Fauci Testifies, HCQ Trials Lack ECG

What your doctor is reading on Medscape.com:

MAY 12, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Fauci Testifies at Senate Committee Hearing

While noting that plans to produce doses of COVID-19 vaccine candidates will be undertaken “at risk,” in advance of approval to allow speedy distribution, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, also told members of the US Senate that a vaccine or a treatment is unlikely to be available in the next 3 months. 

The idea of having treatments or a vaccine available for the beginning of the fall school term “would be a bit of a bridge too far,” Fauci testified via video conference Tuesday before the US Senate Committee on Health, Education, Labor and Pensions meeting about resuming work and school. 

The emphasis in the coming months should be on testing, contact tracing, and isolation of those infected with the virus, Fauci said. 

Hydroxychloroquine Trials Lack ECG Screening

Many planned randomized trials to test the efficacy of hydroxychloroquine or related drugs for preventing COVID-19 do not incorporate ECG assessment, according to an analysis of the posted designs of several dozen studies. 

Because the medications are documented to potentially induce lengthening of the corrected QT interval (QTc), the cardiac arrhythmia researcher who conducted the analysis at the end of April recommends initial ECG screening to exclude people at the highest risk of developing a life-threatening cardiac arrhythmia, and monitoring to flag people who achieve a dangerous QTc interval on treatment. 

“It is not only inexplicable, but also inexcusable that clinical investigators would dare to include healthy individuals in a clinical trial involving QT-prolonging medications without bothering to screen their electrocardiogram,” said another expert. 

Stroke Evaluations Down

The number of people seeking stroke treatment dropped 39% in a 2-week period from late March through early April compared with prepandemic levels, researchers report. The investigators saw the decrease in stroke evaluations across all ages, sexes, and stroke severities, as well as across different geographic regions and a range of hospital volumes.

“I was very surprised by the magnitude of the decline. One of the reasons that hospitals reduced elective care was to maintain availability of hospital resources to treat COVID-19 and other critical conditions like stroke,” the lead author said.

Child Vaccinations Down Too

Pediatric vaccinations decreased sharply after the national emergency was declared on March 13, researchers found when they compared weekly orders for federally funded vaccines from early January to mid-April with those during the same period last year. They noted a cumulative COVID-19-related decline of 2.5 million doses in orders for routine noninfluenza pediatric childhood vaccines recommended by the CDC’s Advisory Committee on Immunization Practices.

Role of Genetics in COVID-19?

Scientists have begun investigating whether human genetic factors might play a role in COVID-19, WebMD Health News reports. 

“There’s reason to believe — like with almost all other diseases we’ve tried to go after — that genetics will impact it to some degree,” says Carlos Bustamante, PhD, a professor of genetics at Stanford University and a member of the COVID-19 Host Genetics Initiative, an international consortium of genetics researchers. “The question, of course, is how do you translate that into treatment or improving outcomes in infected patients?”

Vitamin D

There’s emerging evidence that vitamin D deficiency may be relevant to the risk of developing COVID-19 and the severity of the disease, JoAnn E. Manson, MD, DrPH, from Harvard Medical School and Brigham and Women’s Hospital, comments in Medscape. She and colleagues are planning a randomized clinical trial of vitamin D supplementation in moderate-to-high doses to learn more.

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 for 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.