COVID-19 Update: Persistent Positive PCR, Dire Need for ID Docs

Ellie Kincaid

June 09, 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:

Persistent Positive PCR Tests for Recovered Patients

As the pandemic has moved past an initial peak of cases in some areas and testing becomes more available, physicians are encountering recovered patients who feel well but still test positive with SARS-CoV-2 polymerase chain reaction (PCR) tests. This can be problematic when employers require a negative test for recovered patients to return to work. 

"We are seeing [positive PCR results] 6 and 8 weeks after first presentation," says an expert and medical director of infection control "It's hard to say. Is it still transmittable?” Another expert is more blunt: "PCR test at 14 days, I don't see the value in it."

Most US Counties Have No ID Specialists

Nearly 80% of US counties have no infectious disease (ID) specialists, and 80% of counties in the top quartile of COVID-19 cases have no ID physicians or a below-average ratio of ID specialists to the population, according to an analysis published in the Annals of Internal Medicine. Nearly two thirds of Americans live in the 80% of counties that have a below-average ID specialist density or no access to ID physicians at all.

There are no data yet on the association between ID physician care and COVID-19 outcomes, the researchers note, but evidence about other infectious diseases supports an association between ID physician intervention and improved outcomes.

Almost 600 US Healthcare Workers Have Died From COVID-19

About 600 frontline healthcare workers in the United States have died from the coronavirus, according to a tally by Kaiser Health News and The Guardian.

The number includes doctors, nurses, paramedics, and healthcare staff such as hospital janitors, hospital administrators, and nursing home workers. Most of these workers identified as African Americans or Asians/Pacific Islanders.

Cancer Drug Shows Early Promise in Small Study

Acalabrutinib (Calquence, AstraZeneca), a Bruton tyrosine kinase (BTK) inhibitor, showed early signs it may improve outcomes quickly for patients with severe COVID-19, a case study of 19 patients has found. The authors and outside experts caution that the case series is very small, and the next phases of the trial will be critical in understanding the potential for the drug.

"We saw very rapid decline in the inflammatory markers shortly after giving the drug, and at the same time the patients started breathing easier," said one study author. Within 1 to 3 days after receiving acalabrutinib, most of the 11 patients who were receiving supplemental oxygen had a steep drop in inflammation and breathing improved. Eight of the 11 patients were able to come off supplemental oxygen and were discharged from 6 to 10 days after taking the drug. Results for the eight patients on ventilators were not quite as good.

 

Case Series Hints at Excess Stent Thrombosis

A group of interventional cardiologists from Spain have published details on a series of four cases of stent thrombosis (ST) in patients with COVID-19 seen at their hospital.

"In 2019, we performed 899 PCIs (percutaneous coronary interventions) with 11 being due to stent thrombosis — 3 were acute ST and 8 were very late ST. This incidence is much lower than what we have seen during the COVID-19 outbreak," said one of the case series authors. 

Health System Changes May Be Here to Stay

The COVID-19 pandemic has done what no president or social movement or venture capitalist could have dreamed of: It forced sudden major changes to the nation's healthcare system that are unlikely to be reversed, Kaiser Health News reports.

"Health care is never going back to the way it was before," said Gail Wilensky, a health economist who ran the Medicare and Medicaid programs for President George H.W. Bush in the early 1990s.

Wilensky is far from the only longtime observer of the American healthcare system to marvel at the speed of some long-sought changes. But experts warn that the breakthroughs may not all make the health system work better, or make it less expensive.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1000 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.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine. She can be reached at ekincaid@medscape.net or on Twitter @ellie_kincaid.

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