COVID-19 research round-up: May

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This month’s most popular COVID-19 research articles include a number of studies investigating the much-debated drug hydroxychloroquine, along with a remdesivir study, the first Phase I vaccine clinical trial and an exploration of the burden that the pandemic is likely to have on the healthcare system in the long run.

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Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis
Mehra et al., 2020 – Lancet

Despite a current lack of conclusive evidence of their benefit, hydroxychloroquine and chloroquine are being widely used for the treatment of COVID-19. A study using data from 671 hospitals in six continents analyzed the use of these two malaria drugs, with or without a macrolide, to treat COVID-19. The researchers were unable to confirm a benefit of either drugs, when used alone or with a macrolide, on hospital outcomes for this disease. In fact, each of these treatment regimens were associated with decreased in-hospital survival.

Observational study of hydroxychloroquine in hospitalized patients with COVID-19
Geleris et al., 2020 – N. Engl. J. Med.

A similar yet more localized, observational study taking place at a large medical center in New York City (USA) examined the association between hydroxychloroquine use and intubation or death in patients with COVID-19. They observed that hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the intubation or death in these patient, and call for randomized, controlled trials of this treatment.

The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application
Lauer et al., 2020 – Ann. Intern. Med.

The incubation period of COVID-19 has important implications for surveillance and control measures. Researchers conducted a pooled analysis of confirmed COVID-19 cases reported between 4 January and 24 February, including dates and times of possible exposure, symptom onset, fever onset and hospitalization. Their results demonstrated a median incubation period of approximately 5 days for those with the virus and supported the currently recommended length of quarantine.

High COVID-19 attack rate among attendees at events at a church – Arkansas, March 2020
James et al., 2020 – Mortal. Wkly. Rep.

It is already well-established that large gatherings pose a risk for SARS-CoV-2 transmission. An investigation into the spread of SARS-CoV-2 in a church community allowed researchers to gauge the transmission rate of the virus in a pre-lockdown scenario. Among 92 church attendees during 6–11 March, 38% contracted the virus, with an additional 26 cases linked to the church occurring in the wider community. The results of the study emphasize the need for faith-based organizations to work with local health officials when considering the modification of activities during the COVID-19 pandemic. 

A trial of lopinavir–ritonavir in adults hospitalized with severe COVID-19
Cao et al., 2020 – N. Engl. J. Med.

A randomized, controlled trial investigating the efficacy and safety of lopinavir-ritonavir treatment enrolled 199 patients to receive either lopinavir-ritonavir in addition to standard care, or standard care alone. The researchers observed that there was no benefit associated with lopinavir-ritonavir treatment beyond standard care.

Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France
Million et al., 2020 – Travel Med. Infect. Di.

A retrospective study of COVID-19 patients following a regimen of hydroxychloroquine and azithromycin revealed good clinical outcome and virological cure in more than 90% of patients. The researchers concluded that this combination therapy is safe and associated with a low fatality rate in patients who are treated before serious COVID-19 complications.

Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state
Rosenberg et al., 2020 – JAMA

A similar study, this time taking place in New York (USA) examined the efficacy of the drug, with or without azithromycin. The authors revealed that treatment with either drug, or in combination, was not associated with significantly lower in-hospital mortality, calling for further study into their use and outcomes related to dose and timing of administration. 

Remdesivir for the treatment of COVID-19 – preliminary report
Beigel et al., 2020 – N. Engl. J. Med.

Gilead’s (CA, USA) remdesivir is another drug to have been found in the media spotlight of late. A trial investigating its use enrolled 1063 COVID-19 patients to receive either remdesivir or a placebo, in order to determine whether the treatment improves recovery time. Upon analyzing the outcomes of the participants, the researchers observed that remdesivir does indeed reduce recovery time for COVID-19 patients, with those receiving the drug recovering after 11 days on average, compared with those taking the placebo, who had a median recovery time of 15 days.

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Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial
Zhu et al., 2020 – Lancet

In light of the urgent need for an effective vaccine against COVID-19, researchers in Wuhan (China) conducted a Phase I trial of CanSino’s (Tianjin, China) Ad5 COVID-19 vaccine candidate expressing the spike protein of SARS-CoV-2. The study recruited 108 participants to receive one of three different doses of the vaccine, and assessed its safety over 28 days. Researchers observed a peak in neutralizing antibodies at 28 days post-vaccination and call for further investigation of this promising candidate.

Fair allocation of scarce medical resources in the time of COVID-19
Emanuel et al., 2020 – N. Engl. J. Med.

Although the ultimate course and impact of COVID-19 are uncertain, there is reasonable evidence and forethought to suggest that the repercussions of the disease are likely to overwhelm healthcare infrastructure. An article published in the New England Journal of Medicine expounds the broader implications of the COVID-19 pandemic on the healthcare system, delving into impact modelling, health system capacity and the ethics behind the rationing of health resources.

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