Weekly Review: What’s new in the COVID-19 clinical world? – January 25, 2021

Weekly Review: What’s new in the COVID-19 clinical world? – January 25, 2021

Emergence of SARS-CoV-2 B.1.1.7.

In this CDC publication, the authors discuss the new highly transmissible variant of SARS-CoV-2, B.1.1.7. The report states that B.1.1.7. has the potential to increase the U.S. pandemic trajectory in the coming months. In December 2020, the United Kingdom first reported a variant of concern which was first suspected in September 2020. Current evidence supports that this strain is more efficiently transmitted than others and is projected to exhibit rapid growth in early 2021 and become the predominant variant by March 2021. The authors urge rigorous implementation of public health strategies and increased population immunity to reduce risk for a worsening pandemic. Continued implementation of vaccination, physical distancing, masking, hand hygiene, isolation and quarantine are essential to limiting the spread of the SARS-CoV-2 virus strains. The article goes on to describe the lineage of B.1.1.7. and notes that there is no known difference in clinical outcomes associated with SARS-CoV-2 variants, however, a higher rate of transmission will lead to more cases which will exacerbate the current strain on our healthcare system in the U.S.

Therapeutics to watch in 2021

In this article, authors discuss the current antibody therapeutics development that occurred in 2020 and forecast those which may be useful in the current year. In late November 2020, two anti-SARS-CoV-2 antibody products, bamlanibimab and the casirivimab/imdevimab cocktail were authorized for emergency use by the U.S. FDA, and the repurposed antibodies levilimab in Russia, and itolizumab in India, had been registered for emergency use as treatments for COVID-19. Additional therapeutics had been granted approval during 2020 as discussed in this article. According to the authors, there are currently six antibody therapeutics in late-stage clinical studies for COVID-19. The article highlights specific antibody therapeutics that have been undergoing clinical trials at various stages and discuss analysis of these medications for treatments of both cancerous and non-cancerous disease. A table containing monoclonal antibodies undergoing late-stage clinical studies or authorized for COVID-19 treatment can be found here. The article gives a thorough description of antibody treatments and clinical trials that are currently underway in the fight against COVID-19.

Allergic reactions from Moderna COVID-19 vaccine

In this CDC release, the Vaccine Adverse Event Reporting System detected 10 cases of anaphylaxis after 4,041,396 first doses of Moderna Covid-19 vaccine from December 21, 2020 to January 10, 2021. In 9 of the cases, onset occurred within 15 minutes of the vaccination, and no deaths were reported. Among the case reports, 10 cases were determined to be anaphylaxis and all occurred in women (a rate of 2.5 cases per million Moderna COVID-19 vaccine doses administered), including 9 in persons with a documented history of allergies or allergic reactions. Of those 9, five previously had a history of anaphylaxis. The median interval time from vaccine receipt to symptom onset was 7.5 minutes with the maximum symptom onset occurring at 30 minutes. Among eight of these individuals with follow-up information available all were discharged to home and had recovered. Among the 43 cases of non-anaphylactic allergic reaction to Moderna vaccine, 60% were classified as non-serious. The most commonly reported symptoms include pruritus, rash, itchy sensations in the mouth and throat, sensation of throat closure, and respiratory symptoms. The median patient age was 43 years, and 39 of the reported reactions occurred in women. For 26 case reports, a past history of allergy was documented. Locations and providers administering COVID-19 vaccines should adhere to CDC guidelines, which includes screening recipients for contraindications and precautions. (Link to the Pre-vaccination Checklist can be found here. Ensure that there are necessary supplies and staff members available to manage anaphylaxis should it occur, and implement recommended post-vaccination observation periods. Any suspected anaphylaxis should be treated with intramuscular epinephrine injection, and the person should immediately be transferred to a medical care facility. The CDC states that anyone who has an immediate reaction to the first dose of an mRNA COVID-19 vaccine should not receive additional doses of either of the mRNA COVID-19 vaccines.

Reducing Vaccine Refusal Among High-Risk Groups

In this article, authors discuss the continued battle against COVID-19 as the recent vaccines have been rolling out across our country. COVID-19 has become a health disparity among Americans, with minorities exhibiting the highest burden of illness and deaths related to the pandemic. According to the CDC (2020), Black and Hispanic individuals are 4.7 and 4.6 times more likely, respectively, to be hospitalized for COVID-19 when compared to Whites. In addition, there have been significant economic and social costs for minorities due to the pandemic. COVID-19 Vaccines are vital to producing an immune response to slow the pandemic among all races. To effectively interrupt virus transmission, it is estimated that at least 70% of the American population needs to be vaccinated. Authors discuss a survey used to determine which groups are most hesitant against the COVID-19 vaccine. This particular study shows refusal is highest among women, Blacks, conservatives, and those with a significant religious background. In this survey, 71% of women are less likely to pursue vaccination, while 41% of Blacks surveyed state they are less likely to pursue vaccination. When determining top reasons for vaccine hesitancy among women and Black Americans, the top two reasons cited were that the vaccine is not safe, and the vaccine will not be effective. In particular, Black Americans who are being infected and dying at higher rates than the rest of the population are also less likely to vaccinate because of a combination of concerns, and because they lack the health insurance and financial resources that might be necessary for access to vaccination. Almost ⅓ of U.S. adults intend not to pursue a COVID-19 vaccine. Developing health communication strategies, making the vaccine more accessible to these groups , and targeted education could reduce vaccine refusal and contribute to decreased COVID-19 cases and deaths

Chloroquine nasal drops: An exploratory RCT

In this “ahead of print” article, authors study the efficacy and safety of topical nasal administration of chloroquine nasal drops to determine if there is a reduction in viral load or delay in clinical progression when used during early COVID-19 infection. Using a randomized clinical trial, 60 individuals were chosen based on positive RT-PCR testing and both asymptomatic and mildly symptomatic were included. After exclusions, 49 patients were analyzed as per modified intention-to-treat analysis. The study goes on to show that once infected, nasal chloroquine drops show no significance in clinical or virological outcome, however, authors suggest that use of these drops may help to reduce risk of acquiring COVID-19 if used prior to infection. Further studies are needed to support this claim.

|2021-01-25T08:48:33-05:00January 25th, 2021|COVID-19 Literature|Comments Off on Weekly Review: What’s new in the COVID-19 clinical world? – January 25, 2021

About the Author: Casey Cummins

Casey Cummins
Casey Cummins, MSN, APRN, NP-C is a board-certified Family Nurse Practitioner who currently serves as the Chief Nurse Consultant for the Immunizations Division at the Indiana Department of Health. She is part of the ISDH COVID-19 Outbreak Response Team, and has assisted with coordinating testing efforts state-wide during the pandemic. She enjoys spending time with her husband and their children, being outdoors, gardening, and traveling whenever possible.

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