COVID-19 Scan for Apr 07, 2022

News brief

Fluvoxamine may reduce the odds of COVID-19 patient hospitalization

A new systematic review and meta-analysis of three randomized clinical trials with 2,196 patients suggests that early use of the antidepressant fluvoxamine reduces the risk of all-cause hospitalization in symptomatic adult outpatients.

Fluvoxamine, a selective serotonin reuptake inhibitor used to treat conditions such as obsessive compulsive disorder, also activates the sigma-1 receptor, which quells inflammation, the researchers noted.

McGill University researchers in Montreal led the study, which was published yesterday in JAMA Network Open. They extracted study data from the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov on Nov 12, 2021. All three clinical trials recruited unvaccinated COVID-19 outpatients with symptoms who had tested positive within 7 days of diagnosis but did not require supplemental oxygen.

The relative risk [RR] of a 50% chance of fluvoxamine effectiveness against hospitalization was 0.78, while it was 0.73 for an 85% chance of efficacy against hospital admission. A sensitivity analysis yielded an RR of 0.75.

Depending on the scenario, the odds of any link with reduced hospitalization after fluvoxamine treatment were 94.1% to 98.6%, and the probability of a moderate association were 81.6% to 91.8%.

Previous studies of fluvoxamine in COVID-19 patients have generated mixed results, and the Infectious Diseases Society of America recently recommended against its use in COVID-19 outpatients except in clinical trials. The study authors said, however, that widely available, safe, inexpensive options such as fluvoxamine, which costs about $1 a day, are needed for the prevention of COVID-19 hospitalization.

"Ongoing randomized trials are important to evaluate alternative doses, explore the effectiveness in vaccinated patients, and provide further refinement to these estimates," they wrote. "Meanwhile, fluvoxamine could be recommended as a management option, particularly in resource-limited settings or for individuals without access to SARS-CoV-2 monoclonal antibody therapy or direct antivirals."
Apr 6 JAMA Netw Open study

Home use of pulse oximeters for COVID-19 not linked to better outcomes

Asking COVID-19 patients to use a pulse oximeter at home to measure oxygen levels was no better than asking if they experienced shortness of breath in determining outcomes, according to new research in the New England Journal of Medicine.

The study was based on results seen in COVID Watch, a study from the University of Pennsylvania that sent text messages and monitoring prompts to patients with COVID-19 who were well enough to stay home to recover. The program launched in March 2020, with 28,500 patients using the program in the subsequent 2 years.

Previous studies showed that COVID Watch was linked with a 68% reduction in mortality. In this study, a randomized controlled trial was developed using 2,000 patients who were assigned either a pulse oximeter or the standard care without home oxygen measurements.

There were no significant mortality outcomes with patients using the oximeter, even when the patient population was divided by age, race, and sex. The authors wrote there was no significant between-group difference in the number of days that patients were alive and out of the hospital at 30 days (mean, 29.4 days in the pulse oximetry group and 29.5 days in the standard program group).

Having a pulse oximeter also did not lessen patient anxiety, the authors of the study said.

"Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital," said the study's co-lead author, Anna Morgan, MD, medical director of the COVID Watch program, in a University of Pennsylvania press release.
Apr 6 N Engl J Med study
Apr 6 University of Pennsylvania press release

News Scan for Apr 07, 2022

News brief

Framework outlines One Health collaboration on antimicrobial resistance

The World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE), and the United Nations Environment Programme (UNEP) yesterday published a strategic framework for One Health collaborations on antimicrobial resistance (AMR).

The collaboration between the four groups expands the efforts of the tripartite organizations (WHO, OIE, and FAO), which have been working together for several years to support the development and implementation of national AMR action plans that address the spread of AMR in humans and animals. With increased awareness of the role that the environment plays in developing and spreading resistant pathogens, the addition of UNEP aims to strengthen the integration of environmental aspects of AMR into the joint work.

"The overall role of the Tripartite and UNEP is intended to catalyse and support a One Health response, recognizing that many of the actions needed to address AMR are sector-specific and the responsibility of governments, civil society and the private sector," the framework states.

The two primary objectives laid out in the framework are to 1) optimize the production and use of antimicrobials along the whole life cycle, from research and development to disposal and 2) decrease the incidence of infections in humans, animals, and plants to reduce the development and spread of AMR. The groups aim to help countries achieve those objectives by helping countries recognize AMR as a priority, supporting the creation of policies and laws that support a One Health response, advocating for access to good-quality antimicrobials, and ensuring that national AMR action plans are implemented and resourced.

"We look forward to further strengthening collaboration among our four organizations and with our partners as we work to implement the framework in the coming years," the leaders of the four organizations wrote in a foreword. "Most importantly, we hope that by leveraging our organizations' respective resources and strengths that the multilateral system will make a strong contribution to results and impact across all sectors as the world strives to prevent and mitigate the impact of antimicrobial resistance."
Apr 6 One Health strategic framework

CDC: Norovirus outbreak tied to raw oysters sickens more than 100

The Centers for Disease Control and Prevention (CDC) yesterday announced a new norovirus outbreak that has sickened at least 103 people in 13 states, tied to eating raw oysters from British Columbia.

"Anyone who consumes raw shellfish is at risk of contracting norovirus. Children younger than five years old, the elderly, and those people with weakened immune systems are more likely to have severe infections. Food contaminated with norovirus may look, smell, or taste normal," the CDC warned.

The Food and Drug Administration confirmed that potentially contaminated raw oysters harvested in the south and central parts of Baynes Sound, British Columbia, were distributed to restaurants in several states, including California, Colorado, Florida, Hawaii, Illinois, Massachusetts, Minnesota, New Jersey, Nevada, New York, Oregon, Texas, and Washington. Each of those states have reported cases.

Norovirus is the most common form of foodborne illness in the United States, causing 2,500 outbreaks of illness annually. Most people recover within 3 days.
Apr 6 CDC report