Modeling the Spread of COVID-19 in University Communities (preprint)

Mathematical and simulation models are often used to predict the spread of a disease and estimate the impact of public health interventions, and many such models have been developed and used during the COVID-19 pandemic. This paper describes a study that systematically compared models for a university community, which has a much smaller but more connected population than a state or nation. We developed a stochastic agent-based model, a deterministic compartment model, and a model based on ordinary differential equations. All three models represented the disease progression with the same susceptible-exposed-infectious-recovered (SEIR) model. We created a baseline scenario for a population of 14,000 students and faculty and eleven other scenarios for combinations of interventions such as regular testing, contact tracing, quarantine, isolation, moving courses online, mask wearing, improving ventilation, and vaccination. We used parameter values from other epidemiological studies and incorporated data about COVID-19 testing in College Park, Maryland, but the study was designed to compare modeling approaches to each other using a synthetic population. For each scenario we used the models to estimate the number of persons who become infected over a semester of 119 days. We evaluated the models by comparing their predictions and evaluating their parsimony and computational effort. The agent-based model (ABM) and the deterministic compartment model (DCM) had similar results with cyclic flow of persons to and from quarantine, but the model based on ordinary differential equations failed to capture these dynamics. The ABM's computation time was much greater than the other two models' computation time. The DCM captured some of the dynamics that were present in the ABM's predictions and, like those from the ABM, clearly showed the importance of testing and moving classes on-line.

Bilateral Lower Extremity Compartment Syndrome Secondary to COVID-19 Myositis in a Young Vaccinated Woman.

Coronavirus disease 2019 (COVID-19) typically manifests with respiratory symptoms and can ultimately progress to severe multiorgan failure. Viral myositis, systemic capillary leak syndrome, and arteriovenous thrombosis are atypical manifestations of COVID-19. We present a case of a 33-year-old woman, fully vaccinated against COVID-19, who developed myositis and shock. She ultimately required bilateral lower extremity fasciotomies secondary to compartment syndrome, presumably from COVID-19 myositis. Although compartment syndrome from COVID-19 myositis has been reported for ocular, hand, and thigh compartment syndromes, this is the first case report showing bilateral lower extremity compartment syndrome secondary to COVID-19 myositis in a fully vaccinated individual. As we learn more about COVID-19 and its extrapulmonary effects, it is imperative to consider all working diagnoses when working up patients. Providers must be aware of extrapulmonary effects of COVID-19, particularly in individuals who might deviate from traditional symptoms.

Upper-Extremity Phlegmasia Cerulea Dolens With Compartment Syndrome in Coronavirus Disease 2019 Sepsis.

A 54-year-old woman with leukemia presented with coronavirus disease 2019 and a right upper-extremity indwelling peripherally inserted central catheter line for chemotherapy administration. On hospital admission day 9, she developed acute right upper-extremity edema and pain. Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein. Her examination result was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention. Instead, we performed bedside fasciotomies and administered therapeutic heparin, and the limb was salvaged. This case underscores the potential for successful limb salvage in patients with phlegmasia in the setting of coronavirus disease 2019 via compartment release and therapeutic anticoagulation.

Compartment syndrome: a rare complication following laparoscopic colorectal surgery.

We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.

Eye Protection for Patients With COVID-19 Undergoing Prolonged Prone-Position Ventilation.

Importance: Critically ill patients with coronavirus disease 2019 (COVID-19) who are unresponsive to maximum optimal ventilator settings may be in a prone position for at least 16 hours per day to improve oxygenation. This extended duration of prone positioning puts patients at risk of developing orbital compartment syndrome if direct pressure to the orbit and the globe occurs and concomitant protection of the eyes is not undertaken. Objective: To report 2 cases of orbital compartment syndrome, as well as optic disc edema and retinal hemorrhages, in the setting of prolonged prone positioning of patients in the intensive care unit during the COVID-19 pandemic. Design, Setting, and Participants: The cases took place from April 27, 2020, to May 4, 2020, at a COVID-19 intensive care unit of a tertiary care hospital. Four of 16 patients in the intensive care unit required prolonged prone-position ventilation. A bedside eye examination was performed on 4 selected patients due to the observed presence of substantial periorbital edema. Main Outcomes and Measures: Intraocular pressures and fundus findings of 4 patients with periorbital edema. Results: Two of 4 patients who were in the prone position for extended periods of time had bilateral fundoscopic findings of optic disc edema and retinal hemorrhages, possibly consistent with a papillophlebitis. Additionally, both patients had a substantial increase in intraocular pressure of 2- to 3-fold in the prone position compared with the supine position. Conclusions and Relevance: Prolonged prone positioning of patients with COVID-19 can be associated with elevated intraocular pressure from periorbital edema, direct compression on the eye, and increased orbital venous pressure. Orbital compartment syndrome can be avoided by the use of protective cushioning around the eyes and maintaining the patient's head position above heart level during prone positioning. Patients with COVID-19 may also develop papillophlebitis with optic disc edema and retinal hemorrhages, which may be associated with a hypercoagulable state caused by COVID-19. These observations suggest awareness for the possible presence of these ophthalmic findings while treating severely ill patients with COVID-19.

Systemic Capillary Leak Syndrome Secondary to Coronavirus Disease 2019.

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia, and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute coronavirus disease 2019 (COVID-19) infection who presented with hemoconcentration, shock, and hypoalbuminemia. The patient subsequently developed rhabdomyolysis and compartment syndrome of all four extremities, requiring fasciotomies. This is the first reported case of systemic capillary leak syndrome associated with COVID-19 infection. This case adds to the evolving spectrum of inflammatory effects associated with this viral infection.

Thinking Out-of-the-Box: A Non-Standard Application of Standard Pulse-Oximetry and Standard Near-Infrared Spectroscopy in a COVID-19 Patient.

PURPOSE: Purpose of this report is to describe the feasibility of lingual pulse oximetry and lingual near-infrared spectroscopy (NIRS) in a COVID-19 patient to assess lingual tissue viability after several days of mechanical ventilation in the prone position. MATERIALS & METHODS: In a COVID-19 ICU-patient, the tongue became grotesquely swollen, hardened and protruding from the oral cavity after 20 h of mechanical ventilation uninterrupted in the prone position. To assess the doubtful viability of the tongue, pulse-oximetric hemoglobin O2-saturation (SpO2; Nellcor, OxiMax MAX-NI, Covidien, MA, USA) and NIRS-based, regional tissue O2-saturation measurements (rSO2; SenSmart, Nonin, MN, USA) were performed at the tongue. RESULTS: At the tongue, regular pulse-oximetric waveforms with a pulse-oximetric hemoglobin O2-saturation (SpO2) of 88% were recorded, i.e. only slightly lower than the SpO2 reading at the extremities at that time (90%). Lingual NIRS-based rSO2 measurements yielded stable tissue rSO2-values of 76-78%, i.e. values expected also in other adequately perfused and oxygenated (muscle-) tissues. CONCLUSION: Despite the alarming, clinical finding of a grotesquely swollen, rubber-hard tongue and clinical concerns on the adequacy of the tongue perfusion and oxygenation, our measurements of both arterial pulsatility (SpO2) and NIRS-based tissue oxygenation (rSO2) suggested adequate perfusion and oxygenation of the tongue, rendering non-vitality of the tongue, e.g. by lingual venous thrombosis, unlikely. To our knowledge, this is the first clinical report of lingual rSO2 measurement.

Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic.

PURPOSE: Ocular complications are common in the critical care setting but are frequently missed due to the focus on life-saving organ support. The SARS-CoV-2 (COVID-19) pandemic has led to a surge in critical care capacity and prone positioning practices which may increase the risk of ocular complications. This article aims to review all ocular complications associated with prone positioning, with a focus on challenges posed by COVID-19. MATERIALS AND METHODS: A literature review using keywords of "intensive care", "critical care", "eye care", "ocular disorders", "ophthalmic complications," "coronavirus", "COVID-19," "prone" and "proning" was performed using the electronic databases of PUBMED, EMBASE and CINAHL. RESULTS: The effects of prone positioning on improving respiratory outcomes in critically unwell patients are well established; however, there is a lack of literature regarding the effects of prone positioning on ocular complications in the critical care setting. Sight-threatening ophthalmic disorders potentiated by proning include ocular surface disease, acute angle closure, ischemic optic neuropathy, orbital compartment syndrome and vascular occlusions. CONCLUSIONS: COVID-19 patients may be more susceptible to ocular complications with increased proning practices and increasing demand on critical care staff. This review outlines these ocular complications with a focus on preventative and treatment measures to avoid devastating visual outcomes for the patient.

Management of Orthopaedic Emergencies During a Pandemic: Compartment Syndrome of the Hand in a Patient with COVID-19: A Case Report.

CASE: A 58-year-old man presented with acute respiratory distress syndrome and coagulopathy secondary to COVID-19. He developed acute compartment syndrome (ACS) of the left hand. He underwent a bedside 10-compartment decompression of the hand with volar forearm and carpal tunnel release while in the ICU. This report adds to the scarce body of literature regarding orthopaedic complications related to COVID-19. CONCLUSION: Coagulopathy secondary to COVID-19 can be a risk factor for the development of ACS. Frequent examinations of lines, restraints, and extremities are recommended. The COVID-19 pandemic presents unique challenges, necessitating clinical adjustments to best care for patients.

Mucormycosis with orbital compartment syndrome in a patient with COVID-19.

During the current pandemic of COVID-19, a myriad of manifestations and complications has emerged and are being reported on. We are discovering patients with COVID-19 are at increased risk of acute cardiac injury, arrythmias, thromboembolic complications (pulmonary embolism and acute stroke), and secondary infection to name a few. I describe a novel case of COVID-19 in a previously healthy 33-year-old female who presented for altered mental status and proptosis. She was ultimately diagnosed with mucormycosis and orbital compartment syndrome, in addition to COVID-19. Early identification of these high morbidity conditions is key to allow for optimal treatment and improved outcomes.

[A case report on treatment of compartment syndrome with novel coronavirus pneumonia].

A 49-year-old male patient with compartment syndrome of the right leg caused by acute carbon monoxide poisoning was admitted on December 30, 2019. The patient had a 10-year history of chronic nephritis and began dialysis treatment due to renal failure 1 month ago. Emergency surgical decompression for compartment syndrome was performed after admission. Two weeks later, the patient was diagnosed as the novel coronavirus pneumonia caused by 2019 novel coronavirus (2019-nCoV) infection. Then, the patient was transferred to the isolation ward, where he was given anti-infection, anti-virus, expectorant, heat-clearing and detoxifying drugs, bedside dialysis, and nutrition support symptomatic treatment. After 2 weeks of treatment, the patient is getting better, with no fever, cough, wheezing, and other discomfort. Meanwhile, the sensory and motor functions of right lower limb recovered gradually. This case is rare, severe, and difficult to diagnose and treat. It is the first reported case of novel coronavirus pneumonia after orthopedic surgery.

Clinical Features and Histopathological Changes of Skeletal Muscle in Patients with COVID-19: Two Case reports (preprint)

BackgroundTo the best of our knowledge, muscle soreness is a common manifestation for the coronavirus disease-19 (COVID-19) patients, but the mechanism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) injury to skeletal muscle remains unclear, there has been no publication focused on muscle involvement in COVID-19 patients.Case presentationWe present the case of two Chinese men with COVID-19, whose common symptoms were fatigue and muscle soreness. They went through different treatments, patient 1, 81-year-old, eventually died of multi-organ failure, and patient 2, 53-year-old, underwent amputation of the mid-lower section of left thigh. Laboratory tests in both patients showed abnormal biochemical parameters associated with skeletal muscle injury. We obtained skeletal muscle samples from these two patients, one from postmortem biopsy of gastrocnemius muscle and the other from a resected left lower limb due to thrombosis. The pathological findings in patient 1 were mainly scattered atrophic muscles, while fiber necrosis and minor inflammation were identified in patient 2, and the mild infiltrations were confirmed by CD68 and LCA staining to be predominantly macrophages and lymphocytes.ConclusionsWe report the clinical and laboratory features together with histopathological findings in skeletal muscle tissues from two COVID-19 cases and speculate that the SARS-CoV-2 may cause skeletal muscle injury. Due to the particularity of individual differences in case reports, the background of chronic neuromuscular disease in patient 1 and a minimal compartment syndrome caused by thrombosis in patient 2 need to be excluded prior to the conclusion that the skeletal muscles have been involved in COVID-19.