2020-06-19/20/21 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Dr. Scrase on-line briefing. NM cases. Campgrounds closed through July 4th. Otero prison reports. Navajo nation’s first police dies. Santa Fe cancels 4th July fireworks. Face coverings donated. NM infection rate drops. US Highlights: AZ Governor issues Exec Order. Economics, Workforce, Supply Chain, PPE: Epidemiology Highlights: Reopening hospitals metric. Comparison of mask effectiveness. Private practices suffer. Healthcare Policy Recommendations: Maternal mortality. Practice Guidelines: Recommendations on hepatobiliary surgery and neonate management. Drugs, Vaccines, Therapies, Clinical Trials: Animal studies generate new vaccine candidates and vaccine platform. 16 new clinical trials registered. Other Science: Respiratory secretions detected by trained dogs. MRI findings show brain lesions in non-survivors. Healthy blood vessels may protect children. Meta-analysis on pneumonia severity. Smoking and COVID-19 severity meta-analysis

2020-06-15/16 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: NM case updates. Tribal outreach campaign. Santa Fe firefighters support first responders. US Highlights: COVID-19 hospitalizations rise in Texas. US retail sales up in May. Projected COVID-19 deaths in US. International Highlights: COVID-19 prevention and control in Africa. COVID-19 response and challenge in Africa. Epidemiology Highlights: Herd immunity in Europe. Social distance measures effects. Modeling infections in India. Fecal analysis. Wastewater-based Epidemiology Consortium. Healthcare Policy Recommendations: Public health approach to lockdown debate. All of Us Program adds new COVID-19 initiatives. Practice Guidelines: Guidelines are reviewed on urology care. IBD endoscopy. Convalescent plasma use. Testing: Patient predictors of risk for positive COVID-19 test are reported and an online risk calculator is now available. Drugs, Vaccines, Therapies, Clinical Trials: Steroid dexamethasone reduces 28-day mortality by 1/3. Research links ‘inflamm-aging’ and cytokine storm in elderly. Cancer drug may reduce severe COVID-19. 48 new trials registered. Other Science: Postpone surgery. Proteins predict outcomes. Neurologic manifestations. Thromboembolic risk. Zoonotic transmission. Liver failure. Cardiac complications

2020-06-03/04 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Navajo Nation to end weekend curfew. NM case count. Navajo Nation case updates. Food distribution by PepsiCo. APS to get funding. US Highlights: 5 vaccine candidates. Arizona’s increased cases. Some states postpone primaries. Pork plant infections. Economics, Workforce, Supply Chain, PPE: Impact on global supply chains. Residency selection process disrupted. Facemask filtration efficiency. Resources for underserved countries. Epidemiology Highlights: Morbidity and mortality in Africa. Healthcare Policy Recommendations: Need for social distancing. Psychological support guide. Return to work guidelines. Practice Guidelines: Anesthesia recommendations for ECT. Extracorporeal membrane oxygenation outcomes. Testing: Roche Elecsys IL-6 test is authorized by FDA to identify severe inflammatory response. Drugs, Vaccines, Therapies, Clinical Trials: HCQ RCT does not show disease prevention. Lancet HCQ study retraction. Adjunctive convalescent plasma did not show clinical improvement. Mixed remdesivir results. Virtual drug screening. Heparin improved survival. Moderna phase 3. Skin science for vaccine development. ECMO therapy. 48 new clinical trials. Other Science: Androgens and poor male outcomes. Trust in science enhances prevention compliance. High VTE prevalence in critically ill

2020-06-29/30 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: NM cases update. ABQ nursing home hit hard. UNM student family housing closure. White Sands National Park reopening. 52% of federal COVID-19 relief money for tribal communities. Bill signed to help NM taxpayers. US Highlights: Polarization of political elite response on Twitter. International Highlights: China’s military to use Ad5-nCoV vaccine in trials. Economics, Workforce, Supply Chain, PPE: Decontaminate N95 respirators using a microwave. Epidemiology Highlights: Mask-wearing prevents transmission. Face-masks associated with Italy’s declining epidemic. Healthcare Policy Recommendations: Social distancing reassessed? Lessons learned from previous pandemics. Digital tools against COVID-19. Investigating cultural and psychological factors to reduce spread. Practice Guidelines: Preserving couple relationships during COVID-19. Testing: No difference in viral load between symptomatic and asymptomatic individuals. A new fast point-of-care virus detection test. Few patient serum samples have virus RNA (at low viral load) and these are not associated with infectious disease. Symptoms and temperature reports are informative to screen health care workers. Drugs, Vaccines, Therapies, Clinical Trials: 37 new trials registered June 29-30. Other Science: Multisystem pediatric inflammatory syndrome. Hazardous postoperative outcomes. Childhood immunization in Africa. Citizen science and protein folding

Paxlovid (Nirmatrelvir and Ritonavir) Use in Pregnant and Lactating Woman: Current Evidence and Practice Guidelines—A Scoping Review

COVID-19 virus, since the detection of the first case in Wuhan in 2019, has caused a worldwide pandemic with significant human, economic and social costs. Fortunately, several vaccines and treatments, both IV and oral, are currently approved against the COVID-19 virus. Paxlovid is an oral treatment option for patients with mild-to-moderate disease, and it effectively reduces disease severity in high-risk patients. Paxlovid is an oral antiviral that consists of a combination of nirmatrelvir and ritonavi. As an oral medication suitable for outpatient treatment, it reduces the cost, hospitalization and mortality associated with COVID-19 infection. The pregnant population is a high-risk category for COVID-19 disease. Given their exclusion in clinical trials, there is limited data regarding Paxlovid use in pregnant and lactating women. Indirect evidence from ritonavir use as part of HAART therapy in the pregnant and lactating population with HIV has shown no significant teratogenicity. Moreover, animal studies on the use of nirmatrelvir do not suggest teratogenicity. This article summarizes the available data on ritonavir and nirmatrelvir use during pregnancy and in ongoing clinical trials. We also review the recommendations of major societies worldwide regarding Paxlovid use in pregnant and breastfeeding patients

2020-06-17/18 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: NM case count. UNM housing plan for fall 2020. Navajo Nation health and social inequities. US Highlights: Banning airline passengers. Economics, Workforce, Supply Chain, PPE: COVID-19 Exit Strategy. Effect of extended use respirators and PPE. Epidemiology Highlights: Model predicts effects of strategies on US epidemic. Index for assessing risk of contagion. Practice Guidelines: Institutional antithrombotic protocols in US and France are reviewed. Shortcomings of restricted hospital visitation are discussed. Testing: Current testing strategies and assays. Reducing transmission in incarcerated populations. Drugs, Vaccines, Therapies, Clinical Trials: More detail on dexamethasone trial. Methylprednisolone improved outcomes. Outcomes on ACEI/ARB. 34 new trials. Other Science: Nearly 20% of world’s population is at risk for severe disease. High-flow nasal cannula for acute respiratory failure. Genome-wide association study of patients with severe disease. Frail geriatric COVID-19 patients have a higher risk of delirium. Asymptomatic infection is associated with a longer virus shedding and a weaker immune response

2020-06-10/11 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM Highlights: Governer’s update on COVID-19 efforts. NM case count. Testing for food industry workers. Testing for lawmakers and staffers. Face coverings mandatory in Santa Fe. Lawmakers prepare to $2.4B budget hole. Learning loss due to lockdown. US Highlights: EPA orders unsafe products removed. Cases on the rise after roll back. Economics, Workforce, Supply Chain, PPE: Governments need more money. Study on masks. Hearing impaired masks. Fast spread in Africa. Kenya’s economic slowdown. Epidemiology Highlights: White House Task Force warns of spikes. Mortality risk factors. Higher mortality in cancer patients. UV-C disinfection of mobile phones. Practice Guidelines: Benefits of non-invasive ventilation and prone positioning demonstrated in 15 patient case-series. Canadian Thoracic Society\u27s statement on management of sleep disordered breathing. Experience of providing ketogenic diet in two US epilepsy centers. A review on personalized cardiometabolic approach to reduce COVID-19 complications and costs. Asian guidelines on inflammatory bowel diseases management. Testing: False negative rate in COVID-19 testing. Patients testing negative with subsequent positive test results. IgG and IgM antibody response. SARS-CoV-2 receptor binding domain potential antigen for use in antibody testing. Drugs, Vaccines, Therapies, Clinical Trials: Drug repositioning. Hydroxychloroquine toxicity. Multifaceted immunosuppression described. HCQ not effective for prophylaxis. 63 new trials. Other Science: Containment vs mitigation strategy affects mortality. Prehospital pulse oximetry in detection of silent hypoxemia. Normal D-dimer associated with inpatient survival. Family support and risk of depression, anxiety, PTSD. Limited airborne transmission. Stay-at-home orders and weight