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November 9 | Daily COVID-19 LST Report

Adjusting Practice During COVID-19

· Using medical records from 3 hospitals, researchers at Duke University Health System developed a Clinical Decision Support (CDS) tool, which determines urgency of surgical procedures based on general length of stay, ICU length of stay, ventilator need, and skilled nursing facility (SNF) need. They note the tool is limited by lack of external validity and inability to consider factors like daily or seasonal case load variation. Given the consideration for case prioritization regarding elective producers during the COVID-19 pandemic, authors suggest clinical tools such as CDS could be useful for resource allocation, but further research is needed to confirm their effectiveness in a hospital setting.

R&D: Diagnosis & Treatments

· Investigators at the University of Maryland examined the estimated sensitivity and specificity of several SARS-CoV-2 antibody tests and found in-house ELISAs to have better outcomes. The study tested 3 in-house ELISAs (one detecting anti-trimer IgG antibodies, one anti-trimer IgA antibodies, and another IgG anti-capsid antibodies), 4 commercial ELISAs (EDI Novel Coronavirus COVID-19 IgG and IgM, Euroimmun SARS-CoV-2 IgG and IgA), and one lateral flow immunoassay (DPP COVID-19 IgM/IgG). When analyzing 300 pre-epidemic samples (including 66 HIV infected samples) and 100 RT-PCR confirmed SARS-CoV-2 positive samples, the in-house ELISAs generally showed the greatest sensitivity and specificity. While the in-house ELISAs appear to demonstrate an improvement in antibody detection against SARS-CoV-2, the authors relate that creating testing algorithms with more than 1 assay may be needed to eliminate false positives.

· A randomized Phase III trial conducted by researchers affiliated with AIM Immunotech Inc. in Philadelphia investigated use of rintatolimod (a selective TLR3 agonist) in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and found a subset of patients with symptom duration of 2-8 years who received treatment (n=75) had ≥2 fold increased exercise response, with 51.2% showing >25% increase in exercise tolerance. Among patients with a disease duration window of 2-8 years, this is a significant improvement when compared to 5 FDA-approved drugs, leading to clinically significant quality of life enhancement. Authors advocate for investigation of rintatolimod as a potential therapeutic agent in patients with COVID-19 "long-hauler" post-viral syndrome to reduce lingering brain-fog and fatigue.

· 5-Alpha-Reductase Inhibitors are Associated with Reduced Frequency of COVID-19 Symptoms in Males with Androgenetic Alopecia according to a retrospective cohort study of SARS-CoV-2 positive male patients with androgenetic alopecia (n=113) presenting to outpatient clinics in Brazil. They found men taking dutasteride (a 5-alpha-reductase inhibitor; n=48) had a significantly reduced frequency of 20/29 COVID-19 symptoms (P<0.05) compared to men not taking dutasteride (n=65). Authors suggest androgens may play a role in COVID-19 severity and more studies are needed to investigate possible benefits of 5-alpha-reductase inhibitors.

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