COVID-19 Daily: Infectious Stool, Thyroiditis Risk

Caroline Cassels

May 27, 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: 

Infectious Stool?

The COVID-19 virus isolated from the stool of a sick patient can infect cells in a petri dish, a new study shows.

The research is a step toward proving a new route of transmission for the infection. If confirmed by future studies, it would mean that people could get sick by ingesting tiny amounts of stool from others who are infected — called the fecal-oral route of transmission. Other diarrhea diseases that pass from person to person this way include cholera and hepatitis.

It also raises the question of whether infectious virus can be blown into the air — or aerosolized — by a flushing toilet.

"The world is covered in a thin veneer of stool," David Brett-Major, MD, an infectious disease specialist at the University of Nebraska Medical Center, told WebMD Health News . Brett-Major was referring to studies that have found bacteria from stool on nearly everything we touch daily — from computer keyboards to clothing.

"Stool tends to get everywhere, so regular hand-washing is important," he said.

COVID-19 Linked to Subacute Thyroiditis

COVID-19 has been linked to subacute thyroiditis, a condition suspected to have viral or postviral origins, although its exact etiology is unknown.

Investigators in Italy report a case study of an 18-year-old woman who tested positive for COVID-19 and developed mild symptoms. She subsequently tested negative for the virus, but approximately 3 weeks later presented with fever, fatigue, palpitations, and neck pain that radiated to her jaw.

Testing and physical examination pointed to subacute thyroiditis. The patient was ultimately diagnosed and treated with prednisone. Her neck pain and fever disappeared within 2 days, and the remaining symptoms went away within a week. 

The investigators report that this is the first case of subacute thyroiditis related to COVID-19 and note that physicians need to be alerted to this potential clinical manifestation of the virus.

Stroke More Severe, More Deadly

Ischemic stroke occurring in the presence of COVID-19 appears to be more severe, and more likely to be embolic and deadly, new research shows.

Investigators from the New York University Grossman School of Medicine found that stroke in those infected with COVID-19 was associated with a higher death rate and occurred in younger patients compared with stroke in those without the virus.

"In patients with COVID-19 and ischemic stroke, a majority of strokes were classified as cryptogenic, possibly related to an acquired hypercoagulability, and were associated with increased mortality," the researchers write.

The study was published online May 20 in the journal Stroke.

The investigators report that cryptogenic stroke was more common in patients with COVID-19 (65.6%) vs contemporary controls (30.4%) and historical controls (25.0%).

COVID-19 stroke patients were also younger, with an average age of 63 years vs 70 years for non-COVID-19 stroke patients. The mortality rate in stroke patients with COVID-19 was much higher — 63.6% vs 9.3%.

Staying Financially Afloat During COVID-19

While there's uncertainty around how long the pandemic will last, experts agree that at some point America will return to a "new normal" and business operations will begin to reopen.

In the meantime, for physicians experiencing a reduction in income, Medscape has six valuable tips to help you stay afloat in the near term.

The Long Road Back

As survivors of COVID-19 begin to recover, physicians predict there will be a significant need for rehabilitation in the majority of ICU survivors — including lung rehab.

"The vast majority of COVID patients in the ICU have lung disease that is quite severe, much more severe than I have seen in my 20 years of doing this," said critical care specialist Anna Nolan, MD, an associate professor of medicine at New York University School of Medicine.

Experts discuss with Medscape Medical News the potential for long-term lung and organ damage after severe COVID-19, and emphasize the need for rehabilitation to treat weakness and psychological concerns from prolonged ICU stays.

"Worrisome" Story for Diabetes and COVID-19

Medscape Medical News reports that the American Diabetes Association has dedicated a whole section of its journal, Diabetes Care, to the topic of "diabetes and COVID-19," publishing a range of articles with new data to help guide physicians in caring for patients.

Even so, they say, some points are clear. "The consistency of findings in these rapidly published reports is reassuring in terms of scientific validity, but the story unfolding is worrisome," the journal's editor-in-chief Matthew Riddle Jr, MD, Oregon Health & Science University, Portland, and colleagues note.

While diabetes does not appear to increase the likelihood of COVID-19 infection, progression to severe illness is more likely in these patients, who have a two- to three-fold increased risk of requiring intensive care and death compared with their counterparts without diabetes.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and put themselves at risk for infection. More than 500 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

Caroline Cassels is an editor for Medscape. She has more than two decades of experience editing and reporting on health and medicine for consumer and physician audiences.

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