1. “Immunity passports”: Over the weekend, The World Health Organization stated that there was no evidence of immunity against a second infection among those previously infected with COVID-19. They then backtracked on their messaging saying that while they did expect an infection to result in some degree of immunity, they were more responding to the idea that “immunity passports” could be given to people who have recovered from COVID-19 and have antibodies. The passport could theoretically allow someone to travel or return to work. In a statement, the WHO said, “People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission.” (Plus there is the ‘crappy’ test issue that we have covered in prior posts.)

2. “New” symptoms: The CDC has added chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell to its list of possible COVID-19 symptoms. These join fever, shortness of breath or difficulty breathing, and cough on the list. We have known about these both in clinical practice and in more widespread media reports for several weeks now so I am unclear how these are “new”. Perhaps they are new to the CDC.

3. Presymptomatic transmission in skilled nursing facility: Prior posts have explored the risk of presymptomatic and asymptomatic spread of COVID-19. A New England Journal of Medicine report specifically studied viral transmission in a skilled nursing facility and may have implications for other close living quarters (e.g. assisted living, retirement homes, college dorms, military barracks). Of 89 residents in this Washington State facility, 64% had tested positive for SARS-CoV-2 by March 26 — 23 days after the first positive result in a resident Of those who tested positive, 56% were essentially asymptomatic at testing, but most developed symptoms later. The case fatality rate was 26%. Editorialists write: “A new approach that expands Covid-19 testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now.”

4. Chloroquine/hydroxychloroquine warning: The FDA is warning the public that chloroquine and hydroxychloroquine should not be taken for COVID-19 outside a hospital or clinical trial setting, as the drugs confer potentially life-threatening cardiac risks. In a study from Brazil, roughly 11% of patients taking these medications had a QTC interval above 500 ms, “a known marker of high risk of malignant arrhythmia and sudden cardiac death.” Now, it must be qualified that this study evaluated a Hydroxychloroquine dose 4-times higher than what is administered in an ongoing University of Minnesota randomized prevention trial to comprehensively evaluate its efficacy. The Minnesota study has had 3 interim safety analysis without any identified concerns in over 1000 participants.

5. Kidney-transplant recipients: A New York hospital reported that among 36 adult kidney-transplant recipients who tested positive for COVID-19 only 58% had fever as an initial symptom. Transplant recipients also had faster clinical progression, and at 3 weeks, 28% had died.

6. Kids’ mental health: An estimated 23% of primary school children surveyed in China’s Hubei province while they were under home confinement reported feeling depressive symptoms, and 19% said they had symptoms of anxiety, according to a study in JAMA Pediatrics