Delayed Septal Perforation as a Complication of COVID-19: A Case Report.

BACKGROUND: There are increasing reports of the effects of SARS-CoV-2 on olfactory function, with a significant number of patients reporting anosmia as a symptom. However, our knowledge and understanding of the virus's complete impact on the nose remains poor. This report describes a unique patient case to demonstrate how COVID-19 may be associated with rhinoplasty complications such as septal perforation. CASE REPORT: This is a case report of a previously healthy patient who underwent septorhinoplasty in 2018. She had frequent follow-up including intranasal examinations without evidence of the septal perforation for the 2 years following her operation. In March 2020, the patient was noted to have symptoms suggestive of COVID-19, but testing was not recommended by the pediatrician. Soon after her symptoms resolved, she experienced a sudden onset of whistling and physical examination revealed a perforation in the septum which rapidly enlarged over the ensuing weeks. She tested positive for the COVID-19 antibody. After confirming that she no longer had an active infection via antigen testing, she underwent repair of her septal perforation without complications. CONCLUSION: This case report illustrates a septorhinoplasty complication that may be associated with COVID-19. Further study into this virus's impact on vascularity and wound healing, specifically in the nose, is recommended. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Social Media as an Early Proxy for Social Distancing Indicated by the COVID-19 Reproduction Number: Observational Study.

BACKGROUND: The magnitude and time course of the COVID-19 epidemic in the United States depends on early interventions to reduce the basic reproductive number to below 1. It is imperative, then, to develop methods to actively assess where quarantine measures such as social distancing may be deficient and suppress those potential resurgence nodes as early as possible. OBJECTIVE: We ask if social media is an early indicator of public social distancing measures in the United States by investigating its correlation with the time-varying reproduction number (Rt) as compared to social mobility estimates reported from Google and Apple Maps. METHODS: In this observational study, the estimated Rt was obtained for the period between March 5 and April 5, 2020, using the EpiEstim package. Social media activity was assessed using queries of "social distancing" or "#socialdistancing" on Google Trends, Instagram, and Twitter, with social mobility assessed using Apple and Google Maps data. Cross-correlations were performed between Rt and social media activity or mobility for the United States. We used Pearson correlations and the coefficient of determination (ρ) with significance set to P<.05. RESULTS: Negative correlations were found between Google search interest for "social distancing" and Rt in the United States (P<.001), and between search interest and state-specific Rt for 9 states with the highest COVID-19 cases (P<.001); most states experienced a delay varying between 3-8 days before reaching significance. A negative correlation was seen at a 4-day delay from the start of the Instagram hashtag "#socialdistancing" and at 6 days for Twitter (P<.001). Significant correlations between Rt and social media manifest earlier in time compared to social mobility measures from Google and Apple Maps, with peaks at -6 and -4 days. Meanwhile, changes in social mobility correlated best with Rt at -2 days and +1 day for workplace and grocery/pharmacy, respectively. CONCLUSIONS: Our study demonstrates the potential use of Google Trends, Instagram, and Twitter as epidemiological tools in the assessment of social distancing measures in the United States during the early course of the COVID-19 pandemic. Their correlation and earlier rise and peak in correlative strength with Rt when compared to social mobility may provide proactive insight into whether social distancing efforts are sufficiently enacted. Whether this proves valuable in the creation of more accurate assessments of the early epidemic course is uncertain due to limitations. These limitations include the use of a biased sample that is internet literate with internet access, which may covary with socioeconomic status, education, geography, and age, and the use of subtotal social media mentions of social distancing. Future studies should focus on investigating how social media reactions change during the course of the epidemic, as well as the conversion of social media behavior to actual physical behavior.