COVID-19 Daily: Encephalitis Case Report, Silent Spreaders

Ellie Kincaid

April 03, 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: 

First Presumptive Case Report of Encephalitis Linked to COVID-19

In a case report published online in the journal Radiology, clinicians from the Henry Ford Health System in Detroit, Michigan, describe the first presumptive case of acute necrotizing hemorrhagic encephalopathy associated with COVID-19. 

"Since this is just one report of one patient, the findings are the most preliminary we can conceive, and more research is needed to determine the extent to which COVID-19 may affect the central nervous system," an expert who was not involved in the case commented.

Silent Spreaders

Early research indicates that up to 25% of people infected with SARS-CoV-2 may never have symptoms, and those who develop symptoms may not do so until 48 hours after being infected. Yet these people may still be "silent spreaders" of the virus. 

Earlier this week, an expert panel from the National Academy of Sciences told White House officials that the virus could possibly be spread when people talk or breathe. "The initial epidemiologic [research] suggests that asymptomatic spreading is happening," one expert told WebMD.

CDC Advises Face Masks for All

The Centers for Disease Control and Prevention now recommends that everyone wear a nonmedical face mask to help lower the risk from and the spread of COVID-19, President Donald Trump announced during the White House Coronavirus Task Force briefing today.

Underscoring that it is a recommendation though, and not a requirement, the president said he himself is “choosing not to do it,” according to the New York Times.

Hydroxychloroquine Can Be Toxic to Retinas

Although hydroxychloroquine is one of the safest drugs used for chronic rheumatic and autoimmune disorders, it is difficult to quantify the risk for adverse effects if it is used for treating COVID-19. The jury is still out on its effectiveness for this new indication, but there is an existing body of knowledge around its potential toxic effects, especially to the retina, that every clinician should keep in mind, two experts write in Medscape.

Mental Illness Pandemic

"We are in the midst of an epidemic and possibly pandemic of anxiety and distress," Robert T. London, MD, writes in Medscape. "As I see this period in time, my first thoughts are that we are witnessing a national epidemic of trauma. Specifically, what we have here is a clinical picture of PTSD."

PPE Hoarded, Seized, Redistributed

The US government's departments of Justice and Health and Human Services have seized 192,000 N95 respirator masks, 130,000 surgical masks, and 598,000 medical grade gloves, plus surgical gowns, disinfectant towels, and bottles of hand sanitizer and spray disinfectant from a Brooklyn man who was allegedly hoarding them. The officials said they will redistribute the items to the public health authorities for New Jersey, New York state, and New York City. 

Report from Detroit

Nephrologist Joel Topf, MD, saw his first COVID-19 patient on March 17. He shared some lessons from 2 weeks on the frontlines in Detroit. "This is a bad disease," he wrote. "These patients are sick and if we make progress, it is slow."

Intensivist Webinar

The European Society of Intensive Care Medicine (ESICM) hosted an 8-hour webinar on YouTube last week for intensivists to share stories and information about caring for patients with COVID-19. It's summarized here

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Many 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

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

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