COVID-19 Scan for Sep 15, 2020

Convalescent plasma for COVID-19
Pandemic loneliness in older adults

Small study finds benefit from convalescent plasma in severe COVID-19

Preliminary data from a small study published today in Nature Medicine suggests convalescent plasma may have some efficacy in patients with severe COVID-19.

The retrospective, propensity score-matched case-control study involved 39 patients who received convalescent plasma for severe or life-threatening COVID-19 at Mount Sinai Hospital in New York from Mar 20 to Apr 20. The patients, who were an average age of 55 and had few baseline comorbidities other than obesity (mean mass body index, 31.7), received convalescent plasma under compassionate use guidelines an average of 4 days after admission. For the analysis, they were matched 1:4 to 156 control patients admitted during the same period.

Convalescent plasma recipients and control patients were 100% matched on supplemental oxygen requirements on day 0, but by day 14 after transfusion, oxygen requirements had worsened in 17.9% of convalescent plasma patients, compared with 28.2% of the control patients (adjusted odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75 to 0.98; chi-square test P value = 0.025). At the end of the study, 12.8% of the convalescent plasma patients and 24.4% of the control patients had died. Following adjustment for the duration of symptoms before admission and exposure to therapeutic anti-coagulation and broad-spectrum antibiotics, the analysis showed significant survival benefit for convalescent plasma (adjusted hazard ratio, 0.34; 95% CI, 0.13 to 0.89; chi-square test P = 0.027).

No serious adverse events were judged to be caused by convalescent plasma transfusion. The authors say larger, randomized studies are needed to confirm the findings.

"This initial assessment offers evidence in support of convalescent plasma transfusion as an effective intervention in COVID-19," they write. "Preliminary data suggest a mortality benefit, but greater numbers and a randomized trial design are needed to draw definitive conclusions about the efficacy of convalescent plasma for the treatment of COVID-19."

Convalescent plasma was granted emergency use authorization by the Food and Drug Administration in August, but critics, including an expert panel gathered by the National Institutes of Health, say there are insufficient data to recommend for or against the use of convalescent plasma for COVID-19 treatment.
Sep 15 Nat Med study


Loneliness, isolation doubled among older adults early in pandemic

Twice as many older adults—who are at high risk for serious COVID-19 outcomes—reported feeling lonely and isolated in the first months of the pandemic than in 2018, a new University of Michigan poll shows.

The university's National Poll on Healthy Aging team asked a national sample of more than 2,000 adults aged 50 to 80 about changes in loneliness and the number of social interactions outside of their household from March to June. Chronic loneliness is associated with declines in memory, physical and mental health, and longevity.

After comparing the results with those of a similar poll from October 2018, the team found that 56% of respondents reported feeling isolated, versus 26% in the earlier poll. Forty-six percent said they had social interactions once a week or less, up from 28% in 2018, and 41% felt a lack of companionship, compared with 34% in 2018.

The 46% of respondents who said they had contact with people in their neighborhood once a week or more were less likely than others to report feeling lonely. Technology also helped foster a sense of connection, with 59% of participants logging on to social media and 31% using video chat once a week or more.

Participants who reported loneliness were less likely to engage in healthy behaviors than the 75% who reported spending time in nature and the 62% who said they exercised several times a week.

Poll director Preeti Malani, MD, said in a news release that the difference in responses between the 2 years is remarkable. "The use of technology to bridge the gap, and the importance of keeping up healthy routines like exercise, sleep, a balanced diet and getting outside, will no doubt continue to be important in the months ahead," she said.

Poll team member John Piette, PhD, said in the release that the findings show the importance of paying attention to how society supports the social and emotional needs of older adults. "The intersection of loneliness and health still needs much study, but even as we gather new evidence, all of us can take time to reach out to older neighbors, friends and relatives in safe ways as they try to avoid the coronavirus," he said.
Sep 14 University of Michigan Poll results and news release

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