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BackgroundSince its emergence in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions, such as coughing, and care activities, such as aerosol-generating procedures, likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of the personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. The purpose of the current study was to develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known coronavirus disease 2019 (COVID-19).MethodsThe Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists, with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and gray literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.ResultsThe IDSA guideline panel agreed on 8 recommendations, including 2 updated recommendations and 1 new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included.ConclusionsUsing a combination of direct and indirect evidence, the panel was able to provide recommendations for 8 specific questions on the use of PPE by HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2, and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Background Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. Objective Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. Methods IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Results The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. Conclusions Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Background: Tropospheric winds from northeastern China have been linked to fluctuations in Kawasaki disease (KD) cases in Japan. These winds may carry aerosols that trigger KD in genetically susceptible children. We investigated whether reduced numbers of KD cases were linked to large scale circulation patterns affecting the U.S. West Coast. Methods: KD cases with either date of onset of fever or date of hospitalization (PHIS, Pediatric Health Information System) were obtained from 5 sites from Seattle to San Diego from 1995-2014. Six days were subtracted from date of hospitalization to approximate date of onset. For each site, periods from December-March were identified for which there were no KD cases for an interval of ≥10 days, called “KD dry spells”. Daily NCEP-NCAR atmospheric Reanalysis 700hPa height anomalies were used to represent the atmospheric circulation. Results: From 27-48 dry spells were defined for each site. Composites of atmospheric circulation from Day -20 to Day +10 relative to first day of a dry spell were created for each study site. The atmospheric circulation preceding the KD dry spell featured a higher than normal pressure center (results in weakened onshore flow) either offshore over the North Pacific or directly over the site. The circulation anomalies were statistically significant, and unlikely to have occurred by chance. The dry spell pattern intensified and persisted over several days. The strongest anomalous atmospheric circulation (and associated blocked wind flow) occurred between Day -6 to -1 relative to the start of the dry spell. A similar pattern was shared by 4 of the 5 sites. One site featured strong high pressure anomalies > 6 days before the KD dry spells, but only a weak anomaly in the Day -6 to-1 interval preceding the dry spell. Conclusion: This analysis reinforces results from previous studies of KD case fluctuations in Japan wherein anomalous KD activity was associated with particular wind flow patterns. The circulation patterns associated with the West Coast KD “dry spells” suggest that reduced wind flow from the North Pacific results in reduced KD occurrences. These results support the hypothesis that a KD agent is transported by winds, possibly from a shared source region with transport of the agent across the Pacific.

A Hispanic baby girl born at 42 weeks gestational age develops poor perfusion and respiratory distress at 28 hours after birth. She was born to a 17-year-old G1 P0 mother via cesarean section for failure to progress. The mother’s pregnancy was uncomplicated. Prenatal laboratory results were unremarkable; a vaginal culture for group B Streptococcus was negative. The mother had prolonged rupture of amniotic membranes for 19.5 hours. She developed a temperature of 100.3°F (38.0°C) during labor. No antibiotics were administered preoperatively. The amniotic fluid was stained with thick, “pea soup” meconium. The infant was vigorous at birth, with Apgar scores of 8 at 1 minute and 9 at 5 minutes, and a weight of 2.91 kg. Vital signs were initially stable. She fed and displayed normal newborn behavior during the first postnatal day. The next day, the baby appears dusky and experiences respiratory distress and periods of apnea. She also displays seizurelike activity. On physical examination, her temperature is 98.6°F (37°C), pulse is 165 beats/min, respiratory rate is 42 breaths/min, blood pressure is 56/32 mm Hg, and oxygen saturation is 38% on room air. The anterior fontanelle is open, soft, and flat. The heart has a regular rate and rhythm with no murmur. Lung examination reveals subcostal and suprasternal retractions with bilateral diffuse crackles. Extremities are cool, with a 3-second capillary refill. Laboratory analysis reveals a total peripheral white blood cell count of 8.7×103/mcL …

Sweet's syndrome (SS) is an acute, febrile neutrophilic dermatosis that frequently presents with leukocytosis and erythematous plaques. Lesions show neutrophilic infiltration of the dermis and rarely other organs. We report the case of an adolescent male with chronic pancytopenia secondary to Fanconi anemia (FA) who presented with acute respiratory distress. Despite an exhaustive and ultimately unrevealing work-up, the diagnosis of pulmonary SS was not made until he developed characteristic cutaneous lesions 4 months later. Comprehensive review of pathological specimens revealed metachronous SS manifestations with infiltrates in lung parenchyma, dermis, and subcutis in this neutropenic patient.