Background Hospitalization of patients infected with the severe acute respiratory syndrome virus 2 (SARS-CoV-2) have remained considerable worldwide. Patients often develop severe complications and have high mortality rates. The cycle threshold (Ct) value derived from nasopharyngeal swab samples using real time polymerase chain reaction (RT-PCR) may be a useful prognostic marker in hospitalized patients with SARS-CoV-2 infection, however, its role in predicting the course of the pandemic has not been evaluated thus far. Methods We conducted a retrospective cohort study which included all patients who had a nasopharyngeal sample positive for SARS-CoV-2 between April 4 –June 5, 2020. The Ct value was used to estimate the number of viral particles in a patient sample. The trend in initial viral load on admission on a population level was evaluated. Moreover, patient characteristics and outcomes stratified by viral load categories were compared and initial viral load was assessed as an independent predictor of intubation and in-hospital mortality. Results A total of 461 hospitalized patients met the inclusion criteria. This study consisted predominantly of acutely infected patients with a median of 4 days since symptom onset to PCR. As the severity of the pandemic eased, there was an increase in the percentage of samples in the low initial viral load category, coinciding with a decrease in deaths. Compared to an initial low viral load, a high initial viral load was an independent predictor of in-hospital mortality (OR 5.5, CI 3.1–9.7, p < 0.001) and intubation (OR 1.82 CI 1.07–3.11, p = 0.03), while an initial intermediate viral load was associated with increased risk of inpatient mortality (OR 1.9, CI 1.14–3.21, p = 0.015) but not with increased risk for intubation. Conclusion The Ct value obtained from nasopharyngeal samples of hospitalized patients on admission may serve as a prognostic marker at an individual level and may help predict the course of the pandemic when evaluated at a population level.

Background Approximately 90% of Americans have access to the internet with the majority of people searching online for medical information pertaining to their health, or the health of loved ones. The public relies immensely on online health information to make decisions related to their healthcare. The American Medical Association (AMA) and the National Institute of Health (NIH) recommend that publicly available health-related information be written at the level of the sixth-seventh grade. Materials and methods Patient education materials available to the public on the Annals.org , a website sponsored by the American College of Physicians, were collected. All 89 patient education articles were downloaded from the website and analyzed for their ease of readability. The articles were analyzed utilizing a readability software generating five quantitative readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG). All scores, with the exception of FRE, generate a grade level that correlates with the required school-grade level to ensure adequate readability of the information. Results Eighty-nine articles were analyzed generating an average score as follows: FRE 62.8, FKGL 7.0, GFI 8.6, CLI 9.6 and SMOG 9.8. Overall, 87.6% of the articles were written at a level higher than the 7th-grade level, which is recommended by the AMA and NIH. Conclusion In an era of increased reliance on the internet for medical information pertaining to patients’ health, materials written at a higher grade than recommended has the potential to negatively impact patients’ well-being, in addition to tremendous ramifications on the healthcare system. Potentially redrafting, these articles can prove beneficial to patients who rely on these resources for making healthcare-related decisions.

Background The deaths due to coronavirus disease (Covid-19) in Michigan have been disproportionately centered in the city of Detroit. We sought to characterize hospitalized veterans with Covid-19 infection in Detroit, MI and compare them to inpatients previously reported. Methods A retrospective observational study of 79 veterans admitted to a veteran's hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 10, through April 6, 2020. Each patient had at least 30 days of follow-up. Results The median age of 79 enrolled patients was 69.0 years (interquartile range, 57.0–75.0 years) and 74 (94%) were men. Twenty-four (30%) had a recent emergency department visit. Respiratory symptoms were present in 67 (85%). Gastrointestinal symptoms were common (49 [62%]), including diarrhea (27 [34%]) and loss of appetite (31 [39%]). Only 30 (38%) patients had fever on admission. Comorbidities included hypertension (73 [92%]), diabetes (48 [61%]), obesity (42 [53%]), chronic obstructive pulmonary disease (30 [38%]), coronary disease (28 [35%]), and obstructive sleep apnea (25 [32%]). Nine patients were admitted to the intensive care unit, and 18 (26%) of 70 required intensive care unit transfer. Twenty-Four (30%) were intubated; of which 3 were extubated and 20 (83%) died. Of the 57 (72%) patients discharged alive, 22 (39%) required supplemental oxygen and 8 (14%) were readmitted within 30 days. Conclusions Detroit veterans were primarily older African American men with more comorbidities than inpatients previously described. Gastrointestinal symptoms were twice as common as fever. Rates of mortality and readmission were higher than those previously reported in populations with shorter follow up.

Acute retroviral syndrome (ARS) can present as a wide array of clinical manifestations. Establishing a diagnosis early in the disease course can provide an opportunity to minimize immunosuppression and limit further transmission of human immunodeficiency virus (HIV). We present a case of a previously healthy young male who presented with acute hepatitis, as a manifestation of ARS. Initial HIV antigen/antibody testing was negative; however, a high index of suspicion prompted HIV ribonucleic acid (RNA) virologic testing revealing >10 million RNA copies/mL. Anti-retroviral treatment was initiated, along with supportive measures, accomplishing resolution of the transaminitis and the restoration of CD4 counts within normal at one month. Early in the disease course, HIV screening immunoassay could still be negative; hence, confirmatory testing with HIV RNA virologic testing should be pursued when clinical suspicion is high. Prompt diagnosis and treatment can improve outcome and curtail viral transmission.