COVID-19 Resources by Topic

The COVID-19 pandemic is a major health crisis straining the healthcare system and affecting us all. The IARS is committed to supporting our members who are addressing this illness on the front lines in any way we can.

IARS has assembled a content base with the latest peer-reviewed articles on COVID-19 from leading medical journals, sorted by topic and chronologically. In the COVID-19 Resource Newsletter healthcare professionals on the frontlines are given access to global peer experiences and education from publications hand-selected and reviewed by the IARS COVID-19 Scientific Advisory Board. All of these articles are openly available without login.

Click on a phrase below to see resources on that topic. To search by keyword, select Ctrl + F on a PC and Command + F on a Mac. Then, enter keyword and Enter.

    1. Patients / Family
      July 27, 2020

      July 17, 2020

      • Palliative care for patients with severe covid-19. 7/14/20. Ting R. BMJ.
        Review by the SAB
        By Dr. Lance Lichtor, on behalf of the SAB
        We usually think about a cure, but not everyone can be saved. This is a good article about managing patients with distressing symptoms, explaining the importance of having a strategy to manage patient deterioration and death, and stressing the importance of communication with the family with the sensitivity of noting that their loved one may soon die.

      May 20, 2020

      • Anticipating and curtailing the Cardiometabolic toxicity of social isolation and emotional stress in the time of COVID-19
        Apr 20. Oren. American Heart Journal.
        Opinion from SAB Member: Dr. David M. Clement
        “Individuals experiencing sustained deficiencies in social interaction attributable to quarantine or physical distancing should be considered at higher risk of cardiovascular disease.” “Understanding social isolation and its public health consequences is key to minimizing the late cardiometabolic burden of COVID-19.” In a well referenced opinion paper, the authors briefly explain this increased risk, and encourage health care providers to address this increased risk by paying more attention to risk modification in individual patients: risk assessment, hypertension, and healthy living habits (diet, exercise, smoking reduction). Though far from flashy, these recommendations are important.

      May 1, 2020

      • COVID-19: ICU delirium management during SARS-CoV-2 pandemic
        Apr 28. Kotfis. Critical Care.
        Opinion from C19SAB: Dr. W. Heinrich Wurm
        Well referenced review of central nervous system effects of the corona virus with special focus on current available data on delirium–direct and indirectly caused by SARS-CoV-2 infection. While direct CNS invasion is likely originating from the nasopharynx, there is insufficient data on CNS pathophysiology and resulting delirium in severely ill patients. Secondary neural pathology caused by inflammatory mediators affecting the blood brain barrier may be contributing as are metabolic factors secondary to organ dysfunction, social isolation, sedation and pre-existing disease. These concepts are summarized in a well-organized graph and management advice is given using the Society of Critical Care Medicine’s ABCDEF Safety Bundle framework.

      April 28, 2020

      • COVID-19 in long-term liver transplant patients: preliminary experience from an Italian transplant centre in Lombardy. Apr 9. Bhoori. Lancet Gastroenterol Hepatol.
        A Lancet GI “Correspondence” from Italy. 3/111 liver transplant patients on minimal immunosuppression died of COVID-19, whereas the 3/40 recent liver transplant patients on higher dose immunosuppression that became COVID-19 + survived with quarantining only. Because not all transplant patients were tested, denominators are unknown. The idea is raised, but in no way proven, that an intact immune system may not be beneficial for all patients. Several co-morbidities were more common in the severe patients.
      • Determining risk factors for mortality in liver transplant patients with COVID-19
        Apr 24. Webb. The Lancet Gastroenterology & Hepatology.
        Opinion from SAB Member: Dr. Barry Perlman
        A previous correspondence of liver transplant patients in Italy reported that 3 of their 111 long-term liver transplant survivors (on minimal immunosuppression) died from severe COVID-19, while 3 of 40 more recent liver transplant patients (on full immunosuppression) who had COVID-19 experienced an “uneventful course.” The long-term survivors were older, and had significantly higher incidence of obesity, DM, HTN, kidney disease, cardiovascular disease, and hyperlipidemia. Asymptomatic patients were not tested, so the incidence of SARS-CoV-2 in each group was not known. To address whether co-morbidities contributed to the higher death rate in the long-term transplant patients, the current correspondence reports the outcome of 39 liver transplant recipients with COVID-19 submitted to the COVID-Hep and SECURE Cirrhosis international registries. 9 (23%) died of respiratory failure. Frequency of co-morbidities between fatal and non-fatal cases was not significantly different. A study with larger case numbers will be needed to identify risk factors for severe COVID-19 in liver transplant patients.

      April 17, 2020

      • Towards aerodynamically equivalent COVID-19 1.5 m social distancing for walking and running. Blocken. Urban Physics.
        Social distancing guidelines are based upon distances that droplets from coughing, sneezing, or exhaling can travel from patients standing still. A previous study showed that deep inhalation and exhalation increases aerosol concentration several fold. Wind tunnel experiments simulated the airflow and droplet dispersion around two walkers or runners breathing moderately deeply side by side 1 meter apart, and in line or staggered at various distances apart. The simulations showed that the largest droplet exposure occurs when a trailing person is behind and in the slipstream of the lead person. Separation of 5 meters when walking or 10 meters when running is needed to provide the same droplet exposure protection as standing 1.5 meters apart. Staggered positioning minimized droplet exposure, but the simulations were done in the absence of cross, head, or tail winds, which might allow droplets to escape the slipstream. Further studies will be needed to validate the findings and determine if this exposure poses infection risk.

      April 16, 2020

      • Towards aerodynamically equivalent COVID-19 1.5 m social distancing for walking and running. Blocken. Urban Physics.
        Social distancing guidelines are based upon distances that droplets from coughing, sneezing, or exhaling can travel from patients standing still. A previous study showed that deep inhalation and exhalation increases aerosol concentration several fold. Wind tunnel experiments simulated the airflow and droplet dispersion around two walkers or runners breathing moderately deeply side by side 1 meter apart, and in line or staggered at various distances apart. The simulations showed that that the largest droplet exposure occurs when a trailing person is behind and in the slipstream of the lead person. Separation of 5 meters when walking or 10 meters when running is needed to provide the same droplet exposure protection as standing 1.5 meters apart. Staggered positioning minimized droplet exposure, but the simulations were done in the absence of cross, head, or tail winds, which might allow droplets to escape the slipstream. Further studies will be needed to validate the findings and determine if this exposure poses infection risk.

      April 15, 2020

      April 11, 2020

      • Editorial: Palliative care and the COVID-19 pandemic. Apr 11. The Lancet.
        Editorial by the Lancet Commission on Palliative Care and Pain Relief critical of WHO’s recent “Operational Guidance for Maintaining Essential Health Services during an Outbreak”. The Guideline does not include Palliative Care among essential health services deserving attention during a pandemic. The authors make a strong plea for the inclusion of Palliative Care and an overall effort to alleviation of suffering.
    1. Healthcare Staff
      March 22, 2021
      • Changes in Stress and Workplace Shortages Reported by U.S. Critical Care Physicians Treating Coronavirus Disease 2019 Patients. 3/17/21. Gray BM. Crit Care Med.
        This article discusses questionnaire responses from 1356 (57%) of polled critical care attending physicians who reported stress graded moderate-high by 67.6% in spring 2020 and 50.7% in fall 2020. Staff shortages were reported by 48.3% in spring with nearly no decrease (46.5%) by fall. Medication and equipment shortages largely improved by fall. However, PPE often remained in short supply; N95 respirator supply was short for 42.5% despite altered practices. Physical and emotional exhaustion rates were high. Elevated patient mortality rates, potential risk of SARS-CoV-2 exposure to personal contacts, risk of personal exposure, patient isolation from their families, and ethical challenges were among the most important drivers.
        SAB Comment: For interested readers, detailed results are available in the PDF available via a link in the article or here (http://links.lww.com/CCM/G302). We await updated studies following vaccination of most hospital workers and elderly persons that will likely show further evolution of the incidence of stress in ICU physicians and its drivers.

      March 10, 2021

      November 9, 2020

      • Benchmarking Critical Care Well-Being: Before and After the Coronavirus Disease 2019 Pandemic. 11/2/2020. Gomez S. Crit Care Explor.
        This is the result from the survey with comparison of 2 periods, 16 ICUs of 4 Hospitals to understand burnout and fulfillment among critical care healthcare (N= 482) its impact on well-being. Authors state that a rise of burnout is expanding to all across the team including APPs & Pharm D. & increased during the pandemic. These results reveal that burnout is a threat to the future of critical care team, notes that clinicians with less years of work experience were more likely to suffer adversely from burnout possibly from work load/ schedules. Professional fulfillment varied across the professional/ time/ hospital… To mitigate the burnout the Critical Care Societies Collaborative developed a “Call to Action” in 2016 & recommends that measures of well-being should be benchmarked and compared across ICUs and medical centers. Also consider offering resilience training, professional coaching, mindfulness training all across the team.

      October 9, 2020

      • Psychological Impact of COVID-19 on ICU Caregivers. 9/29/20. Caillet A. Anaesth Crit Care Pain Med.
        In this survey conducted among 208 ICU staff of a French teaching hospital, the incidence of anxiety and depression was 48% and 16% respectively, and PTSD was present in 27%. Use of the “Hospital Anxiety and Depression Scale” (HADS) and “Impact of Event Scale – Revised” (IES-R) revealed lack of critical care training as an important independent risk factor for anxiety syndrome and PTSD. COVID-19 unit assignment was responsible for anxiety syndrome and a prior history of burnout were risk factors for PTSD. The authors suggest intensified training and awareness of individuals’ history to address some of these issues.

      October 2, 2020

      September 23, 2020

      September 4, 2020

      • Symptoms of Anxiety, Depression and Peritraumatic Dissociation in Critical Care Clinicians Managing COVID-19 Patients: A Cross-Sectional Study. 8/31/20. Azoulay E. Am J Respir Crit Care Med.
        A survey of French ICU healthcare workers, using the Hospital Anxiety and Depression Scale (HADS) and Peritraumatic Dissociative Experience Questionnaire (PDEQ), resulted in a 67% response (n=1058). Most disturbing: 23.7% reported beginning or increasing use of tobacco, alcohol, cannabis, cocaine, or other drugs during the pandemic. Prevalence of anxiety (50%), depression (30%), and peritraumatic dissociation (32%) was highest among nurses and lower among males. Potentially modifiable factors included fear of infection, inability to rest or care for family, difficult emotions, restrictive visitation policies, and witnessing hasty end-of-life decisions. Psychological burden among ICU providers is high during the COVID-19 epidemic. Institutions and individuals should strive to reduce modifiable factors.

      August 25, 2020

      • Resilience strategies to manage psychological distress among healthcare workers during the COVID‐19 pandemic: a narrative review. 6/13/20. Heath C. Anaesthesia.
        This article, dealing with the well-being of healthcare workers in this or future pandemics, has well-proven suggestions to adopt at the self and organizational level. The authors have a holistic approach to reduce the morbidity of high-stressed healthcare workers. Psychological, emotional stress may result in: PTSD, substance abuse, isolation, poor judgments, separation, inefficiency of work, absenteeism, premature burnout, depression, and anxiety. The authors’ remedies include increase in emotional intelligence, resilience, altruism, and adaptive coping mechanism. Emphasis on self-care, sleep, exercise, friends/ family support, mindfulness, a role of organizational justice in debriefing, town hall meetings, training modules furthering resilience, and “battle buddies” (based on the US Army peer-support system). The article has support from several studies to prove their recommendations and its positive results.

      July 13, 2020

      • Managing Anxiety in Anesthesiology and Intensive Care Providers during the Covid-19 Pandemic: An Analysis of the Psychosocial Response of a Front-Line Department. 7/8/20. Fleisher LA. NEJM Catalyst.
        Review by the SAB
        A survey about “anxiety / stress induced crisis of health care provider – HCP” conducted by Dr. Lee Fleisher of 242 MDs and CRNAs in the anesthesia and critical care medicine departments at University of Pennsylvania comes up with the best guidelines to follow for healthcare workers’ emotional well being during this pandemic.
        Recommends:
        1. Covid-19 Task Force
        2. Development of a protocol
        3. Simulation training
        4. PPE training for all – addressing comfort level.
        5. Communication through a town hall meeting regarding the root of anxiety, identification of symptoms (insomnia, appetite, living situation).
        6. Complementing weakness and strength of traits, culture, gender, experience, psychology, age-related burnout while addressing shared expertise of healthcare workers in the field.

        Leadership should render the necessary training, psychological support, and clinical support, with acknowledgement of value of their work, to improve emotional health. The author stresses the role of meditation, maintaining routine including sleep, exercise, friends, and psychological assistance, and training.

      July 8, 2020

      • Anesthesiologists’ and intensive care providers’ exposure to COVID-19 infection in a New York City academic center: a prospective cohort study assessing symptoms and COVID-19 antibody testing. 6/11/20. Morcuende M. Anesth Analg.
        Review by the SAB
        By Dr. Heinrich Wurm, on behalf of the SAB
        A prospective cohort study from Columbia University Irving Medical Center based on an email-based survey mailed on April 15, 2020. The survey asked for symptoms and COVID-19 antibody testing after work-related COVID-19 exposures, among anesthesiologists and critical care doctors in a large NYC academic medical center at the height of the pandemic.
        The survey’s goal was to differentiate community from professional exposure and to evaluate the degree of protection PPE affords clinicians. The study achieved a 51% response rate and detected a 58% incidence of work-related exposure, 54% of which were high-risk exposures (e.g. intubation with inadequate PPE) and 26% reported symptoms suggesting COVID-19 infection.
        Antibody testing revealed an almost identical 12% positive result among those with work-related exposure and those who did not report such an event. Antibody positive respondents were more likely to use NYC subway to commute to work and report COVID-19-like symptoms in the last 90 days.

      June 29, 2020

      • Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. 6/9/20. El-Boghdadly K. Anaesthesia.
        Review by the SAB
        By Dr. Heinrich Wurm, on behalf of the SAB
        The “intubateCOVID project” is an ongoing prospective multicenter cohort study using a web-based, self-reporting registry for providers involved in endotracheal intubations. Over 1700 providers in 500 hospitals and 17 countries are registered and as of June 2 performed over 5000 intubations. Of the 184 providers (10.7%) that became infected, only two required hospitalization. Multiple procedural and epidemiological aspects were tracked and statistically evaluated. There was an unexplained higher incidence among women and considerable variation among countries. The authors list a number of serious limitations of this study, among those infection from other sources, self-reporting bias and asymptomatic seroconversion. As the study is ongoing, we will report updates as they become available.

      May 22, 2020

      • Nurturing Morale
        May 8. Vinson. Anesthesia & Analgesia.
        Opinion from SAB Member: Dr. W. Heinrich Wurm
        An “Open Mind” contribution focusing on current pandemic related stressors, but also on the personal impact the “Great Catch-up” phase that we are entering now will have on individual anesthesiologists’ morale. Daily challenges are identified, and remedies suggested. The role compassionate, honest and servient leadership plays under these circumstances is highlighted and leaders are urged to become aware of their crucial role in stressful situations. The author is a pediatric anesthesiologist and chair of the ASA Committee on Physician Well-being.

      April 30, 2020

      • Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Healthcare Workers during the COVID-19 Pandemic
        Apr 24. Albott. Anesthesia & Analgesia.
        Opinion from SAB Member: Dr. David M. Clement
        A very detailed overview of a program implemented at the University of Minnesota, designed to preserve “the psychological health of the medical workforce” through “pre-emptive resilience-promoting strategies” during the COVID-19 pandemic. Their program included three levels of support: 1. A “Battle Buddy” peer support strategy based on a US Army program. 2. A mental health consultant assigned to every clinical unit. 3. Confidential one-on-one additional help for HCW with additional needs. Excellent tables and graphic support. No outcome information.

      April 25, 2020

      • All Hands on Deck: How UW Medicine Is Helping Its Staff Weather a Pandemic
        Apr 24. Kim. NEJM Catalyst.
        Opinion from SAB Member: Dr. J. Lance Lichtor
        University of Washington Medicine was one of the first U.S. health systems to treat COVID-19 patients in large numbers. The article describes how they helped their workforce during the crisis by providing free testing for COVID-19 infection, that included liberalizing history and symptom elements so that more employees would be free to ask for the test; counseling on how to quarantine and when to return to work safely; and then open communication through regular community-wide virtual (Zoom) Friday afternoon town hall meetings and facilitation of peer-to-peer support both emotional and practical.

      April 20, 2020

      • Death from Covid-19 of 23 Health Care Workers in China. Apr 15. Zhan. NEJM.
        NEJM Letter to the Editor from China, describing the epidemiology of the 23 healthcare workers who died from COVID-19 through April 3. Of note, nearly half (11) were HCW rehired after retirement, and only 2 were respiratory physicians assigned to COVID units. Many deaths were early, suggesting better precautions later were effective. Zero of 42,600 HCW who travelled to Hubei Provence to care for patients with COVID-19 were known to have been infected.

      April 14, 2020

      April 9, 2020

      April 8, 2020

      April 3, 2020

Disclaimer
The material on this website is provided for informational purposes and does not constitute medical advice. New knowledge is added daily and may change over time. Opinions expressed should not be construed as representing IARS policy or recommendations. References and links to third parties do not constitute an endorsement or warranty by IARS.

Thank you IARS COVID-19 Scientific Advisory Board and Content Reviewers!

The IARS would like to recognize the COVID-19 Scientific Advisory Board and the Content Reviewers for sharing their expertise and time to help curate and evaluate the most relevant information coming out about COVID-19 for our members. The COVID-19 SAB meet regularly to discuss articles, provide reviews and determine what information would be most valuable to those on the frontline. The Content Reviewers review a list of articles daily to determine their topic areas and relevance to the audience. We greatly appreciate the commitment they have made to help during this major health crisis!

IARS COVID-19 Scientific Advisory Board

Current Members:

Lydia Cassorla, MD, MBA
Specialty: Anesthesiology
Professor Emerita, Department of Anesthesia and Perioperative Care, University of California, San Francisco
San Francisco, CA

David M. Clement, MD
Specialty: Anesthesiology
St. Joseph Hospital
Winthrop, WA

Robert L. Coffey, MD
Specialty: Pulmonology
Retired Physician
Mount Vernon, WA

Anil Hingorani, MD
Specialty: Vascular Surgery, General Surgery
Vascular Institute Of New York
Brooklyn, NY

Nancy Kenepp, MD
Specialty: Anesthesiology
Associate Professor Emeritus, Temple University, Katz School of Medicine, Department of Anesthesiology
Wynnewood, PA

Philip D. Lumb, M.B., B.S., M.D., MCCM, FCCP
Specialty: Cardiac Anesthesiology, Critical Care Medicine
Professor of Anesthesiology
Professor of Trauma Surgery
Director of Research and Data Analytics, Department of Anesthesiology
Keck School of Medicine of the University of Southern California
Los Angeles, CA

Edward S. Schulman, MD, FCCP, FAAAAI, FCPP
Specialty: Pulmonary, Critical Care and Sleep Medicine
Professor of Medicine
Director (1987-2012), Division of
Pulmonary, Critical Care and Sleep Medicine
Associate Chairman of Medicine for Research (1995-2000)
Director, Allergy and Asthma Research Center
Director, Pulmonary Physiology Laboratory
Drexel University College of Medicine
Philadelphia, PA

Jagdip Shah, MD, MBA
Specialty: Anesthesiology
Associate Professor of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Medical College of Virginia - Virginia Commonwealth University School of Medicine
Midlothian, VA

W. Heinrich Wurm, MD
Specialty: Anesthesiology
Chair Emeritus, Tufts Medical Center
Lovell, ME

Guest Contributors:

Jack Lance Lichtor, MD
Specialty: Anesthesiology
Retired Anesthesiologist; Yale University
New Haven, CT

Barry Perlman, MD, PhD, CMI
Specialty: Anesthesiology
Chair, Informatics Committee, Oregon Society of Anesthesiologists
Eugene, OR

Jay Przybylo, MD, FAAP, MFA
Specialty: Anesthesiology
Associate Professor, Department of Anesthesiology, Northwestern University Feinberg School of Medicine
Glenview, IL

Robert N. Sladen, MBChB, FCCM
Specialty: Anesthesiology, Critical Care Medicine
Allen Hyman Professor Emeritus of Critical Care Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons
Roxbury, CT

IARS Content Reviewers

Jonathan V. Roth, MD
Specialty: Anesthesiology
Chairman Emeritus, Department of Anesthesiology; Staff Anesthesiologist, Albert Einstein Medical Center
Dresher, PA

Eugene I. Tolpin, MD, PhD
Specialty: Anesthesiology
ChristianaCare Health Systems
Wilmington, Delaware

IARS Member Community

To assist members in sharing their COVID-19 experience, ideas, and questions, IARS has partnered with DocMatter to create a community for high-quality, clinical discussions. DocMatter is a networking platform tailored to the specific needs and requirements of the medical community.

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology..

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