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Can Survivors Get Reinfected With Coronavirus?

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MONDAY, May 4, 2020 — People all over the globe who’ve recovered from the new coronavirus want to know the same thing: Am I immune, at least for a while? A new study of common coronaviruses is not exactly reassuring.

Researchers found it was “not uncommon” for people with run-of-the-mill coronaviruses (not the one that causes COVID-19) to have a repeat infection within a year. Of 86 New York City residents infected with those coronaviruses, 12 tested positive for the same bug again.

A big caveat is, the study looked only at the four coronaviruses that are endemic in humans — the kind that cause nothing worse than cold symptoms.

“They’re kind of wimpy,” said researcher Jeffrey Shaman, a professor of environmental health sciences at Columbia University Mailman School of Public Health. “People rarely have to go to the doctor for these infections.”

So it’s hard to know, Shaman said, whether our experiences with endemic coronaviruses will translate to SARS-CoV-2 — the coronavirus that causes COVID-19.

“It’s not the same as these endemic viruses,” Shaman said. “But obviously, we can’t look at repeat infections with [SARS-CoV-2], because it’s new.”

In lieu of that, he said, analyzing the patterns of regular coronaviruses — how often reinfections occur, and in what time frame — may at least give a sense of what could happen with the new virus.

For the study, Shaman and colleague Marta Galanti looked at data on 191 healthy adults and children living in New York City. Between fall 2016 and spring 2018, the participants regularly gave nasal swab samples and reported on any respiratory symptoms they were having.

Overall, 86 tested positive for a coronavirus infection at some point. Of those people, 12 — or about 14% — tested positive for the same virus within a year.

And there was no evidence that people’s symptoms were any different — either milder or worse — the second time around.

The findings have not, however, been published in a scientific journal yet. According to Shaman, they are undergoing peer review — the process by which journals decide whether a study is strong enough for publication.

For now, they leave some open questions. It’s not clear, for example, that those 12 repeat positives were all actually repeat infections, Shaman said. That’s particularly true in cases where the “new” positive result came within weeks of the first, he noted. There, the test may simply have detected the original virus again.

A similar issue is playing out right now with COVID-19, said Dr. Bruce Y. Lee, professor of health policy management at City University of New York Graduate School of Public Health.

There have been some reports of people who’d recovered from the disease testing positive for the virus again.

But, Lee said, those cases seem to reflect issues with the tests — including detection of “dead fragments” of the virus, rather than a new infection.

However, in the current study, many of the repeat positives happened months after the first infection, Shaman said — as far out as 48 weeks. It’s more likely those would be repeat infections.

Shaman said genetic analyses are being carried out to help confirm which cases are true reinfections.

The study also raises the question of who, exactly, is prone to reinfection — at least with common coronaviruses. Nine of the 12 repeat positives were in children between the ages of 1 and 9 years. It’s not clear why, but Shaman speculated that their immature immune systems could have something to do with it.

Beyond that, all of the study participants lived in densely populated New York City, and some were health care workers. Shaman said the rate and speed of reinfections in the group might not be seen elsewhere.

Lee, who was not involved in the study, agreed it’s hard to know what kind of relevance these findings have to the current pandemic. “The challenge with this new coronavirus is that it behaves differently,” he said.

The closest comparison that could be made, Lee said, is with SARS-CoV — the virus that caused the multi-country SARS outbreak in 2003. Studies have found that people who recovered from SARS maintained antibodies to it for an average of two years.

But, Shaman said, the mere presence of antibodies does not equal immunity: They need to be effective antibodies, in sufficient numbers.

Those questions are important not only to individuals, but to public policy. Some governments have proposed giving “immunity passports” to people who test positive for antibodies to SARS-CoV-2 — allowing them to return to work or to travel, under the assumption they won’t get infected again.

But the World Health Organization has cautioned against the notion, saying there is no evidence that having antibodies to the new coronavirus guarantees protection from reinfection.

Lee underscored that point. “It’s helpful to be tested for antibodies,” he said. “If you have them, you might have immunity. But that cannot be assumed.”

© 2020 HealthDay. All rights reserved.

Posted: May 2020


Having Heart Symptoms? Dont Delay Care During Pandemic

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MONDAY, May 4, 2020 — The coronavirus pandemic shouldn’t stop people with heart problems from seeking medical care, experts say.

“Either call your doctor or come to the emergency department. Don’t take chances with heart disease,” said Dr. Sam Torbati, co-director of the emergency department at Cedars-Sinai Medical Center in Los Angeles.

“We are very concerned that fears over COVID-19 is resulting in harm,” he said in a news release. “If you’re having chest pain, trouble breathing, feel faint, have new weakness or trouble with speech or any severe unexplained pain, you should call 911 as in the past.”

Although patients with heart disease are not at higher risk for contracting COVID-19, those who do are likely to become sicker than others, said Dr. Noel Bairey Merz, director of the women’s heart center at Cedar-Sinai’s Smidt Heart Institute.

“That’s because viruses like COVID-19 put further stress on an already fatigued heart,” she said.

A Smidt Heart Institute study published recently in the journal Circulation Research suggests that heart injury is prominent in between 20% and 30% of hospitalized COVID-19 patients. The study said it has contributed to about 40% of COVID-19 deaths.

“Those are troubling statistics for healthy individuals who contract novel coronavirus, but for patients with underlying heart conditions, it can be catastrophic,” said lead author Dr. Eduardo Marban, executive director of the heart institute.

“With more research, we hope to better uncover the connection between the respiratory virus and the heart. In the interim, we need patients with heart disease to follow precautionary guidelines to avoid contraction,” he added.

Those precautions include washing hands frequently, not touching the face, social distancing and limiting contact with people outside your household.

Merz noted that men and women often have different symptoms of a heart attack. Women can experience tightness in their jaw and debilitating fatigue, while typical men’s symptoms can include tingling in their left arm.

© 2020 HealthDay. All rights reserved.

Posted: May 2020


AHA News: Is It Safe to Go to the Hospital During COVID-19 Pandemic?

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MONDAY, May 4, 2020 (American Heart Association News) — When concerns about catching the coronavirus encourage people to stay physically distant, that’s healthy. When those fears drive ailing people away from hospitals, though, it could be dangerous.

To such people, doctors say: Your emergency room is safe. And if you need to go, you should.

Hospitals are updating safety procedures in lots of ways, said Dr. Patricia Best, an interventional cardiologist. She is an associate professor of internal medicine and cardiovascular diseases at Mayo Clinic College of Medicine and Science in Rochester, Minnesota.

“With this pandemic likely to go on for months, if not a year or longer, we need to make sure people are getting timely care for all of the things that they need,” she said. And that means if someone is “having something that on any other day, they would be calling an ambulance, they should call an ambulance.”

Not everyone is. An April study in the Journal of the American College of Cardiology said admissions for a serious type of heart attack known as STEMI dropped 38% after March 1, after the pandemic hit. In news reports, people have specifically cited coronavirus worries as the reason for avoiding hospitals.

Dr. Phillip L. Coule, vice president and chief medical officer at the Augusta University Health System in Georgia, said admissions in his hospital were down by 25% to 40%.

“Some of that appears to be driven out of fear,” he said. “Certainly, some of it is driven out of canceling elective cases, delaying procedures and things like that. But I’m quite certain that there is a component that is driven out of people not seeking health care because they’re concerned about the potential of becoming infected with COVID-19.”

That’s a bad idea, he said. “The risks posed by ignoring heart attack and strokes are far greater than the risks posed by COVID-19 and seeking health care.”

That holds true even in cities where the virus has hit hard, said Dr. Alice Jacobs, professor of medicine at Boston University School of Medicine. She’s vice chair for clinical affairs in the department of medicine at Boston Medical Center and a past volunteer president of the American Heart Association.

Fast care is the key to survival, she said. “The relationship between opening the blocked artery causing the heart attack and the chance of dying is measured in minutes.” And hospital workers need extra time now to allow for coronavirus safety measures.

But Jacobs, lead author of new guidance for STEMI care during the pandemic released Saturday by the AHA, said the entire emergency care process is adapting, starting in ambulances, which are being decontaminated and restocked with COVID-19 in mind.

At Coule’s facility, patients with COVID-19 symptoms are being diverted at the emergency room entrance to a separate area so they don’t mix with patients who have non-COVID-19 issues.

At Mayo Clinic, Best’s catheterization lab – the part of the hospital that evaluates and treats heart patients – also has made changes. Some might be obvious. Patients are being met by workers in full protective gear, and family member access is restricted.

Other changes are technical. The temporary STEMI guidance, which Best co-wrote, suggests more intense cleaning procedures and cutting back on the number of workers exposed to potentially infected patients. Other experts have issued temporary guidance from the AHA to help protect stroke patients.

Away from hospitals, new safety measures at a family physician or urgent care clinic might vary, she said. But for a true emergency, people need to call 911 and be taken to an emergency room no matter what.

Concerns about people not heeding such advice led the leaders of eight health organizations, including the American College of Cardiology, Heart Rhythm Society and AHA, to issue a statement in April that said, “Calling 911 immediately is still your best chance of surviving or saving a life.”

Coule agreed.

“I’m a huge fan and proponent of using urgent cares and telemedicine and private physicians when appropriate,” he said. “But if you’re having … symptoms of heart attack or stroke, those are not viable solutions. Those are patients who need to be seen in an emergency department that’s qualified and capable of taking care of them. That’s true on any day, and that’s true during COVID-19.”

Coule follows his own advice.

“I actually had chest pain during this crisis,” he said. He was at work at the time and, as many people do, he pondered for a moment as to whether he really needed to go.

But not for long. He reported to the emergency department and got a cardiac evaluation, “and everything turned out great.” He was sent home at midnight and was back at work the next morning.

Fear of getting COVID-19 was never an issue. But he worries about a wave of people who have delayed care for all kinds of problems. It’s crucial they don’t, he said.

“I would tell my parents, who are both heart disease survivors, that if they needed a procedure, it’s perfectly safe to come in and have that procedure done now,” he said. “I wouldn’t worry about their safety or the potential for catching COVID-19 in the hospital.”

© 2020 HealthDay. All rights reserved.

Posted: May 2020


More Symptoms of Coronavirus: COVID Toes, Skin Rashes

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MONDAY, May 4, 2020 — The virus that causes COVID-19 typically strikes the lungs with full force, but new research shows it can also cause frostbite-like patches on the hands and toes, and rashes on the body.

The condition has recently been dubbed “COVID toes.” Fortunately, it isn’t serious and the lesions usually disappear on their own, said Dr. Esther Freeman, director of Global Health Dermatology at Massachusetts General Hospital in Boston.

“One of the more surprising findings in this epidemic has been the lesions that we’re seeing on people’s toes and hands,” she said.

Freeman noted that COVID toes aren’t caused by exposure to cold, as is frostbite or chilblains. Rather it seems to be an inflammation of the circulatory system that shows up as a skin rash.

“It’s really important to reassure the public that most of our patients who are developing COVID toes are doing very well, so they’re often patients who have a benign clinical course. They either are having mild disease or often their only symptom might be their toes,” she said.

Freeman said that COVID toes don’t just happen to children, as some have believed — adults also get them.

Should you develop COVID toes, you’re not likely to end up in an intensive care unit. “That’s not what we’re seeing in the data,” said Freeman.

Skin rashes aren’t always associated with viruses, but measles, herpes and chickenpox are conditions where skin eruptions are the main symptoms, so it’s not unheard of, Freeman noted.

She can’t say how common COVID toes are because the data that would include the number of cases of COVID-19 and COVID toes doesn’t exist. Freeman is compiling a registry of known COVID toe cases.

Anecdotally, she’s seeing a lot more cases than usual. “In addition to running the registry, I see patients myself through tele-dermatology at Massachusetts General Hospital, and I have seen more toes in the past two weeks than I have in the rest of my career,” Freeman said.

If you have what you think might be COVID toes, don’t panic, Freeman said. Don’t rush off to the emergency room, but don’t ignore it either. The best thing to do is contact your doctor or dermatologist, she added.

Also, don’t try to get a COVID-19 test. “You should talk to your health care provider and decide the risks and benefits for your particular case. It’s important to go by local testing guidelines. It’s not as simple as a yes-no, but I think that it should be considered a COVID-19 infection,” Freeman said.

Dr. Raman Madan is a dermatologist at Northwell Health Huntington Hospital in Huntington, N.Y. He said, “COVID toes is the most common finding I have seen in patients via tele-dermatology. It is a fairly new symptom that we usually do not see with a lot of viruses.”

Traditionally, the condition would result from being out in the cold for a long time or having a rheumatologic problem, he said.

“With COVID-19, I have been seeing it in a lot of young, healthy people. There is still a lot to be learned,” Madan said.

A lot of patients have been asymptomatic aside from the toes and have been testing negative on their viral culture, but positive on their antibody test, Madan said.

“This has led me to believe that this may occur at the convalescent stage of illness, meaning after the body has cleared the virus. We are still working on the best guidance to give patients,” he said.

Two recent reports detail cases of COVID-19 and show that hands and toes aren’t the only places rashes appear.

In one, researchers described a patient in Wuhan, China, with COVID-19 who developed a rash on the torso. The researchers believe the rash was caused by an immune response to the virus and the patient tested positive for the Epstein-Barr virus, which has been tied to COVID-19. The rash disappeared within a week, but the patient died from COVID-19.

In the second case, a Spanish man suffering from COVID-19 developed a rash on his thighs and buttocks. The rash went away after five days and the patient left the hospital after 12 days. The researchers assume that the rash was a reaction to the virus.

“Dermatologists should be aware that patients presenting with this kind of rash, in addition to coughing and fever, could benefit from [COVID-19] testing,” said lead researcher Dr. Borja Diaz-Guimaraens, from the dermatology department, Ramon y Cajal University Hospital in Madrid, Spain.

“We are starting to notice more extra-respiratory manifestations in patients with confirmed COVID-19, and increased awareness for those signs can help diagnosis,” he said.

The two case reports were published online April 30 in JAMA Dermatology.

© 2020 HealthDay. All rights reserved.

Posted: May 2020


FDA Goes After Unproven COVID-19 Antibody Tests

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MONDAY, May 4, 2020 — The U.S. Food and Drug Administration said Monday it will crack down on the fraudulent COVID-19 antibody tests that have flooded the market.

Companies selling coronavirus antibody tests will be required to submit data proving accuracy within the next 10 days, or their products could be yanked from public circulation, FDA officials said.

Since mid-March, dozens of manufacturers have been allowed to sell antibody tests without providing any evidence they are accurate, under the initial policy announced by the FDA.

The intent of the initial policy was to support “the availability of antibody tests, which are an important tool in our fight against the coronavirus,” FDA Commissioner Dr. Stephen Hahn explained during a media briefing.

Unfortunately, many of the tests that came onto the market simply aren’t accurate.

A recent assessment of 14 coronavirus antibody tests now available to consumers revealed that only three delivered consistently reliable results, according a report issued by a team of more than 50 scientists.

Many antibody tests are also being falsely advertised or inappropriately marketed, said Dr. Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health.

“Many companies are marketing them for use at home,” Shuren said. “That was never permitted under our policy, unless authorized by the FDA.”

Others are falsely claiming that their tests are FDA-approved for accuracy, or that the antibody test can be used to diagnose an active case of COVID-19, the agency said.

Antibody tests only can say whether a person has been exposed to the new coronavirus. A viral test to check for the presence of coronavirus in a person’s blood or mucous is the only way to detect active infection.

The FDA also stepped in to halt the import of bad test kits from other countries, Shuren said.

“Flexibility never meant we would allow fraud,” Shuren said in an FDA release co-authored by Dr. Anand Shah, the FDA’s deputy commissioner for medical and scientific affairs. “We unfortunately see unscrupulous actors marketing fraudulent test kits and using the pandemic as an opportunity to take advantage of Americans’ anxiety,” Shuren noted.

Under the new policy, the FDA will provide manufacturers and laboratories with guidelines for gathering the accuracy data needed to acquire an Emergency Use Authorization (EUA).

All companies with an antibody test currently on the market will need to get an EUA. “Our expectation is that those who can’t do that will remove their product from the market, and we will be working with them to help them do that,” Hahn said.

To date, 12 antibody tests have been issued an EUA, including two developed by high-level diagnostic laboratories, Hahn said.

There are more than 250 antibody tests currently being reviewed by the FDA for an EUA, Hahn added.

© 2020 HealthDay. All rights reserved.

Posted: May 2020