Things are heating up in East Texas. On the 6th, Harrison County had 14 new cases. Gregg County had 32 confirmed, 65 probably for a total of 97 new cases in Gregg County in one day. Smith had 79 confirmed, 82 probable for a total of 161 new cases in one day. There were 46 new cases in Henderson, Texas. We will be running out of hospital bed space if this continues, although most of these cases apparently did not require hospitalization. Today, the bed situation is essentially unchanged. J. Harris

When coffee smells like gasoline: Covid isn’t just stealing senses — it may be warping them

Asymptomatic patient was actively infectious for 70+ days, study finds

Laboratory Findings Associated With Severe Illness and Mortality Among Hospitalized Individuals With Coronavirus Disease 2019 in Eastern Massachusetts

(J. Harris: The main message of this article for our use is that there were lots of younger people who got very sick — they were all sick enough to be admitted to very crowded hospitals. There were almost as many women as men and the majority were white. Wear your masks just like old fat men do.)

“The 2511 individuals hospitalized through June 5, 2020, included 1348 (53.7%) at academic medical centers and 1163 (46.3%) at community hospitals; 1277 (50.9%) were male, 1354 (53.9%) were White, and 679 (27.0%) were Hispanic; the mean (SD) age was 62.6 (19.0) years (Table 1). In all, 215 individuals (8.6%) were admitted to the ICU, 164 (6.5%) required mechanical ventilation, and 292 (11.6%) died….” 

HOPKINS SELECTIONS1. UNITED STATES The US CDC reported 9.46 million total cases and 233,129 deaths. The US reported 106,537 new cases yesterday (11/5/20), the first country to surpass 100,000 cases in a single day. The daily COVID-19 incidence continues to increase and set new records, now up to an average of 89,912 new cases per day.

2EUROPE HEALTH SYSTEMS Under substantial strain due to ongoing COVID-19 resurgence, the health systems in numerous high-resourced European countries—including Germany, Belgium, and France—are nearing their maximum capacity. Some Belgian doctors who have tested positive for SARS-CoV-2 but who remain asymptomatic and have a low viral load have reportedly been directed to continue treating COVID-19 patients in order to maintain sufficient clinical capacity. Some hospitals in Belgium are reportedly trying to reduce the COVID-19 burden by transferring patients to neighboring Germany, but this may not be a viable option in the longer term.

3 Characteristics and Outcomes of COVID-19-associated Stroke: a UK Multicentre Case-control Study (BMJ) This case-control study included patients admitted with stroke to 13 hospitals in England and Scotland between 9th March and 5th July 2020. We collected data on 86 strokes (81 ischaemic strokes and 5intracerebral haemorrhages)in patients with evidence of COVID-19 at the time of stroke onset (Cases).EXCERPTS: Our study provides the most compelling evidence yet that COVID-19-associated ischaemic strokes are more severe and more likely to result in severe disability or death, although the outlook is not quite as bleak as previous studies have suggested . Our results suggest the following recommendations for management of stroke patients during the ongoing COVID-19 pandemic.

If at any point a stroke centre is not routinely testing all stroke admissions for SARS-CoV-2, patients presenting with ischaemic stroke and very elevated D-dimers with no other explanation should be considered for testing,even if the clinical suspicion of COVID-19 is otherwise low. Criteria for requesting CT angiography in stroke patients may now need to take account of their COVID-19 status, because the finding of multiple large vessel occlusions may require a specific management strategy such as mechanical thrombectomy or possibly, in the future, a different antithrombotic agent. On the other hand, in most patients with COVID-19-associated ischaemic stroke, very early anticoagulation is probably not warranted as a strategy to prevent inpatient stroke recurrence, as this outcome is too uncommon to justify the increased risk of secondary haemorrhage.

(J. Harris: Covid induced strokes are generally more severe than those without Covid.”Dimers” is a simple blood test that reflects blood clotting in the body. )

Jokes tomorrow. 


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