What proportion of cases of COVID-19 in the US are among health care workers?
We do not yet know the answer for the US. We do have some data from other countries.. Among 72, 314 cases in mainland China (through 2/11/20), 3.8% were in health care personnel [Guan et al]. 75% of these cases were diagnosed in Hubei Province. In a separate study of a selected group of 1099 patients from mainland China with laboratory-confirmed COVID-19 the percentage of healthcare workers among the cases was 3.5% [ICN]. In Italy, which continues to experience widespread community transmission, 9% of COVID-19 cases are in healthcare workers. Currently the California Department of Health is reporting 42/3006 (1.3%) in their latest stats that include HCW. It is likely that depending on local outbreaks this number will vary. We can say HCW transmission is lower than seed with SARS. In the SARS outbreak in Canada in 2002-2003, 43% of the cases were in healthcare workers.
Can SARS-CoV-2 cause cardiac injury?
Perhaps. This is an evolving story. We know patients with underlying cardiovascular disease are at higher risk for severe COVID-19. However, COVID-19 itself may be associated with cardiac injury. Studies of patients hospitalized with COVID-19 in China reported cardiac injury in 17-20% of cases. One study found that patients with cardiac injury were older, had more comorbidities, and a higher risk of death when compared to those without cardiac injury. Another study reported that 7% of 68 COVID-19 related deaths were due to myocardial damage/heart failure. Whether COVID-19 associated cardiac injury is due to direct viral injury or other mechanisms requires further research. Awareness of this potential complication, particularly when considering medications with potential cardiac toxicities is to be noted while researchers study potential mechanisms.
Should patients without symptoms undergoing transplantation or intensified immunosuppression be tested for COVID-19 in settings with widespread community circulation?
Yes, if the logistics allow for it. Physicians may decide to alter management for a patients with a positive PCR for COVID-19 undergoing these procedures. We have described in prior digests that patients can have high viral loads detected on PCR prior to symptoms. It is important to note that the current tests are is only 70% -80% sensitive—so using current assays, one is reducing but not eliminating the possibility the patient has COVID-19 underlying disease. In other words, a positive test confirms disease, but a negative test does not completely rule it out.
Are loss of smell and loss of taste symptoms of COVID-19 infection?
Yes, this is likely true. Physicians in several countries have reported anosmia/hyposmia (loss of/decreased smell) and ageusia/dysgeusia (loss of/dysfunction of taste) as symptoms associated with COVID-19 infection. A cross-sectional survey of 59 hospitalized COVID-19 patients in Italy demonstrated that 34% had at least 1 taste or olfactory disorder symptom; 19% had both. Onset of symptoms occurred prior to hospitalization in 20% (including 91% of taste disorders); the remaining 14% occurred during the hospital stay. Symptoms were more common in women (53%) vs. men (25%) and in younger individuals (affected median age 56 vs. non-affected median age 66). Anecdotal reports have described anosmia in 30% of a COVID-19 cohort in South Korea and in >66% of 100 non-hospitalized COVID-19 patients in Germany. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) proposed that anosmia and dysgeusia is included in clinical screening algorithms for when alternative explanations are absent (i.e. allergic rhinitis, rhinosinusitis).