COVID-19 research news in brief: 5th edition

From the New England Journal of Medicine

How to discover antiviral drugs quickly: “Different types of experimental laboratory screening programs have been set up all over the world and are ramping up. Meanwhile, for several SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) proteins, the virtual high-throughput screening and ensemble docking pipeline is in full production mode, both on supercomputers and with the use of vast cloud-computing resources. None of this guarantees success within any given time frame, but a combination of rationality, scientific insight, and ingenuity with the most powerful tools available will give us our best shot.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMcibr2007042

Pandemic as teacher — forcing clinicians to inhabit the experience of serious illness: “It may be that this time of great stress, when we ourselves are at risk for losing so much, does not provide the most fertile soil for cultivating a more nuanced understanding of others’ experiences. But when else are the disruptions so great that we have this clear a view of them?” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMp2015024

On becoming a plague doctor: “A quick, clear casualty of this pandemic is the intimacy of patient care. We look at each other behind masks and think, consciously or not, of the infectious contrail we each leave behind. Our clinics and wards feel hazardous, and the threat of contagion hangs over everything. I’m resigned to these realities now and trying to let go of the guilt I feel behind the mask and the gown. It is enough to be present, sharing this mortal risk with my patients. A masked face, I can now see, is better than none at all.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMp2011418

COVID-19 crisis triage — optimizing health outcomes and disability rights: “Finally, the science and epidemiology of COVID-19 (coronavirus disease 2019) are rapidly changing, and more will be learned about community acceptance of crisis triage protocols. Health care organizations should consider current triage plans provisional, subject to change based on new learning and actively solicited community input. To ensure the trustworthiness of the health system, disability rights advocates and health care leaders should work together to finalize crisis triage plans that save the most lives, protect the equal worth of all persons, and enhance communities’ capacity to heal in the wake of a once-in-a century pandemic.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMp2008300

From JAMA:

Nasal ACE2 levels and COVID-19 in children: “This emphasizes the importance of understanding the distribution of ACE2 (angiotensin-converting enzyme 2) in cells in different parts of the respiratory epithelium but also between cell-bound and plasma fractions. ACE2 is cleaved from the cell membrane on binding with SARS-CoV-2, releasing ACE2 into the plasma. The role of soluble ACE2 in neutralizing SARS-CoV-2 virus has recently been shown in vitro, but its activity in vivo is still to be determined. Ultimately, studying tissue expression of ACE2 in the lower respiratory tract of children may be helpful in understanding differences in the severity of COVID-19 among children compared with adults.” OPEN ACCESS at https://jamanetwork.com/journals/jama/fullarticle/2766522

Olfactory dysfunction in COVID-19: diagnosis and management: “COVID-19 is associated with OD (olfactory dysfunction) in many patients. This symptom should prompt self-isolation and testing for SARS-CoV-2 when possible. Active, collaborative research is required to delineate the natural history and appropriate management of chemosensory impairment in this virulent disease. In the interim, chemosensory assessment and treatments targeting postinfectious OD may be of use in COVID-19-related OD.” OPEN ACCESS at https://jamanetwork.com/journals/jama/fullarticle/2766523

Assessment of proficiency of N95 mask donning among the general public in Singapore: “These findings support ongoing recommendations against the use of N95 masks by the general public during the COVID-19 pandemic. N95 mask use by the general public may not translate into effective protection but instead provide false reassurance. Beyond N95 masks, proficiency among the general public in donning surgical masks needs to be assessed. Policy measures that encourage mask use in the general public must be coupled with effective training materials beyond instruction leaflets, which our study and a 2013 study by Harber et al found to be inadequate. Other public health measures, such as social distancing, handwashing, and self-isolation when ill, are also critical.” OPEN ACCESS at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766070

Respiratory parameters in patients with COVID-19 after using noninvasive ventilation in the prone position outside the intensive care unit: “Providing NIV (noninvasive ventilation) in the prone position to patients with COVID-19 and ARDS (acute respiratory distress syndrome) on the general wards in 1 hospital in Italy was feasible. The respiratory rate was lower and the oxygenation was higher during and after pronation than they were at baseline. Whether intubation was avoided or delayed remains to be determined.” OPEN ACCESS at https://jamanetwork.com/journals/jama/fullarticle/2766291

From the BMJ

How COVID-19 is accelerating the threat of antimicrobial resistance: “Much remains unknown about how the pandemic is directly impacting overall levels of antimicrobial resistance (AMR), but a review of data from COVID-19 cases, mostly in Asia, found that more than 70% of patients received antimicrobial treatment despite less than 10%, on average, having bacterial or fungal coinfections. The same study also found frequent use of broad spectrum antibiotics — designed to kill a wide range of bacteria — that can spur AMR through overuse. Such findings give weight to researchers’ concerns that increased antibiotic use during the pandemic could increase the long term threat of AMR.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m1983

Clinical efficacy of hydroxychloroquine in patients with COVID-19 pneumonia who require oxygen: observational comparative study using routine care data: “Hydroxychloroquine has received worldwide attention as a potential treatment for COVID-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with COVID-19 who require oxygen.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m1844

Use of all cause mortality to quantify the consequences of COVID-19 in Nembro, Lombardy: descriptive study: “The study findings show how COVID-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the COVID-19 pandemic can only be completely understood if, in addition to confirmed deaths related to COVID-19, consideration is also given to all cause mortality in a given region and time frame.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m1835

Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial: “Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate COVID-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients.” OPEN ACCESS at https://www.bmj.com/content/369/bmj.m1849

From the Lancet

Individual quarantine versus active monitoring of contacts for the mitigation of COVID-19: a modelling study: “Our model highlights the urgent need for more data on the serial interval and the extent of presymptomatic transmission to make data-driven policy decisions regarding the cost–benefit comparisons of individual quarantine versus active monitoring of contacts. To the extent that these interventions can be implemented, they can help mitigate the spread of SARS-CoV-2.” OPEN ACCESS at https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30361-3/fulltext

Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study: “Critical illness among patients hospitalised with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality.” OPEN ACCESS at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31189-2/fulltext

Vitamin-D and COVID-19: do deficient risk a poorer outcome? “Despite difficulties in comparing data across nations, mortality from COVID-19 is clearly higher in some countries than in others. Many factors could have a role in this disparity, including differences in proportion of elderly people in a population, general health, accessibility and quality of healthcare, and socioeconomic status. One mostly overlooked factor that could influence outcome of COVID-19 is the relative vitamin D status of populations. Because people are advised to stay at home as much as possible, the government health agencies of Great Britain have recommended that people take vitamin D supplements through summer and autumn during this pandemic. Vitamin D supplementation could be especially important for older people as they are at high risk of poor outcome from COVID-19 and of vitamin D deficiency.” OPEN ACCESS at https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30183-2/fulltext

Attacks against health-care personnel must stop, especially as the world fights COVID-19: “Finally, health professional associations, societies, and organisations from all specialties and disciplines should unite in speaking out forcefully against all acts of discrimination, intimidation, and violence against health-care workers. They must immediately condemn violence when it occurs and participate in initiatives aimed at responding to and eliminating violence. These actions must be taken now. By protecting health-care personnel, we protect our most valuable assets in the fight against COVID-19: doctors, nurses, emergency medical technicians, medical and respiratory technicians, laboratory workers, and many others on the front lines.” OPEN ACCESS at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31191-0/fulltext

From the MJA

New Zealand’s COVID-19 elimination strategy: “New Zealand has implemented an elimination strategy to control the COVID-19 pandemic. Compared with the mitigation and suppression approaches used in most western countries, elimination can minimise direct health effects and offers an early return to social and economic activity free from the constraints of circulating SARS-CoV-2 virus. Elimination requires highly effective border controls, contact tracing and quarantine measures, high levels of testing and surveillance, and an initial period of intense physical distancing (lockdown) to extinguish virus transmission. As with all COVID-19 strategies, the ultimate exit path will depend on development of effective vaccines and/or therapeutics.” OPEN ACCESS at https://www.mja.com.au/journal/2020/new-zealands-covid-19-elimination-strategy

Emerging viral mutants in Australia suggest RNA recombination event in the SARS-CoV-2 (COVID-19) genome: “The s2m sequence of coronaviruses is highly conserved, and spontaneous mutations in this motif were not expected to have occurred during the apparent short period of time that SARS-CoV-2 has been present, therefore it is highly likely that the changes are due to recombination. Because a high frequency of recombination events in coronaviruses occur, RNA recombination could lead to either enhance the adaptation process to its new host like human or cause unpredictable changes in virulence during infection.” OPEN ACCESS at https://www.mja.com.au/journal/2020/emerging-viral-mutants-australia-suggest-rna-recombination-event-sars-cov-2-covid-19

The National Disability Insurance Scheme and COVID-19: a collision course: “The design of the National Disability Insurance Scheme is putting thousands at risk of COVID-19.” OPEN ACCESS at https://www.mja.com.au/journal/2020/national-disability-insurance-scheme-and-covid-19-collision-course

The impact of COVID-19 pandemic on medical education: “Even prior to the COVID-19, like many other medical schools, we have been examining the ways in which we can adapt our medical program to utilise new technologies better, engage and enhance the student experience and really teach the skills that future doctors will require. These go well beyond a knowledge of basic science and include complex functional skills such as teamwork, reflective practice and adaptive problem solving. The COVID-19 pandemic required a massive and rapid change in the way we deliver medical education, particularly to the junior years of the medical program. Whilst ‘online’ learning has limitations, it is important that we springboard on the advances made during this period to continue to improve our medical programs.” OPEN ACCESS at https://www.mja.com.au/journal/2020/impact-covid-19-pandemic-medical-education