geoffrey modest medical blogs

A recent report  from Wuhan strongly suggested vertical transmission of  SARS-CoV-2  from mothers to newborns (see  c ovid vertical transmission jamaped2020  in dropbox, or  doi:10.1001/jamapediatrics.2020.0878 ) Details: -- 33 neonates born to mothers with COVID-19, of whom 3 were likely  SARS-CoV-2 infected. The 3  cases:     --40 weeks gestation, delivered by C-section because of meconium stained amniotic fluid and confirmed maternal COVID pneumonia. On day 2 of life the infant had lethargy and fever, unremarkable physical exam, was sent to the NICU. Chest x-ray showed pneumonia and pro-calcitonin was positive. nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days 2 and 4 but negative on day 6     --40 weeks/4 days gestation. C-section because of confirmed maternal  COVID  pneumonia. Neonate had lethargy, vomiting and fever. Normal physical. Had leukocytosis, lymphocytopenia, elevated CK-...

A recent study from Wuhan found that markers of cardiac injury were common and associated with increased mortality (see  covid cardiac injury inc mortality jamacard2020  in dropbox, or doi:10.1001/jamacardio.2020.0950) Details: -- over a three-week period in January 2020, a single hospital assessed 416 consecutive hospitalized patients with Covid -- median age 64, 51% female -- symptoms in whole sample: fever in 80%, cough in 35%, shortness of breath in 28%, fatigue in 13% -- lab tests assessed: leukocyte count, C-reactive protein, pro-calcitonin, CK-MB, high-sensitivity troponin-1, BNP, AST, creatinine; also chest x-ray -- cardiac injury was defined as increased high-sensitivity troponin-1, above the 99 th  percentile of the upper reference limit, independent of EKG and echocardiography Results: -- 82 patients (20%) had evidence of cardiac injury      -- overall, patients were older (74 vs 60 years old, p<0.001)  ...

I have heard of a few cases of myocarditis associated with the SARS-CoV-2, one from a physician in Kansas reporting on a COVID-positive patient with respiratory distress, atypical chest pain, EKG changes suggestive of a STEMI but clean (ie atherosclerosis-free) coronary arteries; and an LA cardiologist responding that she has been seeing myocarditis-like presentations. There is little written about this that i could find, but a case report from China was published in the European Society of Cardiology journal, describing a patient with fulminant myocarditis  associated with coronavirus  who apparently responded to glucocorticoids and human immunoglobulin  (see   covid   myocarditis eurjcard2020   in   dropbox , or doi:10.1093/ eurheartj /ehaa190). Case: -- 37-year-old male admitted to the hospital with chest pain and dyspnea for 3 days, and diarrhea. -- Blood pressure 80/50 -- Troponin-T was >10,000 ng/L; CK-MB 112.9 ng/L;  BNP ...

On March 18 the CDC released data on severe outcomes in those with Covid-19, from February 12 to March 16 (see  https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm  ). [this blog was written last week] Details: -- in the US, as of March 16, there been a total of 4226 documented Covid-19 cases reported to the CDC (increasing 500 more cases per day beginning March 14) -- older people did the worst:      -- >65yo: 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths       -- highest percentage of severe outcomes was among people >85yo      -- overall statistics, by age:         -- >85yo: 6% of cases, 9% of hospitalizations, 7% of ICU admissions         -- 65-84yo: 25% of cases, 25% of hospitalizations, 46% of ICU admissions          -- 45-64yo: 36%, 35% of ho...