COVID-19 Update: New CDC Guidance, Antibody Concerns

Ryan Syrek

June 25, 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: 

CDC Updates COVID-19 Guidance

In a briefing today, the Centers for Disease Control and Prevention (CDC) clarified that obesity is associated with a greater risk as an underlying condition in patients with COVID-19, whereas hypertension poses a lower risk than initially believed. 

According to the CDC, the connection between obesity and more severe COVID-19 outcomes is most pronounced among individuals with a body mass index (BMI) over 40, although a BMI over 30 also increases risk.

In addition, the CDC expanded the list of underlying conditions associated with more severe COVID-19 outcomes. These include heart conditions, sickle cell disease, type 2 diabetes, and pregnancy. 

The agency also removed an age cutoff associated with elevated risk for more serious disease, which had been set at older than 65 years. CDC Director Robert Redfield, MD, also offered insight into how many Americans are likely to have been infected — with US cases possibly being 10 times higher than reported.

Dramatic Spike in Young Adults With COVID-19 

The CDC's removal of the age cutoff for severe disease today comes as many regions have recently seen a significant increase in the number of adults aged 20 to 39 years testing positive for COVID-19

Even states with stronger physical and social distancing guidance have seen a spike in young adult cases. For example, people younger than age 35 now comprise more than 44% of new cases in California. 

Across the country, the CDC reports those aged 18 to 29 years now have the second highest number of cases, trailing only those aged 50 to 64 years. Experts are debating the various causes behind this surge, which is likely to have significant bearing on how fast the disease spreads among all groups.

Severe COVID-19 More Likely in Pregnant Women

The CDC also clarified the risk for pregnant women after a report found that pregnant women were 5.4 times more likely to be hospitalized, 1.5 times more likely to be admitted to the ICU, and 1.7 times more likely to need mechanical ventilation. Hispanic and non-Hispanic Black pregnant women were found to be disproportionately impacted. 

In a response, the American College of Obstetricians and Gynecologists (ACOG) advises calm, noting that the risk for severity-associated interventions in the CDC report remains low and that pregnant women with COVID-19 do not appear to have a greater risk for mortality. Still, ACOG recommended certain precautions and guidance for future considerations.  

Lack of Antibodies After COVID-19 Recovery

New research suggests that protection from COVID-19 after recovery may not be long-lasting. A breakdown of the findings suggests that 33% of patients studied had antibody titer amounts that would imply no immunity to repeat infection. Patients hospitalized for COVID-19 were more likely to have neutralizing antibodies, suggesting they are more likely to be immune in the future. 

Although concerning, the findings did offer some hope, as most patients did still produce antibodies, which means a second infection would likely not be as bad as the first. The study has potential implications for vaccine development as well.

Cardiac Arrests Outside of the Hospital Surge in NYC

During the height of the pandemic in New York, cardiopulmonary arrests that occurred outside of the hospital dramatically increased. This year, from March 1 through April 25, the incidence rate was triple that of 2019. On the worst day, Monday April 6, the increase was nearly 10-fold compared with the same day the year prior. 

Whether or not these cardiac arrests were a direct result of COVID-19 or the result of individuals avoiding the hospital during that period remains unclear. The spike placed an extra burden on first responders, who are being celebrated for their heroic actions.  

Helping Patients Sleep During COVID-19

With many people having a hard time sleeping during the pandemic, a sleep physician offers recommendations for how to help patients. Beginning with an evaluation of daytime behaviors, Aaron B. Holley, MD, suggests that better sleep is achievable, even if it won't be easy. 

Holley addresses the potential role of sleep pharmacology while acknowledging that behavioral changes are ultimately the best treatment. When it comes to addressing these issues, he warns that "doing nothing may prolong sleep deprivation and the harms that come with it."

Gowns Now in Short Supply

Gowns are the latest personal protective equipment (PPE) to experience a shortage. Both disposable and reusable isolation gowns are now in limited supply. During the period June 8-14, requests for these items from GetUsPPE almost doubled from the previous week, with other organizations reporting similar increases in demand. 

As they did with masks and other PPE, clinicians are now looking to various alternatives and work-arounds to stay safe. 

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 1500 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.

Ryan Syrek, MA, is the section editor for Medical Student and Resident content at Medscape. 

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