key: cord-284152-6aog88cx
authors: Mitchell, Edith Peterson
title: COVID-19 Innovations: Addressing Rapidly Changing Clinical Needs
date: 2020-07-21
journal: J Natl Med Assoc
DOI: 10.1016/j.jnma.2020.06.004
sha: 
doc_id: 284152
cord_uid: 6aog88cx

nan

T he coronavirus (COVID-19) pandemic, caused by the SARS-CoV-2, has created a rapidly continuously changing challenge for physicians and other healthcare personnel globally. First announced in December 2019 in Wuhan China in 2019, COVID-19 now has been reported in 213 countries and territories around the world. Data reported on May 31,2020 indicated a total of 6,235,704 individuals were reported as infected with the virus and 373,176 had succumbed to disease complications. In the United States, on the same date a total of 1,833,569 infections had been reported and 106,127 deaths recorded. 1 The symptoms most frequently reported as related to COVID-19 infection are fatigue, fever, and shortness of breath. Respiratory symptoms are thought to be more common as the virus is usually transmitted by airborne exposure and more frequently enters the host by binding of its spike glycoprotein to the angiotensin converting enzyme 2 (ACE2) receptor which has a high concentration in lung tissue. This mechanism may also account for disease manifestations and clinical findings in other organ systems, including hypertension, gastrointestinal disorders, thromboses, acute renal dysfunction, pulmonary embolism, cerebrovascular and neurological disorders and dermatologic findings described as Kawasaki like disease in young patients. 2 The pathogenesis of COVID-19 entrance into host cells involves attachment of the surface glycoprotein spike to the ACE2 receptor which has been demonstrated as a co-receptor for entry. There are additionally other receptors that may facilitate or mediate entry into cells. The presence of many of these receptors has been demonstrated on endothelial cells. Thus some COVID-19 research strategies involve targeting endothelial cell function.

Progressive respiratory insufficiency leading ultimately to failure is the main cause of death secondary to COVID-19. A meticulous review of the pulmonary pathologic findings in seven patients dying of the disease has been reported. Reported findings included diffuse alveolar damage with perivascular T-cell infiltration. Additionally, endothelial injury with features characterized as intracellular viral particles and disrupted membranes was described. Histologic features also demonstrated extensive thromboses with new vessel formation described as vascular angiogenesis. 3 Myocardial injury and myocarditis are frequently found in patients with COVID-19 disease. In fact acute heart failure may be the primary presenting disorder, as well as acute myocardial infarction, dysrhythmias, and venous thromboembolism. 4 Reports also indicate that approximately one third of COVID-19 patients admitted to hospitals developed acute kidney injury which correlated with the development of respiratory failure. 5 Evidence suggests that many individuals fail to seek routine medical care for fear of viral exposure. Furthermore, patient participation in clinical trials decreased, including cancer diagnostic and treatment trials. The National Cancer Institute recently established the Overview of NCI COVID-19 in Cancer Patients Study (NCCAPS) to evaluate the long-term effects of COVID-19 on cancer care. 6 Additional research is ongoing evaluating treatments, vaccines and serologic tests evaluating prior exposure to the virus. It is of great necessity that clinicians maintain currency of reports and be aware of to effectively utilize results appropriately in clinical practice, and self-care, and preventive strategies. Moreover, knowledge of stress, grief, and psychological trauma may occur in patients, families, clinicians and other healthcare personnel.

Worldometer's COVID-19 Data accessed 31

on behalf of the National Medical Association

Hypertension, thrombosis, kidney failure, and diabetes: Is COVID-19 an endothelial disease? A comprehensive evaluation of clinical and basic evidence

Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Cardiovascular complications in COVID-19

Acute kidney injury in patients hospitalized with COVID-19