more_vert
From the New England Journal of Medicine
A trial of lopinavir–ritonavir in adults hospitalized with severe COVID-19: A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomisation; 99 were assigned to the lopinavir–ritonavir group, and 100 to the standard-care group. Treatment with lopinavir–ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio [HR] for clinical improvement, 1.24; 95% CI, 0.90–1.72). Mortality at 28 days was similar in the lopinavir–ritonavir group and the standard care group (19.2% v 25.0%; difference, −5.8 percentage points; 95% CI, −17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir–ritonavir led to a median time to clinical improvement that was shorter by one day than that observed with standard care (HR, 1.39; 95% CI, 1.00–1.91). Gastrointestinal adverse events were more common in the lopinavir–ritonavir group, but serious adverse events were more common in the standard care group. Lopinavir–ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. Conclusion: in hospitalised adult patients with severe COVID-19, no benefit was observed with lopinavir–ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMoa2001282
Audio interview: new research on possible treatments for COVID-19. With Dr Eric Rubin and Dr Lindsay Baden. OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMe2005759?query=featured_home
COVID-19 — the law and limits of quarantine: “Despite the breadth and allure of travel bans and mandatory quarantine, an effective response to COVID-19 requires newer, more creative legal tools. With COVID-19 in our communities, the time has come to imagine and implement public health laws that emphasize support rather than restriction.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMp2004211
SARS-CoV-2 infection among travelers returning from Wuhan, China: “Understanding the implications of transmission of SARS-CoV-2 infection from persons with asymptomatic or very mild symptomatic cases of COVID-19 is vital for the formulation of containment strategies.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMc2003100
Facing COVID-19 in Italy — ethics, logistics, and therapeutics on the epidemic’s front line: “Unifying all these principles, both ethical and pragmatic, is the recognition that only with transparency and inclusivity can public trust and cooperation be achieved. Around the world — from muzzled doctors in China, to false promises of testing capacity in the United States, to refutations of resource-rationing claims in Italy — we are seeing that denial is deadly. The point at which preparedness dissolves into panic will always be context-dependent. But the tragedy in Italy reinforces the wisdom of many public health experts: the best outcome of this pandemic would be being accused of having overprepared.” OPEN ACCESS at https://www.nejm.org/doi/full/10.1056/NEJMp2005492
From the BMJ
COVID-19: how doctors and healthcare systems are tackling coronavirus worldwide: As coronavirus continues to spread, doctors and health care systems are facing a multitude of challenges at all stages of the pandemic. OPEN ACCESS at https://www.bmj.com/content/368/bmj.m1090
COVID-19: the painful price of ignoring health inequities: “It clearly serves all of us to end to the COVID-19 pandemic quickly. But it is also time that we ensure that this pandemic does not widen the gaps between health haves and have nots. Doing so will require concerted effort towards ensuring health equity in a time of true and unique challenge for all of us.” OPEN ACCESS at https://blogs.bmj.com/bmj/2020/03/18/covid-19-the-painful-price-of-ignoring-health-inequities/
COVID-19: ibuprofen should not be used for managing symptoms, say doctors and scientists: “Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of COVID-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.” OPEN ACCESS at https://www.bmj.com/content/368/bmj.m1086
COVID-19: medical schools are urged to fast-track final year students: “UK medical schools have been urged to fast-track final year medical students into the workforce in the wake of severe disruptions to teaching programs caused by the COVID-19 outbreak.” OPEN ACCESS at https://www.bmj.com/content/368/bmj.m1064
From JAMA
Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. OPEN ACCESS at https://edhub.ama-assn.org/jn-learning/module/2763188
Supporting the health care workforce during the COVID-19 global epidemic: “Ensuring that workers feel they get adequate rest, are able to tend to critical personal needs (such as care of an older family member), and are supported both as health care professionals and as individuals will help maintain individual and team performance over the long run.” OPEN ACCESS at https://edhub.ama-assn.org/jn-learning/module/2763136
Risk factors associated with acute respiratory distress syndrome (ARDS) and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China: “In this cohort study involving 201 patients with confirmed COVID-19 pneumonia, risk factors associated with the development of ARDS and progression from ARDS to death included older age, neutrophilia, and organ and coagulation dysfunction. Treatment with methylprednisolone may be beneficial for patients who develop ARDS.” OPEN ACCESS at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184
From Nature
The coronavirus pandemic in five powerful charts: From papers published to carbon emissions to confirmed cases, these data reveal an unprecedented viral outbreak and its impacts around the world. OPEN ACCESS at https://www.nature.com/articles/d41586-020-00758-2
South Korea is reporting intimate details of COVID-19 cases: has it helped?: Extensive contact tracing has slowed viral spread, but some say publicising people’s movements raises privacy concerns. OPEN ACCESS at https://www.nature.com/articles/d41586-020-00740-y
Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19: “We propose that these immune parameters should be characterized in larger cohorts of people with COVID-19 with different disease severities to determine whether they could be used to predict disease outcome and evaluate new interventions that might minimize severity and/or to inform protective vaccine candidates.” OPEN ACCESS at https://www.nature.com/articles/s41591-020-0819-2
Elevated exhaustion levels and reduced functional diversity of T cells in peripheral blood may predict severe progression in COVID-19 patients: “Subsequent hierarchical cluster analysis showed that these immunological factors could better distinguish healthy, mild, and severe patients, independent of age and chronic ailment … In conclusion, our study identified potential immunological risk factors for COVID-19 pneumonia and provided clues for its clinical treatment.” OPEN ACCESS at https://www.nature.com/articles/s41423-020-0401-3
What’s new online at the MJA
Managing haematology and oncology patients during the COVID-19 pandemic: interim consensus guidance
Weinkove et al; preprint publication … OPEN ACCESS permanently
Pre-emptive low-cost social distancing and enhanced hygiene implemented before local COVID-19 transmission could decrease the number and severity of cases
Dalton et al; preprint publication … OPEN ACCESS permanently
Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group
Brewster et al; preprint publication … OPEN ACCESS permanently
COVID-19 precautions – easier said than done when patients are homeless
Wood et al; preprint publication … OPEN ACCESS permanently
Early clinical response to a high consequence infectious disease outbreak at the Royal Melbourne Hospital Emergency Department – insights from COVID-19
Rojek et al; preprint publication … OPEN ACCESS permanently
Loading ...
I agree with the above comments
*A trial of lopinavir–ritonavir in adults hospitalized with severe COVID-19*:
This present study design is like sending the fire department once the building has mostly burnt down. Three subjects died within 24 hours of being allocated. And they have not identified outcomes for the earliest treated group (days from commencement of any symptoms …. sometime up day 11 from original onset.)
I read another study showing definite benefit when treatment was started within 0 – 2 days, the less so at 3-5 days, of ?what? …getting *any* pneumonitis symptoms?
We would then see whether the disease does or does not progress.
Keeping them out of hospital is a key endpoint that would solve the crisis *and* pay for the treatment.
Now they have shown that this treatment does no harm, the study must be repeated using the same combination on patients prior to becoming severely ill. I’d start it on the initial CT scan findings in response to dyspnoea.
I am not in any way an expert but agree with shut down/isolation procedures immediately . Vaccination is a long way off but I believe we should be looking carefully at any drugs currently in use for other diseases which may be helpful. Deepest admiration for Prof Patterson’s trial with hydroxychloroquine. I still do not know about continuing with ACEI and ARB for hypertension and for that matter statins but I gather it is safe enough and may even be beneficial. Clearly our front line doctors and other staff to whom we owe our profound gratitude are flat out but where possible it would be important to document all drugs taken by our patients to detect any trends for or against altering the course of the viral infection. For example Doxycycline commonly used in community acquired pneumonia has some antiviral activity as to a lesser extent does Ciproxin. Perhaps there is already a system underway to monitor this . In any event it is just a thought which may prove helpful.
This poll would have been more useful if it asked for the top 3 or top 5 things – we all know that all of those things need to be done, but which ones are the most important? Also, does “flatten the curve” mean reducing transmission or reducing mortality???