June 5, 2020 | Researchers around the globe are studying how COVID-19 impacts patients and clinical care. Findings include high percentages of asymptomatic patients, how pulmonary embolism in involved in the disease, new data on convalescent plasma, and many concerning updates about decreased cardiac care. Meanwhile, Covance and researchers in Japan are sharing data and collecting people who want to be involved in clinical trials.

Literature Updates

Daniel P. Oran and Eric J. Topol published a review of asymptomatic patients infected with SARS-CoV-2 yesterday in Annals of Internal Medicine. Asymptomatic persons seem to account for approximately 40% to 45% of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days, they observed. The absence of COVID-19 symptoms in persons infected with SARS-CoV-2 might not necessarily imply an absence of harm, they emphasized. More research is needed to determine the significance of subclinical lung changes visible on computed tomography scans. DOI: 10.7326/M20-3012

Researchers have studied the test results from universal preoperative screening for COVID-19 at the Children’s Hospital of Philadelphia in Philadelphia, Pennsylvania, Texas Children’s Hospital in Houston, and Seattle Children’s Hospital in Seattle, Washington and shared their findings in JAMA Surgery. 1295 pediatric surgical patients were included in this study, with a mean age of 7.35 years. Overall incidence of COVID-19 was 0.93% (12 of 1295). However, there was a significant difference in incidence across hospitals, ranging from 0.22% (1 of 456) to 2.65% (9 of 339) in different geographic areas. DOI: 10.1001/jamasurg.2020.2588.

Researchers at Henry Ford Health System in Detroit conducted a retrospective study to look at how pulmonary embolism is connected to COVID-19 and how changes in diagnosis could impact outcomes. The study looked at 328 COVID-19 patients who underwent a pulmonary CT angiography between March 16 and April 18 at Henry Ford's acute care hospitals. Risk factors for pulmonary embolism include obesity, an elevated D-dimer, elevated CRP and a rising D-dimer over time. They suggest that patients who test positive for COVID-19 should be started on preventive blood thinners early on in their treatment. Timely diagnosis and use of blood thinners could improve outcomes. The findings were published in Radiology. DOI: 10.1148/radiol.2020201955

The country's first convalescent plasma transfusion trial results show 19 out of 25 patients improving with the treatment and 11 discharged from the hospital. The results were published in the American Journal of Pathology. With no adverse side effects caused by the plasma transfusion, the study concluded that convalescent plasma is a safe treatment option for patients with severe COVID-19 disease. More on convalescent plasma. DOI: 10.1016/j.ajpath.2020.05.014

Several recently-published studies look at the impact of COVID-19 on cardiac conditions. In a survey of hospitals in 141 countries, researchers found the number of heart attack patients seeking urgent hospital care has dropped by more than 50% during the COVID-19 outbreak. The findings are published in European Heart Journal - Quality of Care and Clinical Outcomes (EHJ-QCCO). DOI: 10.1093/ehjqcco/qcaa046. Marc Ruel at the University of Ottawa has authored two articles examining how cardiac surgery centers have been impacted by the COVID-19 pandemic, and how they can resume operations in an environment characterized by a low-grade, long-term prevalence of SARS-CoV-2. In Circulation, Dr. Ruel and his co-authors published findings suggesting that 60 cardiac surgery centers in 19 countries had reduced their cardiac surgeries by an average of 50 to 75% in response to the pandemic. DOI: 10.1161/CIRCULATIONAHA.120.047865. In The Annals of Thoracic Surgery, he submitted 12 recommendations developed by a consortium of experts in 19 countries for prioritizing surgeries; dealing with cardiac patients who test positive for COVID-19; and patient discharge and follow-up protocols. DOI: 10.1016/j.athoracsur.2020.05.004

Stroke patients aren’t faring much better. Research published in the Journal of NeuroInterventional Surgery (JNIS) shows ischemic stroke patients are arriving to hospitals and treatment centers an average of 160 minutes later during the COVID-19 pandemic, as compared with a similar timeframe in 2019. These delays, say stroke surgeons from the Society of NeuroInterventional Surgery (SNIS), are impacting both survival and recovery. DOI: 10.1136/neurintsurg-2020-016299

According to a small study from a hospital in Paris, an inflammatory syndrome in children and adolescents, believed to be linked to COVID-19, seems to be more common among children of African ancestry. The paper, published in BMJ, describes 21 children and adolescents (average age 7.9 years) with features of Kawasaki disease who were admitted to a hospital in Paris between 27 April and 11 May 2020. Over half of the children (12; 57%) were of African ancestry. Twelve children presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. Nineteen (90%) had evidence of recent covid-19 infection. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers in their bloodstream. DOI: 10.1136/bmj.m2094

Company Updates

Covance has created COVID-19 Clinical Trial Connect in the U.S., a registry of patients interested in taking part in COVID-19 research. The COVID-19 clinical trial opportunities are diverse, with sponsors recruiting patients who currently have COVID-19, those who may be now recovered, and those who may have been exposed to coronavirus. Through the Covance COVID-19 Clinical Trial Connect site, prospective patients would be notified of studies run by Covance on behalf of a biopharmaceutical company, as well as those listed in clinicaltrials.gov. People visiting the Covance COVID-19 Clinical Trial Connect will be invited to opt-in to register their details. This information will be used to connect people with suitable clinical studies in their area. If a study is unavailable in their area at this time, prospective participants will have the option to be contacted when one becomes available. Press release.

A group in Japan has released findings of the Favipiravir Observational Study on the Japanese Association for Infectious Diseases website. Favipiraivr (brand name Avigan) is an anti-influenza drug which was developed by FUJIFILM Toyama Chemical Co. Favipiravir can be administered to hospitalized patients with COVID-19 on a compassionate use basis with timely reporting of overall characteristics of patients who received anti-viral agents such as favipiravir. A registry (COVID-19 Registry Japan) is tasked with detailed reporting of COVID-19 patients in general. This preliminary report contains data on 2,158 patients who received favpiravir for COVID-19 and describes their background, clinical course, outcome and adverse events. The dataset is available here: http://www.kansensho.or.jp/uploads/files/topics/2019ncov/covid19_casereport_en_200529.pdf

Octapharma USA is extending funding for researcher projects focused on COVID-19. First, researchers in California have launched a randomized open label study evaluating the standard of care (SOC) plus intravenous immunoglobulin (IVIG) compared to SOC alone in the treatment of COVID-19 infection, specifically in preventing mechanical ventilation in COVID-19 patients requiring high-flow oxygen. Octapharma extended funding after promising early results. Press release. Octapharma is also supporting researcher out of Norton Heart & Vascular Institute in Louisville, Ky., focused on treating patients with the coronavirus (COVID-19) and presenting with COVID-19-associated myocardial dysfunction. Octapharma USA is donating Octagam 10% and cutaquig 16.5%, the company's intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG), for the study. BioMatrix Specialty Pharma is donating patient education, including instruction in subcutaneous injection. Press release.