COVID-19 Daily: Airborne Transmission, Vaccine Timing Doubt

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:

COVID-19 Is Likely Airborne

Evidence is mounting that the virus that causes COVID-19 is transmitted via aerosol transmission, a researcher at the University of California San Diego reports in Science. The findings underline the importance of wearing masks.

At the same time, however, the Centers for Disease Control and Prevention and the World Health Organization have not released strong statements addressing how people could catch COVID-19 by breathing it in, Kimberly Prather, PhD, said. "It’s just shocking to me, quite honestly, that this has not been factored in."

Scientific Doubt Tempers Vaccine Optimism

There is little room for error or for safety surprises in the timeline offered by the US government and industry for a COVID-19 vaccine by this coming December or January, according to experts. The optimistic prediction works if "all the cards fall into the right place," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases said, but he added that a more realistic timeline is 12 to 18 months. Experts consulted by Medscape Medical News agree.

The government recently granted $1.2 billion in funding to AstraZeneca to accelerate vaccine development. That action, coupled with positive results from a phase 1 vaccine trial, have buoyed the hopes among some for an accelerated timeline. But some experts say that even with such funding, there is no guarantee that the usual time needed to ensure safety and efficacy can be shortened.

Persistent Effects on the Right Ventricle

It may be worthwhile to image the right ventricle of patients presenting with COVID-19, two reports in JACC: Cardiovascular Imaging suggest. Researchers in one study found almost 1 in 3 people with COVID-19 imaged using bedside echocardiography had right ventricular dilation. Importantly, imaging features differed from those typically seen with pulmonary embolism.

The second research team evaluated postdischarge MRI findings among people who recovered from COVID-19 but later experienced cardiac symptoms. "The presence of myocardial tissue abnormalities in otherwise healthy subjects suggests cardiac involvement as a lasting consequence of SARS-CoV-2 infection," the authors write.

Complete "Fibrinolysis Shutdown"

Add "fibrinolysis shutdown" to hypercoagulability as a possible blood-related complication of COVID-19, clinicians in Colorado report in the Journal of the American College of Surgeons. Venous thromboembolism, stroke, and renal failure are potential outcomes associated with the shutdown.

There may be a way to identify high risk patients, they suggest. Complete lack of clot lysis at 30 minutes, for example, could flag individuals who will potentially require more aggressive anticoagulation.

Malpractice Insurance Risks

Despite some federal and state measures to limit the liability of many doctors and nurses working the COVID-19 front line, many could face an increased malpractice risk, Medscape reports. Doctors may be practicing outside their specialty and across state lines during the pandemic, for example, which can present issues.

Nurses may be particularly vulnerable. "The biggest problem with nurses is too many don't have professional liability insurance because they've been told by their employers that they don't need it, which is a mistake," said Edie Brous, RN, MPH, an attorney who defends nurses in malpractice cases.

Furthermore, calls for nationwide immunity from liability during the pandemic may not be a perfect solution.

COVID-19 Immunity Passport?

A positive antibody test, in many cases, makes it about 50/50 that a person actually has any antibodies against the coronavirus, F. Perry Wilson, MD, MSCE, at the Yale School of Medicine, explains in a video report on Medscape.

"It's the difference between the false-positive rate of a test and the positive predictive value of a test," Wilson said. "These are different things." He walks viewers through an example of a location with a population of 100,000 to highlight the importance of this distinction.

Ischemic Stroke Guidelines Updated

An international panel of stroke experts from 18 countries issued recommendations for evaluating and managing acute ischemic stroke patients with either suspected or confirmed infection with SARS-CoV-2.

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 of infection. More than 1000 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.

Damian McNamara is a journalist at Medscape Medical News and MDEdge, focusing on GI, surgery, dermatology, rheumatology, primary care, obstetrics & gynecology, pediatrics and more.

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