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August 31 | Daily COVID-19 LST Report

· Smoking Is Associated With COVID-19 Progression: A Meta-analysis: Authors affiliated with University of California, San Francisco and Mahidol University conducted a meta-analysis (n= 19 studies between January 1 and April 28, 2020 from China, U.S., and Korea) of 11,590 total patients with COVID-19 and found that 731 of these patients reported a history of smoking. Of these 731 patients, 29.8% (n=218) were found to have progression of their COVID-19, while only 17.6% of non-smokers were noted to have disease progression. Additionally, a significant relationship between smoking and COVID-19 progression was observed (OR: 1.91, 95% Cl: 1.42-2.59, p = 0.001;). The authors support smoking cessation as a reasonable practice during this time, although further investigation is needed on COVID-19 progression in current versus former smokers to support the claim that smoking cessation can stunt the pandemic.



· Household Composition May Explain COVID-19 Racial/Ethnic Disparities: A summary of a study by the Agency for Healthcare Research and Quality (U.S.), written by JAMA scientific news writer Rita Rubin, MA, explains that the higher observed death rates from COVID-19 in Black and Hispanic patients compared to White patients may be due to differences in exposure to the virus from work. A simple analysis of risk factors (e.g. age and preexisting conditions) does not explain the ethnic/racial disparities in COVID-19 death rates, but it may be explained by the fact that Black and Hispanic individuals are more frequently employed in a job where in-person essential work is required compared to White individuals. This suggests that amount of viral exposure may be linked to differential death rates among ethnic/racial groups.


Management

· Marked factor V activity elevation in severe COVID-19 is associated with venous thromboembolism: Pathologists from the Massachusetts General Hospital conducted a prospective cohort study of 102 patients with severe COVID-19 in March through April 2020, showing elevated Factor V activity at unprecedented levels in the hospital's history (median 150 IU/dL with 16% of values above 200 IU/dL), which was associated with thromboembolitic complications (Figure 1). The authors suggest Factor V levels may serve as an important diagnostic and prognostic marker for COVID-19, and recommend further investigation of increased anticoagulation doses for prophylaxis in patients with severe COVID-19 and markedly elevated Factor V activity.

· Heart Failure In Covid-19 Patients: Prevalence, Incidence And Prognostic Implications: Researchers within the departments of cardiology, clinical analytics, and pharmacy at the Hospital Universitario La Paz, Spain performed a single-center, retrospective study on 3,080 COVID-19-positive patients (with a 30-day or more follow-up) and heart failure. Based on this study's findings (illustrated below), the authors suggest maintaining heart failure guideline directed medical therapy (GDMT) when possible or re-instituting these regimens at discharge.

Adjusting Practice During COVID-19

· A Novel Non-contact Self-Injection-Locked Radar for Vital Sign Sensing and Body Movement Monitoring in COVID-19 Isolation Ward: A case series of two patients with COVID-19 in hospital isolation, conducted at Kaohsiung Medical University Hospital in Taiwan, investigated the accuracy of patient vitals collected by a novel contactless device, a non-contact self-injection-locked radar (Figure 1), compared to a nurse's vital sign testing. Over the course of patient isolation (13 days and 5 days), the patients' temperatures and heart rates were insignificantly different between the device's and nurse's measurements. This novel device needs to be tested on a larger sample size to prove its effectiveness and may need to record other vitals to be useful, but the use of a contactless way of recording vitals will be of high utility in the future due to ability to monitor infectious patients from a distance.

R&D: Diagnosis & Treatments

· Hydroxychloroquine for treatment of non-severe COVID-19 patients; systematic review and meta-analysis of controlled clinical trials: Researchers in Biostatistics, Human Data Science, and Neuropsychiatry located in Egypt performed a meta-analysis of clinical trials of hydroxychloroquine for patients with COVID-19 between June up to July-18, 2020. Their findings were (Figure 4): • Progression of disease (within 28 days) between the two groups (those treated with hydroxychloroquine and those not treated) was not statistically significant, with risk difference (RD) -0.00 (-0.04 to 0.04) • Mortality at five days was not statistically significant, with RD 0.01 (-0.01 to 0.03). • Mortality at 28 days was not statistically significant, with RD 0.00 (-0.01 to 0.01). • Radiological progression gauged by CT scan was statistically significant with RD of -0.2 (-0.36 to -0.03). • Viral clearance as measured via pharyngeal swab showed no statistically significant differences between the groups with RD of 0.04 (-0.1 to 0.18). These findings show that the use of hydroxychloroquine has no additional clinical benefit that would outweigh the risk profile of this drug and has little viral clearance.

· Large Simple Double-Blind Randomized Trials for the Rapid Assessment of the Effectiveness of COVID-19 Vaccines: An ethicist affiliated with the Institute for Medical Information Processing, Biometry, and Epidemiology at the University of Munich in Germany responds to the human challenge study by Eyal et al (2020) to accelerate coronavirus vaccine licensure. The author raises concerns about inherent sampling bias and ethical issues of the proposed challenge trials for COVID-19, citing the study design's need for young, healthy participants without definitive knowledge of risk factors for severe or fatal complications of COVID-19 and the lack of an effective and safe treatment to avoid any adverse consequence. The author instead proposes the large, simple, randomized trial (LSRT) as an alternative to the challenge trial because the LSRT allows for a wide eligibility criteria with large sample sizes and short-term treatment with minimal follow-up, suggesting LSRTs may yield more representative data than the exclusive challenge trials.

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