Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations.

There is a growing evidence of cardiovascular complications in coronavirus disease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediated inflammatory effects on the myocardium, substantial attention has been directed towards cardiovascular imaging modalities that facilitate this diagnosis. Cardiac magnetic resonance imaging (CMRI) is the gold standard for the detection of structural and functional myocardial alterations and its role in identifying patients with COVID-19 mediated cardiac injury is growing. Despite its utility in the diagnosis of myocardial injury in this population, CMRI's impact on patient management is still evolving. This review provides a framework for the use of CMRI in diagnosis and management of COVID-19 patients from the perspective of a cardiologist. We review the role of CMRI in the management of both the acutely and remotely COVID-19 infected patient. We discuss patient selection for this imaging modality; T1, T2, and late gadolinium enhancement imaging techniques; and previously described CMRI findings in other cardiomyopathies with potential implications in COVID-19 recovered patients.

A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March-September 2020.

OBJECTIVES: The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. METHODS: We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. RESULTS: COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant (P < .001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence (P < .001) but not CFRs. CONCLUSIONS: From March through August 2020, COVID-19 incidence rose in Georgia's counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19-related patient outcomes in these environments.

Early detection of change patterns in COVID-19 incidence and the implementation of public health policies: A multi-national study.

OBJECTIVES: The COVID-19 pandemic caused by the novel SARS-CoV-2 coronavirus has drastically altered the global realities. Harnessing national scale data from the COVID-19 pandemic may better inform policy makers in decision making surrounding the reopening of society. We examined country-level, daily-confirmed, COVID-19 case data from the World Health Organization (WHO) to better understand the comparative dynamics associated with the ongoing global pandemic at a national scale. STUDY DESIGN: Observational study. METHODS: We included data from 20 countries in Europe, the Americas, Africa, Eastern Mediterranean and West Pacific regions, and obtained the aggregated daily new case data for the European Union including 27 countries. We utilized an innovative analytic approach by applying statistical change point models, which have been previously employed to model volatility in stock markets, changes in genomic data, and data dynamics in other scientific disciplines, to segment the transformed case data. This allowed us to identify possible change or turning points as indicated by the dynamics of daily COVID-19 incidences. We also employed B-spline regression models to express the estimated (predicted) trend of daily new incidences for each country's COVID-19 disease burden with the identified key change points in the model. RESULTS: We identified subtle, yet different change points (translated to actual calendar days) by either the mean and variance change point model with small p-values or by a Bayesian online change point algorithm with large posterior probability in the trend of COVID-19 incidences for different countries. We correlated these statistically identified change points with evidence from the literature surrounding these countries' policies regarding opening and closing of their societies in an effort to slow the spread of COVID-19. The days when change points were detected were ahead of the actual policy implementation days, and in most of the countries included in this study the decision lagged the change point days too long to prevent potential widespread extension of the pandemic. CONCLUSIONS: Our models describe the behavior of COVID-19 prevalence at a national scale and identify changes in national disease burden as relating to chronological changes in restrictive societal activity. Globally, social distancing measures may have been most effective in smaller countries with single governmental and public health organizational structures. Further research examining the impact of heterogeneous governmental responses to pandemic management appears warranted.

Elective cardiovascular care in the era of the COVID-19 pandemic: managing tragic choices.

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed 'elective' have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.