This week's roundup of some of the latest scientific studies on the coronavirus and efforts to find treatments and vaccines for COVID-19 comes on the heels of a promising breakthrough after Pfizer Inc. and BioNTech announced that their vaccine has shown 90% efficacy in trials.
Prone positioning might help more patients
Prone positioning, or lying face down, might be useful for severely ill COVID-19 patients who can still breathe on their own, early data suggest.
Lying face down makes it easier for the lungs to deliver oxygen to the blood. The position is often used in COVID-19 patients on mechanical ventilators, but it is not without risks.
Until the pandemic, it was not used in patients who were not intubated, even if they had low oxygen levels.
In a report in CMAJ, researchers say the evidence is emerging that hospitalized COVID-19 patients who are awake and breathing on their own might benefit. Their review of published data found that studies so far have been small, and randomized trials are needed to clarify the benefits and risks in COVID-19 patients, they advise.
Earlier this year, Dr. Sanja Jelic of Columbia University Medical Center told Reuters she would not recommend prone positioning at home.
"Lay people may not be able to assess accurately whether somebody has altered mental status or is too weak for this maneuver," she said.
"Patients need to have intact mental status and be able to turn themselves in bed without assistance. Being in a prone position while confused or lethargic may increase the risk for aspiration and possibly worsen already low oxygen levels."
New study adds to symptoms list
Fever, coughing, and shortness of breath are known symptoms of COVID-19, but other warning signs can include weakness, poor blood sugar control and gastrointestinal complaints, according to a new study published in the American Journal of Emergency Medicine.
Researchers analyzed nearly 12,000 visits by adult patients to emergency departments at five New York City hospitals. They found COVID-19 in 57.5% of patients who went to the hospital because of weakness, falls, or altered mental status, in 55.5% of those who came in because their blood sugar was out of control, and in 51.4% of patients whose chief complaint was a gastrointestinal problem.
Patients over the age of 65 tended to have more atypical complaints such as diarrhea, fatigue and weakness. Patients with dehydration, altered mental status, falls and high blood sugar were at higher risk for death in the study.
The new findings can help hospitals provide better care and are "also important for family members and people that work with the elderly to better identify possible warning signs of COVID-19 infection," co-author Dr. Christopher Clifford of the Icahn School of Medicine at Mount Sinai told Reuters.
COVID-19 can fuse heart cells, disrupt rhythm
COVID-19 can disrupt the heart's electric system, according to a report undergoing peer review at a Nature Research journal.
The heart pumps blood by sending electrical signals through its "conducting cells" to tell "muscle cells" to contract. Normally, each conducting cell activates the one next to it in a domino effect to ensure smooth contractions.
An autopsy of a COVID-19 patient found the virus had infected her heart in an unusual patchy pattern, "with small islands of infected cells here and there," Dr. Jay Schneider of the Mayo Clinic in Rochester, Minnesota told Reuters.
Upon further study in the laboratory, his team realized the spike protein on the surface of the new coronavirus can create holes between neighboring cells, causing them to fuse together. So instead of orderly electrical signal transmission and a steady heart rhythm, the signals flow like "a tsunami tidal wave" through the fused cells.
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