By Amy Orciari Herman
NEJM Journal Watch
Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM
Check out some of the latest news on novel coronavirus disease (COVID-19):
Asymptomatic infection: Some 81% of 128 COVID-19 infections detected on a cruise ship were asymptomatic, according to a study in Thorax. Separately, in JAMA Network Open, researchers report that asymptomatic COVID-19 is more common among women and younger adults, based on an analysis of 78 patients in Wuhan, China. For example, the median age of asymptomatic patients was 37, versus 56 among the symptomatic. Of note, asymptomatic patients shed virus for a median of 8 days (vs. 19 days among the symptomatic).
Stay-at-home orders: Stay-at-home orders were associated with a slowing in the rate of COVID-19 hospitalizations in four states studied — Colorado, Minnesota, Ohio, and Virginia — according to a JAMA report. In Minnesota, for example, 988 hospitalizations were projected by mid-April, but just 361 actually occurred.
Racial differences: Black adults are at particularly high risk for severe COVID-19, a New England Journal of Medicine study suggests. Of nearly 3500 COVID-19 patients studied in Louisiana, 70% were black and 30% were white — even though the health system’s population is 31% black and 65% white. Black patients accounted for 77% of COVID-19 hospitalizations and 71% of in-hospital deaths. After adjustment for sociodemographic and clinical factors, however, black race was not associated with mortality.
Remdesivir treatment duration: For patients with severe COVID-19 not requiring mechanical ventilation, 5 days of remdesivir may be as beneficial as 10 days, according to an open-label, industry-supported study in the New England Journal of Medicine. Nearly 400 patients with severe COVID-19 pneumonia were randomized to intravenous remdesivir for 5 or 10 days. At 14 days, 65% of patients in the 5-day group and 54% in the 10-day group had a clinical improvement of at least 2 points on a 7-point scale. After adjustment for baseline differences in disease severity, there was no significant difference in clinical improvement between the groups. The authors caution that “with no placebo control … the magnitude of benefit cannot be determined.” Editorialists advise: “In our current era of limited remdesivir supplies, priority should be given to a 5-day remdesivir regimen for patients at the early stages of severe disease.”