Trending Clinical Topic: SARS-CoV-2

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APRIL 03, 2020 –New research and information regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, resulted in this week’s top trending clinical topic. The Coronavirus Study Group of the International Committee on Taxonomy of Viruses termed the novel coronavirus “SARS-CoV-2” on the basis of its relationship to the original SARS-CoV that caused an outbreak of disease starting in 2002. Among the many concerns related to SARS-CoV-2 is its means of transmission. An article published in the New England Journal of Medicine suggests that the virus can remain viable in aerosols for hours and on surfaces for days. According to the Centers for Disease Control and Prevention, however, the primary means of transmission is still believed to be person-to-person.

Recently, the US Food and Drug Administration (FDA) issued a safety alertwhich stated that fecal microbiota transplants (FMTs) are also associated with a risk for SARS-CoV-2 transmission. The FDA recommends the following actionsregarding any use of FMT that involves stool donated after December 1, 2019:

  • Screen donors by asking questions designed to identify donors who currently may be infected or who recently may have been infected with SARS-CoV-2;

  • Test donors and/or donor stool for SARS-CoV-2, as feasible;

  • Develop criteria for screening and testing so as to exclude donors and donor stool;

  • Inform FMT recipients about the potential for transmission of SARS-CoV-2 via FMT, including FMT prepared from stool from donors who are asymptomatic for COVID-19.

To further reduce the spread of SARS-CoV-2, the American Heart Association (AHA) has issued interim guidance for CPR and emergency cardiovascular care for patients with COVID-19. In addition to standard and transmission-based precautions, specific guidance includes restricting who is present during CPR, performing aerosol-generating procedures in airborne infection isolation rooms, and prioritizing gowns for aerosol-generating procedures if they are in short supply. The guidelines also cover other concerns related to personal protective equipment  and specific considerations for EMS and other first responders.

The relationship between hypertension and COVID-19 is also under investigation. SARS-CoV-2 enters the lungs through ACE2 receptors, and evidence suggests that people with hypertension appear to have worse outcomes than those with any other underlying condition. The biggest question is whether ACE inhibitors, which are commonly used to treat high blood pressure, may help or hurt people at the highest risk for severe COVID-19. At this point, whether patients taking an ACE inhibitor or angiotensin-receptor blocker should switch to another medication is unclear. Experts suggest that urgent investigation is needed to clarify this and other related questions. As more findings emerge and the pandemic continues, subjects related to COVID-19 are likely to remain the top trending clinical topics.

SARS-Cov-2 chart

Medscape Medical News

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