COVID-19 Scan for May 01, 2020

CIDRAP COVID-19 planning report
Hydroxychloroquine and heart problems
Health workers at risk for poor outcomes

CIDRAP publishes COVID-19 report, says to plan for long haul

Though many organization have published guidance on the best way forward during this COVID-19 pandemic, the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota saw a need for recommendations based on current realities and restrictions, not on technology such as widespread testing that may one day be in place.

So the center, in consultation with Harvard epidemiologist Marc Lipsitch, DPhil, and pandemic flu expert and historian John Barry, MA, yesterday published a report, "The future of the COVID-19 pandemic: lessons learned from pandemic influenza," that details how the novel coronavirus is behaving epidemiologically more like past influenza pandemics and not like any known coronavirus, some of which cause severe disease like SARS (severe acute respiratory syndrome).

"We realize that other expert groups have produced detailed plans for reopening the country after stay-at-home orders and other important mitigations steps are eased," said CIDRAP Director Michael Osterholm, PhD, MPH. "So with this report we sought to add key information and address issues that haven't garnered the attention they deserve—not to duplicate efforts.

"For example, the first CIDRAP Viewpoint report lays out three scenarios for how cases might ebb and flow in the coming months. We are now on virus time, and no one knows exactly how this virus will behave. But, based on what scientists have recorded so far and on previous influenza pandemics, we illustrate some of the possibilities."

Osterholm added, "The key message of this report is that the COVID-19 pandemic likely will not end any time soon, if any of the scenarios we have outlined come to pass. We need to be prepared to deal with this pandemic and its 'aftershocks' for 18 months or more."

The report is the first in a series titled "COVID-19: The CIDRAP Viewpoint" that will also cover crisis communication, testing, contact tracing, surveillance, supply chains, epidemiologic issues, and key areas for research. CIDRAP publishes CIDRAP News.
Apr 30 CIDRAP report landing page


Hydroxychloroquine linked to prolonged QT intervals in COVID-19 patients

New research in JAMA Cardiology today describe prolonged QT internals in COVID-19 patients treated with hydroxychloroquine either alone or combined with the antibiotic azithromycin. The studies are based on hospitalized patients in Lyon, France, and in Boston, and show the QT intervals lengthened in more than 90% of patients.

Hydroxychloroquine was first approved for use in the United States in 1955 as an antimalarial. The drug has anti-inflammatory properties and is widely prescribed for lupus and arthritis, but has recently been thrust in the spotlight as a potential therapeutic for COVID-19.

In the Lyon case series, 37 of 40 (93%) showed an increase in the QT interval after the administration of antiviral hydroxychloroquine therapy, which included azithromycin. The patients were hospitalized in the second half of March, and did not experience ventricular arrhythmias, including torsades de pointes, after being treated with hydroxychloroquine and azithromycin.

In Boston, scientists conducted a cohort study involving 90 patients receiving hydroxychloroquine, and 53 receiving concomitant azithromycin. "Seven patients (19%) who received hydroxychloroquine monotherapy developed prolonged QTc of 500 milliseconds or more, and 3 patients (3%) had a change in QTc [corrected QT] of 60 milliseconds or more. Of those who received concomitant azithromycin, 11 of 53 (21%) had prolonged QTc of 500 milliseconds or more and 7 of 53 (13%) had a change in QTc of 60 milliseconds or more," the authors found.

Ten of the 90 patients (11%) stopped taking hydroxychloroquine prior to day 5 of treatment for QT prolongation, the authors said.

"The data … underscore the potential risk associated with widespread use of hydroxychloroquine and the combination of hydroxycholoquine and azithromycin in ambulatory patients with known or suspected COVID-19," wrote Robert O. Bonow, MD, MS, Northwestern University Feinberg School of Medicine, and colleagues in an accompanying editorial on the studies.
May 1 JAMA Cardiol French research letter
May 1 JAMA Cardiol Boston study
May 1 JAMA Cardiol editorial


Study: 26% of US healthcare workers at risk for poor COVID-19 outcomes

A study this week in Annals of Internal Medicine shows that 26.5% of American healthcare workers are at risk for poor outcomes from COVID-19 infections because of age or medical conditions, and a sizable portion of them lack health insurance or paid sick leave.

The study was based on data collected from the 2018 National Health Interview Survey and the March 2019 Current Population Survey, both of which included frontline health workers who have patient contact in hospitals, dental and doctor offices, nursing homes, or in emergency services.

Of 13.79 million healthcare workers with patient contact, 3.66 million (95% confidence interval [CI], 3.20 million to 4.13 million), or 26.6% (95% CI, 23.6% to 29.5%), were at risk for poor COVID-19 outcomes because of age or chronic conditions, the authors found. Of those at risk, 7.5% said they lacked health insurance or paid sick leave in the past 12 months.

"Our data indicate that millions of health workers likely to be exposed to SARS–CoV-2 have medical conditions that increase their risk for poor COVID-19 outcomes," the authors concluded. "Many lack health insurance and paid sick leave, and more than 600,000 live in poverty, potentially compromising their ability to maintain social distancing outside their workplace."
Apr 28 Ann Intern Med study

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