltzer, MD, of Emory University in Atlanta and Mahmud Mossa-Basha, MD, of the University of Washington in Seattle discuss how radiology can help with COVID-19 and how radiologists can protect themselves, their departments, and their patients. Both physicians were on the Scientific Expert Panel that recently published recommendations in Radiology.

Emergency management and infection control in a radiology department

Physicians from the Department of Radiology at West China Hospital in Chengdu, China, share their department’s approach to emergency management and infection control. Despite examining over 3,000 patients with suspected or confirmed COVID-19 infection in 7 weeks, none of the radiology staff contracted the virus.

Coagulation

Incidence and risk factors of venous thromboembolism in patients admitted to the ICU or general ward with COVID-19

Given that COVID-19 can lead to systemic coagulation activation and thrombotic complications, researchers in the Netherlands investigated the incidence of confirmed VTE in 198 hospitalized patients with COVID-19. Their single-center study found that VTE appeared to be associated with death, and that the cumulative incidence was higher among ICU patients.

Clinical characteristics of patients with COVID-19 who develop acute pulmonary embolism

It is becoming clear that thrombotic complications contribute to morbidity and mortality in COVID-19. This led researchers in the U.S. to study COVID-19 patients with PE, and to compare their inflammatory markers, D-dimer values, and outcomes. In contrast to an earlier study, the findings suggest that even patients who do not require ICU care can develop PE.

Abnormal coagulation results are common in deaths from novel coronavirus pneumonia

This retrospective study describes the coagulation features of 183 patients with COVID-19 pneumonia. Coagulation parameters were compared between survivors and non-survivors on admission, and dynamic changes were tracked at regular intervals for 14 days. Those who died exhibited abnormal coagulation results, in particular markedly elevated D-dimer and FDP.

The relationship between SARS-CoV-2 infection and coagulation

Researchers in China report on the blood coagulation function of patients with SARS-CoV-2 infection. Their findings include higher D-dimer and FDP values in SARS-CoV-2 cases compared to the controls, and higher values in patients with severe disease than those with milder cases. The data could benefit efforts to identify severe cases at an early stage.

Common laboratory abnormalities encountered in COVID-19

This letter to the editor gives an overview of the laboratory abnormalities most frequently found in patients with COVID-19. The authors performed an electronic search to identify articles describing significant laboratory abnormalities in severe cases. The findings show that some parameters can be significant predictors of adverse clinical outcomes.

Description of the epidemiological and clinical characteristics of COVID-19 pneumonia in Wuhan, China, in January 2020

For this single-center case series, researchers analyzed data from 138 patients who were hospitalized with COVID-19 pneumonia. They discuss the presenting characteristics, vital signs and lab parameters in ICU and non-ICU patients, organ dysfunctions and main interventions, the dynamic profile of lab findings, and hospital transmission and infection.

Anticoagulant therapy could reduce mortality in severe COVID-19 patients with coagulopathy

In light of recommendations to treat COVID-19 patients with anticoagulants, researchers performed a retrospective analysis to validate the usefulness of coagulation parameters in identifying patients who could benefit from this therapy. The study found that, in some circumstances, the 28-day mortality of heparin users was lower than that of non-users.

International Society on Thrombosis and Haemostasis provides interim guidance for recognizing and managing coagulopathy in COVID-19

Described as a “pragmatic statement,” this document aims to enable risk stratification at admission and management of coagulopathy using various laboratory parameters. Recommendations include considering hospital admission in cases with markedly raised D-dimer, monitoring coagulation markers to determine prognosis, and managing coagulopathy with heparin.

Concise and practical guidance for managing thrombotic risk, coagulopathy, and disseminated intravascular coagulation in COVID-19 patients

This living guidance document will be updated weekly. It discusses current knowledge on the three areas (thrombotic risk, coagulopathy, and DIC) in the context of COVID-19 and outlines practical recommendations for each. These include VTE risk assessment for all patients admitted to hospital, and targeted approaches for managing minor and major bleeding.

Computed Tomography

A standardized system for assessing pulmonary involvement in COVID-19 using CT images

CO-RADS, developed by the Dutch Radiological Society, is a system that provides a five-point scale for assessing pulmonary involvement in patients with moderate to severe COVID-19 symptoms. The article describes the system and reports on an initial study that evaluated the interobserver variability and diagnostic accuracy of CO-RADS using 105 chest CT scans.

Unexpected findings of COVID-19 identified at lung bases in abdominal CT scans

This paper reports on a retrospective review of abdominal CT images in 23 patients within a single, multicenter institution. Although the patients were not clinically suspected of having COVID-19, the images provided unanticipated findings at the lung bases that raised concern for COVID-19. Most of the patients subsequently tested positive the disease.

Is low-dose submillisievert chest CT imaging suitable for assessing ER patients for COVID-19?

RT-PCR is the gold standard for diagnosing COVID-19, but it is not without drawbacks. Chest CT could be an additional tool for assessing patients. Researchers in Belgium investigated whether low-dose chest CT imaging can rapidly, accurately, and reproducibly stratify ER patients with possible COVID-19.

Retrospective analysis from early 2020 compares chest CT and RT-PCR for sensitivity to COVID-19

This Chinese study involved 51 COVID-19 patients who all had non-contrast chest CT scans and RT-PCR within three days or less. Chest CT imaging was found to have a higher sensitivity than RT-PCR. The authors stress that their results support the use of chest CT for screening patients who have clinical and epidemiological features consistent with COVID-19.

Low-dose protocols to protect patients undergoing CT scans for detecting and managing COVID-19

This editorial notes that, under Chinese guidelines, COVID-19 patients might undergo several CT scans in a short space of time. Since the patient population includes those for whom radiation dose is a particular concern, the authors suggest using low-dose protocols. Their experience provides the framework for the recommendations.

Using well-aerated lung on baseline CT to predict adverse outcomes in COVID-19 pneumonia

To describe the relationship between well-aerated lung on chest CT and COVID-19 prognosis, researchers performed a retrospective study of chest CT scans performed at ER admission. The images were visually scored by radiologists and evaluated using software. Quantifications of lung abnormality were predictors of ICU admission or death in COVID-19. 

Feasibility of a low-dose, long-pitch, dual-source chest CT protocol for COVID-19 patients

These researchers tested the feasibility of an ultra-low-dose, fast, long-pitch, dual-source acquisition. Three radiologists were involved in subjectively and objectively analyzing the imaging results to establish their usefulness for evaluating the lungs of patients with COVID-19 pneumonia.

Assessing the characteristics and clinical value of chest CT images in COVID-19 pneumonia

To further the understanding of novel coronavirus pneumonia, this study retrospectively analyzed chest CT images from 80 patients, along with corresponding clinical data and literature. As well as discussing the characteristic lesions, the authors note that inflammatory changes can be present in the lungs even if a patient’s first nucleic acid test is negative.

Study in Xiaogan area of Hubei province reports on imaging manifestations and diagnostic value of chest CT in COVID-19 

The authors analyze the epidemiological, clinical, and radiological characteristics of COVID-19 patients admitted to a Hubei hospital. They describe the lung imaging manifestations and disease development, examine correlations between imaging manifestations and clinical data, and clarify the role that chest CT can play in COVID-19 diagnosis and follow-up.

CT and MRI features of COVID-19–associated acute hemorrhagic necrotizing encephalopathy

This paper discusses the first reported case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy in a woman in her fifties. The authors present findings from both CT and MR imaging. They call on clinicians and radiologists to be aware of this rare form of encephalopathy in patients presenting with COVID-19 and altered mental status.

Timely diagnosis and treatment accelerates resolution of COVID-19 pneumonia and lowers the highest and last CT scores from sequential chest CT

Researchers used sequential chest CT scans to investigate how the time from symptom onset to diagnosis and treatment affects the progression of COVID-19. Patients who waited longer for diagnosis and treatment after symptom onset generally had more severe symptoms at the peak stage, and it took longer for the disease to resolve.

Thoughts on the conundrum of using CT imaging as a diagnostic tool in COVID-19 

The internet is full of recommendations against using imaging in the diagnosis of COVID-19. Yet as the author here has found, “there’s always a rationale to get imaging” – in this case, to see if something else is happening in the lungs. The article provides a diagnostic radiologist’s perspective on the COVID-19 imaging conundrum.

High-resolution computed tomography findings in COVID-19 patients of different ages

Researchers compared chest HRCT signs of infected patients in four age groups ranging from 4 to 88 years. Age-related differences were observed. They included the distribution, size, and density of lung lesions. These lesions appeared to be milder in younger populations.

Longitudinal study of temporal changes in CT findings yields useful data about pattern of COVID-19 pneumonia

Researchers in Wuhan analyzed serial CT findings over time in 90 patients with COVID-19 pneumonia. Key findings relate to progression and peak of abnormalities, predominant patterns of abnormalities, and rates of residual disease. The temporal changes in CT manifestations followed a specific pattern, which could indicate illness progression and recovery.

Evolution of CT manifestations in five patients who recovered from COVID-19 pneumonia

Following PCR diagnosis of COVID-19, five patients had initial chest CT scans and underwent treatment. All five received antiviral medications, while some received additional therapies such as antibiotics or oxygen therapy. Later-stage CT scans of all patients showed marked improvement in chest radiographic abnormalities after active intervention.

Chest CT images of COVID-19 patients from Diamond Princess cruise ship show changes in asymptomatic cases

What happens to the lungs when a COVID-19 patient is asymptomatic? This retrospective study compared CT findings from symptomatic and asymptomatic patients, all of whom had been aboard the Diamond Princess cruise ship. Although abnormalities were more frequent in symptomatic cases, lung parenchymal changes were present in over half of the asymptomatic cases.

Endothelialitis

Study shows endothelial cell involvement across vascular beds of different organs in patients with COVID-19

The ACE2 receptors used by SARS-CoV-2 are also expressed in endothelial cells. This letter reports on three cases in which researchers found viral elements within endothelial cells, an accumulation of inflammatory cells, and evidence of endothelial and inflammatory cell death. The authors’ concluding hypothesis provides a rationale for specific therapies.

Pulmonary vascular endothelialitis, thrombosis, and angiogenesis found in lungs of patients who died from COVID-19

To help shed light on morphologic and molecular changes in the lung of patients who die from COVID-19, researchers examined seven lungs from patients who died from COVID-19, and compared them with seven from patients who died from ARDS secondary to H1N1, and ten uninfected control lungs. The results showed three distinctive angiocentric features of COVID-19.

Geriatrics

Rapid overview of peer-reviewed and pre-print COVID-19 literature with a specific focus on older adults

Advanced age is linked to poor prognosis in COVID-19, yet clinical trials are potentially excluding older adults. To help address this issue, the authors performed a rapid review of English-language research into testing, drugs, and prognosis with a focus on older adults. Their paper could serve as a basis for future work on COVID-19 in this population.

Infection Control

Study on transmission routes and extent of contamination by SARS-CoV-2 from a symptomatic patient 

This research letter describes a study conducted with three COVID-19 patients in airborne infection rooms. Surface environmental samples were taken from multiple sites, samples of PPE were collected from physicians, and air samples were taken from the rooms and anterooms. Overall, the findings suggest the environment is a potential medium of transmission.

Review of the literature about the persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents 

This paper was published online on February 6. Its analysis of 22 studies found that human coronaviruses can persist on surfaces such as metal, glass, or plastic for up to nine days. The authors also found that surface disinfection with specific agents could inactivate the viruses within one minute. They expect this to also apply in the case of SARS-CoV-2.

Strategies used by a Wuhan hospital to protect radiologic technologists against COVID-19

With chest CT playing a key role in diagnosing COVID-19, technologists are at high risk of direct or indirect virus exposure. The authors of this article describe their strategies for protecting technologists in the radiology department of a hospital in Wuhan. The strategies concern staffing arrangements, environmental modifications, CT workflows, and PPE.

FAQs about preventing and controlling COVID-19 infection in healthcare settings

The Centers for Disease Control and Prevention are publishing answers to frequently asked questions about infection control for COVID-19 in healthcare facilities. The page is aimed at healthcare personnel involved in caring for patients with confirmed or suspected COVID-19. Topics covered include PPE, aerosol-generating procedures, and nasopharyngeal swabs. 

Researchers compare aerosol and surface stability of SARS-CoV-2 and SARS-CoV-1

In a letter to the New England Journal of Medicine, researchers show that SARS-CoV-2 (COVID-19) and SARS-CoV-1 were similarly stable under the circumstances tested – i.e., in aerosols and on various surfaces. The findings provide information for mitigating the pandemic, as they suggest that aerosol and fomite transmission of SARS-CoV-2 is possible.

Inflammation/Plasma Protein Testing

SAA identified as a potential biomarker for clinical severity of COVID-19

To provide knowledge about underlying immunity and early biomarkers in COVID-19, researchers performed a retrospective study of patients diagnosed with the disease at a hospital in China. Dynamic observations of the patients’ serum biochemistry profiles and chest CT imaging indicated that SAA could be a predictor for severe cases of the disease.

Cytokine storm syndromes and immunosuppression in COVID-19

This letter to the Lancet addresses the increasing evidence that suggests some patients with severe COVID-19 might have a cytokine storm syndrome. Given the need to reduce rising mortality, the authors recommend screening patients for hyperinflammation and treating the relevant subgroup with existing, approved therapies that have a proven safety profile.

Retrospective multicenter study indicates predictors of fatal outcomes in COVID-19

To help prioritize resources for high-risk COVID-19 patients, these researchers identified clinical predictors of severe patient outcomes. Using data from death cases and discharged cases, they found that predictors of death include age, underlying diseases, and elevated inflammatory indicators. They also note that cytokine storm syndrome may lead to death.

How immune-suppressive and immune-stimulating drugs affect host immunity against COVID-19

Cancer and transplant patients with COVID-19 are at high risk of severe or fatal outcomes, especially as they might also be receiving drugs to suppress or stimulate their immune systems. This article examines the effects of these drugs on host immunity. The aim is to help physicians identify which drugs could be harmful, and which might be of benefit.

Clinical and biochemical indexes linked to viral loads and lung injury in COVID-19

The authors report on various characteristics and potential biomarkers of disease severity in COVID-19. In their study, laboratory abnormalities mainly included hypoalbuminemia, lymphopenia, and a decreased percentage of lymphocytes and neutrophils. They also found a positive link between viral load in the respiratory tract and lung-disease severity.

Laboratory Testing

A systematic review and meta-analysis of the clinical, laboratory, and imaging features of COVID-19

For this systematic literature review, the authors retrieved articles from the Jan–Feb period of the outbreak, as well as observational studies and case reports. They assessed clinical, laboratory, and imaging features of COVID-19, and its outcomes. Pooled prevalences and 95% confidence intervals were calculated using a random-effects model meta-analysis.

Early study on the clinical features of COVID-19 in patients in Wuhan, China

This article, published in late January, reports on the 41 patients in Wuhan, China, who had been admitted to hospital and identified as having lab-confirmed COVID-19 by January 2. The researchers discuss the epidemiological, clinical, laboratory, and radiological characteristics of the disease, as well as the patients’ treatment and clinical outcomes.

Retrospective cohort study on the clinical course of COVID-19 and risk factors for mortality among adult inpatients in Wuhan, China

To close the research gap on definite COVID-19 outcomes, researchers studied adult inpatients in Wuhan, China, who had either died of the disease or been discharged. They identified risk factors for in-hospital mortality, which could help clinicians quickly identify patients with a poor prognosis, and gained insights into aspects such as viral shedding.

Clinical characteristics and allergy status of patients infected with SARS-CoV-2 in Wuhan, China

For this detailed clinical investigation, researchers analyzed the electronic medical records of 140 patients hospitalized with COVID-19. They paid special attention to the links with asthma, chronic obstructive pulmonary disease, and smoking behavior. Their findings indicate that these conditions and behaviors are not risk factors for SARS-CoV-2 infection.

Establishing the role of clinical laboratory data in the differential diagnosis of severe forms of COVID-19

In order to identify the warning index in patients with severe COVID-19, researchers performed a retrospective study of 43 adult patients. The patients were classified as having either mild or severe disease, and hematological parameters were compared. Findings regarding interleukin-6 and D‐dimer have clinical value for predicting the severity of COVID-19.

Laboratory medicine has a critical role to play during viral outbreaks such as COVID-19

This paper discusses three areas where in vitro diagnostics can play a key role in diagnostic reasoning and managed care for suspected or confirmed COVID-19. The areas are: etiological diagnosis, patient monitoring, and surveillance. The authors also look at how viral outbreaks can impact laboratory organization, and outline possible solutions.

Hematologic parameters of COVID-19 patients in Singapore in February 2020

By late February, 2020, the National Centre for Infectious Diseases had treated 69 of Singapore’s confirmed COVID-19 patients. This letter reports on the hematological indices of all 69 patients from the day of admission until February 28. Dividing the patients into an ICU and non-ICU group made it possible to identify factors associated with ICU admissions.

Lymphopenia can help predict the prognosis of COVID-19 patients

Having studied both patients who died from COVID-19 and those who had symptoms and treatment outcomes, the authors of this letter suggest that lymphopenia is a reliable predictor of prognosis in COVID-19. Building on their findings, they developed a model for disease classification and prognosis prediction based on blood lymphocyte percentage over time.

Opinion paper on potential preanalytical and analytical vulnerabilities in RT-PCR for diagnosing COVID-19

RT-PCR is currently the gold standard for the etiological diagnosis of COVID-19. However, its diagnostic accuracy can be jeopardized by various vulnerabilities. These include identification problems and testing outside the diagnostic window. The authors discuss the vulnerabilities and outline practical methods for minimizing the risk of diagnostic errors.

A summary of the unique epidemiological and clinical features of COVID-19 pneumonia, and special control measures for COVID-19

For this article, accepted in March 2020, the authors summarize the latest literature on various features of SARS-CoV-2 and how these compare to SARS-CoV and MERS-CoV. They also examine challenges in diagnosing COVID-19, and outline interventions and therapies. The aim is to shed more light on the unique features of COVID-19 and enhance control measures.

Magnetic Resonance Imaging

Evaluating ultrashort echo time MRI for effectiveness in assessing COVID-19

This prospective study examines whether UTE-MRI could be an alternative to chest CT for assessing COVID-19 without ionizing radiation. Using CT imaging as the reference, researchers compared the two modalities in terms of representative imaging findings and image quality. The findings imply that UTE-MRI could aid diagnosis and surveillance of COVID-19.

Assessing respirators and facemasks for use in MRI during COVID-19

Given that some COVID-19 patients could require MRI exams for comorbidities, researchers assessed four respirators and one facemask for ferromagnetic properties. The study, which involved no patients, found that some respirators were unsuitable for MRI use – due to MRI safety reasons and because torque broke the seal between the mask and the user.

Guidance from the American College of Radiology on COVID-19 and use of MR

These recommendations call on practitioners to only use MR when absolutely necessary, and to postpone all non-urgent exams. They also suggest using alternative imaging methods if appropriate. Other topics addressed include MR room cleaning, use of MR-safe facemasks or respirators for patients, and considerations regarding PPE worn by MR technologists.

First report on using MRI to evaluate patients with anosmia induced by SARS-CoV-2 in Iran

Isolated anosmia/hyposmia has recently been described as a marker of COVID-19. The authors of this letter explain that while olfactory bulb MRI is used for anosmia patients, it has yet to be applied for COVID-19–induced anosmia. Seeking to fill this gap, they give the first report of MRI findings in a patient with isolated anosmia secondary to COVID-19.

Mental Health

JAMA interview discusses mental health for physicians during COVID-19 

Eileen Barrett, MD, MPH, stresses the importance of maintaining physician mental health during the pandemic – a lesson she learned while working in Africa during Ebola. The interview touches on topics such as key stressors, loneliness, and guilt. Barret also explains how healthcare leaders should be responding, and how physicians can take care of themselves.

Micropractices recommended for preventing burnout and improving emotional wellness in medical professionals 

COVID-19 is increasing the need to prevent burnout and promote wellness in radiologists and physicians. This paper discusses “micropractices,” which require just a few seconds or minutes to perform. They include mindfulness in daily activities, gratitude lists, and breathing techniques. A robust toolbox of these practices can help users navigate challenges.

Assessing mental health outcomes and associated factors among healthcare workers treating patients exposed to COVID-19 in China

This cross-sectional study of healthcare workers treating COVID-19 patients across China found that many experienced symptoms of anxiety, depression, insomnia, and distress. Women, nurses, those in Wuhan, and front-line healthcare workers were especially at risk of unfavorable mental health outcomes and may need psychological support or interventions.

Neurology

MRI evidence of in vivo brain alteration in a patient with COVID-19 and anosmia

This case reports on a woman who presented with a mild cough followed by anosmia and dysgeusia, but no fever. MRI findings showed in vivo brain alteration, and the patient then tested positive for COVID-19. The authors speculate that SARS-CoV-2 might invade the brain through the olfactory pathway and cause an olfactory dysfunction of sensorineural origin.

Report on clinical characteristics of patients with ischemic stroke and COVID-19 in a New York health system

Increasing evidence indicates that COVID-19 patients might develop clinically significant coagulopathy with thromboembolic complications such as ischemic stroke. This retrospective study compares stroke patients with and without COVID-19 in New York. The authors report on the main findings, and discuss mechanisms of associations and therapeutic implications.

Retrospective, multicenter study from Italy examines neurological symptoms and neuroimaging features in COVID-19 patients

This study seeks to help fill the gap in case reports describing neuroimaging findings in the context of COVID-19. Neuroradiologists evaluated images from 108 patients hospitalized in one of three major Italian institutions. The neuroimaging features varied without pattern, but were dominated by acute ischemic infarcts and intracranial hemorrhages.

Case report addresses neurologic manifestations of COVID-19

Growing evidence indicates that complications of COVID-19 are not limited to the pulmonary system. The authors of this report present the case of a 64-year-old man with acute COVID-19 and acute cerebral infarcts. It is likely that this is the first reported case of its kind to include brain imaging at multiple time points, and CT angiography.

Retrospective study evaluates brain MRI findings in ICU patients with COVID-19

Recent evidence suggests that a relatively high percentage of COVID-19 patients have symptoms in the central nervous system. In this article, researchers report on brain MRI findings in ICU patients with neurological symptoms. Although abnormalities were found, it is unclear which are related to neurotropism of COVID-19 and which concern other etiologies.

Nuclear Medicine

Helping nuclear medicine departments function in the COVID-19 pandemic

These guidelines were informed by a systematic review of the literature and input from international experts during an IAEA webinar. The aim is to help nuclear medicine facilities adjust and adapt to the current situation. The authors address six main processes, based on WHO guidance, for maintaining nuclear medicine operations during the pandemic.

Nuclear medicine departments in different countries report on their COVID-19 strategies, precautions, and experiences

Strategies to contain the spread of COVID-19 are crucial. Nuclear medicine services can tackle the challenge in various ways, and this article reports on the approaches used at facilities across five continents. The take-home messages include advice to screen patients on arrival, cancel all elective scans/procedures, and implement separate teams if possible.

First 18F-FDG PET/CT findings in patients with highly suspected COVID-19

This case series presents 18F-FDG PET/CT findings from four patients admitted to hospital with COVID-19 symptoms before the outbreak was recognized. Results include a high 18F-FDG uptake for lung lesions and a suggestion of specific lung tropism. The authors conclude that the modality could play a complementary diagnostic role, especially at an early stage.

Nuclear medicine examinations might lead to incidental findings suggestive of COVID-19 in asymptomatic patients 

A number of asymptomatic patients who received 18F-FDG-PET/CT or 131I-SPECT/CT for standard oncologic indications at a hospital in Italy showed unexpected signs of interstitial pneumonia. Most were later diagnosed with COVID-19 using RT-PCR. The authors encourage nuclear medicine services in other high-prevalence regions to prepare for similar situations.

Key considerations for COVID-19 policies and processes in a nuclear medicine service, based on experience from Singapore

The authors of this short communication describe their experience of implementing policies and processes for managing the COVID-19 threat in a nuclear medicine service in Singapore. Topics discussed include infection control, screening, segregation of risk groups and staff, service continuity plans, staff welfare, electronic platforms, and telereporting.

FDG PET/CT could offer added value for patients with COVID-19 pneumonia

This letter discusses FDG PET/CT in the context of COVID-19 pneumonia and MERS-CoV. One study of suspected COVID-19 patients found lung lesions with higher FDG uptake and evidence of lymph node involvement. The authors say that FDG PET/CT is a sensitive method for detecting and monitoring viral pneumonia, and for tracking progression and treatment outcomes.

Other Specialties

Researchers examine clinical impact of COVID-19 on cancer patients

This cohort study reports on what might be the largest series of cancer patients with COVID-19 to date. Including over 900 patients from the USA, Canada, and Spain, the study seeks to characterize the outcomes and identify potential prognostic factors for mortality and severe illness. The findings have implications for both patients and healthcare providers.

European experts publish position paper on managing liver disease during the COVID-19 pandemic

These recommendations, published by the EASL and ESCMID, focus on caring for patients with chronic liver disease and for those who have received a liver transplant. They address specific characteristics of patients with liver disease, and discuss topics such as outpatient care, methods for reducing direct exposure, and liver-related diagnostic procedures.

Leaders in breast imaging in the U.S. discuss their response to COVID-19

COVID-19 is not known to affect the breast or the risk of breast cancer, but it obviously has ramifications for patients, staff, and radiologists. For this paper, several leaders in breast imaging answered six key questions related to COVID-19. Topics covered include delays to care, PPE, social distancing, and effective use of staff and radiologists.

Pediatrics

Report on a pediatric COVID-19 patient with focal cerebral arteriopathy and ischemic stroke

This research letter presents a presumptive case of ischemic stroke caused by focal cerebral arteriopathy in a previously healthy 12-year-old. The patient tested positive for COVID-19, both from nasopharyngeal swab and cerebral spinal fluid. The authors discuss the major imaging findings and explain the reasoning for their leading diagnosis of FCA.

Characterizing CT findings in pediatric patients with laboratory-confirmed COVID-19 in mainland China

The authors report on CT findings and clinical symptoms of 30 children with COVID-19. The aim is to familiarize radiologists with the disease’s imaging appearance so that they can identify it on images produced for non-COVID reasons. The CT findings were often negative, but features such as ground-glass opacities were common in those with positive findings.

Up-to-date review of new pediatric lung disorders to enhance understanding of characteristic imaging findings

To help enable optimal care in new pediatric lung disorders, this article reviews the characteristic imaging findings of severe viral infections in pediatric patients. The authors focus on SARS-CoV, MERS-CoV, SARS-CoV-2, H1N1, and EVALI. Their work should enable radiologists to accurately recognize and differentiate these viruses in the pediatric population.

Preliminary report of lung ultrasound characteristics in children with COVID-19 in Italy

Researchers in Turin investigated lung ultrasound findings in children with SARS-CoV-2 infection. The modality offers many benefits (such as reducing patient movement around the hospital and minimizing radiation exposure) that are relevant for COVID-19 and children. The observational study found a high concordance between radiologic and ultrasound findings.

A concise overview of laboratory abnormalities in children and adolescents with COVID-19

The authors of this letter to the editor examine existing laboratory data on symptomatic and asymptomatic children and adolescents with confirmed COVID-19. Their aim is to address the knowledge deficit among pediatric specialists regarding SARS-CoV-2 infection. They analyze 12 articles with a sample size of n=66 patients aged between 2 weeks and 17 years. 

Experts from five continents publish consensus statement on chest imaging in pediatric patients with COVID-19

Though scarce, the literature on pediatric chest imaging in COVID-19 pneumonia indicates that imaging features differ between children and adults. This consensus statement therefore describes relevant manifestations, the potential use of structured reporting, and recommendations for using chest X-rays and CT images to evaluate pediatric COVID-19.

Comparing clinical and CT features of COVID-19 in pediatric and adult patients in Guangzhou, China

Many epidemiological, clinical, and radiological studies of COVID-19 focus on adults. This study therefore analyzes how clinical and radiological features differ between children and adults. Children were found to have a lower rate of positive CT findings and milder clinical grade than adults. They were also more likely to show bronchial wall thickening.

Pregnancy

Lung ultrasound changes clinical treatment in eight pregnant women with COVID-19

Noting the emerging trend for using lung ultrasound to assess patients with COVID-19, the authors of this article focus on its use pregnant women. They present the LUS findings, changes in clinical management, and clinical courses of eight pregnant women with COVID-19. In every case, the LUS findings altered the women’s clinical treatment.

Early-onset infection with SARS-CoV-2 in neonates born to mothers with COVID-19 in Wuhan, China

This study recruited 33 neonates born to mothers with COVID-19. The researchers report on the three neonates who had COVID-19. Symptoms were largely mild and outcomes were favorable. The infection was probably maternal in origin, so the advice is to screen pregnant women, perform infection control, quarantine infected mothers, and monitor at-risk neonates.

A preliminary analysis of pregnancy and perinatal outcomes of women with COVID-19 pneumonia

After reviewing clinical data and CT examinations of 15 pregnant women with mild COVID-19 pneumonia, the authors found that pregnancy and childbirth did not aggravate the course of symptoms or CT features of the disease. The study describes clinical manifestations and CT features, and provides some initial evidence that can be used for guiding treatment of pregnant women.

Radiography

Study uses scoring system to evaluate relationship of radiographic severity to age and sex in 783 COVID-19 patients in Italy

Having developed the first chest X-ray scoring system specifically for COVID-19 pneumonia, Italian researchers used it to retrospectively evaluate how the score was linked to age and sex. The authors believe this is the first study to examine the links in European patients. Men aged ≥ 50 and women aged ≥ 80 were at the highest risk of severe lung disease. 

Analyzing the prognostic value of chest X-ray scoring for young and middle-aged adults with COVID-19

To shed light on using chest radiography to help predict COVID-19 outcomes, researchers studied chest X-ray scoring in non-elderly patients presenting to the emergency department of a multicenter health system in New York. As well as finding that X-ray scores were a predictor of outcomes, the authors also identified clinical risk factors in their cohort.

Assessing radiography’s usefulness in detecting COVID-19

Although an early study from February cast doubt over the usefulness of radiography in detecting COVID-19, recent papers paint a more nuanced picture. This AuntMinnie article gives an overview of some of the most important studies and their findings, highlighting both the benefits and limitations of using X-ray technology in the current pandemic. 

Researchers investigate frequency and distribution of chest X-ray findings in COVID-19 patients

The authors of this study aimed to close a research gap by examining the time course and severity of chest X-ray findings in COVID-19 and correlating these with RT-PCR testing. Key results included evidence that baseline chest X-ray was less sensitive than initial RT-PCR, and that common chest X-ray findings mirrored those previously described for CT.

Radiology

Spectrum of radiological features seen in COVID-19 across multiple imaging modalities

In order to enhance radiologists’ understanding of COVID-19, this article describes the imaging features identified by a wide range of modalities – including CT, MRI, PET/CT, and ultrasound – and discusses their clinical utility in diagnosing and managing the disease. The primary focus is on thoracic findings, as COVID-19 mainly affects the lung parenchyma.

Radiologists propose six variables to help plan for imaging volumes in the next phase of COVID-19

With a view to helping practices plan for the near future, radiologists from California describe how COVID-19 has impacted their imaging volumes and set out variables that may influence the rate and degree to which volumes recover in the coming weeks. The variables include local severity of the disease, patient concern, and impact of the economic downturn.

Survey of radiology practices in the U.S. examines shift to offsite workflows triggered by COVID-19 

As COVID-19 forces radiology practices to reassess their workflows, these researchers conducted a survey to evaluate the proportion of U.S. practices that had introduced offsite reading. The survey, from March 2020, also asked respondents about factors associated with the change, their subjective assessment of teleradiology, and protective measures.

Examining abdominal imaging findings in patients with COVID-19 

High levels of ACE2 surface expression in the GI tract could explain abdominal symptoms in SARS-CoV-2 infection. This retrospective cross-sectional study reviewed abdominal imaging findings in patients hospitalized at a single center. Bowel abnormalities and cholestasis were common findings, but more research is needed to establish the specific causes.

Guidance from the RSNA COVID-19 Task Force

This document sets out best practices for protecting healthcare workers and the public, maintaining critical radiology functions, and preserving key resources such as PPE. Topics include precautions for suspected or confirmed cases, room cleaning, chest imaging, pregnancy, and workflows. The information is subject to change as the situation evolves.

The importance of transparency and trust during the COVID-19 pandemic

In a healthcare crisis, transparency within institutions and departments is more important than ever. Providing transparency, say the authors of this paper, can unify teams and build trust. To illustrate this, they explain how the regular, scheduled bidirectional communication in their department is helping reduce stress and fear during the current pandemic.

Interview with the vice president of the Spanish Society of Medical Radiology (SERAM)

Milagros Martí de Gracia, vice president of SERAM and head of a Madrid radiology unit, talks about COVID-19 from the perspective of chest X-rays, CT scans, and more. Topics include protocols for dealing with confirmed and suspected patients, the importance of radiology in diagnosing infection, typical imaging findings, and her view on the situation in Spain.

How radiology departments can prepare for the postcrisis situation

While guidance on preparing for COVID-19 exists, resources for postcrisis planning are lacking. This article aims to create awareness of how the aftermath and consequences of COVID-19 might affect radiology departments. The authors address issues that will arise once hospitals begin to normalize, and offer solutions drawn from their own radiology department.

Imaging studies from SARS and MERS as lessons for radiologists in the current pandemic

This study from February 2020 reviews imaging studies of SARS and MERS patients. Since these diseases overlap with COVID-19, experiences drawn from them can help guide radiologists in the current pandemic. The authors discuss the imaging spectrum of SARS and MERS during the acute and chronic phases, and then examine imaging findings in COVID-19 patients.

COVID-19 pneumonia and the value of imaging in its diagnosis

The authors of this review note that problems with viral nucleic acid testing have led some clinicians to propose CT for diagnosing COVID-19. After discussing the etiology and epidemiology of SARS-CoV-2, the authors then describe imaging features on chest radiographs and CT scans, and assess the role of imaging in COVID-19 and for differential diagnosis.

COVID-19 will have a profound economic impact on radiology practices in the United States

This special report examines how an economic recession coupled with the need to restrict imaging will create serious financial challenges for radiology practices across the United States. It discusses possible avenues of federal relief, approaches to surviving the downturn, and ways in which COVID-19 might permanently alter the radiology field.

Preparing to get cancer imaging back on track after COVID-19

COVID-19 has disrupted cancer imaging in both clinical care and research. In light of this, the authors seek to provide the community with information about the pandemic’s immediate and projected future impact on the field. To do so, they asked cancer imaging leaders about their response to COVID-19 and what they are doing to transition to a “new normal.”

A normal chest X-ray does not guarantee the absence of COVID-19

In what is currently the largest observational study of its kind, researchers examined chest X-ray films of COVID-19 patients who presented to urgent care centers in the greater New York area. The majority of films from the confirmed and symptomatic patients were normal. Where abnormalities did exist, the findings were similar to those described elsewhere.

University of Washington shares policies and guidelines for COVID-19 preparedness

The first known case of COVID-19 in the U.S. occurred in Washington State. This report shares the University of Washington’s experience of managing the outbreak, and the programs and policies it has implemented. The authors say radiology departments must prepare for patient surges with streamlined approaches that protect patients and staff.

Fleischner Society publishes consensus statement on the role of chest imaging in patient management during the COVID-19 pandemic

This statement by a multidisciplinary, multinational panel explores the utility of chest imaging for managing COVID-19 within three scenarios representing a variety of risk factors, community conditions, and resource constraints. Expert evaluations of the scenarios were used to formulate recommendations on using chest imaging to manage COVID-19.

Mass-casualty incident planning for radiology departments during the COVID-19 pandemic

COVID-19 will bring an unusually high volume of patients into hospitals around the world over the coming months. Imaging studies for suspected cases are also likely to increase. This paper explains how radiology departments can develop and implement mass-casualty incident plans that will help them manage a surge in COVID-19 patients requiring CT imaging. 

Singapore radiology department draws on SARS experience to provide strategies for preventing COVID-19 spread in radiology 

As COVID-19 cases increase, so too will the demand for chest imaging. This places radiology staff at risk of exposure and disease transmission. The authors of this paper use experience gained during the SARS outbreak in 2003 to offer operational strategies and guidelines for minimizing COVID-19 transmission and protecting staff in radiology departments.

European Society of Radiology broadcasts experts discussing their experiences in the radiology and management of COVID-19

ESR Connect has launched a series of videos in which experts from around the world report on their experiences with COVID-19. The first video is a report from a thoracic radiologist working in Italy. In the second, world-leading geneticist and immunologist Josef Penninger talks about a possible treatment for COVID-19. More videos will be added over time.

Ambra Health CEO says COVID-19 spotlights the need for virtual services, including teleradiology

As COVID-19 changes the way we think about our daily lives, virtual services (including teleradiology) are moving from “want to have” to “need to have.” New guidelines in the U.S. have made it easier for physicians to provide telehealth services. These solutions can help reduce physician burnout and keep only the most at-risk patients in hospitals. 

Radiology-specific resources for COVID-19 collected by the American College of Radiology®

To help radiology professionals make more informed decisions about COVID-19, the American College of Radiology® is publishing links to reliable radiology-specific materials about the virus. The page will be updated regularly and is intended to assist radiologists in protecting themselves, their patients, and other healthcare workers.

Implications for radiology management during the COVID-19 international public health emergency

This article by physicians at a radiology department in Shenzhen, China, discusses how they managed potentially infected patients receiving CT scans at their institution. Due to a shortage of medical supplies, the department adopted district management and hierarchical measures to protect medical staff.

Treatment

Viewpoint on the importance of randomized clinical trials during pandemics

This article begins by examining why no Ebola therapies were discovered during the 2014 outbreak: All studies were single-group interventions without controls, which prevented definitive conclusions about efficacy and safety. With drugs now being used off-label in COVID-19, the author argues that RCTs are crucial to finding safe and effective treatments.

Antibody from SARS-CoV patient found to cross-neutralize SARS-CoV-2

For this study, researchers investigated a set of human monoclonal antibodies drawn in 2004 and 2014 from a patient infected with the SARS-CoV virus. Their aim was to characterize the potential cross-reactivity of the antibodies with SARS-CoV-2. The study identifies one of the antibodies – S309 – as being capable of inhibiting SARS-CoV-2. 

A review of the literature on existing drugs that could help to treat COVID-19 

The authors of this literature review identified 22 articles that reported on the effectiveness of existing drugs against COVID-19. Published between January 1 and March 25, the articles include case reports, lab tests, and animal trials. They cover four categories of drug: antiviral/anti-inflammatory, antimalarial, traditional Chinese, and others.  

Outcomes of severe COVID-19 patients who received remdesivir on a compassionate-use basis  

This paper describes a program sponsored by Gilead Sciences. Patients with severe COVID-19 received remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, on a compassionate-use basis. While clinical improvement occurred in over half the patients, randomized controlled trials will soon provide more informative evidence about the drug. 

Evaluating the evidence for using remdesivir to treat patients with COVID-19  

The authors of this paper note that treating patients with “conventional drugs in new use” has become a feasible option for COVID-19, and that remdesivir could become a “specific drug” for the disease. After examining aspects of both the virus and the disease, the paper analyzes remdesivir to establish the feasibility of conducting experiments on COVID-19. 

A network-based methodology for repurposing drugs to target novel coronavirus 2019-nCoV/SARS-CoV-2 

As a drug discovery strategy, drug repurposing has the potential to achieve its goal quicker and at a lower cost than de novo drug discovery. With that in mind, these researchers have developed a powerful, network-based methodology capable of rapidly identifying possible repurposable drugs and potential drug combinations for targeting SARS-CoV-2. 

Unravelling the cellular factors used by SARS-CoV-2 for cell entry

This study shows that SARS-CoV-2 infection relies on host cell factors ACE2 and TMPRSS2, and that a clinically proven protease inhibitor can block it. The authors also describe how SARS-CoV antibodies could offer some protection against SARS-CoV-2. The results provide important knowledge about the new virus, and point to a target for antiviral intervention.

Narrative review of proposed pharmacologic treatments for COVID-19

This paper reviews relevant English-language articles (randomized controlled trials, case reports, case series, reviews) and active clinical trials focusing on major proposed treatments for COVID-19. It addresses selected repurposed drugs, selected investigational drugs, adjunctive therapies, and current clinical treatment experience and recommendations.

Passive immunization via monoclonal antibodies as a possible therapeutic intervention for COVID-19

This article discusses neutralizing monoclonal antibodies and their potential for treating coronaviruses. The authors outline existing knowledge about antibodies that performed well in targeting the spike proteins of SARS-CoV and MERS-CoV. Since these viruses are similar to SARS-CoV-2, the findings could potentially be effective for the current pandemic.

Using a tried-and-tested approach for the new challenge of COVID-19

Noting that passive immunization has been successfully used to treat infectious diseases, this editorial refers to studies in which convalescent plasma was found to reduce mortality and viral load in SARS-CoV and MERS-CoV. Serum from recovered COVID-19 patients could potentially prove helpful in the short term, until definitive treatments are found.

Initial clinical experience of administering convalescent plasma to critically ill COVID-19 patients in Shenzhen, China

In this uncontrolled case series, five patients who were critically ill with COVID-19 and ARDS received convalescent plasma containing neutralizing antibodies. The patients’ clinical status subsequently improved, suggesting that plasma transfusion could be beneficial. However, the study had a number of limitations and randomized clinical trials are needed.

Ivermectin, an FDA-approved drug, found to inhibit SARS-CoV-2 replication in vitro

Ivermectin is an FDA-approved antiparasitic that has shown broad antiviral activity. This study specifically tested the drug against SARS-CoV-2 in vitro. The results show that, in the tested system, a single dose can control viral replication within 24 to 48 hours. Ivermectin should therefore be further considered as a possible antiviral for SARS-CoV-2.

Ultrasound

Researchers in Brazil report on ultrasound-guided minimally invasive autopsies of fatal COVID-19 cases

This paper describes ten COVID-19 autopsies performed at a hospital in Sao Paulo using an ultrasound-guided minimally invasive procedure. The US technique allowed physicians to take tissue samples while minimizing the contagion risks of a conventional autopsy. The findings shed light on the pathological aspects and systemic manifestations of COVID-19.

Current state of the art of lung ultrasound and its use in diagnosing and managing COVID-19 patients

By reviewing the state of the art of LUS in evaluating pulmonary changes caused by COVID-19, this article aims to identify characteristic sonographic findings most suited to diagnosing COVID-19 pneumonia. After describing the basics of normal LUS and features linked to pathological changes, the authors present LUS findings from COVID-19 cases worldwide.

Using contrast-enhanced ultrasound to assess pulmonary consolidations in COVID-19

This case series is described against the backdrop of the hypothesis that COVID-19 could reflect an immune response as well as a viral effect. The cases involve three patients hospitalized with COVID-19. All had pulmonary consolidations. Contrast-enhanced ultrasound identified large perfusion defects in a pattern not typical of pneumonia or atelectasis. 

Webinar brings together emergency physicians to discuss the use of ultrasound on the frontlines of COVID-19

The American College of Emergency Physicians hosted the international webinar on March 18, 2020. The participants included emergency physicians working in Spain, Italy, and Washington State. This report outlines current imaging approaches and provides informally derived recommendations from the panel on using point-of-care ultrasound during COVID-19.

Direct comparison of lung ultrasound with low-dose CT scan in patient with SARS-CoV-2 infection

A 54-year-old man with suspected COVID-19 underwent low-dose thoracic CT and “no-dose” lung ultrasonography. The scans were performed in close temporal proximity, allowing a direct comparison of results. The authors report that the modalities produced similar findings, and that lung ultrasonography may be considered a useful alternative to low-dose CT.

ICU adopts ultrasound-focused approach to reduce conventional imaging and staff exposure to COVID-19

The authors of this Clinical Note describe how, as a coronavirus-dedicated ICU, they focused on ultrasound instead of traditional imaging. Their comparison of conventional imaging performed in the early weeks of COVID-19 and the same period in 2019 showed that the US approach reduced chest X-rays and CT scans. This has benefits for both staff and PPE.

Study investigates the role of point-of-care ultrasound (POCUS) in ICU lung examinations during the COVID-19 pandemic

After explaining the advantages of POCUS, the authors use seven articles to analyze its role in COVID-19. They review its lung findings, its usefulness for monitoring treatment response and recovery, and its ability to exclude alternative diagnoses. This is followed by an outline of practical barriers to POCUS use, and methods for deployment in hospitals. 

Protocol for using bedside lung ultrasound with COVID-19 patients in emergency settings

The CLUE protocol is designed to help emergency clinicians risk-stratify suspected COVID-19 patients and reduce the radiological resource burden expected with a rapid increase in highly infectious patients. The protocol uses an anatomical parameter (a lung ultrasound scoring system) and a physiological parameter (oxygen requirement at time of examination).

First report on point-of-care lung ultrasound in COVID-19 pneumonia, and potential applications

Researchers from Italy provide the first lung ultrasound description of COVID-19 pneumonia in a 52-year-old man. As well as documenting the findings, which were obtained at the bedside, the authors also explain how the examination was performed. They conclude by outlining the benefits and possible applications of lung ultrasound in the current pandemic.

Early experience with lung ultrasonography for evaluating SARS-CoV-19 infection in China

The authors of this letter report on using lung ultrasonography in 20 patients with COVID-19. They list the characteristic findings and compare them with CT findings. After noting a key limitation of the modality, the authors conclude that the benefits – such as repeatability and point-of-care use – mean that it has major utility for managing COVID-19.

Can lung ultrasound help in the early diagnosis of COVID-19 pneumonia in critical care settings?

Given that CT scanning is often unavailable in emergency departments, investigators in Italy evaluated the use of lung ultrasound in 12 patients who presented to an emergency department with COVID-19 pneumonia. The patients underwent bedside ultrasound and CT examinations, and there was a strong correlation between the findings from each modality.

A simple, quantitative, and reproducible method for standardized use of lung ultrasound for COVID-19 patients

Growing evidence shows that lung ultrasound can be useful in patients with COVID-19. Given that the virus has caused a global emergency, a globally unified approach is needed. With this in mind, a team of experts from Italy has developed a standardized approach to lung ultrasound that can be used to manage COVID-19 patients around the world.

Guidelines for cleaning and preparing ultrasound transducers and equipment, and for safe handling and use of coupling gel

The American Institute of Ultrasound in Medicine discusses transducer cleaning and preparation, lists new literature, and explains how to handle ultrasound coupling gel and equipment safely. The page includes details relevant to the COVID-19 outbreak. For instance, it directs readers to online information about EPA-approved disinfectants against SARS-CoV-2.

A practical approach to lung ultrasound in pregnant women with suspected COVID-19 infection

Pregnant women might be a target for respiratory infection during the COVID-19 outbreak, and any lung examination should ideally avoid radiation. This paper provides obstetricians/gynecologists with a method for performing lung ultrasound. The authors discuss potential applications, semiology, and practical aspects in the context of the current pandemic.

Chinese researchers present early experience with lung ultrasonography for evaluating COVID-19 infection

This report explains how lung ultrasonography could help manage COVID-19 due to the method’s safety, repeatability, absence of radiation, low cost, and point-of-care use. Chest CT could then be reserved for cases where ultrasound is not diagnostically sufficient, for rapid assessment, and for deciding when to wean patients off interventional ventilation.

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