COVID-19 resources: serological tests, face masks and benefits of physical activity

 | Post date: 2020/07/11 | 
Covid-19 resource hub
Dear Amirhossein,

Read our extensive coverage of the COVID-19 outbreak, which includes all research, education, news, opinion and treatment updates from across BMJ. All content is free to access and updated daily.
Find out what your peers are currently reading. Most popular content from BMJ Journals: 
  BMJ Global Health: Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China 
  Archives of Disease in Childhood: Children are not COVID-19 super spreaders: time to go back to school 
  BMJ Open: A cluster randomised trial of cloth masks compared with medical masks in healthcare workers
  Gut: Famotidine use and quantitative symptom tracking for COVID-19 in non-hospitalised patients: a case series
BMJ Learning
30 minute online course - The health benefits of physical activity: depression, anxiety, sleep, and dementia
In these challenging times we must remain aware of the longer term effects on mental wellbeing, particularly as a result of staying at home for a prolonged period of time. Featuring multimedia video, this course covers the importance and effectiveness of physical exercise as both a preventer and combatant to depression, anxiety, sleeplessness, and dementia, plus how to recommend it to patients. Sign in or register for a free account to start.
New to BMJ Learning? Test your skills with hundreds of accredited, peer-reviewed online courses in text, video, and audio formats. Learn more.
Diagnostic accuracy of serological tests for COVID-19: systematic review and meta-analysis
A recently-published research article in The BMJ shows that available evidence does not support the continued use of existing point-of-care serological tests for COVID-19.
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FDA approves generic albuterol inhaler to mitigate shortages during pandemic

 | Post date: 2020/07/8 | 
On April 8, FDA, recognizing the increased demand for albuterol products during the novel coronavirus pandemic, approved the first generic albuterol inhaler. The albuterol sulfate metered-dose inhaler, 90 mcg/inhalation (Cipla Ltd) is the first AB-rated generic therapeutic equivalent version of Merck’s Proventil HFA and the first generic metered-dose inhaler to be approved in almost 2 decades. The generic inhaler is used to treat or prevent bronchospasm in patients ages 4 years and older who have reversible obstructive airway disease and to prevent exercise-induced bronchospasm in this age group.

Addressing shortages

According to the American College of Allergy, Asthma, and Immunology (ACAAI), certain areas of the country are experiencing shortages of albuterol inhalers because of their increased use in hospitals for patients with COVID-19. These shortages could have implications for the more than 26 million people in the United States who have asthma, of which 7 million are children.
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“FDA recognizes the increased demand for albuterol products during the novel coronavirus pandemic,” said FDA Commissioner Stephen M. Hahn, MD. “We remain deeply committed to facilitating access to medical products to help address critical needs of the American public.”
According to allergist Michael Blaiss, MD, ACAAI executive medical director, the organization learned of possible shortages about a month ago. “With the introduction of this inhaler, we have a generic product to add to the supply,” Blaiss said in a statement to patients on ACAAI’s website. “While shortages may not be occurring in every part of the country, we want patients to know they may now have additional options if they are having an issue getting their medicine.”
ACAAI has developed recommendations for patients with asthma who are having difficulties accessing inhalers (see sidebar).

Dosage and administration

The recommended dosage for adults and children ages 4 years and older is two inhalations repeated every 4 to 6 hours. More frequent administration or a larger number of inhalations is not recommended. In some patients, one inhalation every 4 hours may be sufficient.
Each actuation delivers 108 mcg of albuterol sulfate (equivalent to 90 mcg of albuterol base) from the mouthpiece.
Patients should prime the inhaler before using for the first time and in cases where the inhaler has not been used for more than 2 weeks by releasing four test sprays into the air, away from the face.

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What do we know for sure about hydroxychloroquine for COVID-19? Not much

 | Post date: 2020/07/8 | 
For a while there, hydroxychloroquine (HCQ) became the new toilet paper: Everyone thought they needed it to stay safe during COVID-19, and resulting demand placed stress on supply.
HCQ had support from high places. President Trump called it “a game changer” at a White House press briefing on March 19. “What do you have to lose? Take it. I really think they should take it,” he said at another briefing on April 4. But in late April, FDA cautioned against its use for COVID-19 outside of a hospital setting. By June 15, FDA had put the kibosh on the whole thing—it revoked the drug’s emergency use authorization (EUA).
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How did we get here?


Researchers had been exploring the use of antimalarials like HCQ and chloroquine (CQ) against viral infections for decades, so the recommendation wasn’t totally implausible. CQ had shown promise against the 2002 outbreak of sudden acute respiratory syndrome (SARS), another coronavirus, by inhibiting viral replication.
In addition, some hypothesized that CQ or HCQ could inhibit immune response that could lead to lung and other organ damage in patients with COVID-19.
Trump’s initial endorsements came from two sources. A letter in BioScience Trends summarized the experience of a Chinese medical group, reporting that “results from more than 100 patients have demonstrated that chloroquine phosphate is superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus negative conversion, and shortening the disease course.” The letter, however, included no additional detail about study design, patient selection criteria, outcomes, or safety. Read the letter at
An International Journal of Antimicrobial Agents study out of France included more detail but still had significant limitations. Read that study at
The French study had a very small sample size—42 patients were enrolled, of whom 16 were controls. Still, it found that patients who were positive for COVID-19 and were treated with HCQ, sometimes in combination with azithromycin depending on a patient’s clinical presentation, had a significantly reduced viral load compared with controls.
HCQ hype was born. Though evidence supporting their effectiveness was scant, FDA approved HCQ and CQ for COVID-19 treatment by EUA on March 28. EUA was granted based on SARS-CoV-2’s potential to cause life-threatening disease; a reasonable belief that HCQ/CQ could effectively treat COVID-19 based on the limited in vitro and anecdotal clinical data in case series, and that the drugs’ known and potential benefits outweighed their known and potential risks; and the lack of an adequate, approved, and available alternative treatment.
Literature about HCQ and COVID-19 began to proliferate, but most consisted entirely of speculation (, hypothesis (, calls for further study (, or trial design proposals (

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Webinars for the Week of July 6th

 | Post date: 2020/07/8 | 
Webinars for the Week of July 6th
Ian Crozier, MD
Medical Affairs Scientist II, Clinical Monitoring Research Program
Leidos Biomedical Research, Inc.,
National Institute of Allergy and Infectious Diseases
Integrated Research Facility

Swati Shah, PhD
Staff Scientist, Hammoud Lab,
Center for infectious diseases imaging,
Clinical center, NIH
Molecular imaging in BSL-4 setting is very challenging. It can be extremely valuable, however, in elucidating the pathophysiology of the infectious process and improving our understanding of disease progression and long-term sequelae. Examples of molecular imaging applications in SARS-CoV-2 and Ebola virus infection will be discussed, demonstrating the potential of imaging for better characterization of disease pathophysiology in high consequence viral infections.
Sponsored by:
Olivia Claire Sehl, BS
Graduate Student
Robarts Research Institute 
Kimberly Brewer, PhD
Assistant Professor
Dalhousie University

July 10, 2020 | 11:00 AM ET
This talk will focus on three imaging modalities used for in vivo cell tracking: iron-based MRI, fluorine-19 MRI, and magnetic particle imaging (MPI). The advantages and limitations of each modality will be discussed. We will explore pre-clinical MRI and MPI imaging of therapeutic cells, including mesenchymal stem cells, T cells, and peripheral blood mononuclear cells (PBMC). We will also show how these imaging techniques are used to visualize and quantify transplant- and tumor-associated inflammation.
Sponsored by:
Join us online for
WMIC Virtual 2020
Starting October 7th
Late-Breaking Deadline August 5
© 2020 World Molecular Imaging Society. All Rights Reserved.

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COVID-19: Bacteriophage Could Decrease Mortality

 | Post date: 2020/06/29 | 

New Rochelle, NY, June 24, 2020—Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up. This could decrease the mortality of patients affected by COVID-19, according to the peer-reviewed journal PHAGE: Therapy, Applications, and Research. Click here to read the article.

“The bacterial growth rate could potentially be reduced by the aerosol application of natural bacteriophages. These prey on the main species of bacteria known to cause respiratory failure,” says Marcin Wojewodzic, PhD, University of Birmingham (U.K.).

Decreasing bacterial growth would also give the body more time to produce protective antibodies against the disease-causing coronavirus.

“Used correctly, phages have an advantage here of being able to very specifically target the bacteria that cause secondary infections,” said Martha Clokie, PhD, Editor-in-Chief of PHAGE and Professor of Microbiology, University of Leicester (U.K.). “They would remove the problematic bacterium but leave an otherwise fragile microbiome intact.”

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Animal Models of COVID-19

 | Post date: 2020/06/28 | 
Stanley Perlman, MD, PhD
Professor of Microbiology and Immunology
Professor of Pediatrics, Mark Stinski Chair in Virology
University of Iowa
Animal models for COVID-2 will be discussed, with special emphasis on murine models. Mice are naturally resistant to infection with SARS-CoV-2, but there are various approaches that render them sensitive, resulting in models for mild to severe pulmonary disease. The pros and cons of these experimental infections will be discussed.
Sponsored by:
Upcoming IOI Live Webinars
Alireza Radmanesh, MD
Assistant Professor, Department of Radiology
Director, Pediatric Neuroradiology
NYU Grossman School of Medicine
Sponsored by:
July 2, 2020
11 AM ET
Ian Crozier, MD
Medical Affairs Scientist II, Clinical Monitoring Research Program
Leidos Biomedical Research, Inc.,
National Institute of Allergy and Infectious Diseases
Integrated Research Facility

Swati Shah, PhD
Staff Scientist, Hammoud Lab,
Center for infectious diseases imaging,
Clinical center, NIH
Sponsored by:
July 7, 2020
11 AM ET
Join us online for
WMIC Virtual 2020
October 7-10
Late-Breaking Deadline July 15t

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Social isolation can lead to depression in children long after current lockdown

 | Post date: 2020/06/28 | 

Children and adolescents are likely to experience high rates of depression and anxiety long after current lockdown and social isolation ends and clinical services need to be prepared for a future spike in demand, according to the authors of a new rapid review into the long-term mental health effects of lockdown.

The research, which draws on over 60 pre-existing, peer-reviewed studies into topics spanning isolation, loneliness and mental health for young people aged 4 – 21, is published today (Monday 1 June 2020) in the Journal of the American Academy of Child and Adolescent Psychiatry.

According to the review, young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.

The studies highlight an association between loneliness and an increased risk of mental health problems for young people. There is also evidence that duration of loneliness may be more important than the intensity of loneliness in increasing the risk of future depression among young people.

This, say the authors, should act as a warning to policymakers of the expected rise in demand for mental health services from young people and young adults in the years to come – both here in the UK and around the world.

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Is COVID-19 Risk Linked to Blood Type?

One of the things that has really bothered me about COVID-19 is the dramatic variability in presentation, from being asymptomatic to having sniffles, complete respiratory failure requiring ECMO, and, of course, death. I've seen all of these firsthand at this point. And sure, we know that there are risk factors for bad outcomes, such as older age and comorbidities. But ask any of us who have cared for these patients and we'll tell you that there is clearly other stuff going on. I've seen a 35-year-old man with no comorbidities fighting for his life on ECMO.

It seems logical that genetics may play a role here, but those studies are just in the early phases. Nevertheless, some tantalizing clues are emerging—and some from really unlikely places.

Okay. A couple of months ago, my family did tests to figure out our blood type. We did this for no scientific or medical reason; we were bored, stuck at home, wanted some fun science-y stuff to do with the kids, and found some cheap kits on Amazon.

I am type O. My wife, type A.

And that was that. Until I started seeing that blood type may be associated with the risk for coronavirus infection and death from COVID-19.

This supposition immediately raised red flags for me. Correlating blood type with various outcomes has long straddled the border between regular science and pseudoscience—and often had a racially tinged flavor. I am pretty sure blood type does not correlate with various personality traits, for example. So why would blood type dictate susceptibility to a respiratory virus?

But, since I am often wrong and love to find out when I'm wrong, I looked into it. And I honestly think there may be something here.

Caveats: Data are really limited, and studies are sort of trickling out in preprint form and in various esoteric journals. But I'll point out a couple that hold water for me.

The first, a preprint out of China, looked at just over 2000 COVID-positive individuals and reported that there was a higher infection rate in people with type A blood.

What you see here is that there was a higher-than-expected rate of individuals with blood group A diagnosed with COVID-19 than in the general population.


Conversely, fewer-than-expected individuals with blood group O appeared in the pool of those infected. Similar results were seen when the analysis was restricted to the 206 individuals who died from COVID-19. Again, blood group A was overrepresented.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Is COVID-19 Risk Linked to Blood Type? - Medscape - Jun 16, 2020.

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