Steroid cuts deaths in COVID-19 patients with severe respiratory illness
Unpublished data from a large randomized controlled trial in the United Kingdom indicate that dexamethasone, a cheap, widely available steroid, reduces deaths in hospitalized COVID-19 patients requiring respiratory support.
In a news release today, investigators with the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial said that, when compared with usual care, 6 milligrams of dexamethasone administered once per day for 10 days reduced deaths by one-third in ventilated COVID-19 patients (rate ratio [RR], 0.65; 95% confidence interval [CI], 0.48 to 0.88; P = 0.0003) and by one fifth in patients receiving oxygen (RR, 0.80; 95% CI, 0.67 to 0.96; P = 0.0021). No benefit was found in patients who did not require respiratory support (RR, 1.22; 95% CI, 0.86 to 1.75; P = 0.14).
In the trial, 2,104 patients were randomized to receive dexamethasone and were compared with 4,321 patients who received usual care. Among the patients who received usual care, mortality was 41% in those who required ventilation, and 25% in those who required oxygen.
"Dexamethasone is the first drug to be shown to improve survival in COVID-19," said Peter Hornby, MD, PhD, a professor of emerging infectious diseases at the University of Oxford and a lead investigator in the trial. "This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients."
"This is a very positive finding and it's a robust finding," former US Food and Drug Administration Commissioner Scott Gottlieb, MD, said this morning on CNBC's Squawk Box, in response to the news. "I think it needs to be validated, but it certainly suggests this could be beneficial in this setting."
But former Centers for Disease Control and Prevention Director Tom Frieden, MD, sounded a note of caution. "Need to see the data. Other studies have not found this," Frieden said on Twitter.
The investigators say they are working to publish the full details of the trial as soon as possible.
Jun 16 RECOVERY trial news release
Study: Newborns of moms with COVID-19 at low risk for infection
A meta-analysis published late last week in BJOG has found that transmission of COVID-19 from mother to baby during pregnancy is uncommon and that newborns are no more likely to become infected when they are born vaginally, breastfed, or allowed contact with the mother.
Researchers in the United Kingdom, Canada, and Australia conducting a systematic review of 49 studies involving 666 newborns and 655 mothers from September 2019 to June 2020 found that 28 newborns (4%) tested positive for COVID-19. Of the 28 infected infants, 7 were breastfed, 3 were fed formula, and 1 received expressed breast milk; feeding method was not reported for the remaining 17.
Only 8 of 292 women (2.7%) who delivered their babies vaginally had a baby who tested positive for the novel coronavirus, and only 20 of 364 women (5.3%) who had a cesarean delivery had a baby infected with COVID-19. Most babies who tested positive had no symptoms.
The authors noted that their findings conflict with those of early reports recommending cesarean delivery, separation of the mother and infant at birth, and formula feeding. And the data support the notion that, with proper hygiene, the benefits of infant-mother contact outweigh the potential benefits of isolation, they added.
Coauthor Jeannette Comeau, MD, MSc, of Dalhousie University in Halifax, Nova Scotia, said in a University of Nottingham press release, "I am happy to see that the data continues to be reassuring, supporting keeping the mother/infant pair together after birth, underlining that while occasional postnatal infant infection is detected, clinical course tends to be mild. From the cases of infection in the newborn we do not have confirmatory evidence that this infection was acquired in the womb or during birth."
Jun 12 BJOG abstract
Jun 15 University of Nottingham press release
Household contacts biggest COVID threat to hospital staff, research finds
Providing direct patient care or working on a COVID-19 unit didn't increase the likelihood of workers at a Belgian tertiary care hospital having evidence of previous infection on antibody testing, but living with someone with suspected infection did, according to a research letter published yesterday in JAMA.
All workers at Hospital East-Limburg in Genk, Belgium, were offered serologic antibody testing to determine if they had been infected with the novel coronavirus. Of 3,056 tested, 197 (6.4%) had IgG antibodies against SARS-CoV-2, the virus that causes COVID-19; IgM results were excluded because of poor test specificity and sensitivity for those antibodies.
While providing care to COVID-19 patients, working during the lockdown phase, or being exposed to infected coworkers was not significantly associated with the presence of antibodies, having a household exposure was (81 of 593 [13.7%] of those with household exposure vs. 116 of 2,435 [4.8%] with no household exposure).
Of all staff members, 2,294 of 3,052 (75%) reported having one or more symptoms, while 30 of 197 (15%) of those with antibodies against the coronavirus said they had no symptoms.
An inability to smell, as well as fever and cough, were associated with the presence of antibodies.
The authors say that the relatively low prevalence of serum antibodies in hospital workers without household exposures could be attributed to the wide availability of personal protective equipment, strict infection-control measures, polymerase chain reaction screening of symptomatic workers, contact tracing, and quarantine.
"Quick screening of large cohorts is important to control the pandemic," they wrote. "Hospital-wide antibody screening for SARS-CoV-2 can help monitor transmission dynamics and evaluate infection control policies."
Jun 15 JAMA research letter