COVID-19 Alaska Daily Clinical Update, May 1

Alaska Department of Health sent this bulletin at 05/01/2020 05:13 AM AKDT

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Friday, May 1, 2020
Liz Conway Ohlsen, MD
With information from Anne Zink, MD, FACEP, Alaska Chief Medical Officer

May 1 Cases
Nearly 70% of Alaskans diagnosed with COVID-19 have recovered. Alaska has had around a 2.5% mortality rate (9 Alaskans have died of 355 known cases), compared to around 5% nationwide and 7% globally. New cases have slowed, while the state's rate of testing continues to increase. 

Alaska public health news: AK percent positive tests is now well under 2% overall from around 3.4% in late March, likely because we are increasing testing faster than cases are increasing. The national percentage of respiratory specimens positive for SARS-CoV-2 is around 15%. Continuing to increase testing will be critical as Alaska relaxes some restrictions. 

National public health news: Total known US cases: 1,046,022 (2% increase); 61,288 deaths (3% increase) according to the   Johns Hopkins University tracker, which aggregates local, state and national data. There are now more than 3.2 million COVID-19 cases diagnosed worldwide, and more than a quarter million confirmed deaths- around 7.1% of the total confirmed cases.

 

Neurologic effects of COVID-19 have been reported in various forms, from impaired consciousness to stroke. Two new case reports in the New England Journal of Medicine describe neurologic findings in COVID-19. 

 

The first, from New York City, reports five cases of COVID-19 presenting as large vessel stroke in patients under age 50 over a period of two weeks. Authors describe a partial right ICA occlusion in a 33 year old woman with no risk factors which resolved after antiplatelet and anticoagulation therapy, a left MCA occlusion treated with clot retrieval and apixaban in a 37 year old male with no risk factors (patient later discharged home), a right PCA occlusion in a 39 year old man with hyperlipidemia and hypertension, treated with clot retrieval and aspirin but who remained intubated in the ICU at time of publication, a 44 year old man with undiagnosed diabetes who had a left MCA occlusion requiring t-PA, clot retrieval, hemicraniectomy who remained hospitalized, and a 49 year old man with a history of diabetes and prior stroke who had a right MCA stroke, had clot retrieval and a stent, and was discharged to rehabilitation on dual antiplatelet therapy. The average NIHSS score on presentation was 17. Authors note that in this two week period, their institution saw more than six times the number of strokes they usually see in that time in patients under age 50. 

 

The second letter reports neurologic features in a cohort of 58 patients admitted to one of two French ICUs with ARDS due to COVID-19. Features included encephalopathy, agitation, confusion, and corticospinal tract signs. Two were also found to have acute ischemic stroke. Findings of encephalopathy may have been confounded by critical illness-related encephalopathy or sedating medications.

New testing guidance from the State of Alaska for symptomatic and asymptomatic patients:

  • Test anyone with any symptoms of COVID-19 (fever, cough, shortness of breath, difficulty breathing, chills, decreased appetite, diminished sense of taste or smell, diarrhea, fatigue, headache, myalgias/arthralgias, nausea, rash, rigots, runny nose, sore throat, sputum production)
  • Consider testing anyone with new unexplained symptoms that may be compatible with COVID-19
  • Decide which lab to send the test to based on the urgency of the test, and only send specimens from symptomatic patients to the state lab 
  • Test patients within 48 hours of admission to a congregate living facility, but do not extend a hospital stay to await a test result
  • Congregate living facilities include skilled nursing, assisted living, residential treatment and correctional facilities.
  • Do not use serologic (antibody) tests to decide whether someone has COVID-19
  • Every test has a chance of a false negative. In a patient with clinical signs of COVID-19, particularly if they have known contact to a confirmed case or are severely ill, retesting may be helpful.
 
For anyone wanting a refresher on performing a nasopharyngeal swab, the New England Journal of Medicine has a technique video.

AK Clinical Reminders:

COVID-19 testing guidelines and  testing site locator

Report any positive test to the state Section of Epidemiology using the COVID Reporting Hotline at 1-877-469-8067 or by faxing in the Infectious Disease report form. If you suspect COVID-19 in an outpatient who cannot isolate in their own home (for example they are unsheltered or from out of town) or for another urgent situation call SOE at 907-269-8000 or 800-478-0084 (after-hours).

DHSS hosts an AK COVID-19 Update on Zoom Tuesdays at 7PM. Register here for the link to join.

AK COVID-19 clinical information hotline for physicians: 883-751-4212. Staffed 24/7. 8PM-8AM is for urgent/emergent questions only.