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COVID-19 Update: Plasma Concerns, Testing Guidance Changes COVID-19 Update: Plasma Concerns, Testing Guidance Changes

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: 

Plasma Concerns

After last week’s emergency use authorization (EUA) by the US Food and Drug Administration (FDA) for convalescent plasma for COVID-19, experts are now worried there won’t be enough volunteers to conduct the randomized controlled trials needed to assess the treatment’s efficacy.

Patients may not want to enroll in a clinical trial and risk being given a placebo when they could get plasma directly through the new EUA clearance, physicians noted during a briefing organized by the Infectious Diseases Society of America.

Volunteers joining studies are “the only way that we’re going to get to know whether this stuff works for prevention and treatment,” Shmuel Shoham, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland, said during the IDSA call with reporters.

CDC Changes Testing, Travel Guidance

The US Centers for Disease Control and Prevention (CDC) has changed its recommendations regarding testing for COVID-19 in asymptomatic individuals. The agency states that testing is now optional for this group of people, regardless of whether they have been exposed to the virus.

Experts are concerned that such reductions in testing will impede efforts to decrease the number of infected individuals — especially because the virus appears to be highly contagious during the asymptomatic stage.

In more controversy, various officials have said that the agency was pressured “from the top down” to change their testing guidance.

The CDC also dropped its recommended 14-day quarantine for individuals who have traveled to coronavirus hot spots. Instead, the updated recommendations note that “state, territorial, tribal, and local” mandates should be followed after travel.

However, the CDC added that any traveler should still wear a mask, wash hands frequently, and social distance upon return; and those who participate in “higher-risk activities” should stay home as much as possible and consider COVID-19 testing.

Data Reporting Penalties for Hospitals

A new rule released by the Centers for Medicare & Medicaid Services is drawing the ire of two major US hospital associations. The change in COVID-19 reporting requirements, which is the sixth since February and goes into effect immediately, states that COVID-19 data must be sent directly to the US Department of Health and Human Services and not the CDC.

Hospitals that don’t follow the new regulations could have their participation in Medicare and Medicaid terminated. Members of both the American Hospital Association (AHA) and the Federation of American Hospitals voiced strong objections to the newest change.

“This disturbing move, announced in final form without consultation or the opportunity to provide feedback…could jeopardize access to care and leave patients and communities without vital health services from their local hospital during a pandemic,” AHA President and CEO Rick Pollack said in a statement.

Preexisting Immunity

There appears to be a large percentage of the adult population who cannot get infected by COVID-19 after exposure.

“There are now several studies that, taken together, give us a useful indication of the possible role of preexisting immunity (antibodies/T cells, etc.) in SARS-CoV-2 dynamics,” Adam Kucharski, PhD, MMath, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom, writes in a Medscape commentary.

He adds that a reason why children seem to be at reduced risk for infection may be because some younger kids have cross-reactive antibodies. 

Kids More Contagious Than Adults?

That said, are some asymptomatic children with COVID-19 more contagious than sick adults? asks F. Perry Wilson, MD, Yale School of Medicine.

He notes that several news organizations have run headlines implying the answer is yes. However, Wilson said these headlines contain an error. Although the research had some “worthy take-home points,” it didn’t report whether the children were shedding live virus because the investigators didn’t conduct viral assays.

“Higher viral load does not necessarily mean more contagious,” Wilson said.

Surprising Postmortem Findings

In a case study from the United Kingdom, thrombotic features were found in all nine full autopsies of patients who died from COVID-19, with some showing these features in the lung, heart, or kidneys. In addition, diffuse alveolar damage was found in 100% of the patients.

Among the “major unexpected findings” was the presence of acute pancreatitis, adrenal micro-infarction, and/or pericarditis in some of the patients — all of which will need additional research, the investigators note.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and put themselves at risk of 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.

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