COVID-19 Daily: Antiviral Combo, Hospital Volumes

What your doctor is reading on Medscape.com:

MAY 11, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Antiviral Combo 

In an open-label, randomized phase 2 trial in patients with mild or moderate COVID-19 infections, the median time to viral negativity by nasopharyngeal swab was 7 days for 86 patients assigned to receive a lopinavir/ritonavir, ribavirin, and interferon beta-1b, compared with a median time to negativity of 12 days for patients treated with lopinavir/ritonavir alone, physicians from Hong Kong report. The triple combination also decreased the time to complete alleviation of symptoms and median hospital stay. 

“The open-label nature and small size of the study limits the broad use of the regimen,” said one expert who was not involved with the study. “However, the study does suggest that a larger, truly randomized study is warranted,” he said.

Hospital Volumes

About 55% fewer Americans than last year sought hospital care during a 2-week period this March and April, according to a report from Strata Decision Technology, a Chicago-based financial analytics firm. The analysis included more than 2 million patient visits and encounters from 228 hospitals in 40 states. 

The decrease even affected patients with life-threatening illnesses: In the context of clinical service lines, there was a 57% drop in cardiology volume, a 55% decline in breast health volume, and a 37% decline in cancer care. 

The Strata report estimated that the 51 health systems in the study lost $1.35 billion in revenue during the 2-week study period compared with the prior year. If all hospitals nationwide lost an equivalent amount, on average, they would have seen a revenue decline of $60.1 billion during the study period, the report said.

Remdesivir Combo Study Begins

The National Institute of Allergy and Infectious Diseases (NIAID) has started the next iteration of its adaptive trial of remdesivir, which will test a combination of remdesivir and the anti-inflammatory baricitinib compared with remdesivir and a placebo pill. The study will be randomized and double-blind, and is currently enrolling patients hospitalized with COVID-19. Investigators expect to enroll more than 1000 participants.

In an interview with STAT News, NIAID Clinical Director H. Clifford Lane, MD, explained some nuances of what happened with the initial remdesivir study, and the investigators’ thinking when they decided to halt it and allow patients in the placebo arm to receive remdesivir: “How many patients would we want to put at risk of dying,” he asked, for a little bit more data? 

Pandemic Palliative Care

In late March, when it became clear that hospitals in the greater New York City area would face a capacity crisis in caring for seriously ill patients with COVID-19, members of the leadership team at the Children’s Hospital at Montefiore in The Bronx convened to draft a response plan. One of the items was expanding the palliative care team, including redeployed and retrained clinicians. 

“It struck everyone as logical that palliative care had to be expanded, because all of the news we had received as the surge came to New York from around the world was full of death and uncertainty, and [it] would require thoughtful conversations about end-of-life wishes at critical times,” said the hospital’s director of pediatric palliative care and leader of the expanded team, which also calls patients’ family members. “We provide support for the worry, anxiety, and fear that we know creeps in when you’re separated from your family member, especially during a pandemic when you watch TV and there’s a death count rising.”

COVID-19 Literature Surveillance Team

An emergency medicine physician and third-year medical student at the University of Washington School of Medicine cofounded a group called the COVID-19 Literature Surveillance Team to read the latest research articles on COVID-19, grade their evidence level, and write daily summaries delivered by email. 

Serology Test Performance

Can’t keep track of all the SARS-CoV-2 antibody tests granted an emergency use authorization from the US Food and Drug Administration? The agency lists all the tests, plus their performance metrics, on this webpage. 

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1000 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form. 

Ellie Kincaid is Medscape’s associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.