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The COVID-19 pandemic has presented unpreceded challenges to conventional surveillance systems, including high day-to-day reporting variability, timeliness, cost, manpower, and interpretability of large-volume data. A review of the advantages and limitations across common visual surveillance approaches to SARS-CoV-2/COVID-19 disease progression are discussed. A novel surveillance methodology using a two-month moving locally estimated scatterplot smoothing (LOESS) procedure, laid out in a small-multiple panel format, was successfully able to address many surveillance issues that occurred with onset of the COVID-19 pandemic. This surveillance system was used throughout the COVID-19 response by the state of Texas to detect daily incidence trends across disparate regions. The LOESS panel methodology can be applied to daily new cases or other variables of interest across multiple levels of aggregated regions for COVID-19 or other diseases. Use-case testing indicated the LOESS strikes a successful balance between daily variability versus early detection of true change in overall country and regional COVID-19 trends beyond that of a weekly moving average. In sum, the paneled LOESS smoothing methodology described herein presents a highly useful addition to other conventional methods of trend detection. This approach can be applied to COVID-19 and other rapidly spreading infectious diseases across multiple regions of interest and could be an additional highly accessible tool available for utilization by many state and regional jurisdictions. [ABSTRACT FROM AUTHOR]

Hyperhemolysis syndrome (HHS) is an uncommon transfusion reaction described in several hematologic disorders, including sickle cell disease (SCD). HHS is characterized by a decline in hemoglobin (Hb) values below pre-transfusion levels following transfusion of red blood cells (RBCs), coupled with laboratory markers consistent with hemolysis. The proposed pathophysiologic mechanisms underlying HHS include increased phosphatidylserine expression, macrophage activation, and complement dysregulation. Many pathophysiologic mechanisms thought to contribute to HHS have been similarly described in cases of severe COVID-19. A 28-year-old male with a history of HbSS presented with shortness of breath, right-sided chest pain, and a two-day history of fever. Polymerase chain reaction (PCR) detected SARS-CoV-2 infection with the omicron variant. The patient required an RBC transfusion (pre-transfusion hemoglobin [Hb]5.8 g/dL) with an immediate post-transfusion Hb of 6.3 g/dL. However, Hb rapidly declined to 1.7 g/dL, and lactate dehydrogenase (LDH) rose to 8701 u/L. The absolute reticulocyte count of 538 × 109/L correspondingly fell to 29 × 109/L. Despite additional RBC transfusions and initiation of immunosuppressive therapy, he expired on Day 9(D9). Given the similarities in their proposed pathophysiology, patients with SCD and concomitant SARS-CoV-2 infection may be predisposed to developing HHS. [ABSTRACT FROM AUTHOR]