Author Interviews, Cost of Health Care, COVID -19 Coronavirus, Critical Care - Intensive Care - ICUs, JAMA / 05.03.2021
COVID-19: Staggering Mortality and Medical Costs
MedicalResearch.com Interview with:
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Dr. Nguyen[/caption]
Ninh T. Nguyen, MD
Chief of Gastrointestinal Division, Surgery
UCI
MedicalResearch.com: What is the background for this study? What are the main findings
Response: There are limited national data on hospitalized patients in the US. To our knowledge, the current publication provides data on the largest cohort of COVID-19 patients hospitalized at US academic centers.
Dr. Nguyen[/caption]
Ninh T. Nguyen, MD
Chief of Gastrointestinal Division, Surgery
UCI
MedicalResearch.com: What is the background for this study? What are the main findings
Response: There are limited national data on hospitalized patients in the US. To our knowledge, the current publication provides data on the largest cohort of COVID-19 patients hospitalized at US academic centers.
Dr. Traverso[/caption]
Carlo Giovanni Traverso, MB, BChir, PhD
Associate Physician, Brigham and Women's Hospital
Assistant Professor,
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Dr. Chai[/caption]
Peter R. Chai, MD, MMS
Emergency Medicine Physician and Medical Toxicologist
Harvard Medical School
Brigham and Women's Hospital
Department of Medicine
MedicalResearch.com: What is the background for this study? What are some of the functions that Dr. Spot can facilitate?
Response: During the COVID-19 pandemic, we wanted to consider innovative methods to provide additional social distance for physicians evaluating low acuity individuals who may have COVID-19 disease in the emergency department. While other health systems had instituted processes like evaluating patients from outside of emergency department rooms or calling patients to obtain a history, we considered the use of a mobile robotic system in collaboration with Boston Dynamics to provide telemedicine triage on an agile platform that could be navigated around a busy emergency department. Dr. Spot was built with a camera system to help an operator navigate it through an emergency department into a patient room where an on-board tablet would permit face-to-face triage and assessment of individuals.
Laura M. Bogart, PhD
Senior Behavioral Scientist
RAND Corporation
Santa Monica, CA 90407-2138
MedicalResearch.com: What is the background for this study?
Response: Recent media polls continue to show that Black Americans are less likely to intend to get the COVID-19 vaccine than White Americans, and initial state data show a similar racial/ethnic disparity in vaccination rates. Initial uptake of the vaccine has been significantly affected by inequities in vaccine access and supply. In addition to these challenges, other factors contribute to hesitancy around vaccination, including self-perceived risk of infection, trust in the vaccine itself, trust in healthcare systems, healthcare providers, and policymakers who support the vaccine, and trust in the pharmaceutical industry and clinical research. In this study, we conducted a survey of a nationally representative sample of 207 Black Americans in late 2020, after initial COVID-19 vaccine effectiveness and safety data were released to the public. We also did in-depth interviews with a subsample of those surveyed who said that they would not get vaccinated. In addition, we engaged with a stakeholder advisory committee comprised of individuals who represent different subgroups and organizations in Black communities in the U.S., in order to discuss the results and make recommendations for policies to increase COVID-19 vaccination among Black Americans.
Dr. Zimmerman[/caption]
Frederick Zimmerman, PhD
Professor, Department of Health Policy and Management
Fielding School of Public Health
UCLA
MedicalResearch.com: What is the background for this study?
Response: The science on school transmissions of COVID is becoming clearer all the time in its conclusion that there is little to no transmission in school environments as long as reasonable precautions are taken. Yet one recent study got a lot of attention for claiming that states that allowed their schools to remain open in the early days of the pandemic saw more cases. That study did not control for several important factors that might explain this association, so our study aimed to correct that work.
Dr. Taub[/caption]
Pam R. Taub, MD, FACC, FASPC
Director of Step Family Foundation Cardiovascular Rehabilitation and Wellness Center
Associate Professor of Medicine
UC San Diego Health System
Division of Cardiovascular Medicine
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by postural orthostatic tachycardia syndrome? Is it more common in patients who have incompletely recovered from a COVID-19 infection?
Response: Postural Orthostatic Tachycardia Syndrome (POTS) is a, complex multisystem clinical syndrome Patients experience a wide spectrum of symptoms of varying severity, which are often debilitating. Upon assuming an upright standing position from being supine, patients experience an increase in heart rate by 30 beats per minute (bpm) from supine position, This is often accompanied by lightheadedness, palpitations, dyspnea, mental clouding (“brain fog”), headaches.
POTS can occur after infections as it thought to be triggered by the immune system . The hypothesis is that when the body is fighting an infection some of the antibodies it produces can attack our regulatory systems that control heart rate and blood pressure.
We are seeing an increase in POTS cases occurring after COVID-19 infection. These patient are referred to as the “long haulers”
These long haulers have elevated heart rate, fatigue, brain fog and shortness of breath with activity consistent with POTS.
We are seeing that COVID-19 is another infection that can lead to POTS.
Some articles on this
Rahul Subramanian[/caption]
Rahul Subramanian PhD candidate
Department of Ecology and Evolution
Biological Sciences Division
University of Chicago
Chicago, IL 60637
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Understanding the proportion of COVID-19 cases that become symptomatic, as well as the extent to which people without symptoms contribute to COVID-19 transmission, has important public health implications.
However, changes in PCR testing capacity over time have made these quantities hard to estimate precisely.
We used a model that incorporates daily changes in PCR testing capacity, cases, and serology to precisely estimate the proportion of cases that were symptomatic in New York City during the initial wave of the outbreak.
Only 1 in 7 to 1 in 5 cases were symptomatic.
Furthermore, non-symptomatic cases of the virus (this includes people who are either pre-symptomatic or asymptomatic) substantially contribute to community transmission, making up at least 50% of the driving force of SARS-CoV-2 infection. 
Tejasvi Hora[/caption]
Tejasvi Hora, PhD Candidate
Department of Geography and Environmental Management, University of Waterloo
Data Analyst, GEMINI, Unity Health Toronto
MedicalResearch.com: What is the background for this study?
Response: Death rates and resource use for COVID-19 hospitalization vary significantly worldwide, however, the characteristics and outcomes of COVID-19 hospitalizations in Canada have not been described in detail. Further, there is considerable uncertainty about how COVID-19 compares with influenza. In some circles, COVID-19 has been dismissed as being not more severe than “the flu”. We used data extracted from electronic health records of 7 hospitals in Ontario, Canada to describe characteristics and outcomes of hospitalization for COVID-19 and influenza. 
Ankur Dalsania[/caption]
Ankur Dalsania
Rutgers New Jersey Medical School (NJMS)
M.D. Candidate 2021
MedicalResearch.com: What is the background for this study?
Response: Similar to past pandemics, prior studies and news articles have highlighted the disproportionate impact of COVID-19 mortality in marginalized populations, especially Black Americans. Rather than biological differences, other factors like neighborhood conditions, educational attainment, economic stability, healthcare access, and social contexts have been hypothesized to influence the racial disparities.
Using county-level data, we sought to quantitatively determine how these factors, collectively referred to as social determinants of health, impact COVID-19 mortality in Black Americans. 
Dr. Cano[/caption]
Marlene Cano MD. PhD.
Post-Doctoral Research Fellow in Pulmonary Transplant Immunology
Division of Pulmonary and Critical Care
Department of Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
MedicalResearch.com: What is the background for this study? How does this test differ from other tests for COVID-19?
Response: We know COVID-19 causes a wide spectrum of disease, and that while many develop only mild uncomplicated illness, others develop severe respiratory failure, multi-organ failure and death. These patients often require prolonged hospitalization, ICU level care and even mechanical intubation for respiratory support. However, we still do not have a great way to identify which patients are likely to develop severe disease. We felt it was important to have a test that could act as sort of a ‘biomarker’ that we could measure early in COVID-19 patients and would help predict which patients would develop severe disease. From prior work, we knew that mitochondrial DNA, which are proinflammatory molecules that are released into the circulation from damaged organs could be this such ‘biomarker’. So, we measured the levels of mitochondrial DNA circulating in the plasma of patients with COVID-19 at the time they first presented to the hospital. Then we investigated if higher levels of mitochondrial DNA indeed predict the development of more severe disease.
Currently there are no ‘biomarker’ tests specific for COVID-19. We do currently measure levels of other markers in the hospital that we feel might help us assess overall how sick patients may be, but these are very non-specific and assess only level of inflammation. This test instead can measure level of tissue injury.
Dr. Wei Shan Hoong[/caption]
Dr Caroline Wei Shan Hoong, MBBS, MRCP
Associate Consultant Endocrinologist
Department of General Medicine
Woodlands Health Campus
National Healthcare Group, Singapore
MedicalResearch.com: What is the background for this study?
Response: In the course of our clinical work, we have noticed a predominance of musculoskeletal complaints among some of COVID-19 patients who are otherwise clinically well, and a small subset of them who develop a viral arthralgia (joint pains) sometimes occurring separately from the onset of acute respiratory symptoms. Besides a few isolated case reports, there was not much described about COVID-19 associated viral arthralgia in the literature.
Clinicians are well aware of the need to test for COVID-19 when patients present with cough or shortness of breath. However, when they present as joint pains without any respiratory symptoms, a diagnosis of COVID-19 could easily be missed. Due to overlapping clinical features like low platelet count and elevated liver enzymes, they could easily be misdiagnosed as having other vector-borne infections such as dengue fever, if clinicians do not have a high clinical suspicion of COVID-19. Hence we decided to describe the epidemiology and various presentations of musculoskeletal manifestations of COVID-19 in our cohort of patients. 
Dr. Conway Morris[/caption]
Dr Andrew Conway Morris
Wellcome Trust Clinical Research Career Development Fellow
University of Cambridge
Hon Consultant in Intensive Care Medicine
Addenbrookes Hospital, Cambridge
MedicalResearch.com: What is the background for this study?
Response: Patients with COVID-19 frequently need to come to the intensive care unit (ICU), where we use mechanical ventilation to support their lungs as they get over the intense inflammation caused by the virus. During the first wave of the virus we noted that a lot of our patients appeared to be developing secondary infections (infections they didn’t have when they came into the ICU).
We therefore rolled out a rapid diagnostic test for these secondary bacterial infections that we had developed previously, and this study reports the use of this diagnostic and also describes the types of bacteria seen. To see if the increase in secondary infections was due to COVID specifically, we compared them to patients who were managed in the same ICU but who did not have COVID.
Dr. Butler[/caption]
Jay C. Butler, MD, FAAP, MACP, FIDSA
Deputy Director for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA 30333
MedicalResearch.com: What is the background for this study?
Response: There are still disagreements about the significance of transmission of SARS-CoV-2 from asymptomatic persons. It has been known since at least March 2020 that, unlike the closely related coronavirus that causes SARS, transmission of COVID-19 from asymptomatic and presymptomatic persons occurs and that at least 30% of infected persons do not develop symptoms. Estimating the proportion of transmissions from persons without symptoms informs the decision analysis for prioritization of community mitigations opportunities: wearing of masks, social distancing, and hand hygiene. If only a low proportion of transmission occurs from people without symptoms, these interventions would be less likely to control transmission when broadly applied in the community. On the other hand, if a significant proportion of spread is from infected persons without symptoms, the value of these measures is enhanced.
Additionally, obtaining strategic and systematic screening tests for SARS-CoV-2 to identify and isolate persons without symptoms in selected settings, such as congregational housing settings, will have greater potential impact if spread from persons without symptoms is common. 
Dr. McGahan[/caption]
Anita M. McGahan PhD, MBA
University Professor
Professor of Strategic Management
Professor, Munk School of Global Affairs & Public Policy
George E. Connell Chair in Organizations & Society
Rotman School of Management
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The article by Phebo Wibbens, Wesley Wu-Yi Koo, and me that came out today in PLOS ONE at 