COVID-19 Daily: Chilblains in Children,
Antibody Tests Removed

May 21, 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:

New Reports of Chilblains in Kids

Two new reports of chilblain-like lesions in children suspected of having COVID-19 in Spain and Italy have been published, joining other recently catalogued cases in the United States and elsewhere. Most were foot or toe lesions, but in some cases, there were lesions on the fingers too.

Many of the children initially tested negative for the virus, so until further studies are available, the Italian authors emphasize that clinicians should be "alert to the presentation of chilblain-like findings" in children with mild symptoms "as a possible sign of COVID-19 infection." The lesions typically don't require any treatment, say the doctors from hospitals in Milan and Madrid.

FDA to Remove Some Antibody Tests

The FDA has today removed a whole host of antibody tests from its "notification list" of those being offered under the Policy for Coronavirus Disease-2019 Tests During the Public Health Emergency.

Tests removed include those voluntarily withdrawn by their commercial manufacturer, and those for which there is not a pending Emergency Use Authorization (EUA) request or issued EUA. The FDA expects that the tests on the removal list will not be marketed or distributed.

"Our action today is an important step the agency has taken to ensure that Americans have access to trustworthy tests," says FDA Commissioner Stephen M. Hahn.

Palliative Care Training Needed on COVID-19 Front Line

Clinicians on the COVID-19 front line say they have little training in end-of-life care, and they report feeling alone with dying patients, given the absence of family members.  

Palliative care teams are needed more than ever to guide their colleagues through the unfamiliar business of "organizing" death during this pandemic, but often the teams can't get access or the necessary PPE to be physically present where they're needed.

COVID-19 has thus turned the spotlight on the need for universal education on palliative care for both doctors and nurses, stress experts in the field.

When Will a COVID-19 Vaccine Be Ready?

As one small, early-stage safety trial testing Moderna Inc's experimental COVID-19 vaccine in just eight people has not yet provided sufficient data to assess its effectiveness, according to a report in Stat News, hopes may now be shifting to another candidate, developed by AstraZeneca.

First doses of this coronavirus vaccine could be available as soon as September, some UK reports said today, as the venture was given a big boost when the US Department of Health and Human Services (HHS) agreed to provide up to $1.2 billion to accelerate development, in turn securing 300 million doses of vaccine for the US.

HHS Secretary Alex Azar was a little more measured in his response: "This contract with AstraZeneca is a major milestone…toward a safe, effective, widely available vaccine by 2021," he said.

Severe COVID-19 Link to Psychiatric Sequelae in Future

Severe COVID-19 may cause delirium in the acute stage of illness, followed by the possibility of depression, anxiety, fatigue, insomnia, and posttraumatic stress disorder (PTSD) over the longer term, new research suggests.

Previous coronavirus epidemics were associated with a significant psychiatric burden in both the acute and post-illness stages, say the authors of this study.

"Most people with COVID-19 will not develop any mental health problems, even among those with severe cases requiring hospitalization, but given the huge numbers of people getting sick, the global impact on mental health could be considerable," says Jonathan Rogers, MRCPsych, Department of Psychiatry, University College London, UK.

Pandemic Is Infecting Approach to Medicine

The 'superinfection' of COVID-19 "has led us to forget long-standing principles of evidence-based medicine, abandon logic and clear-headedness, and lower the bar for adopting unproven standards of care," says Vinay Prasad, MD, MPH, in a new commentary for Medscape.

Ongoing debates include whether to ventilate COVID-19 patients in the same way as those with acute respiratory distress syndrome (ARDS), and which anticoagulation regimen is best to adopt. And probably most contentious of all: which antiviral treatments to try.

"I have never [before] witnessed doctors giving five, six, or 10 drugs to treat [a]…virus without any proof that it will help," says Prasad.

COVID-19 Exacerbates Mental Health Burden in Latino Community

The disproportionate burden of COVID-19 in Latino patients is complicating mental health care in this community, say doctors in the field.

Psychiatrists are seeing prior psychological conditions in patients being exacerbated by fears about COVID-19, and new problems are arising from the current pandemic environment.

Issues include greater difficulty with accessing telehealth among many in this community, and a lack of COVID-19 information translated to Spanish. Many are also socially distanced from family units, which have traditionally provided good support. And for many Latino patients, these adverse impacts come on top of multiple prior traumas.

Lisa Nainggolan is managing editor of news for Medscape Diabetes & Endocrinology. She can be reached at

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