COVID-19 Alaska Daily Clinical Update, May 17

COVID-19 Clinical Newsletter Banner

Sunday, May 17, 2020
Liz Conway Ohlsen, MD
With information from Anne Zink, MD, FACEP, Alaska Chief Medical Officer

May 17 Cases

Alaska public health news: Fewer than 1.7% of all AK tests have been positive, decreased from around 3.4% in late March, likely because we are increasing testing faster than cases are increasing. Over the last 3 days, 0.16% of tests performed have been positive, and the percent of tests positive has been below 1% since late April. Continuing to increase testing will be critical as Alaska reopens, and more than 30,000 tests have been performed in AK already. More than 88% of the Alaskans known to have had COVID-19 have now recovered, and only 41 have required hospitalization, around 10%. DHSS also tracks cases discovered in Alaska in residents of other states. 9 nonresident cases are known. 

National public health news: Total known US cases: 1,454,504; 87,991 US deaths. There are now 4.5 million COVID-19 cases diagnosed worldwide and well over a quarter million confirmed deaths- around 7% of the total confirmed cases.

Renal effects in COVID-19: An autopsy series of 27 patients who died from COVID-19 found that the highest levels of SARS-CoV-2 were found in the respiratory tract and lower levels in the kidneys, liver, heart, brain and blood. They found particularly high viral levels in glomerular cells in the kidney, and cited public data sets to demonstrate high levels of ACE2 in kidneys, which they suggested may facilitate SARS-CoV-2 associated kidney injury. An earlier autopsy series described diffuse proximal tubule injury with loss of brush border and necrosis as well as electron microscopy-observed concentrated virus in tubular epithelium and podocytes. This is broadly consistent with an observed relatively high incidence of acute kidney injury in COVID-19 pneumonia even in previously well patients with noncritical disease. 

A more comprehensive overview of current knowledge of kidney disease in COVID-19 notes that the cause of kidney injury is likely to be multifactorial, with prerenal contributing factors, renal endothelial dysfunction and direct viral damage to tubular epithelium and podocytes. The authors note supportive care is the current standard, which includes avoiding nephrotoxins, monitoring creatinine and urine output, maintaining normal volume status and hemodynamics, lung protective ventilation (e.g. limiting ventilation-induced hemodynamic effects and increased cytokines which may increase stress on kidneys) and renal replacement therapy when needed. They make specific recommendations regarding anticoagulation for CRRT in severely ill patients exhibiting signs of hypercoagulability.

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.