Thread by @andreaprinzi

In some roles I currently have, I review #COVID19 literature several times a week and summarize the findings. There are thousands of studies to review, so it's impossible to get to them all, but I think sharing some easy-to-digest summaries on #Medtwitter doesn't hurt (thread)

Below are brief summaries of a handful of papers released within the last day or so. Click the links to go to the article and read more if you desire.

Title: Comparing Chinese children and adults with RT-PCR positive COVID-19: A systematic review
Link: doi.org/10.1016/j.jiph… (full text is available for free)

Brief Study Design: A review of published literature in PubMed and the Chinese Medical Journal Network. Quality of the papers were assessed using a validated tool, and then the authors explored the clinical differences between children and adults with COVID-19.

Simple Summary: Fever is the most common symptom in both children and adults with COVID-19, but the proportion of children with no fever is significantly higher than adults. Overall, children have fewer clinical symptoms and better prognosis than adults.

The most common exposure history for adults was travel to Wuhan, China. The most common exposure history for children was family cluster. The authors conclude that this demonstrates the importance of testing children with sick family members, even if they do not have symptoms.

2. Title: Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series
Link: thelancet.com/pdfs/journals/… (you can access the full text for free)

Brief Study Design: This is a case series, meaning this is an observational/descriptive study design that summarizes clinical findings of a group of patients. Fourteen autopsies were performed on COVID-19 patients, and the findings are described in this paper.

Simple Summary: Patient ages ranged from 42-84 years. All patients had clinically significant comorbidities, the most common being high blood pressure, chronic kidney disease, sleep apnea, diabetes, and obesity.

Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. The most common presenting symptoms of these patients were fever, cough, respiratory distress.

Less commonly encountered initial symptoms included altered mental status and gastrointestinal symptoms (nausea, vomiting, or diarrhea). During severe infection, there seems to be involvement outside of the lungs.

3. Title: Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients during medical isolation observation
Link: nature.com/articles/s4159…
Brief Study Design: Prospective cohort study (the researchers followed a group of ppl forward in time and looked for outcomes)

Simple Summary: 182 recovered COVID-19 patients were followed for 14 days after they were discharged from the hospital. All patients were re-tested using PCR at least once. 20 out of 182 patients re-tested positive during the 14-day follow up period.

The authors conclude the following: Patients under 18 years of age and those with mild/moderate disease had a higher risk of re-testing positive. People who re-tested positive and those who did not had the same levels of antibodies.

It is possible for asymptomatic carriers to test positive again. The patients who tested positive again did not have new symptoms and their positive results were believed to be viral shedding.

4. Title: Using Serology with Models to Clarify the Trajectory of the SARS-CoV-2 Emerging Outbreak
Link cell.com/trends/immunol…
Brief Study Design: Article in press discussing how serological testing can be used to model estimates regarding the outbreak.

Simple Summary: While widespread testing should remain a priority, serological data can be used to build models that can predict pandemic trajectories.
For people who want to see some stats: Check out figure 1 in this paper, it will make some of your stats dreams come true.

5.Title: Early Experience of COVID-19 in a US Children's Hospital
Link:pediatrics.aappublications.org/content/pediat…
Brief Study Design: This is a retrospective cohort study meaning COVID-19 and non-COVID-19 pts were identified, and then the researchers looked back in time at various risk factors...

to see how these patients differ. 65 patients were identified for this study.
Simple Summary: Of children who are hospitalized with COVID-19, most are either younger than 60 days or older than 12 years.

Children may require intensive care (severe disease) or die. In this study, 35% of the patients studied required intensive care (ICU). The clinical course of patients with immunosuppression (suppressed immune systems) was not more severe than other children.

6. Title: Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with COVID-19 in New York City.
Link:ncbi.nlm.nih.gov/research/coron…

Brief Study Design: Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020 to 9 NYC pediatric intensive care units (PICUs) with SARS-CoV-2 infection.

Simple Summary: Fever and cough were the most common presenting symptoms. The majority of children with severe COVID-19 are adolescents, have comorbidities, and require some form of respiratory support.

7. Title: Clinical characteristics, laboratory findings, radiographic signs and outcomes of 61,742 patients with confirmed COVID-19 infection: A systematic review and meta-analysis

Link doi.org/10.1016/j.micp…
Brief Study Design: Systematic review of published studies

Simple Summary: 80 studies were included in the meta-analysis, including 61,742 patients with confirmed COVID-19 infection. Most common symptoms =fever and cough. 61% of patients had thrombocytosis. For all ages, the case fatality rate was 6%.