COVID-19 Scan of December 15, 2020

UK trial shows no effect of azithromycin in hospital COVID-19 patients

Researchers in the UK RECOVERY trial yesterday reported that a preliminary analysis of data from the study’s azithromycin group showed that antibiotics did not affect the clinical outcome of hospitalized COVID-19 patients.

In a study of COVID-19 patients at 176 National Health Service hospitals, 2,582 patients were randomized to receive 500 milligrams of the antibiotic azithromycin once daily for routine care. It was compared to 5,182 patients who received. Patients participated in the study on average 8 days after the onset of symptoms. The main result was 28-day mortality, and the unpeer-reviewed results were published on the preprint server medRxiv.

A preliminary analysis of the data showed that 496 patients (19%) who received azithromycin and 997 patients (19%) who were assigned to regular care died within 28 days (rate). Ratio 1.00; 95% confidence interval 0.90 to 1.12; P = 0.99). The researchers also found no evidence of a risk of progression to ventilator or a beneficial effect on length of stay.

Azithromycin is one of several treatments for COVID-19 tested in the RECOVERY trial under the theory that it can reduce lung inflammation.

“Our results very clearly show that it is not an effective treatment for patients admitted with COVID-19 azithromycin,” said the study’s lead researcher and emerging infectious disease at Oxford University. Dr. Peter Hobby, MD, a professor of global health, said in a press release. “It’s a shame, but it’s still an important outcome in guiding clinical care around the world.”

The researchers concluded that azithromycin should be used in patients with COVID-19 only if antibiotics are clearly indicated.
December 14 medRxiv Research
December 14 Recovery Trial Press release

High risk of death, readmission found after admission to COVID-19

A JAMA A yesterday study of veterans admitted with COVID-19 found that the first 10 days after admission were the most dangerous for patients and that they died or were readmitted compared to similar patients who were treated for pneumonia or heart failure. We found that the risk was 40% to 60% higher.

The University of Michigan Veterans Affairs (VA) Ann Arbor Healthcare Systems research team admitted to COVID-19 and retired from 132 U.S. Department of Veterans Affairs hospitals between March 1st and July 1st, with 2,179 people. We compared the outcomes of veterans. COVID-19 Pneumonia and heart failure at the same time.

All but 5% of the patients were male and half were black. Both represent groups at high risk for severe COVID-19. Overall, 18.5% of COVID-19 patients died during hospitalization.

Researchers found that COVID-19 patients had a 43% higher risk of readmission or death during the first 10 days of discharge compared to similar patients with pneumonia other than COVID-19 (hazard ratio). [HR], 1.43; 95% confidence interval [CI], 1.09 to 1.87), 62% higher risk compared to similar patients with heart failure (HR, 1.62; 95% CI, 1.31 to 2.01). Overall, 9% of VA COVID-19 patients discharged within 60 days of discharge died and 20% required readmission (most often extremes for COVID-19 complications, sepsis, or infection). Because of the reaction).

In a University of Michigan news release, lead author Dr. John P. Donnelly said, “This study suggests that special caution is required for the first few days after discharge.”

“Unfortunately, this is even more evidence that COVID-19 is not” completed in one “,” co-author Theodore J. Iwashina, MD, said in a news release. “For many patients, COVID-19 seems to cause a series of problems that are as serious as those found in other illnesses, but our medical response is too low and there are too few studies. It is designed to help these patients. Continue for days, weeks, or even months to recover from COVID-19. “

The authors of the study advocate better discharge planning design, communication, and post-hospital care.
December 14th JAMA Research
December 14 University of Michigan news release

Low risk of severe COVID-19 attracting attention to young children

French study in Pediatrics Today, we report a low risk of severe COVID-19 in children younger than 3 months and point to low blood oxygen levels and high levels of inflammatory proteins as reliable predictors of severe disease in children. doing.

Researchers conducted surveillance studies in 60 hospitals, or 38.5% of French children admitted with SARS-CoV-2. They identified 397 infected children who were hospitalized between February 15th and June 1st. These include 385 children confirmed to be infected by reverse transcription-polymerase chain reaction (RT-PCR) and 12 children diagnosed with characteristic chest CT scan lesions. Severe illness was defined as the need for ventilation or hemodynamic support. This is an effort to restore blood volume and blood flow to improve oxygen supply.

In this study, infants younger than 3 months were the main group requiring hospitalization (37% of all cases), but only 3% had severe illness. Almost all of these babies (92%) showed fever, and the authors stated that hospitalization was a precautionary measure against the potential bacterial infection of most babies.

“Using rapid bedside testing to identify SARS-CoV-2 will help improve the care of these children in the pediatric emergency department,” the authors write.

Only 11% of all children suffer from serious illness (except for children with multi-organ inflammation syndrome (severe COVID-19 complications) and children hospitalized for reasons unrelated to SARS-CoV-2 ( 23 out of 306), 6 of whom died. Twenty-nine percent of the children in this study had comorbidities such as weakened immune system, chronic respiratory disease, and heart disease, but these were not associated with serious illness.

“Our findings suggest that the incidence of severe forms is lowest in very young children and highest in children over 10 years of age,” the author writes.

In addition to ages over 10 (odds ratio) [OR], 3.4; 95% confidence interval [CI], 1.1 to 10.3), another independent risk factor was low blood oxygen at admission (OR, 8.9; 95% CI, 2.6 to 29.7; P = 0.0004) and elevated levels of inflammatory marker C-reactive protein (OR, 6.6; 95% CI, 1.4-27.5; P = 0.012). The authors suggest that monitoring these clinical markers may help identify children at high risk of increased monitoring and support.
December 15th Pediatrics Research