Infectious Disease

COVID-19 Roundup: Body Position, Cancer, and Transmission Through Tears

Comorbid Cancer

A research letter published in JAMA Oncology details a study of the medical records of 1524 patients with cancer admitted to the hospital during the COVID-19 outbreak in Wuhan, China.1

The researchers estimated the infection rate among patients with cancer, finding that it was higher in these patients than the cumulative incidence of all diagnosed cases reported in the city over the same time period (12 of 1524 patients [0.79%] vs 41,152 of 11,081,000 cases [0.37%]). Of the 12, 7 of the patients had non-small cell lung carcinoma and 5 were being treated with chemotherapy or radiotherapy.

“We propose that aggressive measures be undertaken to reduce frequency of hospital visits of patients with cancer during a viral epidemic going forward. For patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection,” they concluded.

Prone Positioning

A study of 12 patients in Wuhan, China, published in the American Journal of Respiratory and Critical Care Medicine, suggests that alternating ventilated patients’ body positions with periods of time spent in the prone position could help to improve lung recruitability.2 At the start of the study, 10 patients were poorly recruitable. Patients who did not spend time in the prone position maintained poor recruitability while those with alternating body positions saw increased recruitability (13 of 36 daily measurements showing high recruitability).

“Our findings do not imply that all patients with SARS-CoV-2 associated ARDS were poorly recruitable, and both the severity and management of these patients can remarkably differ among regions. Instead, we think these findings might incite clinicians to assess respiratory mechanics and lung recruitability in this population,” they wrote.

Spreading Through Tears

A study to be published in the journal Ophthalmology examined the spread of COVID-19 through bodily fluids other than mucus and respiratory droplets.3

In it, the researchers examined tear samples from 17 patients with COVID-19, collected from presentation to recovery (approximately 20 days later). Samples were also collected from the back of the throat and nose during this time.

Neither viral culture nor reverse transcription polymerase chain reaction detected the virus in tears during the course of illness, while samples from the nose and throat were elevated for approximately 2 weeks following onset of symptoms.  

—Michael Potts

References:

  1. Jing Y, Ouyang W, Chua MLK, et al. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China [published online March 25, 2020]. JAMA Oncol. doi:10.1001/jamaoncol.2020.0980.
  2. Pan C, Chen L, Lu C, et al. Lung recruitability in SARS-CoV-2 associated acute respiratory distress syndrome: a single-center, observational study [published online March 23, 2020]. Am J Respir Crit Care Med. https://www.atsjournals.org/doi/pdf/10.1164/rccm.202003-0527LE.
  3. Yu Jun IS, Anderson DE, Zheng Kang AE, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019(COVID-19) patients [published online March 24, 2020]. Ophthalmology. https://doi.org/10.1016/j.ophtha.2020.03.026.