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COVID-19 news from Annals of Internal Medicine

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Annals of Internal Medicine News @Annalsofim 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. ACP, Annals of Internal Medicine host third Virtual COVID-19 Vaccine Forum for physicians

The American College of Physicians (ACP) and Annals of Internal Medicine hosted a third virtual COVID-19 vaccine forum on COVID-19 with the focus on the allocation and distribution of available vaccines, a topic that has created controversy as the nation works to get millions of Americans vaccinated.

The forum, Allocation and Distribution: What Physicians Need to Know, was the third in a series of vaccine forums hosted by ACP and Annals of Internal Medicine and was held on Jan. 22. ACP and Annals of Internal Medicine invited four experts to offer their perspectives on vaccine allocation and distribution. Panelists included Capt. Amanda Cohn, Chief Medical Officer of the National Center for Immunizations and Respiratory Diseases (NCIRD) and Executive Secretary of the Advisory Committee on Immunization Practices; David Fairchild, MD, MPH, Chief Medical Officer, CVS MinuteClinic, Professor of Medicine, University of Massachusetts Medical School; Wayne J. Riley, MD, MPH, MBA, MACP, President, SUNY Downstate Health Sciences University and President Emeritus, American College of Physicians; and Mark Levine, MD, Commissioner of Health, Vermont.

Dr. Jason M. Goldman, a member of the ACP Board of Regents and a practicing internist in Florida, moderated the discussion. The full recording is available for replay here (https://www.acpjournals.org/doi/10.7326/M21-0331) and is published in Annals of Internal Medicine along with commentary by Christine Laine, MD, MPH, ACP senior vice president and editor in chief.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text and view a recording of the event. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org.

2. Early anticoagulation therapy in critically ill COVID-19 cases did not affect survival in observational study

Among critically ill adults with COVID-19, early therapeutic anticoagulation did not affect survival in an observational study. This is an important finding, as hypercoagulability may be a key mechanism of death in patients with COVID-19. The study is published in Annals of Internal Medicine.

Researchers from Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School studied health records for 3,239 critically ill adults with COVID-19 from 67 centers throughout the United States to evaluate the incidence of venous thromboembolism (VTE) and major bleeding and examine the observational effect of early therapeutic anticoagulation on survival. A target trial emulation in which patients were categorized according to receipt or no receipt of therapeutic anticoagulation in the first 2 days of ICU admission was done and a Cox model with inverse probability weighting to adjust for confounding was used.

The researchers found that the rates of radiographically confirmed VTE and major bleeding to be 6.3% and 2.8%, respectively. Male sex and higher D-dimer levels were independently associated with VTE. Patients who received therapeutic anticoagulation in the first 2 days of ICU admission had similar in-hospital survival compared with those who did not. These data suggest that rates of VTE in critically ill patients with COVID-19 may be considerably lower than previously reported in smaller studies, and that initiation of early therapeutic anticoagulation may not have a survival benefit in critically ill patients. According to the study authors, these findings do not support early empirical use of therapeutic anticoagulation in critically ill patients with COVID-19. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-6739.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Hanny Al-Samkari, MD, can be reached through Sarah Alger at salger@mgh.harvard.edu or Mike Morrison mdmorrison@partners.org.

3. Reports of adverse reactions to hydroxychloroquine and chloroquine more than doubled during early months of SARS-CoV-2 pandemic

Researchers found an increase in reported adverse drug reactions (ADRs) for hydroxychloroquine and chloroquine use during the first months of the SARS-CoV-2 outbreak, when use of these medications was substantially higher, compared to the same months in 2018 and 2019. Reported ADRs seemed to be concomitant with positive endorsements by public leaders, media, or health regulatory authorities. A brief research report is published in Annals of Internal Medicine.

Researchers from Grenoble Alpes University Hospital and the University of Grenoble, Grenoble, France used the FDA Adverse Event Reporting System (FAERS) database to quantify the change in number and type of reported ADRs associated with hydroxychloroquine and chloroquine since the beginning of the outbreak, compared with 2018 and 2019. The team extracted 21,305 reports of 152,201 suspected ADRs concerning chloroquine and hydroxychloroquine from January 2018 through September 2020. The data showed that the number of reported ADRs for chloroquine and hydroxychloroquine more than doubled in 2020 compared with the same months in 2018 and 2019. Of ADRs reported in 2020, 97.1% were considered serious, whereas 73.4% and 84.8% were defined as serious in 2018 and 2019, respectively. Likewise, 5.1% of reported cases in 2020 were fatal, compared with 3.1% in 2018 and 1.9% in 2019.

The authors also noted that countries in 2020 with the highest reported ADRs were also those most affected by the virus during this period. Despite the FDA's revocation of its emergency use authorization, the number of reported ADRs remained high, potentially reflecting the persistent use of hydroxychloroquine across the world. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-7918.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. To reach the corresponding author, please email Professor Jean-Luc Cracowski at jlcracowski@chu-grenoble.fr.

4. Pregnant and lactating women should not be excluded from vaccination efforts

In a new commentary published in Annals of Internal Medicine, authors from Weill Cornell School of Medicine and Emory University School of Medicine suggest that pregnant and lactating women should not be excluded from COVID-19 vaccination efforts. This is important because evidence suggests that pregnant women with COVID-19 have higher risk than similar nonpregnant persons for poor health outcomes and that risks may also be higher for their babies. Of additional concern, the same racial and ethnic disparities in COVID-19 outcomes seen in the general population are observed in the pregnant population.

While pregnant and lactating women were not included in vaccine trials, vaccination is a regular part of prenatal care and few, if any, vaccines are contraindicated in breastfeeding women. The authors argue that on the basis of what we know about the mRNA COVID-19 vaccines, as well as broader principles of how vaccines work and the safety of other vaccines during pregnancy and breastfeeding, it seems that pregnant and lactating women can be safely included in COVID-19 vaccination efforts. Clinicians should be prepared to discuss the issues with their pregnant and lactating patients, as well as with those who may be considering pregnancy. Read the full text: https://www.acpjournals.org/doi/10.7326/M21-0173.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Laura E. Riley, MD, can be reached through Megan Howard at meh4006@med.cornell.edu.

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