COVID-19 Daily: Speech vs Feces, ACE Inhibitors Protective

Laura A. Stokowski, RN, MS

May 20, 2020

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 research confirms that masking is still one of the most important methods of preventing the spread of the SARS-CoV-2 virus that causes COVID-19. A study published online May 13 in PNAS found that normal human speech emits droplets that can linger in the air up to 14 minutes, which is plenty long enough for them to be inhaled by someone standing nearby. This study suggests that these floating particles could be the primary method of person-to-person transmission of the virus.

The researchers used an intense sheet of laser to measure the size of the droplets emitted during speech that were small enough to remain airborne. They estimated that 1 minute of loud speaking generated at least 1000 droplets capable of carrying the virions that can result in infection. Face masks should go a long way toward blocking these droplets.

Another study, published in Science Immunology, addressed concerns that have been raised about the possibility of fecal–oral transmission of SARS-CoV-2, especially after diarrhea was recognized as a COVID-19 symptom.

This study had some reassuring findings. Researchers found that although SARS-CoV-2 does replicate within the human intestine, the virus is inactivated in the lumen of the colon. The fecal–oral route, therefore, is not likely to be a major route of transmission.

Do ACE Inhibitors Protect Seniors?

Early in the COVID-19 pandemic, healthcare professionals and patients alike were asking whether antihypertensive drugs should be discontinued, based on the theory that a higher number of ACE2 receptors could provide binding sites for the SARS-CoV-2 virus, increasing the risk for infection.

Although we don't yet have all the answers, a new observational study suggests that ACE inhibitors may actually protect against severe illness in COVID-19–positive older people with hypertension. The use of ACE inhibitors was associated with a 40% lower risk for hospitalization in Medicare Advantage enrollees. No benefit was found among younger patients or those taking angiotensin-receptor blockers. While it's not known why ACE inhibitors would protect against COVID-19 only in older patients, a large randomized "virtual" trial is planned to confirm these findings.

Post-Mortem Risk for COVID-19

Funeral directors and others who handle the bodies of those who have died of COVID-19 are taking a lot of precautions to prevent infecting themselves. But the true postmortem risk for infection remains a big question. Little research has been done on the safe handling of corpses following COVID-19 infection.

We still don't know, for example, how long after death the SARS-CoV-2 virus remains active and able to infect another human. The advice of existing guidelines is a blend of common sense and experience with other infectious diseases, and differs depending on who is making the recommendations.

UV Lights to Disinfect

Hospitals have been using ultraviolet light for years to disinfect surgical suites and reduce the spread of drug-resistant microbes. But there is now interest in using the technology in spaces like schools, office buildings, and restaurants to help reduce SARS-CoV-2 transmission once public spaces are open again, WebMD Health News reports

The National Academy of Sciences says although there is no concrete evidence for the effectiveness of ultraviolet light on SARS-CoV-2, it has worked on other similar viruses.

Extra Pandemic Pounds?

Misery loves company, or so they say. But for some during the pandemic lockdown, misery has apparently had to drown its sorrows in food, among clinicians and patients alike. It's a potentially serious problem, as rates of overweight and obesity are already high in the United States.

Take our survey and find out how your experience compares with that of your colleagues, both with your patients and personally.

COVID-19: East vs West

What factors underlie the dramatic differences in case and death rates between New York and California?

To date, there have been nearly 350,000 COVID-19 cases and more than 27,500 deaths in New York. In contrast with the opposite side of the country, California has experienced less than 75,000 cases and slightly more than 3000 deaths.

Although experts have theories about the underlying reasons (population density, use of public transportation), ProPublica reports it will likely take years to fully understand why these two states had dramatically different outcomes.

High Rate of Kidney Injury in COVID-19

Kidney injury is turning out to be a key feature of severe COVID-19 illness. Findings of a study just published in Kidney International show that 36.6% of patients hospitalized with COVID-19 in the United States developed acute kidney injury (AKI), often leading to the need for dialysis.

Of note, the rate of AKI was highest among patients with more severe illness —particularly those with respiratory failure requiring mechanical ventilation — almost all of whom, 90%, developed kidney injury. In this largest cohort to date of AKI in hospitalized COVID-19 patients, kidney injury was typically linked to a poor prognosis.

Why Must Physicians Work for Free?

Are hospital administrators in need of more physicians on the COVID-19 front lines taking advantage of the profession's altruism and sense of duty?

That question has arisen because many physicians who have left home to participate directly in the war against COVID-19 have noticed that nurses and other healthcare providers are being tempted to help out with huge offers of money and other compensation, yet some physicians are expected to volunteer or receive very little pay for their services.

Some agencies are offering lucrative contracts to nurses, lab technicians, respiratory therapists, nurse practitioners, and physician assistants, but not to physicians. This commentary poses the question: Is this fair?

Laura A. Stokowski, RN, MS, is the editor of Medscape Internal Medicine and Medscape Family Medicine.

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