Tulane University SOM COVID19 Daily Digest

29 April 2020

Gilead has released the results of one of their early clinical trials with remdesivir. The results, set to be submitted for publication in a peer-reviewed journal this week, purportedly show that there is no real difference in efficacy of treatment with the drug for 5 days vs. 10 days. Additionally, the data show that patients who are treated with the drug sooner fare better than those who start treatment further into their illness. The drug’s safety profile in these patients was good. Critically, this study lacks a control group that was not treated with the drug, which means that establishing absolute efficacy is not possible from this study. As STAT reports, this study is not the only remdesivir data that Gilead has released in the last day. Their NIAID double-blind study with 800 patients has met its primary endpoint, meaning that the drug has helped patients recover faster. Without the data, which is expected to be released soon, it is impossible to say how dramatic the effect is, though it is worth noting that these results were not expected for some time. Because it is believed that remdesivir works by blocking the activity of the viral protein responsible for copying the virus’ genetic material, and due to the fact that is must be administered via IV, it is likely to remain part of a toolbox of drugs that can help hospitalized patients early on in the disease course. The FDA may issue emergency use authorization for the drug based on these data.

Inovio has completed enrollment and delivered the first dose of its DNA-based COVID-19 vaccine to all 40 initial volunteers. Results on safety and immune response generated by the vaccine are expected in June.

Diabetes and obesity are major risk factors for severe COVID-19, and a research group has proposed that the fat cells themselves are a contributing factor. In an editorial in Obesity, they argue that the fat cells, adipocytes, can act as a haven for the virus due to their high levels of ACE2 expression. The authors also postulate that adipocyte-like cells in the lung may impact physiology in such a way as to lead to some of the clinical lung problems that have been observed.

Multiple new technologies, 3D printing among them, have had their adoption accelerated by the COVID-19 pandemic. An editorial in 3D Printing in Medicine outlines the variety of ways in which 3D printing is being used in the pandemic, including through the design and production of educational models, breathing support materials, personal protective equipment (PPE), and modifications to door handles to prevent direct skin-to-surface contact. 3D printed materials are easy to sterilize and reuse, as well as easy to replace.

In some rare cases, skin lesions can be a distinct symptom of COVID-19. The Journal of the American Academy of Dermatology published a review of the skin conditions sometimes seen in COVID-19 patients, which are largely similar to rashes seen in other viral diseases.

Artificial intelligence (AI) is being leveraged on multiple fronts to help fight COVID-19, including as a radiological diagnostic tool. Original research published in Radiology showed that an AI assistance program improved radiologists’ ability to distinguish between COVID-19 pneumonia and non-COVID-19 pneumonia. Multiple groups are exploring utilizing CT image trained AI models to help assist in COVID-19 diagnosis in healthcare settings, including a group from Jinan University in Guangzhou, China, which published the promising results of their study on preprint server medRxiv. These methods, while potentially helpful, would be limited to more moderate and severe cases of COVID-19 that require addressment in a healthcare setting.

The effects of the COVID-19 pandemic on national health expenditures are unknown, but are likely to have a lasting impact. JAMA published early predictions and scenarios as to how this may unfold. The picture is incredibly complex, with US Government programs like Medicare and Medicaid likely bearing the majority of treatment expenses as compared to private insurers, due to the elderly and low-income populations that are most affected by the disease. The negotiating power that the US Government has through these programs means that less money will be spent per patient. However, because healthcare expenditures are measured as a percentage of GDP, which is likely to decrease as a result of the virus, the percentage of healthcare spending attributable to the COVID-19 pandemic will appear larger. The healthcare and economic ramifications of COVID-19 will continue to evolve and develop throughout the coming months and years.

In places where gender and gender roles have been used to inform social distancing measures to curtail the spread of COVID-19, the transgender community is disproportionately at risk. An editorial in AIDS and Behavior highlights this reality, citing reports of anti-trans violence in Peru as evidence of this effect. This is, unfortunately, one of the broader themes of the pandemic, wherein marginalized communities are feeling outsized impacts and must navigate elevated risks in comparison to the general public.

In some parts of the world, places of worship have remained open and very active even with social distancing guidelines in place. A commentary published in the Journal of Travel Medicine calls for an immediate temporary closure of these venues, citing the unprecedented actions taken by the Kingdom of Saudi Arabi in closing Islam’s holiest mosques to the public. The contributors cite instances of large-scale spreading events linked to religious gatherings in other countries, and speak to the importance of engaging community religious leaders as part of the effort to educate the public about the virus.

The components of CRISPR can be leveraged to detect specific viruses, including SARS-CoV-2, thanks to their high degree of specificity in recognizing genetic sequences. Nature published the results of a study in which a CRISPR-based method was able to detect and differentiate many types of viruses in a given sample, including SARS-CoV-2. These types of technologies could aid in diagnostic and surveillance efforts.

Switching scientific conferences to a virtual format due to COVID-19 comes with some upsides, including increased accessibility and the power to screen out “non-questions” during a virtual Q&A after a presentation. Science covers how the pandemic has not so much caused the embrace of virtual conferences as much as accelerated them, as they have been long advocated for.

Heparin, an anticoagulant drug with mild anti-inflammatory properties, may have multiple uses in treating COVID-19. Researchers published results on preprint server bioRxiv that showed that heparin can stop SARS-CoV-2 from infecting cells in culture, and can bind to the spike protein the virus uses to enter cells. This suggests that it could be used as a direct antiviral in addition to a prophylactic in hospitalized patients, as it is already used to prevent the clotting dysfunction seen in some COVID-19 patients. However, heparin may in some cases be doing harm, as very preliminary retrospective data from China that was published on preprint server medRxiv showed that a precipitous and potentially dangerous decline in the body’s ability to clot was observed in some patients, and this decline may have been attributable to heparin treatment.

Revisited: Serology Testing - Wide-spread antibody testing is essential to move into the next phase of pandemic control and mitigation. Multiple options for serology testing have emerged, and ascertaining which are accurate is a key step in their deployment into communities. A preprint published on medRxiv compares a number of different tests, including laboratory-based ELISA tests and rapid tests. The ELISA-based tests were fairly accurate, however the results caution against use of the rapid tests. Another study also published on medRxiv found that the rapid tests performed variably, and that training for readers would be essential in deploying these types of tests.

Lagniappe: Children and Understanding COVID-19 - Explaining the basics of virology and epidemiology is difficult to do even for adults, let alone inquisitive children. The European Journal of Immunology has released the drawings of one five-year-old who has an excellent grasp of the pandemic, which feature a trio of viruses with three very different emotions. One can only assume the bacteriophage is so sad because it has to be so close to the “angry coronavirus”. This is a (very playful) reminder that children should be considered when information about the virus is disseminated.

 

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Edited by Claiborne M. Christian, PhD, on behalf of The Tulane University School of Medicine.  Editions are regularly published Monday – Friday. Content is generated by reviewing scientific papers and preprints, reputable media articles, and scientific news outlets.  We aim to communicate the most current and relevant COVID-19-related scientific, clinical, and public health information to the Tulane community. In keeping with Tulane’s motto, “Not for Oneself but for One’s Own", we are making it available to anyone else who would benefit.