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What your doctor is reading on Medscape.com:
APRIL 12, 2020 — Compassionate Use of Remdesivir
More than two thirds of severely ill COVID-19 patients improved after being given the experimental drug remdesivir (Gilead Sciences, Inc), according to an analysis published in the New England Journal of Medicine.
However, numerous experts expressed concern about the interpretability of the findings. The 53 patients included in the analysis were given a 10-day course of the experimental drug for “compassionate use” consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment.
The findings, which showed significant improvements in 32 of the patients (68%), are “hopeful,” the paper said. But the authors also caution that the number of patients was small and there was no control group.
British Prime Minister Leaves Hospital
With much of the world celebrating the Easter holiday today, here is a bit of good news from the United Kingdom. British Prime Minister Boris Johnson is on the mend after being hospitalized with COVID-19 last week.
Johnson was discharged earlier today from London’s St Thomas’ Hospital, Medscape News UK reports. A Downing Street spokesperson said that on the advice of his medical team the Prime Minister would not be back at work immediately. Johnson, who entered the hospital last Sunday for persistent symptoms of COVID-19 and spent 3 days in intensive care, will continue his recovery at his country residence, Chequers.
“It is hard to find the words to express my debt to the NHS for saving my life,” Johnson said in a tweet quoted in the Medscape report.
The Hydroxychloroquine Controversy Continues
Elsevier weighed in on its controversial paper about the use of hydroxychloroquine to treat COVID-19. The publisher defended the peer review process for the article after concerns about including the top editor of the journal as one of the paper’s lead authors, Retraction Watch reports.
Earlier this month, Medscape reported that the International Journal of Antimicrobial Agents expressed concern that the March 20 article, “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial” did not meet the International Society of Antimicrobial Chemotherapy’s expected standard, especially relating to the lack of clear explanations of the inclusion criteria and the triage of patients to ensure patient safety.
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A Shift in Thinking
Asymptomatic or presymptomatic for COVID-19? Experts with the Infectious Diseases Society of America (IDSA) discussed the difference between the two terms and announced new guidelines on management of COVID-19.
“Pre” is really the right terminology, Carlos del Rio, MD, professor of medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, said during a news briefing. It’s not that people are asymptomatic but that they develop symptoms later and start transmitting the virus 24 to 48 hours before they develop symptoms, he said. The briefing also included a discussion of racial disparities in COVID-19. For example, in Alabama, around 20% of the population is African American, yet this population accounts for about 40% of COVID-19 deaths.
Quantifying Infections
The US National Institutes of Health (NIH) has announced a recruitment drive for a new study to determine how many adults in the United States without a confirmed history of infection with SARS-CoV-2 have antibodies to the virus.
SARS-CoV-2 is the virus that causes COVID-19. The presence of its antibodies in the blood indicates a prior infection, the announcement on the NIH website says. Researchers leading the “serosurvey” hope to collect and analyze blood samples from as many as 10,000 subjects to provide critical data for epidemiologic models. Results should help illuminate previously undetected infections and identify which communities and populations have been hit the hardest. The study will be conducted by researchers at the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB), with additional support from the National Center for Advancing Translational Sciences (NCATS) and the National Cancer Institute (NCI), all divisions of NIH. Healthy volunteers over the age of 18 from anywhere in the United States can participate. Anyone interested in joining the study should contact the NIH directly, referencing the clinical trial identifier NCT04334954 in their query.
Possible Re-infections Under Investigation
The World Health Organization (WHO) is investigating reports of recovered COVID-19 patients testing positive for a second time.
Ninety-one patients who were thought to be clear of the novel coronavirus have tested positive again after initially testing negative for the disease while being considered for discharge, according to South Korean officials. Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention, told a news briefing that the virus may have been “reactivated” rather than the patients being re-infected.
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“As COVID-19 is a new disease, we need more epidemiological data to draw any conclusions of virus shedding profile,” said a brief statement from the Geneva-based World Health Organization. It remains unclear what is behind the trend, the statement added. South Korean researchers say that epidemiologic investigations are underway.
Patients With Mental Illness May Be Hit Hardest by COVID-19
In an interview with Medscape Medical News , the author of a new JAMA Psychiatry study said patients with severe mental illness have “a whole range of vulnerabilities” that put them at higher risk for COVID-19. These include high rates of smoking, cardiovascular and lung disease, poverty, and homelessness, said Benjamin Druss, MD, MPH, from Emory University’s Rollins School of Public Health in Atlanta, Georgia. He says that the looming crisis COVID-19 presents for those with mental illness can be avoided if their healthcare providers stay up to date on risk mitigation and communicate clearly with their patients.
ARDS Reference
Patients with severe illness related to COVID-19 may quickly progress to acute respiratory distress syndrome (ARDS). With so many healthcare professionals stepping outside their specialties to help out with coronavirus patients, Medscape has published a short quiz to help review best practices in ARDS management.
