SARS-CoV-2 literature review March 25 – April 1, 2020

Dear colleague,

Our weekly FOAMed Quiz is suspended until further notice. 

However, quite a large body of evidence is published weekly on COVID-19. Evidence that might help us and our patients get through the upcoming weeks to months.

These are the best FOAMed resources and most useful papers of the last 7 days.

Last weeks most useful FOAMed resources:

Clay Smith provides an overview on the evidence so far on Journal Feed (COVID-19 | Spoon-Feed Version). 

Justin Morgenstern covered some really useful papers on First10EMs COVID Research Roundup and published his take on the evidence behind antivirals (Antivirals for COVID19 – Not ready for clinical use)

EmDocs covered anti-inflammatory agents (Anti-Inflammatory Agents and Corticosteroids in COVID-19: What’s the Controversy?) and antivirals  (Antiviral Agents: What is their use in COVID-19?)

Salim Rezaie discussed NIV, awake proning and more on RebelEM  (COVID-19 Hypoxemia: A Better and Still Safe Way.)

EM cases provided another on the latest literature as well  (COVID-19 Updates)

Scott Weingard uploads a new podcast almost every other day about a range of critical care topics (EMCrit RACC Blog & Podcast)

Josh Farkas discusses how a risk stratification tool for COVID might look like (PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0)).

EM Ottawa covered the airway (Guidelines for Emergency Airway Management of COVID-19)

And taming the SRU is thinking of ways to make intubation safer (The Mother of Invention Meets the Little Red Hen – The “Nat Mat”).

The following papers deserve some additional attention or are not yet covered in the FOAM society.

Paper 1

Title: Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)
Author: Alhazzani, W.
Publication date: March 28, 2020
Journal: Intensive Care Medicine

A panel of 36 experts from 12 countries was formed. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU.

Results: Follow this link for a Table containing all Recommendations and statements

Link to paper:

FOAMed sources covering the guideline: 
First10EM: Surviving Sepsis Campaign COVID Guidelines
CanadiEM: Surviving Sepsis Campaign: COVID-19 Recommendations
RebelEML Surviving Sepsis Campaign Guidelines on the Management of Critically Ill Adults with COVID-19

Paper 2

Title: Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study
Author: To, K. K.
Publication date: March 25, 2020
Journal: The Lancet INfectious Diseases

Aim: To ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses.

Methods: This is a cohort study at two hospitals in Hong Kong. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). 

Results: 23 patients were included. Salivary viral load was highest during the first week after symptom onset and subsequently declined with time. In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load.

Conclusion: The high viral load on presentation suggests that SARS-CoV-2 can be transmitted easily, even when symptoms are relatively mild. 

Link to paper:

Paper 3

Title: Quantitative Detection and Viral Load Analysis of SARS-CoV-2 in Infected Patients
Author: Yu, F.
Publication date: March 28, 2020
Journal: Clinical Infectious Diseases

Aim: To explore the changes in viral load in different tissue samples and during disease progression with SARS-CoV-2- infected patients.

Methods:  127 patients were tested simultaneously by RT-PCR and ddPCR. 

Results: 76 COVID19 confirmed cases were included in the final analysis (77.6% mild). The average viral load in sputum was significantly higher than in throat swabs and nasal swabs. The viral load in the early and progressive stages were significantly higher than that in the recovery stage.

Conclusion: Sputum is a better indicator of viral replication in the body than throat and nasal swabs. The viral load of sputum samples tends to increase and then decrease during the course of the disease.

Link to paper:

Paper 4


Title: Performance of VivaDiagTM COVID-19 IgM/IgG Rapid Test is inadequate for diagnosis of COVID-19 in acute patients referring to emergency room department
Author: Cassaniti, I.
Publication date: March 30, 2020
Journal: Journal of Medical Virology

Aim: To investigate the diagnostic Performance of VivaDiagTM COVID-19 IgM/IgG Rapid Test 

Methods: Pre-proof. The performance of VivaDiagTM COVID-19 IgM/IgG Rapid Test LFIA was tested in 50 patients at their first access at emergency room department with fever and respiratory syndrome (34 M/16 F; median age 61.50 range 33-97 years) in comparison with results of nasal swab molecular screening.

Results:  All 30 COVID-19 negative volunteers were negative for both IgG and IgM. No cross-reactivity was detected in the 10 subjects with previous coronaviruses infection. 38 patients were positive for COVID-19 by real time RT-PCR. Of these, only seven (18.4%) showed a positive or weak positive serology for IgM and/or IgG while the other 31/38 (81.6%) tested negative for the rapid serology assay.

Conclusion: VivaDiagTM COVID-19 IgM/IgG Rapid Test LFIA is not recommended for triage of patients with suspected COVID-19.

Link to paper:

Paper 5

Title: Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method.
Author:  Soldatini, G.
Publication date: March 30, 2020
Journal: Journal of Ultrasound in Medicine

Aim:  The authors share their experience and propose a standardized approach in order to optimize the use of lung ultrasound in covid‐19 patients.

Link to paper:

Paper 6

Title: Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19
Author: Hua, A.
Publication date: March 30, 2020
Journal: European Heart Journal

Aim: This is the first reported case of COVID-19-associated cardiac tamponade.

Conclusion: Cardiac tamponade is an important differential to consider in a deteriorating patient with COVID-19.

Link to paper:

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