Your Coronavirus Update for August 17, 2020

Your Coronavirus Update for August 17; stay up to date with Elite.

Nearly 22 million cases of coronavirus (COVID-19) have been diagnosed worldwide as of Monday evening, including 772,000 deaths. Healthcare officials in the United States have reported more than 5.4 million positive COVID-19 cases and at least 170,000 deaths. Source: Johns Hopkins University & Medicine

JAMA Study Touts  Use Of ECMO In COVID-19 Cases

A new study published by JAMA Surgery claims that extracorporeal membrane oxygenation (ECMO) is successful with COVID-19 patients who are experiencing severe respiratory failure. According to the study,1 which included 40 patients ages 22-64, single-access, dual-stage, veno-venous ECMO allows for early extubation in these extreme circumstances. Each patient reportedly had considerably elevated levels of inflammatory markers, including D-dimer and ferritin, prior to ECMO use.

The mean time from intubation to ECMO was four days and all patients were subsequently able to discontinue ventilatory support, with a mean interval of 13 days from ECMO initiation to extubation. Most patients no longer required ECMO care and 29 patients were discharged from the hospital without supplementary oxygen, according to the report. Ten patients required re-intubation, but all have reportedly since been extubated. Complications were said to be minimal, with no ischemic strokes, inotropic support, or tracheostomies. All patients received systemic anticoagulation as part of their therapy. Overall mortality was 15%.

ECMO has also previously been proven useful for treating acute respiratory distress syndrome, but its use has not been well documented in patients with COVID-19 for whom mechanical ventilatory support is insufficient, according to the report.

Multiple Sclerosis Drug May Help In COVID Treatment

The safety and efficacy of a broad-spectrum antiviral in combination with a drug used to care for patients diagnosed with multiple sclerosis is being evaluated in a randomized controlled trial for patients diagnosed with COVID-19. 

According to a report published by The New England Journal of Medicine,2 the Adaptive COVID-19 Treatment Trial 3 (ACTT-3) is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) and is evaluating the drugs antiviral remdesivir and the immunomodulator interferon beta-1a (Rebif). The trial aims to enroll more than 1,000 adults hospitalized with COVID-19 at up to 100 centers in the United States and abroad, according to the report.

ACTT-3 is the third iteration of ACTT. ACTT-1 found that for patients hospitalized with COVID-19 who received a 10-day course of remdesivir, time to recovery was significantly shorter statistically compared with those who received placebo.

The U.S. Food and Drug Administration has issued an emergency use authorization for the drug for patients with severe COVID-19, the report claims.

In a statement explaining the rationale for ACTT-3, the first large randomized controlled trial to test the combination of the two treatments in COVID-19 patients, NIAID officials said type 1 interferon has been shown to inhibit SARS-CoV-2 and two closely related viruses, SARS-CoV and MERS-CoV. There is also evidence that the normal interferon response is suppressed in some people infected with SARS-CoV-2.3 Evidence from two small randomized trials also suggests that treatment with interferon beta may benefit patients with COVID-19.3

Patients eligible for ACTT-3 have laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen; abnormal results on chest x-ray; or illness that requires mechanical ventilation.3 Patients with confirmed SARS-CoV-2 infection who have only mild symptoms or no apparent symptoms are reportedly not eligible for the study.

ACTT-3 participants are randomly assigned to receive standard doses of remdesivir (one 200-mg IV dose on day 1, followed by a 100-mg once-daily IV dose while hospitalized for up to a 10 days, which represents the total course) and either interferon beta-1a (44-μg subcutaneous injection on days 1, 3, 5, and 7 while hospitalized for a total of four doses) or matching placebo injections.3

The trial is expected to study whether time to recovery is shorter in the combination therapy group relative to the remdesivir-only group. Recovery is defined as being “well enough for hospital discharge.” Patients are being evaluated until Day 29, the report states. ACTT-3 will also compare patient outcomes at Day 15 using an ordinal eight-point scale ranging from “fully recovered” to “death.” The trial also will compare other secondary outcome variables between treatment groups, including mortality alone.3

Preliminary results of ACTT-3 are expected this fall. 

ACTT-2 is evaluating the safety and efficacy of remdesivir plus the anti-inflammatory drug baricitinib (Olumiant) for hospitalized adults with COVID-19 and reportedly launched May 8.

FDA Grants Emergency Use For Yale-Developed Saliva Test

The U.S. Food and Drug Administration (FDA) has been granted an emergency use authorization for a saliva-based laboratory diagnostic COVID-19 test developed by researchers at the Yale School of Public Health.

According to Yale officials, the SalivaDirect method is also being further validated as a test for asymptomatic individuals through a program that tests players and staff from the National Basketball Association’s (NBA’s) bubble in Florida. SalivaDirect is said to be an easier, less expensive, and less invasive testing method compared to the traditional nasopharyngeal (NP) swabbing method. Results have found that SalivaDirect is highly sensitive and yields similar outcomes as NP swabbing, according to Yale.  

The testing method is immediately available to other diagnostic laboratories that want to use it in the coming weeks, researchers said. 

Researchers say that a key component of SalivaDirect, is that the method has been validated with reagents and instruments from multiple vendors.4 This flexibility reportedly enables continued testing if some vendors encounter supply chain issues, Yale reports.

According to Yale officials, a separate study found that SARS-CoV-2 is stable in saliva for prolonged periods at warm temperatures and that preservatives or specialized tubes are not necessary for collection of saliva.4

Connecticut-based Jackson Laboratory for Genomic Medicine will reportedly partner with Yale to explore how to implement the test for a broader audience. Related research was reportedly funded by the NBA, National Basketball Players Association, and a Fast Grant from the Emergent Ventures at the Mercatus Center, George Mason University.

Thank you for joining us for your coronavirus update for August 17. If you missed last week’s article, please consider reading it here.

References

  1. Mustafa AK, Alexander PJ, Joshi DJ, et al. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure. JAMA Surgery. 2020; doi:10.1001/jamasurg.2020.3950
  2. Adaptive COVID-19 Treatment Trial 3 (ACTT-3). ClinicalTrials.Gov. 2020. Accessed online: https://clinicaltrials.gov/ct2/show/NCT04492475
  3. Brooks M. NIAID testing remdesivir plus MS drug for COVID-19. Medscape. 2020. Accessed online: www.medscape.com/viewarticle/935606
  4. Greenwood M. Quick and affordable saliva-based COVID-19 test developed by Yale scientists receives FDA Emergency Use Authorization. YaleNews. 2020. Accessed online: https://news.yale.edu/2020/08/15/yales-rapid-covid-19-saliva-test-receives-fda-emergency-use-authorization

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