COVID-19


GW COVID-19 Intelligence Report

Obtained from GW Himmelfarb Library | Report generated on October 26, 2020
Created by GW School of Medicine and Health Sciences, Himmelfarb Health Sciences Library and the GW Covid-19 Incident Management Intelligence Unit

Epidemiology/Transmission

  • A study funded by NIOSH and CDC reports the efficacy of different face coverings as follows: N95 respirator blocked 99% of the cough aerosol, a procedure mask blocked 59%, a 3-ply cloth face mask blocked 51%, and a polyester neck gaiter blocked 47% as a single layer and 60% when folded into a double layer. In contrast, the face shield blocked 2% of the cough aerosol.

 

  • Under laboratory conditions, SARS-CoV-2 can remain infectious on some surfaces for significantly longer periods, up to 28 days, at colder temps (20 degrees Celsius) but survive less than 24 hours at 40 degrees Celsius.

 

  • CDC has updated its primer on SARS-CoV-2 and potential airborne transmission, underscoring the majority of infections are spread through close contact, not airborne transmission.

 

  • Mild-to-moderate COVID-19 patients are highly unlikely to be infectious after day 10. Immunocompromised and severe-to-critical patients may be infectious for more than 10 days.

Diagnostics

  • The CDC has released guidance on point-of-care tests, including regulatory requirements regarding who can administer the tests, what tests can be used, and specimen collection, handling, and reporting requirements. The NIH has launched the Rapid Acceleration of Diagnostics (RADx) program to support the development, production scale up, and deployment of accurate, rapid tests for COVID-19.

 

  • A recent study of SARS-CoV-2 diagnostics found molecular tests showed excellent specificity (ranging from 95% to 100%) but significant differences in sensitivity, which ranged from 62.4% to 91.8%. However, there is no significant difference in mortality rates between infected patients who initially test positive or negative.

Treatments: Positive Studies

  • FDA gave traditional approval (as opposed to emergency use authorization) for Veklury (remdesivir) on October 22 for use in adults and pediatric patients (12 years of age and older) for the treatment of COVID-19 requiring hospitalization. Veklury should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care.

 

  • A systematic review of 4 clinical trials on remdesivir in patients with COVID-19 found that it may improve recovery and reduce serious adverse events and may reduce mortality and time to clinical improvement. For adults with moderate COVID-19, not receiving mechanical ventilation or ECMO, a 5-day course of remdesivir may provide similar benefits to and fewer harms than a 10-day course.

 

  • A RCT showed remdesivir was superior to placebo in shortening the time to recovery in adults who were hospitalized with COVID-19 and had evidence of lower respiratory tract infection.

 

  • In one study, hospitalized patients with severe COVID-19 treated with methylprednisolone had a significantly increased clinical improvement and lower mortality rate compared with patients in the standard care group. A second study found that methylprednisolone administered within the second week after the onset of symptoms improved the outcomes for patients with severe disease.

 

  • Therapeutic enoxaparin improves gas exchange and decreases the need for mechanical ventilation in severe COVID-19.

 

  • A pilot study found that a high dose of Calcifediol or 25-hydroxyvitamin D significantly reduced the need for ICU treatment of patients requiring hospitalization for COVID-19.

 

  • Eli Lilly has reported preliminary results of a randomized placebo-controlled trial that its combination of two monoclonal antibodies was found to be effective in non-hospitalized patients in reducing levels of coronavirus and may reduce hospitalization.

 

  • A prospective observational study on patients treated with oral antivirals (lopinavir/ritonavir and chloroquine) with or without intramuscular administration of IFN-alpha2b suggests benefit for IFN treatment with respect to complete recovery and reduced mortality.

Treatments: Negative or inconclusive studies

  • A Cochrane review of 19 studies found information too limited to determine the benefit or safety of convalescent plasma therapy for patients with COVID-19. There are 138 ongoing studies, including 73 RCTs and so more data is forthcoming.

 

  • Leflunomide combined with IFN alpha-2a did not reduce the duration of viral shedding in COVID-19 patients beyond IFN alpha-2a alone.

 

  • In a recent RCT, tocilizumab did not improve clinical status or mortality for hospitalized COVID-19 patients.

 

  • In a WHO-sponsored RCT, remdesivir, hydroxychloroquine, lopinavir and interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay.

 

  • A RCT of lopinavir-ritonavir was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death.

 

  • Hospitalized patients with Covid-19 receiving hydroxychloroquine did not have a lower incidence of death at 28 days than those who received usual care. A systematic review and meta-analysis of hydroxychloroquine or chloroquine with or without azithromycin found that hydroxychloroquine or chloroquine alone did not decrease mortality and the combination with azithromycin significantly increased mortality. Further, hydroxychloroquine administered as a pre-exposure prophylaxis to health care workers offered no benefit.

Vaccines

  • The National Academies of Science, Engineering and Medicine released its framework and recommendations for equitable allocation of vaccine for SARS-CoV-2 which propose criteria to be used to set priorities for equitable distribution among groups of potential vaccine recipients, taking into account factors such as population health disparities; individuals at higher risk because of health status, occupation, or living conditions; and geographic distribution of active virus spread.

 

  • A study of the mRNA-1273 vaccine involving older adults found that adverse events were mainly mild or moderate and supported the use of the 100-microgram dose in a phase 3 vaccine trial.

Clinical Updates

  • Progression to respiratory failure within 24 hours of admission to the hospital can be predicted using bedside respiratory examinations within the Quick COVID-19 Severity Index scoring system.

 

  • Using Hopkins’ COVID Inpatient Risk Calculator, the factors on hospital admission that are predictive of severe disease or death include: age, nursing home residence, comorbid conditions, obesity, respiratory symptoms, respiratory rate, fever, absolute lymphocyte count, hypoalbuminemia, troponin level, and C-reactive protein level and the interactions among these factors.

 

  • Stanford researchers have compiled a summary report on what is known about the impact of COVID19 across disease states and specialty areas including specific findings for cardiovascular, pulmonary, renal, hematologic, oncologic, traumatic, psychiatric, obstetric/gynecologic, operative, rheumatologic/immunologic, neurologic, gastrointestinal, ophthalmologic, and endocrine disorders.

 

  • Despite limited evidence, researchers are trying to better understand the long-term effects of COVID19, also called “ongoing COVID-19” and “Long Covid,” and how many patients are affected.

 

  • Neurological manifestations of COVID-19 are not uncommon and include myalgias, headaches, encephalopathy, dizziness, dysgeusia, and anosmia. Seizure, stroke and hypoxic/ischemic injury were seen, although less frequently. Severe COVID-19 increased risk for developing neurologic symptoms.

 

  • In one global study of adults hospitalized with COVID-19, compared with adults hospitalized with flu between 2014-2019, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use.

 

  • Acute kidney injury (AKI) in hospitalized patients with COVID-19 was associated with significant risk of death. Among patients with AKI not on dialysis, 74.1% achieved kidney recovery by discharge.

Disease Trends

  • Compared to 18 other countries, the U.S. experienced high COVID-19 associated mortality and excess all-cause mortality into September 2020, higher than even countries with high COVID-19 mortality.

 

  • A large study of patients treated at the VA found that Black and Hispanic individuals were more likely to be tested and to test positive for COVID-19 than Whites, even after adjustment for underlying health conditions, geography and other demographics.

 

  • One retrospective study found that non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32% below baseline) and remained well below baseline for patients with pneumonia (-44%), COPD/asthma (-40%), sepsis (-25%), urinary tract infection (-24%) and acute ST-elevation myocardial infarction (-22%).

Pediatrics

  • Although the majority of children with SARS-CoV-2 infection have normal leukocyte counts, the most common hematological finding is leukopenia, followed by lymphopenia which may be a marker of severe disease. In neonates and infants, the most common abnormality is lymphocytosis. Anemia and hypercoagulability is mainly present in children with MIS-C.

 

  • The International Late Effects of Childhood Cancer Guideline Harmonization Group has released guidance on caring for childhood, adolescent, and young adult cancer survivors, who may be at higher risk of a severe course of COVID-19.

Workforce

  •  Family-centered care is widely regarded as best practice for ICU patients, and because of restricted visitation, medical student “Family Engagement Navigators” can be trained to fill the gap.

 

  • An updated study on COVID-19 in health care workers across 8 countries found that goggles and face shield usage and infection control education reduced risk. The incidence of infection ranged from 0.4% to 49.6% and the prevalence of seropositivity ranged from 1.6% to 31.6%.

Influenza

  • The WHO Strategic Advisory Group of Experts (SAGE) has prioritized the following groups for seasonal flu vaccination during the pandemic: Health workers, older adults (both at highest risk) and pregnant women, individuals with underlying health conditions, and children.

Regulatory

  • CMS has posted requirements and an enforcement process for reporting COVID-19 data elements for hospitals.