Continuing dexamethasone after COVID hospital release shows no benefit
Continuing the corticosteroid dexamethasone after hospital release didn't benefit COVID-19 patients who didn't complete the 10-day drug regimen during their stay, finds a study published yesterday in JAMA Network Open.
Kaiser Permanente Southern California researchers studied the continuing use of dexamethasone at a dosage of 6 milligrams (mg) per day after hospital release in 1,164 adult COVID-19 patients who were released from 1 of 15 hospitals from May 1 to Sep 30, 2020.
Among the 1,164 patients, 59.5% continued dexamethasone after hospital release. Median patient age was 55 years, 70.6% were Hispanic, 57.9% were men, and 90.0% needed supplemental oxygen during hospitalization.
The rate of hospital readmission or death within 14 days of release was 9.1% in patients who continued dexamethasone, compared with 11.4% among patients who didn't, but the difference wasn't statistically significant.
The adjusted odds ratio (OR) for readmission or death within 14 days was 0.87 (95% confidence interval [CI], 0.58 to 1.30) for patients who continued dexamethasone, compared with those who did not. A sensitivity analysis that limited the treatment group to those given exactly 10 days of dexamethasone showed comparable results (OR, 0.89; 95% CI, 0.55 to 1.43).
A subgroup analysis stratified by length of dexamethasone therapy in the hospital also yielded similar findings (1 to 3 days: OR, 0.71; 4 to 9 days: OR, 1.01), oxygen requirement at release (room air: OR, 0.91; supplemental oxygen use: OR, 0.76), and illness duration at release (10 days or less: OR, 0.81; more than 10 days: OR, 0.94).
The study authors noted that corticosteroids like dexamethasone were the first type of medication to show a survival benefit in severely ill COVID-19 patients and are now a mainstay of hospital treatment. Because early readmissions after hospital release are largely due to respiratory causes that probably reflect illness progression, the authors had theorized that continuing corticosteroids could reduce these outcomes.
"Continuing treatment with dexamethasone, 6 mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality," the researchers wrote. "This finding suggests that dexamethasone should not be routinely prescribed beyond discharge."
Mar 8 JAMA Netw Open study
Pangolins in Vietnam found to have SARS-CoV-2–related coronavirus
A study today in Frontiers in Public Health confirms that pangolins confiscated from the illegal wildlife trade in Vietnam harbored coronaviruses related to SARS-CoV-2, something previously detected only in China.
The study offers further evidence that the wildlife trade can add to coronavirus transmission.
"This study confirms the presence of coronaviruses in the SARS-CoV family in trafficked pangolins in Vietnam. Eliminating the trade in pangolins and other wild mammals and birds will eliminate this high-risk pathway for viral spillover and pathogen emergence," said the study's lead author, Nguyen Thi Thanh Nga of the Wildlife Conservation Society (WCS), in a WCS press release.
To conduct the study, researchers at the WCS and elsewhere in Vietnam and the United States tested specimens from 246 pangolins confiscated in Vietnam from 2015 to 2018. Seven of those animals from a group of 15 confiscated tested positive for a SARS-CoV-2–related coronavirus.
From 2016 to 2020, law enforcement officials carried out 91 independent pangolin confiscations in 23 Vietnamese provinces and the cities of Ha Noi and Ho Chi Minh, the authors said. Pangolins have been discussed as possible "bridge species" for the jump of SARS-CoV-2 from animals to humans.
Mar 9 Front Public Health study
Mar 9 WCS press release