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Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today.
WHO Set to Resume Hydroxychloroquine Trial
The World Health Organization (WHO) will resume its trial of hydroxychloroquine (HCQ) for the treatment of patients with COVID-19, Reuters reports. The United Nations agency had briefly stopped giving it to newly enrolled patients over health concerns following a report that the drug might increase the risk for death and irregular heartbeats.
In the interim, the study continued with other medicines. Now, WHO’s director-general, Tedros Adhanom Ghebreyesus, said its experts had advised the continuation of all trials including hydroxychloroquine.
“The executive group will communicate with the principal investigators in the trial about resuming the hydroxychloroquine arm of the trial,” Tedros told an online media briefing. WHO aims to run clinical tests of potential COVID-19 treatments on approximately 3500 patients in 35 countries.
Weaker COVID-19 Virus?
With the rates of infection and death from COVID-19 declining in Italy, a group of doctors there say SARS-CoV-2, the virus that causes it, is weakening. But experts from WHO, the Italian government, and beyond say that’s just not true, WebMD Health News reports.
Experts do agree that the virus is changing and mutating, but not enough to make a difference in the severity of disease. Rather, some speculate the improvements in outcomes ― cited by the Italian doctors as evidence of reduced virulence ― might actually be the result of healthcare professionals taking care of patients in and out of the hospital and an increase in testing, which raise the case numbers by which outcomes are measured.
Remdesivir Shows Benefit in Moderately Ill Patients
Moderately ill COVID-19 patients benefit from a 5-day course of the drug remdesivir, according to randomized trial data released by Gilead Sciences earlier this week. The topline results from the company’s phase 3 SIMPLE trial are the first to show that the drug improves outcomes among patients who are hospitalized with COVID-19 but who do not need respiratory support.
According to a company news release, researchers found that moderately ill patients who received a 5-day course of remdesivir were 65% more likely to improve by day 11 compared with patients who received the standard of care. However, patients randomly assigned to receive a 10-day course of the drug did not show statistically significant improvements over the standard-of-care group.
Although the study provides further support for the drug’s use for the treatment of COVID-19, the results may not immediately affect clinical practice, experts told Medscape Medical News. “It does create a little bit of a challenge; it’s only an intravenous drug, and in general it’s already in short supply,” said one study site investigator.
Does the Virus Attack the Brain?
Neurologic effects can be a significant aspect of COVID-19, but it’s unclear whether the central nervous system is directly affected or if the neurologic symptoms are secondary effects, according to a new review of the data.
“We know that SARS-1 and MERS have been shown to enter the nervous system, and several coronaviruses have been shown to cause direct brain effects,” said one expert. “There is also some evidence that SARS-CoV-2 can do this too. As well as these latest MRI findings linked to loss of smell, there is a report of the virus being found in endothelial cells in the brain, and a French autopsy study has also detected virus in the brain.”
Fatality Rates May Be Higher Than Stated
The infection fatality rate (IFR) of COVID-19 is of keen interest, but calculating it from existing data isn’t straightforward. And a recently posted preprint by John Ioannids is a case in point, says Gideon Meyerowitz-Katz, an epidemiologist with the Australian Academy of Science.
Ioannidis used seroprevalence (antibody test) studies to estimate the IFR, but the inclusion criteria he used for his analysis may have introduced substantial bias, Meyerowitz-Katz writes in Medscape Medical News. For example, studies involving blood donors were included, but studies involving healthcare workers were excluded.
Meyerowitz-Katz speculates that Ioannidis’s own biases may have influenced his methodology. “Ultimately, it’s hard to know the why, but what we can say is that this review appears to have very significantly underestimated the IFR of COVID-19. Moreover, the methodology is quite clearly inadequate to estimate the IFR of COVID-19, and therefore the study fails to achieve its own primary objective,” writes Meyerowitz-Katz.
As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1000 throughout the world have died.
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Rabiya S. Tuma, PhD, is an executive editor with Medscape Medical News. She has covered science and medicine for a variety of publications, including the Economist and the Journal of the National Cancer Institute. She can be reached at firstname.lastname@example.org.
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