DHM COVID-19 Clinical Dispatch

Introduction

Welcome to our inaugural weekly COVID-19 Clinical Dispatch for the DHM! 

Each week we will bring provider-facing clinical updates on COVID-19, with summaries of the literature, a look into our local data, and rapid reviews of COVID cases seen on Hospital Medicine. 

In this rapidly changing environment the amount of information we see to tackle the clinical management of COVID patients is overwhelming. Over the next several weeks we will organize and summarize key resources into a digestible format and highlight amazing work done a UCSF and beyond in the are of COVID-19.

In the future you can look here to find relevant educational resources for our trainees as well as important guides for managing COVID on the front lines. We couldn't be more excited to work in this community and share collective knowledge with you. 

- The COVID Clinical Working Group

This Week's Theme: GI Manifestations of COVID!

SARS-CoV-2 was detected in gastric, duodenal and rectal epithelia demonstrating that the virus infects these gastrointestinal glandular epithelial cells. Credit: National Institute of Allergy and Infectious Diseases

Quick Lit - One-Page Literature Review

How common are GI symptoms on presentation in COVID?

Initial reports suggested a low incidence of these findings but as more data from around the world are released a different picture is emerging. Aline Zorian and UCSF MS3 Karly Hampshire review a new meta-analysis in the journal, Gastroenterology. Click on the image below for a better look, and at the bottom right for the article.

Within our Walls - The UCSF COVID data

When seeing a patient...don't forget GI!

We reviewed the charts of 31 patients admitted to the Moffitt Hospital Medicine service with a focus on symptoms at presentation. GI symptoms (particularly anorexia and diarrhea) were found to be common in our patients, in line with the pooled data from the meta-analysis above. 

From the Files of C&C

In case you missed last week's Cases and Conundrums, we had a fantastic presentation from two of our pulmonology and critical care fellows, Kate Malcom and Narges Alipanah-Lechner

The Case

46-year-old man with obesity, who presented with severe hypoxemic respiratory failure, requiring invasive mechanical ventilation, prolonged neuromuscular blockade (16 days!), and proning. He is now extubated and clinically improving in the ICU.

Clinical Highlights:

• SARS-CoV2 testing:
  • Positive on hospital days 0, 5, 16, 23
  • Negative on hospital day 34
  • Pending on hospital day 35

• Obesity in patients with COVID-19 – this patient’s BMI was greater than 35. Here is a recent paper in Clinical Infectious Diseases from New York University regarding the relationship between obesity and severity of disease.

• Vaping in patients with COVID-19 – this patient had a history of vaping. Here is a UCSF resource regarding smoking/vaping and COVID-19.

Links

Questions, thoughts, insights? Share them here! Clinical Knowledge Portal