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Morning Rounds Shraddha Chakradhar

Doctors lambaste federal process for distributing Covid-19 drug remdesivir

As the federal government starts to dole out its limited supply of remdesivir for Covid-19 patients, hospitals and physicians across the U.S. are criticizing the distribution process as uneven and opaque. About two dozen medical centers are believed to have been selected to receive the drug, but why these centers were chosen is unclear. “Those of us on the frontlines treating people with Covid-19 need to know what the criteria are and where this drug is going to be available and why those places were selected,” Daniel Kaul, an infectious disease physician at the University of Michigan, tells STAT's Eric Boodman and Casey Ross. Read more here

Here's what else is happening with the Covid-19 crisis: 

  • Preliminary data from a team at Mount Sinai in New York suggest that giving Covid-19 patients blood thinners may reduce deaths among those of them who need to be placed on ventilators, especially since data from different hospital groups have suggested that Covid-19 patients may suffer from abnormal clotting in their lungs or legs. 
  • Despite reports on Tuesday of the White House's coronavirus task force likely disbanding by Memorial Day, President Trump refuted those claims yesterday, saying the group would continue on indefinitely, but would instead focus on restarting the economy. He also added that the task force would be focused on vaccines and therapeutics. 
  • Retail and tech giant Amazon is getting increasingly involved in a range of efforts to support the Covid-19 response, from funding a clinical trial testing blood plasma from recovered Covid-19 patients to at-home delivery of coronavirus test kits.

Study using human brain tissue shows herpes link to Alzheimer's

Newly published research is the first to show in a lab model that the herpes simplex virus HSV-1 might cause Alzheimer's. In the study, scientists found that mini 3D models of the human brain, when infected with the virus that causes cold sores, went on to develop hallmarks of Alzheimer's, including amyloid plaque-like formations and neuroinflammation. The brain models were also less efficient at conducting electrical signals, another byproduct of the neurodegenerative disease. The findings throw weight behind the "microbial theory" that some in the Alzheimer's field have championed — in which the disease is likely caused by pathogens infecting the brain. But this theory has largely been overlooked in favor of other thinking, including the presence of amyloid plaques and tau tangles as drivers of disease — although this is starting to change. STAT's Sharon Begley has more here.

Lessons from China show how U.S. hospitals could be overwhelmed without mitigation strategies

Data from how two different Chinese cities handled the Covid-19 outbreak suggest that U.S. cities will need to implement strict strategies to keep the demand for ICU and general hospital beds low. Researchers looked at Wuhan and Guangzhou's prevention and control measures plus hospitalizations in January and February this year. Guangzhou implemented contact tracing and strict social distancing within a week of its first imported Covid-19 case, and, on average, there were nine patients in the ICU daily with 17 hospitalized for serious illness. Wuhan waited six weeks after confirming transmission to implement distancing measures, and 429 patients were in the ICU daily with more than 1,500 hospitalized for serious illness. Researchers then looked at the 30 most populous U.S. cities and calculated that if these cities were to experience an an outbreak like Wuhan, the U.S. demand for hospitalizing critically ill patients could be twice as high as Wuhan's — and so plans to mitigate such outbreaks in the U.S. are "urgently needed," the authors write. 

Inside STAT: A peek inside one Boston hospital's response to Covid-19


Nurse Michelle Harris secures her personal protective equipment before entering a patient room in a Covid-19 ICU at Brigham and Women's Hospital in Boston. (CRAIG F. WALKER/THE BOSTON GLOBE/STAT)

When we think of pandemic-time hospitals, we think Italy. We think New York. We think about physicians forced to decide who will get the last piece of life-sustaining equipment. But even those hospitals that aren't among the hardest hit have changed drastically to confront the crisis of Covid-19. Reporter Eric Boodman and photographer Craig Walker have spent time in a few Boston hospitals, to chronicle their response, looking on as a sports medicine center became a respiratory clinic and an oncology area morphed into an ICU. “As soon as you write it, the story changes,” says Eric. “In the morning, they don’t have enough masks for everyone; by the evening, they’ve scrounged up a new supplier and masking is obligatory.” In this photo essay, Walker captures some of the most intimate moments of the coronavirus response at Brigham and Women’s Hospital.

Growth in autism diagnoses likely fueled by genetics, not environmental factors

As autism spectrum diagnoses have increased, people have wondered whether recent environmental changes are responsible for the spike. A new study suggests that environmental factors — such as air pollution or the kinds of medication the mother took during pregnancy — are not playing a big role in the growth in ASD diagnoses. Scientists looked at two different cohorts of twins in Sweden — one set born between 1982 and 2008, with the other born between 1992 and 2008 — to determine any discernible differences in ASD diagnoses. The researchers found that across both cohorts, autistic traits could overwhelmingly be attributed to genetics. And even though researchers observed a slight increase in traits associated with environmental factors, they also noticed a similar uptick in genetically associated traits. "Our results emphasize the enduring importance of genetic factors," the scientists conclude. 

Tapping into selfies to send a public health message about UV exposure

Brazil has one of the highest UV indexes in the world and tanning is very common among its population. A new study finds that when youth there were shown the effects of UV radiation using a face aging app, they got better about using sunscreen and other skin protection measures. Researchers enrolled around 1,500 high schoolers, roughly half of whom were assigned to a control group that wasn't shown the aging app. Selfies of those in the intervention group were used to project uneven pigmentation, more wrinkles, and other effects of UV exposure. At the six-month follow-up, more students in the intervention group reported daily sunscreen use than in the control group. Roughly twice as many in the intervention group reported doing self examinations of their skin at follow-up than before they were shown the altered selfie, and these youths also reduced their use of tanning beds. 

What to read around the web today

  • Beware overblown claims of dangerous coronavirus strains. The Atlantic
  • Trump will urge Supreme Court to strike down Obamacare. Politico
  • How memes, text chains, and online conspiracies haves fueled coronavirus protesters and discord. The Boston Globe
  • India's Covid-19 contact tracing app could leak patient locations. Wired
  • Fighting fat discrimination, but still wanting to lose weight. The New York Times

Thanks for reading! More tomorrow,

Shraddha

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Thursday, May 7, 2020

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