Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.
1. Hydroxychloroquine shows no benefit for postexposure prophylaxis for preventing SARS-CoV-2 infection
Clinical trials have ruled out the role of hydroxychloroquine in the treatment of COVID-19, but some believe that it may have a role in preventing SARS-CoV-2 infection in people after exposure to someone with known infection. Researchers from the University of Washington, Fred Hutchinson Cancer Research Center, New York University Grossman School of Medicine, and the University of Maryland School of Medicine conducted a randomized controlled trial among 671 households. 337 households were given 400mg of hydroxychloroquine daily for 3 days, followed by 200mg for 11 days. 334 households served as the control group and were given 500mg of vitamin C for 3 days, followed by 250mg for 11 days. The researchers note the risk for SARS-CoV-2 infection within the households was high, but there was no statistically significant difference in the development of SARS-CoV-2 infection between the hydroxychloroquine and control group.
The researchers conclude hydroxychloroquine should not be used to prevent SARS-CoV-2 infection after exposure to a close contact with infection.
Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6519.
A free summary for patients is also available: https://www.acpjournals.org/doi/10.7326/P20-0015.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Ruanne V. Barnabas, MBChB, MSc, DPhil, can be reached through Bobbi Nodell at bnodell@uw.edu.
2. Patients with COVID-19 may develop an array of symptoms that evolve over time
COVID-19 can persist in persons and result in prolonged illness, sometimes referred to as "long COVID." Public health messages around persisting symptoms could help reinforce measures to avoid the spread of infection. In a brief research report, authors from Geneva University Hospitals and the University of Geneva present their findings from reviewing COVID-19 symptom evolution and persistence in an outpatient setting in Geneva, Switzerland, from day 1 through day 30 to 45 after diagnosis.
The study's findings show that patients with COVID-19 develop an array of symptoms that evolve over time. Fatigue, dyspnea, and loss of taste or smell were the main persistent symptoms. Recognizing the persistence of symptoms could legitimize patients' concerns about an unknown and new disease.
Read the full text: https://www.acpjournals.org/doi/10.7326/M20-5926.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Mayssam Nehme, MD, can be reached at Mayssam.Nehme@hcuge.ch.
3. Wuhan study helps researchers better understand SARS-CoV-2 positivity and the disease course of COVID-19
Knowledge is limited about the patterns of viral persistence and host response in patients with COVID-19. Researchers from Wuhan, China conducted a large, retrospective study to describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity. They found the rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within four to five weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity.
The researchers note the data would be valuable for developing effective, preventive, and treatment strategies against COVID-19. Appropriate prevention and therapeutic approaches should be established on the basis of viral kinetics, clinical manifestations, and laboratory testing. They note further work is urgently needed to improve our understanding of the potential effects of the virus, host innate and adaptive immune responses, and their interactions during the acute and convalescent phases of COVID-19.
Read the full text: https://www.acpjournals.org/doi/10.7326/M20-3337.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding authors, Gang Chen, PhD, Chaoyang Sun, PhD, Ding Ma, PhD, and Peng Wu, PhD, can be reached through Chaoyang Sun, PhD at suncydoctor@gmail.com.
4. Simultaneous COVID-19 infection in identical twins helps to explain differences in illness severity
Although we are rapidly learning more about COVID-19, we still know little about why some infected persons have severe disease and others are asymptomatic or have mild disease. Authors from Italy describe a case report describing the differences in clinical illness between male identical twins who tested positive for SARS-CoV-2. Neither twin had a history of chronic disease, cardiovascular risk factors, or long-term therapy. They lived at the same address and worked at the same location. The same medical team provided care to both brothers during the first 2 weeks of their hospital stays. Despite having similar presentations and early treatment, Twin 1 was discharged without complications and recovered uneventfully, and Twin 2 required more care and had four days of invasive ventilation. The authors suggest the differences in the virus, such as differences in the infecting dose or viruses with different mutations, may explain differences in illness severity.
Read the full text: https://www.acpjournals.org/doi/10.7326/L20-1207.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Davide Lazzeroni, MD, can be reached at davide.lazzeroni@gmail.com.
5. Caring for dying patients during the pandemic shows the human side of medicine
The COVID-19 pandemic has affected the hospital experience for patients, visitors, and staff. Researchers from McMaster University and St. Joseph's Healthcare sought to understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic. They identified themes from semi-structured clinician interviews and found many barriers to end-of-life care arose because of infection control practices that mandated visiting restrictions and PPE. During hospitalization, family visits inside or outside the patient's room were possible 80 percent of the time. At the time of death, more than 44 percent of patients had a family member at the bedside.
Researchers found that clinicians were inspired to express humanity, seek each patient's story, ensure dignity-conserving care, adopt new roles, and catalyze connections.
Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6943.
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A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Deborah J. Cook, MD, MSc, can be reached at debcook@mcmaster.ca.
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Journal
Annals of Internal Medicine