A Case of Post-COVID-19-Associated Paracentral Acute Middle Maculopathy and Giant Cell Arteritis-Like Vasculitis.

ABSTRACT: A 47-year-old man with a history of COVID-19 infection 2 months before presentation, presented with a scotoma of the paracentral visual field of the right eye. After thorough testing and evaluation, a diagnosis of paracentral acute middle maculopathy (PAMM) was established. Two months later, the patient developed temporal headache and jaw claudication. High-dose steroids were initiated, and workup for giant cell arteritis (GCA) was undertaken. The patient experienced resolution of the symptoms within 24 hours of steroid initiation. ESR, CRP, and temporal artery biopsy results were normal, although all were obtained more than 2 weeks after steroid initiation. To the best of our knowledge, our patient represents the first individual to date to potentially implicate COVID-19 in both small and large vessel vasculitis in the ophthalmic setting.

Impact of COVID-19 on breast andprostate cancer screening and early detection in a largehealth care provider group

Purpose: Massachusetts has been heavily impacted by the COVID-19 pandemic with new cases rising from 6,621in March to 55,584 in April and 34,760 in May 2020. Most clinics and hospitals stopped performing electiveprocedures and reduced the volume of patients seeking in-person care starting in mid-March. This abstractquantifies the rates of mammography and PSA testing, both for screening and diagnostic purposes, as well asbreast and prostate biopsies performed during the first five months of 2020 as compared to the same months in2019 for a large health care provider group in central Massachusetts. Methods: Men and women aged 30-85 without a history of breast or prostate cancer who were active patients ofthe provider group between January 2019 and May 2020 were included in this analysis. We compared the monthlyrates per 1,000 people of mammography, total PSA, and breast and prostate biopsy for the period of January-May2019 and January-May 2020 overall and by age and race/ethnicity. Procedures were identified by CPT codes in thegroup's electronic health record. Results: In total, 65,312 men and 80,629 women were included in the analysis of 2019 data and 66,396 men and82,695 women in 2020. About 70% of the population was non-Hispanic white, 3% non-Hispanic Black, 4% Hispanic,4% Asian, and 18% other/unknown. The median age was 53 for men and 52 for women. The monthly number ofmammograms declined significantly between January-May 2019 and the same months in 2020 from an average of13.6 mammograms per 1,000 women per month in 2019 to 6.1 in March, 0.25 in April and 1.1 per 1,000 women inMay 2020. Digital tomosynthesis also declined from an average of 34.7 per 1,000 women in 2019 to 14.6, 1.4, and1.5 across March through May of 2020. The level of decline increased with age and was greatest among the oldestwomen, aged 75-85. Parallel declines occurred among all racial/ethnic groups. Breast biopsies declined steadilyfrom an average of 0.9 per 1,000 women per month in 2019 to 0.8 in March, 0.4 in April and 0.1 per 1,000 women inMay 2020. PSA testing was conducted in 2019 with an average of 34.4 men tested per 1,000 per month. Declines inPSA were slightly less than mammography with 17.6 tests completed per 1,000 men in March, 6.1 in April, and 11.3in May 2020. Prostate biopsies were infrequent in 2019 with an average of 0.15 per 1,000 men per month and didnot decline in 2020. Declines were slightly greater in younger men aged 30-54 and similar across racial/ethnicgroups. The greatest single-month change in test rates occurred between April 2019 and April 2020 in both women(screening mammogram rate declined 98%, tomosynthesis 96%) and men (PSA testing rate declined 83%), reflecting the peak of the COVID-19 surge in Massachusetts. Conclusions: The observed decline in these common screening and diagnostic procedures reflects the impact ofthe COVID-19 pandemic on cancer prevention and early detection, signaling possible downstream effects on thetiming and staging of future cancer diagnoses.

For us, COVID-19 is personal

We are colleagues and friends working together in busy emergency departments in Washington DC. As Black physicians working in urban America, we do not find the recent deluge of news reports chronicling the disproportionate effect that the coronavirus disease (COVID-19) pandemic is having on the disenfranchised and minority populations in our country shocking. We have long been witness to and are in a constant state of alarm over the legal, medical, educational, social and economic inequities faced by the most vulnerable residents of this country.