Trial data show hydroxychloroquine doesn't help hospitalized COVID patients

Data released today from a randomized controlled trial evaluating the use of hydroxychloroquine in hospitalized COVID-19 patients show that the antimalaria drug was not associated with reductions in 28-day mortality but was linked with increased time in the hospital and an increased risk of progressing to mechanical ventilation or death.

The interim results from the RECOVERY trial, which is evaluating several treatments in hospitalized COVID-19 patients in the United Kingdom, appeared today on the preprint server medRxiv and have not yet been peer reviewed.

The results show that, among 1,561 patients randomly allocated hydroxychloroquine, 26.8% (418 patients) died within 28 days, compared with 25% (788) of 3,155 patients who received usual care (rate ratio, 1.09; 95% confidence interval [CI], 0.96 to 1.23; P = 0.18). Consistent results were seen in all pre-specified subgroups of patients.

Allocation to the hydroxychloroquine arm was also associated with a longer time until discharge from the hospital (median 16 days vs 13 days) and a lower probability of being discharged from the hospital within 28 days (60.3% vs 62.8%; rate ratio, 0.92; 95% CI, 0.85 to 0.99). Among those patients who were not on mechanical ventilation at baseline, patients in the hydroxychloroquine arm were more likely to reach the composite end point of mechanical ventilation or death (29.8% vs 26.5%; risk ratio, 1.12; 95% CI, 1.01 to 1.25). There was no significant difference between the two groups in the occurrence of major heart arrythmia.

"Although preliminary, these results indicate that hydroxychloroquine is not an effective treatment for patients hospitalized with COVID-19," RECOVERY trial chief investigators Peter Hornby, MD, PhD, and Martin Landray, PhD, wrote.

Enrollment in the hydroxychloroquine arm of the trial was halted on Jun 5 after Hornby, Landray, and the trial steering committee reviewed the data and concluded that the drug demonstrated no beneficial effect in hospitalized patients.
Jul 15 medRxiv study

Report details common underlying diseases, costs of US COVID patients

Chronic kidney disease and kidney failure were the most common underlying conditions in hospitalized COVID-19 patients across the United States from January to March, according to a new Fair Health report.

The nonprofit's study found that patients with these diseases made up 13% of all hospitalized COVID-19 patients during that period. Type 2 diabetes was the second most-common predisposing disease in all but the southern region, where high blood pressure was more common than type 2 diabetes.

Using the nation's largest repository of private health insurance claims, the researchers showed that the median cost of COVID-19 hospitalizations ranged from $34,662 for patients 23 to 30 years old to $45,683 for those 51 to 60. Estimated median in-network costs for patients older than 70 years was $17,094, rising to $24,012 for those aged 51 to 60.

Nationally, 33% of coronavirus patients first visited a doctor's office, while 23% went directly to a hospital. People 61 and older tended to go directly to a hospital. In the Northeast, however, patients were slightly more likely to be diagnosed with COVID-19 via telehealth than in an emergency department.

Males tended to have a larger share of COVID-19 claims than females (54% vs 46%), according to the report. And people aged 51 to 60 accounted for 30% of claims with this diagnosis, while pediatric patients made up only 2%. But the authors pointed out that the age distribution of COVID-19 patients may be changing, with the age of new US coronavirus patients having fallen by roughly 15 years over the last few months.

Patients 19 to 40 years made up larger proportions of coronavirus claims in Southern, Midwestern, and Western states than in the rest of the nation.

Robin Gelburd, JD, Fair Health president, said in a press release that the statistics should be useful for "determining risk factors, influencing treatment protocols, setting priorities for eventual vaccination distribution, inspiring further research, and planning and budgeting for use of healthcare resources."
Jul 14 Fair Health brief and press release

Universal COVID testing of nursing home residents finds many undiagnosed infections

Universal COVID-19 testing at 11 Maryland long-term care facilities increased total detected cases from 153 to 507, 281 (55%) of them asymptomatic, according to a researcher letter by Johns Hopkins University investigators published yesterday in JAMA Internal Medicine.

The homes had previously conducted testing of only symptomatic residents, which had identified 153 positive coronavirus cases within 20 days after detection of the first case.

Of 893 residents universally tested, 354 (40%) tested positive for COVID-19. Two-week follow-up data from 426 residents showed that 177 were positive for coronavirus, and 249 were negative, at seven facilities.

Of the 177 cases identified with universal testing, 154 (87%) had no symptoms. Of those who tested positive and were asymptomatic at testing, 20 (13%) were hospitalized, and 7 (5%) died within 14 days after testing.

Of the 23 residents who tested positive and had symptoms at testing, 4 (17%) were hospitalized, and 2 (9%) died within 14 days after testing.

The authors noted the Centers for Disease Control and Prevention had advised testing only nursing home residents and staff with typical coronavirus symptoms early in the pandemic, but widespread outbreaks and high death rates in those facilities still occurred. Since then, the agency has begun recommending universal testing at nursing homes with COVID outbreaks in residents or healthcare providers.

While the Centers for Medicare & Medicaid Services has reported a case-fatality rate in nursing home residents of roughly 33%, the current study found a much lower short-term death rate in universally tested residents, "suggesting that true COVID-associated mortality rates in long-term care facilities may be reduced through broader testing and case identification," the authors said.

They added that symptom-based testing alone in long-term care facilities, which have emerged as hot spots of coronavirus infection and death, "is not adequate to assess case burden and inform outbreak-control efforts in these settings," the authors wrote. "Additional testing resources are urgently needed to identify the true burden of COVID-19 and curb transmission in long-term care settings."
Jul 14 JAMA Intern Med research letter