SARS-CoV-2 literature review March 17-24 2020

Dear colleague,

Our weekly FOAMed Quiz is postponed until further notice.

However, quite a large body of evidence is published weekly on COVID-19. Evidence that might help us to help more patients in the upcoming weeks to months.

This is a selection of useful papers on SARS-CoV-2 published in the last 7 days.

Wishing you all the courage and strength to push forward…

Paper 1

Source: First10EM

Title: Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.
Author: Gautret P,
Publication date: March 20, 2020
Journal: International Journal of Antimicrobial Agents.

Goal: This is an observational study of patients 12 years and older with documented COVID-19 admitted to a single hospital in France, with a control group from other hospitals around France.

Methods: Patients in the primary centre with rather mild disease were treated with hydroxychloroquine. Patients in the control centres did not. The authors originally enrolled 42 patients. However, 6 were excluded from the main site, mostly because of death or transfer to the ICU, while no patients were excluded from the controls.

Results: Viral clearance on day 6 occured in 70% of the treatment group and 13% of the controls (p=0.001)

Conclusion: Due to profound methodological flaws this paper does not provide any evidence for treatment of COVID-19 with hydroxychloroquine

Chloroquine for COVID: No good evidence yet

Paper 2

Title: The characteristics and clinical value of chest CT images of novel coronavirus pneumonia
Author: Zhao, X.
Publication date: March 19th, 2020
Journal: Clinical Radiology

Goal: This study was undertaken to retrospectively analyse the chest CT images of 80 PCR-confirmed COVID-19 patients at various hospitals in Anhui Province, China.

Conclusion: The chest CT of these patientis is typically characterised by bilateral groundglass lesions located in the subpleural area of the lung. Pleural effusions and mediastinal lymphadenopathy are rare.


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Paper 3

Title: Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy
Author: Onder, G.
Publication date: March 23, 2020
Journal: JAMA

Goal: To explain the relatively high case fatality (CFR) rate in Italy compared to China and other countries

Conclusion: The relatively high CFR in Italy may be due to an older population, a difference in definition of SARS-CoV-2 related death compared to other coutries and a difference in testing strategies (less testing in Italy compared to China).


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Paper 4

Title:  COVID-19 outbreak: less stethoscope, more ultrasound
Author: Buonsenso, D.
Publication date: March 20, 2020
Journal: The Lancet

Goal: A view on the use of portable ultrasound in these challenging times

Conclusion: The use of ultrasound is now essential in the safe management of the COVID-19 outbreaks, since it can allow the concomitant execution of clinical examination and lung imaging at the bedside by the same doctor.


Paper 5

Title:  Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection
Author: Chang, D.
Publication date: March 20, 2020
Journal: American Journal of Respiratory and Critical Care Medicine

Goal: To determine the time kinetics of viral clearance in reference to the resolution of symptoms in 16 patients treated in Beijing, China

Conclusion: Half (8/16) of the patient remained viral positive (a surrogate marker of shedding) even after the resolution of symptoms (median 2.5 days, range 1 to 8 days).


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Paper 6

Title: Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with Corona Virus Disease‐19
Author: Qu, R.
Publication date: March 17, 2020
Journal: Journal of Medical Virology

Goal: The platelet‐to‐lymphocyte ratio (PLR) is considered quite a good marker for overall badness (and mortality). If this holds true for SARS-CoV-2 patients is the main question in this paper.

Conclusion: The PLR, when measured at the peak of thrombocytosis, was significantly higher in patients with severe disease (from oxygen sat <94% and a respirtory rate of > 30 to respiratory failure) compared to patients with non-severe disease.
Only 30 patient were enrolled in this study.

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Paper 7

Title:  Transmission potential and severity of COVID-19 in South Korea
Author: Shim, E.
Publication date: March 17, 2020
Journal International Journal of Infectious Diseases

Goal: To examine the growth rate of the outbreak, the authors aimed to present the first study to report the reproduction number of COVID-19 in South Korea.

Conclusion: The mean reproduction number of COVID-19 in Korea was estimated at 1.5. Futhermore, the crude case fatality rate is higher among males and increases with age.

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Paper 8

Title: Covid-19: European drugs agency to review safety of ibuprofen
Author: Michael Day (journalist)
Publication date: March 23, 2020
Journal: BMJ

Goal: This newsflash is about the use of ibuprofen for symptoms relief in SARS-CoV-2 patients? The authors interviewed several specialists on this topic.

Conclusion: 1. There is no evidence relating specifically to people with covid-19. 2. Pending further research, a pragmatic and cautionary approach would be for the public to avoid these plausible harms.

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Paper 9

Title:  Systematic review of COVID‐19 in children show milder cases and a better prognosis than adults
Author: Ludvigsson, J.
Publication date: March 23, 2020
Journal:Acta Pedeatrica

Goal: A systematic literature review was carried out to identify papers on COVID‐19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), using the Medline and EMBASE databases between 1 January and 18 March 2020.

Summary: This review identified 45 relevant studies on COVID-19 in children. The disease course in paediatric COVID-19 was milder than in adults, children had a better prognosis and deaths were extremely rare. Diagnostic findings have been similar to adults.

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