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New Symptom, Test to Guide Steroid Treatment

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Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:

New Symptom

Oral petechial lesions observed in a small number of COVID-19 patients have some dermatologists curious if enanthem, in addition to skin rash exanthem, is a new symptom of the virus. Madrid researchers examined the oral cavity of 21 patients with the virus who also had a skin rash, and published their findings in a research letter in JAMA Dermatology. 

“The presence of enanthem in a patient with a skin rash is a useful finding that suggests a viral etiology rather than a drug reaction,” said Jimenez-Cuahe, MD, a dermatologist and one of the study’s authors. “This is particularly useful in COVID-19 patients, who were receiving many drugs as part of the treatment.”

Test to Guide Steroid Treatment

Hospitalized COVID-19 patients with high levels of inflammation may benefit significantly from dexamethasone and other steroids, new research indicates — but there is still a need for more clarity about which patients are the best candidates for steroids. 

Researchers at Albert Einstein College of Medicine and Montefiore Health System in the Bronx, New York, concluded that patients with low levels of inflammation may experience a significantly higher risk for severe outcomes with steroid use. They also found that a C-reactive protein test can help physicians decide which patients are likely to benefit.

Combination Therapy Quells Cytokine Storm

In a new study, the combination of high-dose methylprednisolone and tocilizumab was associated with faster respiratory recovery, lower likelihood of mechanical ventilation, and fewer in-hospital deaths among COVID-19 patients experiencing a hyperinflammatory state known as a cytokine storm compared with those who received supportive care alone. 

Researchers compared patients who received the treatments with historic controls and found that participants in the treatment group were 79% more likely to achieve at least a two-stage improvement in respiratory status.

Chronic COVID

COVID-19 can mean weeks’ long illness, even in young adults and those without chronic conditions who have mild disease and are treated in outpatient settings, according to survey results in today’s Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC).

In a multistate telephone survey of symptomatic adults who tested positive for SARS-CoV-2, 35% had not returned to their usual state of wellness when they were interviewed 2 to 3 weeks after testing. Delayed recovery (symptoms of fatigue, cough, and shortness of breath) was evident in nearly a quarter of 18- to 34-year-olds and a third of 35- to 49-year-olds who were not sick enough to require hospitalization.

Cheap Generics: Potential Treatments, but Hard to Test

Vascular medicine specialist Yogen Kanthi, MD, had a hunch that dipyridamole, a cheap, FDA-approved drug typically prescribed with blood thinners to prevent strokes, could help patients with COVID-19. But because of how clinical trials are run in the United States, he found it much harder to test this theory than he anticipated.

Researchers at Johns Hopkins wanted to test another cheap generic drug — alpha-blocker prazosin, which prevents inflammatory surges — and ran into similar hurdles.

With COVID-19 still spreading rapidly in many areas throughout the United States, physician-researchers are scrambling to work around these systems in hopes of testing what they believe could be lifesaving treatments.

Can the Virus Disrupt the Endocrine System?

Through its effects on angiotensin-converting enzyme 2 (ACE2), researchers say that SARS-CoV-2 may disrupt various endocrine functions throughout the body, Reuters reported. Researchers from Louisiana State University Health Sciences Center and Southeast Louisiana Veterans Health Care Systems, New Orleans, reviewed the available literature on ACE2 expression and function in endocrine tissues and the possible impact of SARS coronaviruses.

“With respect to COVID-19, clinical studies show more severe outcomes in patients with diabetes, obesity and hypertension,” the authors conclude. “However, the lack of data in humans on ACE2 expression in pathological conditions in endocrine tissues does not allow us to conclude on a direct role of ACE2 expression in severe COVID-19 outcomes.”

CDC Urges Schools to Reopen

As the new school year looms, the CDC has issued expanded guidelines on school reopening that stress the importance of putting children back into the classroom.

“It is critically important for our public health to open schools this fall,” CDC Director Robert R. Redfield, MD, said in a statement. “I know this has been a difficult time for our nation’s families [and] CDC is prepared to work with K-12 schools to safely reopen while protecting the most vulnerable.”

Still, some research suggests that the guidelines may be downplaying potential health risks. “While children infected by the virus are at low risk of becoming severely ill or dying, how often they become infected and how efficiently they spread the virus to others is not definitively known. Children in middle and high schools may also be at much higher risk of both than those under 10, according to some recent studies,” the New York Times reports.

Trending Clinical Topic: Airborne Virus 

For several months, concerns have been raised about the possibility of SARS-CoV-2 spreading via airborne transmission. As cases surge throughout the nation, this potential pathway of infection is now drawing increased scrutiny, making it this week’s trending clinical topic.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Thousands throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Victoria Giardina is Medscape’s editorial intern. She has previously written for The Dr. Oz Show and is currently a national lifestyle writer for Her Campus . She can be reached at [email protected] or on Twitter @VickyRGiardina .

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