Remdesivir tied to lower COVID death rates in hospital patients receiving oxygen

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Remdesivir vial and syringe
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A comparative-effectiveness study that spanned the dominance of SARS-CoV-2 variants of concern (VOC) finds that the antiviral drug remdesivir (Veklury) significantly reduced in-hospital COVID-19 death rates among adults receiving supplemental oxygen on admission.

The study, led by researchers from remdesivir manufacturer Gilead Sciences, was published today in Open Forum Infectious Diseases.

The team compared 67,582 hospitalized COVID-19 patients receiving low-flow oxygen (LFO), 34,857 on high-flow oxygen/noninvasive ventilation (HFO/NIV), and 4,164 receiving invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO) treated with remdesivir with control patients from December 2020 to April 2022. At least one dose of remdesivir was administered within 2 days of hospitalization.

The study authors noted that World Health Organization guidelines conditionally recommend remdesivir for severely—but not critically—ill COVID-19 patients. "This lack of recommendation for remdesivir use in critically ill patients may reflect either lower efficacy or alternatively, the inability to detect beneficial effects, since clinical trials were not designed or powered to detect differences in remdesivir efficacy in subgroups according to baseline COVID-19 severity," they wrote.

Drug appears protective across variants

Across VOC periods, 5,853 (16.8%) remdesivir recipients and 6,770 (19.4%) controls died by 14 days. By 28 days, 9,009 (25.8%) remdesivir recipients and 9,853 (28.3%) controls died.

In the US, approximately 1 in 2 patients requiring invasive ventilation has died since the beginning of the pandemic.

Unadjusted death rates were significantly lower for remdesivir recipients than controls at 14 days (LFO, 6.4% vs 8.8%; HFO/NIV, 16.8% vs 19.4%; IMV/ECMO, 27.8% vs 35.3%) and 28 days (LFO, 9.8% vs 12.3%; HFO/NIV, 25.8% vs 28.3%; IMV/ECMO, 41.4% vs 50.6%).

After adjustment, remdesivir was tied to significantly lower in-hospital death rates at 14 days (LFO adjusted hazard ratio [aHR], 0.72; HFO/NIV aHR, 0.83; IMV/ECMO aHR, 0.73) and 28 days (LFO aHR, 0.79; HFO/NIV aHR, 0.88; IMV/ECMO aHR, 0.74) relative to no remdesivir.

"In the US, approximately 1 in 2 patients requiring invasive ventilation has died since the beginning of the pandemic," wrote the authors, who said remdesivir should be administered immediately to all hospitalized COVID-19 patients. "It remains essential to continue to evaluate therapeutic options to treat patients throughout the spectrum of COVID-19 disease and VOC periods."

WHO: Cholera cases more than doubled in 2022

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Vibrio cholerae bacteria
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New data released by the World Health Organization (WHO) today show global cholera cases more than doubled last year and are continuing to climb in 2023.

The data show 472,697 cholera cases were reported to the WHO in 2022, up from 223,370 in 2021. The number of countries reporting cholera cases rose from 35 to 44. In addition, cholera outbreaks in 2022 were both more frequent and larger, with seven countries—Afghanistan, Cameroon, Democratic Republic of the Congo, Malawi, Nigeria, Somali, and Syria—reporting outbreaks of 10,000 people or more. 

Twenty-four countries are currently reporting active outbreaks, including Malawi, which is experiencing one of the largest outbreaks in its history.

Multiple factors contributing to surge

Cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae, which spreads through food and water contaminated with feces. Outbreaks tend to occur in places lacking clean water and sanitation.

"Longterm development, including water, sanitation and hygiene (WASH), is the longterm solution for preventing cholera," the WHO said.

But the agency says the upsurge in extreme weather events linked to climate change, conflict, population displacement, and weakened healthcare systems are all playing a role in the rise in cholera activity.

The WHO also said that the increased demand for cholera materials has forced cholera outbreak programs to use a single-dose vaccination regimen as opposed to the standard two-dose regimen.

Main US COVID markers continue slow rise

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US COVID-19 hospitalizations and deaths continued their slow rise over the past week, but two early indicators showed declines, the Centers for Disease Control and Prevention (CDC) said in its latest data update.

Hospitalizations rose 7.7% compared to the week before, with admissions at the medium level in some parts of southern half of the country and sporadic pockets of high-level counties in roughly the same areas but also including a few locations in Montana and Oregon. Deaths were up 2.7% from the past week, with Kentucky the only state in the high range.

Of the early indicators, emergency department visits for COVID declined 19.3%, with Oregon as the only state at the moderate level. Test positivity dropped slightly, by 1.6%, and is at 12.5% nationally, with the highest levels in the southern tier of Midwestern states and part of the northeast.

SARS-CoV-2 micrograph
NIAID/Flickr cc

A little more than a week ago, the CDC recommended the updated COVID mRNA vaccines for people ages 6 months and older, and with distribution and coverage now handled by the private sector instead of the government, some Americans are facing glitches such as insurance coverage denials, the Washington Post reported today.

In international developments, the European Centre for Disease Prevention and Control (ECDC) said today in its weekly communicable disease update that COVID indicators are rising in about half of reporting countries, but so far, the activity is having relatively limited impact on hospitalizations, intensive care unit (ICU) admissions, or deaths. XBB.1.5 and related variants are dominant and rising, according to sequencing from reporting countries.

As of September 21, there were 172 detections of the highly mutated BA.2.86 variant, which were from 9 European Union or European Economic Area countries and 11 other world regions.

Quick takes: Montana H1N2v flu case, Lithuania to ban fur farming, DRC battles suspected triple gastroenteritis outbreak

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  • Montana health officials have reported a variant H1N1 (H1N2v) infection in a patient younger than 18 who sought care the first week of August, the Centers for Disease Control and Prevention (CDC) said in its weekly flu update. Investigators found that the person, who was not hospitalized, had attended an agricultural fair before symptoms began. The illness marks the nation's third variant flu case of the year. Earlier infections were reported from Michigan, one involving H3v and the other H1N2v.
  • Lithuania's parliament has approved a measure to ban fur farming, which awaits final approval from the country's president, according to a Finnish media report. Lithuania is Europe's third-biggest mink producer, behind Poland and Greece. Minks are known to be a potential mixing vessel for respiratory viruses, and the recent outbreaks at fur farms have intensified calls to shutter fur farms to due to pandemic risks.
  • Health officials in the Democratic Republic of the Congo (DRC) are battling a gastroenteritis disease outbreak centered near the capital of Nairi department in the western part of the country that is swamping local health facilities, the World Health Organization (WHO) said in an outbreak announcement yesterday. The illnesses involved suspected typhoid fever, shigellosis, and cholera, and since late June, officials have reported 2,389 suspected cases, 52 of them fatal. The city of Dolisie in Nairi department is the outbreak's epicenter, but five other departments in the DRC have also reported suspected cases: Bouenza, Brazzaville, Kouilou, Pointe-Noire, and Pool. Eighty-eight patients have undergone surgery for intestinal perforation, a known complication of untreated typhoid fever, which the WHO said is an unusually high level.

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