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Additional Clinical Issues and Guidance


Coordinated COVID-19 Response Helped Western Washington State “Flatten the Curve”

Posted June 23, 2020

Despite having the first confirmed case of coronavirus and being the first COVID-19 hot spot in the U.S., the state of Washington implemented a response plan that kept its death rate the lowest among all states that have had major outbreaks. A multidisciplinary consensus panel of 26 experts analyzed western Washington’s response and identified six key factors that contributed to “flattening the curve” in the state. They report on their findings in an article in press on the Journal of the American College of Surgeons website.

The six pillars of the COVID-19 response identified by the consensus panel are as follows:

  • Early communication and coordination among all stakeholders including public health, academia, hospital systems, emergency medical services, and long-term care facilities (LTCFs)
  • Regional coordination and situational awareness of the health care system response
  • Rapid development and access to viral testing
  • Proactive management of LTCFs and skilled nursing facilities
  • Proactive management of vulnerable populations
  • Effective physical distancing in the community

Stakeholders recognized the need for increased infrastructure to support a coordinated response, and the Western Washington Regional COVID Coordination Center (WRC) was established as a Regional Medical Operations Center (RMOC). This RMOC is a vital structure and contributed to the successful response.

As of June 5, Washington State had 22,729 confirmed cases of COVID-19 and 1,138 ensuing deaths, a rate of about 5 percent. The overall death rate in the U.S. is 5.7 percent, according to Centers for Disease Control and Prevention data. New York State, by comparison, has had more than 380,000 confirmed cases and 30,000 deaths, a death rate of 8 percent.

“Along with the governor’s stay-at-home and physical distancing orders, preexisting relationships across the health care system were critical in facilitating this response,” said corresponding author Eileen M. Bulger, MD, FACS, chief of trauma at Harborview Medical Center in Seattle and Chair of the American College of Surgeons (ACS) Committee on Trauma. The consensus panel noted that early communication and coordination among the various hospitals systems, emergency medical services, and LTCFs was pivotal in the response.


New Study Shows Link Between Blood Type and Severity of COVID-19

Posted June 23, 2020

A study in the New England Journal of Medicine identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. The study involved 1,980 patients at seven hospitals in the Italian and Spanish epicenters of the COVID-19 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1,255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, the authors analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case-control panels.

The authors detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genome-wide level (P < 5 × 10−8) in the meta-analysis of the two case-control panels (odds ratio, 1.77; 95 percent confidence interval [CI], 1.48 to 2.11; P = 1.15 × 10−10; and odds ratio, 1.32; 95 percent CI, 1.20 to 1.47; P = 4.9 5× 10−8, respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group–specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95 percent CI, 1.20 to 1.75; P = 1.48 × 10−4) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95 percent CI, 0.53 to 0.79; P = 1.06 × 10−5).


Public Officials Forced to Leave Their Posts Amid Waves of Protests

Posted June 23, 2020

According to an article published June 22 in The Washington Post, public health officials are leaving their jobs amid waves of protest at their homes and offices, as well as pressure from politicians who want to reopen their states or cities more quickly. Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, said more than 20 health officials have been fired, have resigned, or have retired in recent weeks because of conditions related to enforcement of lockdowns and other public health tactics during the COVID-19 pandemic. Attacks on health officials have been particularly harsh in California, Colorado, Georgia, Ohio, and Pennsylvania.

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