U.S. Department of Health & Human Services

10/20/2020 | Press release | Distributed by Public on 10/20/2020 17:51

COVID-19 Science Update released: October 20, 2020

Clinical Treatment & Management

PEER-REVIEWED

Characteristics of hospitalized children with SARS-CoV-2 in the New York City metropolitan area.external icon Verma et al. Hospital Pediatrics (October 1, 2020).

Key findings:

  • 28% of children were admitted to the critical care unit.
  • 70% of children with comorbidities required critical care vs 37% of those without comorbidities (p = 0.008).
    • Obesity was the most common factor associated with critical care, 63% of obese vs 28% of non-obese children (p = 0.02).
    • 43% of children presenting with renal dysfunction vs 10% without renal dysfunction required critical care (p = 0.002).
  • A greater proportion of children with asthma, 28%, than those without, 8% (p = 0.002) received any respiratory support, with no difference in need for critical care (p = 0.26).

Methods: Multicenter retrospective cohort study of 82 children hospitalized with COVID-19 between March 1, and May 10, 2020. Analyses compared patients based on admission to acute or critical care units and need for any respiratory support. Limitations: Small sample size; subjects from a single locality; observational study.

Implications: Like clinical course in adults, comorbidities in children hospitalized for COVID-19 increased acuity. Attention to comorbidities in children hospitalized for COVID-19 is warranted.

Gaining back what is lost: Recovering the sense of smell in mild to moderate patients after COVID-19.external icon Iannuzzi et al. Chemical Senses (October 9, 2020).

Key findings:

  • At baseline, 10% of patients were anosmic (loss of sense of smell) and more than 50% were hyposmic (decreased sense of smell).
  • On follow-up, olfactory deficits improved in most patients (Figure).
    • Olfactory threshold (lowest concentration of an odor that could be detected) improved almost 2-fold, with less improvement in odor discrimination (ability to detect differences between odors).
    • No improvement was observed in odor identification (ability to correctly identify an odor).
    • By two months after symptom onset, there was a decrease in the number of hyposmic patients (53.3% to 6.7%), and an increase in normosmic patients (36.7% to 73.3%).
    • No patients remained anosmic.

Methods: Adults hospitalized with mild to moderate COVID-19 (n = 30) between April and May, 2020 were evaluated with a quantitative olfactory test during hospitalization and approximately two months after symptom onset. Repeated measures ANOVA was used to calculate differences. Limitations: Small sample size; no explanations for figures in the article are given.

Implications: Findings indicate that many patients, with olfactory deficits due to SARS-CoV-2 infection, re-gain their sense of smell within a couple of months of symptom onset.

Figure:

Note: From Iannuzzi et al. Results of olfactory testing during and after COVID-19. TDI, a composite of the olfactory threshold (T), odor discrimination (D) and odor identification (I) score. Anosmia defined as (TDI ≤16.5), hyposmia (16.5< TDI <30.5) and normal ability to smell (TDI ≥30.5). No explanations for figures in the article are given. Permission request in process.

Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry.external icon Siegler et al. Journal of Stroke (September 30, 2020).

Key findings:

  • Incidence of cerebrovascular events (CVE) was 1.13% or 1,130 per 100,000 (95% CI 970-1,320 per 100,000).
    • Incidence of acute ischemic stroke (1.08%) was greater than either intracranial hemorrhage (0.19%) or cortical vein and/or sinus thrombosis (0.02%).
  • In-hospital mortality for stroke and intracranial hemorrhage was 38.1% and 58.3%, respectively.
  • Median time from onset of CVE to death was ~4 days in persons with acute ischemic stroke or intracranial hemorrhage.

Methods: Multinational observational cohort study of 14,483 patients with laboratory-confirmed SARS-CoV-2 infection and hospitalization between February 1 and June 16, 2020. CVE incidence of and mortality were determined.Limitations: Analysis limited to patients from large referral hospitals which may have biased toward more severe cases; no comparisons made to COVID-19 inpatients without CVE or to general population.

Implications: Although CVE are uncommon in patients with COVID-19, they have a high associated mortality indicating that these patients require early diagnosis and intervention to improve survival.

PREPRINT (NOT PEER-REVIEWED)

Repurposed antiviral drugs for COVID-19-interim WHO SOLIDARITY trial resultsexternal icon . WHO Solidarity trial consortium. MedRxiv (October 15, 2020).

Key findings:

  • Overall 28-day mortality was 12%; 39% if ventilated at randomization, 10% otherwise.
  • The risk of death for each drug vs standard of care was (Figure):
    • Remdesivir (rate ratio [RR] = 0.95, 95% CI 0.81-1.11, p = 0.50).
    • Hydroxychloroquine (RR = 1.19, 95% CI 0.89-1.59, p = 0.23).
    • Lopinavir plus ritonavir (RR = 1.00, 95% CI 0.79-1.25, p = 0.97).
    • Interferon (RR = 1.16, 95% CI 0.96-1.39, p = 0.11).
  • Hydroxychloroquine and lopinavir were discontinued for futility (unlikely to show a benefit).
  • No drug reduced initiation of ventilation or hospitalization duration.

Methods: Open-label randomized control trial comparing drug treatment, for adults hospitalized for COVID-19, to local standard of care, in 30 countries. Patients were randomized to remdesivir (n = 2,750), hydroxycholoroquine (n = 954), lopinavir plus ritonavir (n = 1,411), interferon plus lopinavir (n = 651), interferon only (1,412) or local standard of care (n = 4,088). Trial was adaptive; unpromising drugs could be dropped. Primary study outcome was 28-day mortality. These interim study results are for the original four drugs. Limitations: Differences in local standard of care not evaluated.

Implications: Although the Adaptive COVID-19 Treatment Trial external icon indicates that remdesivir reduces time to recovery, in this larger trial there were no differences in time to hospital discharge or in mortality. An editorialexternal icon discusses these disparate results. Findings from this trial are consistent with results from the larger RECOVERY trial for hydoxycholoroquineexternal icon , and lopinavir plus ritonavirexternal icon . Taken together, the benefit of remdesivir is unclear. However, it appears none of the other potential drugs studied here for COVID-19 treatment have significant effect on mortality.

Figure:

Note: Adapted from WHO Solidarity trial consortium. In-hospital mortality of each drug tested. The inset shows the same data on an expanded y-axis. Permission request in process.