COVID-19 Daily: Hospital Mortality Data, Drug Trial Raises Eyebrows

What your doctor is reading on Medscape.com:

APRIL 30, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

How Many Hospitalized Patients With COVID-19 Die?

A new preprint study of almost 17,000 patients with COVID-19 admitted to 166 hospitals in the United Kingdom between February 6 and April 18 indicates that 33% died. This rose to 53% when considering those who received mechanical ventilation.

These latest figures confirm that obesity is a significant risk factor for poor outcomes, including a significantly increased risk of death, along with other previously recognized comorbidities such as cardiovascular disease and diabetes. Yet almost half (47%) of hospitalized patients with COVID-19 had no documented comorbidity.

“We must do everything humanly possible to understand this disease, so that we are better prepared for the next wave of this pandemic,” said Calum Semple, PhD, from the University of Liverpool, who led the study.

New Trial Causes Controversy

Doctors are raising eyebrows at the decision by AstraZeneca to begin a randomized placebo-controlled trial of its popular type 2 diabetes drug dapagliflozin (Farxiga, AstraZeneca) to see if it reduces the risks of disease progression and clinical complications in patients with mild-to-moderate COVID-19 and a medical history of diabetes, cardiovascular disease, or chronic kidney disease.

There is concern and skepticism because several expert groups have advised that drugs in this class — the sodium-glucose cotransporter 2 (SGLT2) inhibitors — be stopped in all patients hospitalized with COVID-19.

“Giving SGLT2 inhibitors to patients in the DARE-19 study is a dangerous proposition because these drugs can induce ketoacidosis during the stress of acute illness such as COVID-19,” nephrologist Bruce R. Leslie, MD, told Medscape Medical News.

New PPE Guidelines

The Infectious Disease Society of America has released its latest guidelines on the use and reuse of personal protective equipment (PPE) during COVID-19, most of which address the use of face protection.

Panel chair John Lynch III, MD, MPH, said of the eight new recommendations, “A large part of them are really focused on masks, but there are a huge number of other disparate questions that need to be answered where there is really no good evidence basis.” 

The document will be updated continuously as more data become available, he noted.

Leading Treatments in COVID-19

Acetaminophen leads the field when it comes to pharmacologic treatments prescribed for patients with COVID-19, according to a new US survey of 203 frontline doctors. More than 80% of them used the popular analgesic.

About 40% have employed antibiotics and bronchodilators, 20% prescribed hydroxychloroquine for COVID-19, and just under 20% have used remdesivir. Of interest, slightly more than 20% of physicians have also tried plasma from recovered patients.

Battling the Pandemic in New York

Michael Dowling, president and CEO of Northwell Health in New York, tells WebMD’s Chief Medical Officer John Whyte, MD, in a video commentary how his institution rapidly adapted to the challenges of COVID-19, and how they are starting to plan the road back toward a new normal, which he estimates will take a year. He speaks proudly of the extraordinary commitment his staff have shown under extreme difficulty, describing the myriad ways in which they have left their traditional silos to work across disciplines. 

Northwell Health has dealt with 20% of all COVID-19 patients in New York State, said Dowling, and he estimates the pandemic is costing them about $350 million a month in lost revenue.

No matter, Dowling said. “You put aside your concerns about whether doing this or that is going to lose you money or gain money. You decide to do the right thing for the purpose of treating the public the right way, and then come back later and try to figure it out.”

Northwell Health recently reported in JAMA  the comorbidities and outcomes among 2634 hospitalized patients with COVID-19.

Use of Virtual Medicine Soars

COVID-19 has led to a massive surge in appointment cancellations for routine care, with practices scrambling to try to replace as many visits as they can with virtual consultations, a new report shows.   

There was a 37-fold rise in text, email, and automated voice messages to patients from March 1 to April 1, compared with figures for January and February, before the pandemic’s seriousness was generally recognized.

These communications were employed for a number of reasons: to educate patients about precautions regarding COVID-19; to update them about clinic policies and screening procedures; to introduce new telehealth services; and to explain other changes that might affect access to care.

In Memoriam

As frontline 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 500 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.