First10EM Journal Club: May 2020… more COVID-19

We are back with another Journal club discussion on all things COVID-19… apologies in advance if you are already swamped by info, but it is what has been occupying our minds in recent times.

This episode is long and has a lot of papers… it is a matter of quantity over quality as we know a lot of the data out there is not great and often comes direct from bench science which is not ideal for clinical practice.

Anyway – hopefully back to more clinical stuff next month!  Stay tuned.

 


COVID is everywhere

Guo ZD, Wang ZY, Zhang SF, et al. Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020 [published online ahead of print, 2020 Apr 10]. Emerg Infect Dis. 2020;26(7):10.3201/eid2607.200885. doi:10.3201/eid2607.200885 PMID:


Droplets spread more than 2 meters

Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or droplet precautions for health workers treating COVID-19? [published online ahead of print, 2020 Apr 16]. J Infect Dis. 2020;jiaa189. doi:10.1093/infdis/jiaa189 PMID: 32301491 [article]


No symptoms, but still giving you COVID

He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19 [published online ahead of print, 2020 Apr 15]. Nat Med. 2020;10.1038/s41591-020-0869-5. doi:10.1038/s41591-020-0869-5 PMID: 32296168


Will patients be immune?

Galanati M and Shaman J. Direct observation of repeated infections with endemic coronaviruses. 2020. Preprint, not officially published, available here.


In hospital cardiac arrest in the COVID era

Shao F, Xu S, Ma X, et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China [published online ahead of print, 2020 Apr 10]. Resuscitation. 2020;151:18–23. doi:10.1016/j.resuscitation.2020.04.005 PMID: 32283117


Where did all the patients go?

Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. 2020;ehaa314. doi:10.1093/eurheartj/ehaa314 PMID: 32297932 [free full text]


Is COVID causing clots?

Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;S0049-3848(20)30120-1. doi:10.1016/j.thromres.2020.04.013 PMID: 32291094 [article]


Can we reuse N95s?

Fischer RJ, Morris DH, van Doremalen N, et al. Assessment of N95 respirator decontamination and re-use for SARS-CoV-2. 2020. Prepublished online


Awake proning?

Caputo ND, Strayer RJ, Levitan R. Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID-19 Pandemic. Acad Emerg Med. 2020;10.1111/acem.13994. doi:10.1111/acem.13994 PMID: 32320506 [free full text]


Pseudoscience and COVID-19 — we’ve had enough already

Caulfield T. Pseudoscience and COVID-19 — we’ve had enough already. Nature. 2020; [ARTICLE]


Some hydroxychloroquine/chloroquine updates

Since the last edition, there have been a number of studies looking at hydroxychloroquine, but none are really worth going into in detail. The answer is the same: you shouldn’t be using this drug for COVID. All the studies were updated in the main post. As a quick review:

  • Tang 2020 is a multi-center RCT of hydroxychloroquine in 150 patients that showed no difference in either viral cure or symptoms, but a significant increase in adverse events with hydroxychloroquine.
  • Magagnoli 2020 is a retrospective look at 368 patients admitted to the Veterans Health Administration hospitals in the United States. The rate of death was higher in patients who were treated with hydroxychloroquine than in those who were not (28% vs 11%, p=0.03). Of course, this is not a randomized trial, and hydroxychloroquine might just have been given to sicker patients, but it is not promising data.
  • Borba 2020 is a double blind RCT comparing two doses of chloroquine (600 mg BID for 10 days or 450 mg BID on day one then daily for 4 more days). They were supposed to enrol 440 patients, but the trial was stopped early after only 81 patients because mortality was significantly higher in the high dose chloroquine group. 

Our first look at remdesivir (if you don’t count press conferences) is negative

Yeming Wang*, Dingyu Zhang  Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multi-centre trial Lancet April 29, 2020  (Published Online April 29, 2020 https://doi.org/10.1016/ S0140-6736(20)31022-9 )


A Reminder to Reason

Zagury-Orly I, Schwartzstein RM. Covid-19 – A Reminder to Reason. N Engl J Med. 2020;10.1056/NEJMp2009405. doi:10.1056/NEJMp2009405 PMID: 32343505 [free full text]


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