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Research updates: The NIH is enrolling 10,000 patients in a “serosurvey”, testing blood samples for antibodies to SARS-CoV-2 to look for previous, undetected infections. This clinical trial should give us a better picture of the real magnitude of the COVID-19 pandemic in the United States. The NIH is enrolling healthy adults from anywhere in the US and has a plan to collect blood samples remotely. People interested in participating in the study can contact clinicalstudiesunit@nih.gov or can read the NIH Q&A on the study.
Pathology in COVID-19: A New Orleans autopsy series discussed pulmonary and cardiac pathology observed in a four case series. All cases began with mild cough and fever followed by sudden respiratory decompensation and deterioration despite antibiotics and mechanical ventilation. Lungs were notable for bilateral diffuse alveolar damage with mild to moderate lymphocytic infiltrate, hemorrhagic foci, viral inclusions in desquamated type-2 pneumocytes, scattered hyaline membranes, and thickened alveolar capillaries with fibrin thrombi. The patient with a history of immunosuppression had a focal inflammatory infiltrate possibly consistent with secondary infection, while the three without immunosuppression prior to COVID-19 had no evidence of secondary infection. Myocardium sections found necrosis seen in scattered individual myocytes, which the authors note may be more consistent with microvascular dysfunction than direct viral cytopathic effect. Myocarditis was not seen. The authors note that the thrombotic and microangiopathic effects of the virus may be a plausible therapeutic target.
Patients on ACE-i and ARB medications should continue taking them, according to a joint statement released by the American Heart Association, the Heart Failure Society of America and the American College of Cardiology. The AHA president noted that although people with cardiovascular disease are at higher risk of serious complications with COVID-19, there is not evidence that these medications should be discontinued because of the pandemic. A more recent in-depth review in JAHA came to the same conclusion and also observed that discontinuing RAAS blockade may exacerbate frank heart failure, potentially worsening pulmonary outcomes in COVID-19.
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