RCT’s of therapeutic interventions against COVID-19
In this journal article, the authors discuss the challenges that plagued us during the early days of the COVID-19 pandemic. When the pandemic emerged, clinicians were faced with an unknown virus and had very little ammunition to combat the affliction. Although many clinical trials were thrown together in those early months with little evidence, there have been high-quality studies that have emerged and define the current evidence- based treatment options we have now. While we still lack a pharmacological treatment or vaccine, this article discusses what supportive evidence has been gained because of these clinical trials. One study discusses a randomized study that evaluated the use of hydroxychloroquine as a postexposure prophylaxis. This study included young (median age 40 years) healthcare workers who had no coexisting conditions. To summarize, this study was negative. There was no statistical difference in the confirmed/probable cases between the groups, however, the drug did seem to produce increased gastrointestinal side effects. Another study discussed focuses on remdesivir, a drug typically used to treat Hepatitis C and was repurposed during the Ebola virus. The National Institute of Allergy and Infectious Disease ran a randomized, double-blind, placebo-controlled trial of remdesivir, given for 10 days or until discharge or death. This study included a predominately male cohort with a median age of 59 years, with many having at least one coexisting condition. The primary results show that time to recovery was significantly shorter among patients who received the drug (11 days vs 15 days; P < .0001).
Meta-analysis does not support the possibility of COVID-19 reinfections
In this article, the authors completed a meta-analysis of nearly 30,000 peer reviewed publications on COVID-19. Out of the vast literature, only 15 specifically target the topic of reinfections. The results of this study are very interesting as many articles indicate there is no clear answer on the possibility of reinfection and that it may be possible. This study, however, indicates that following the first episode of infection, cases of clinical relapse are reported at 34 (mean) ± 10,5 days after full recovery. Patients with clinical relapse had persistent positive COVID-19 PCR testing results until 39 ± 9 days following an initial positive result. In patients without a relapse, positive testing was reported up to 54 ± 24 days. In all cases there were no reports of clinical reinfection after a 70-day period following the initial infection. The authors conclude that cases of COVID-19 reinfection are protracted initial infections and not a repeat case. Further studies would be needed to determine if reinfection is possible, or likely.
Testing for SARS-COV-2 antibodies
There has been great interest in the reliability of SARS-COV-2 antibodies when determining immunity or lack thereof once someone has recovered from the virus. In this article, the authors review COVID-19 antibody testing and how it can be useful in other ways. Positive antibodies are identified by measuring IgA, IgG, and/or IgM. In COVID-19, IgM rises soonest and typically declines after infection. IgG and IgA typically persist and reflect a longer immune response. Antibody testing is done using enzyme linked immunosorbent assays or chemiluminescence immunoassays (CLIA) with a venous blood sample. Antibody testing should be undertaken at least two weeks after symptom onset, however, sensitivity and specificity will vary over time. For diagnosis of COVID-19, viral RNA by PCR testing is the gold standard, however, antibody testing may be useful when individuals have a late presentation, extended symptoms or who are asymptomatic, or when PCR tests are negative and the patient has ongoing symptoms consistent with COVID-19. Accuracy of antibody testing is discussed within the article and the authors are sure to note that antibody testing is not a reliable method to determine immunity to future infections. In fact, measures of diagnostic accuracy vary depending on the timing of the antibody test. The maximum sensitivity for combined IgG or IgM tests was 96% at 22-35 days after symptom onset. For IgG, the maximum sensitivity was 88.2% at days 15-21 after symptom onset. Antibody testing can help to tell if a patient has had COVID-19, however, data is lacking on the accuracy of these tests beyond 35 days. In addition, there is insufficient evidence that the presence of antibodies confers last immunity. As the authors note, further studies are needed to determine the improve the understanding of the late sequelae of COVID-19.
Simple evaluation tool to triage COVID patients?
In this article, authors aimed to evaluate the predictive value of an evaluation tool when triaging patients for COVID-19. The study evaluated the value of five early warning scores based on the admission data of critical COVID-19 patients. By examining the medical records of 319 COVID-19 patients, the authors calculated the Standardized Early Warning Scores (SEWS), national early warning scores (NEWS), national early warning score2 (NEWS2), Hamilton early warning score (HEWS), and Modified early warning score (MEWS). Outcomes were based on survival or death and were collected for each patient and used to analyze data. The results conclude that SEWS, NEWS, NEWS2, and HEWS demonstrated moderate discriminatory power and offer a prognostic tool for screening severely ill COVID-19 patients, however, MEWS is not a good predictor. Further information may be found within the article.