Prepared by Dr. Kate Gliske and Dr. Quyen Ngo
Download the COVID-19 Research Update #2
New evidence calls into question efficacy of Hydroxychloroquine (HCQ; Plaquenil) and Azithromycin (azm; Z-Pak) combo for patients with severe COVID-19 infections: On March 16, Gautret et al. (2020) published a preprint article containing early results from an open label trial of one of the more promising off-label uses of the antimalarial medication, Hydroxychloroquine and the antibiotic Azithromycin for the treatment of severe COVID-19 cases.
Key Takeaway #1: There is not enough evidence in controlled research trials to suggest efficacy of the medication combo of HCQ/azm in the treatment of severe cases of COVID-19. Larger randomized, controlled trials are needed to determine if this medication combination improves outcomes for this population in the future.
Key Takeaway #2: The pressure to accelerate findings that will help fight this virus is profound. The peer review process must be undertaken carefully to ensure biased or inaccurate results are not inadvertently influencing treatment and care of patients during a period of frenzied adoption of any therapies that appear to be evidence-based.
COVID-19 is significantly more contagious than SARS was, and individuals seem to be at their most contagious early on in the illness: Wölfel et al. (2020) conducted a virological analysis of nine hospitalized patients with clinically mild cases of COVID-19 in Germany to determine at what point individuals with upper-respiratory symptoms are most contagious.
Key Takeaway: COVID-19 is an extremely contagious virus, and is most contractible early on in the course of the illness. This highlights the importance of preventative tactics, such as social distancing and wearing masks, as a way to prevent the spread of the illness before people may realize they are infected.
Coronavirus infections (including COVID-19, SARS and MERS) in pregnant women found to be associated with a host of negative fetal outcomes: Di Mascio et al. (2020) conducted a systematic review and meta-analysis of coronavirus spectrum infections, pooling data from 19 small studies of outcomes for pregnant women from all three outbreaks.
Key Takeaway: Preliminary evidence based on aggregation of small case studies suggest that COVID-19, like previous coronaviruses, places pregnant women at increased risk for negative pregnancy and perinatal outcomes, including miscarriage, C-section and perinatal death. Larger datasets with additional variables are needed to better understand the full extent of the risk to pregnant mothers.
Projections of virus spread continue to improve in short-term but often only project a first wave: The Institute for Health Metrics and Evaluation (IHME), part of the University of Washington, created an interactive model (updated daily) designed to show demand for and existing capacity of hospital services on both a local and global level during the COVID-19 pandemic.
Key Takeaway: We will have to continue to fight the novel coronavirus until a vaccine becomes available, and the amount of social distancing that will be required to stop subsequent waves will depend on how well-coordinated our nationwide containment response is from this summer forward.
There have been many questions regarding the accuracy and utility of data modeling of the spread of COVID-19. Skepticism in regard to these models’ accuracy has abounded among the public because of how trajectories have changed over time. Below we explain why modeling is essential and helps officials to determine which courses of actions are most helpful at limiting the worst consequences of the pandemic.
One of our data experts modeled the rate of infection and death using the Johns Hopkins University COVID-19 dataset. Based on this data alone, trend lines forecast where cases and deaths may be in the future based on the rate of growth until the date the model was run. This helps to model if and how environmental changes (such as shelter-in-place mandates) change the course or trajectory of a forecast.
Key Takeaway: The current trajectories show the effectiveness of social distancing; however, given the contagiousness of COVID-19 and potential for rapid spread, the gains could be completely undone in a very short period of time without careful planning in the weeks ahead.
There are two primary types of tests that have been developed to detect the novel coronavirus:
The Antigen Test (Polymerise Chain Reaction; PCR): PCR tests were the first type to be developed for the novel coronavirus and represent the majority of testing being conducted in clinics and hospitals today. PCR tests directly detect the current presence of the virus in the body.
The Antibody Test (Serological Tests): Antibody tests for COVID-19 have more recently become available and test for past exposure to the virus. This is done through evidence of the antibodies that develop after an individual has been infected by a virus.
Key Takeaway: Both antigen and antibody tests will be key in stemming the pandemic. Antigen tests are crucial at point-of-care locations to more swiftly identify those infected with COVID-19. Antibody tests are critical for understanding the extent of the infection in the broader population, in helping to determine who would be safe to return to work due to established immunity and in helping to track the course of the spread of infection.
Is COVID-19 seasonal, with infections likely to ebb in the summer months?
Experts believe this is unlikely. In a rapid expert consultation published by the National Academies of Sciences, Engineering, and Medicine, the Committee on Emerging Infectious Diseases and 21st Century Health Threats addressed the potential seasonality of COVID-19.
Key Takeaway: The committee concluded that the highly infectious nature of COVID-19 in a population with no natural immunity to the virus would override any potential seasonality, suggesting cases will not decline in the summer months without continued aggressive mitigation tactics.
Download the COVID-19 Research Update #2
Di Mascio, D., Khalil, A., Saccone, G., Rizzo, G., Buca, D., Libarati, M., Vecchiet, J., Nappi, L., Scambia, G., Berghella, V., & D’Antonio, F. (2020). Outcome of Coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. Advanced online publication. https://doi.org/10.1016/j.ajogmf.2020.100107
Gautret, P., Lagier, J.-C., Parola, P., Hoang, V. T., Meddeb, L., Mailhe, M., Doudier, B., Courjon, J., Giordanengo, V., Vieira, V. E., Dupont, H. T., Honoré, S., Colson, P., Chabrière, E., La Scola, B., Rolain, J.-M., Brouqui, P., & Raoult, D. (2020). Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents. Advanced online publication. https://doi.org/10.1016/j.ijantimicag.2020.105949
Institute for Health Metrics and Evaluation. (2020). Hospital resource use [Data set]. Retrieved April 9, 2020, from http://covid19.healthdata.org/united-states-of-america
Molina, J. M., Delaugerre, C., Le Goff, J., Mela-Lima, B., Ponscarme, D., Goldwirt, L., & de Castro, N. (2020). No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Médecine et Maladies Infectieuses. Advanced online publication. https://doi.org/10.1016/j.medmal.2020.03.006
National Academies of Sciences, Engineering, and Medicine. (2020). Rapid expert consultation on SARS-CoV-2 survival in relation to temperature and humidity and potential for seasonality for the COVID-19 pandemic (April 7, 2020). https://www.nap.edu/read/25771/chapter/1
Voss, A. (2020, April 3). Statement on IJAA paper. International Society of Antimicrobial Chemotherapy. https://www.isac.world/news-and-publications/official-isac-statement
Wölfel, R., Corman, V. M., Guggemos, W., Sellmater, M., Zange, S., Müller, M. A., Niemeyer, D., Jones, T. C., Vollmar, P., Rothe, C., Hoelscher, M., Blelcker, T., Brünink, S., Schnelder, J., Ehmann, R., Zwirglmaler, K., Drosten, C., & Wendtner, C. (2020). Virological assessment of hospitalized patients with COVID-2019. Nature. Advanced online publication. https://doi.org/10.1038/s41586-020-2196-x