Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/11/covid-19-scan-nov-13-2020
COVID-19 Scan for Nov 13, 2020
Mild-to-moderate COVID treatment; Airline COVID-19 screening; Pandemic mental health in kids
Filed Under:
COVID-19
Fluvoxamine possible treatment for mild-to-moderate COVID
In a preliminary study conducted on 152 patients with mild-to-moderate COVID-19 infections, no patient in a group of 80 people who took a 15-day course of fluvoxamine, an antidepressant, reported clinical deterioration, as opposed to 6 (8.3%) of 72 who took a placebo.
The study, published yesterday in JAMA, defined clinical deterioration as severe shortness of breath, hospitalization for shortness of breath or pneumonia, or when oxygen saturation fell below 92% without aid.
While both groups had lesser symptoms of adverse events, the fluvoxamine group reported no serious consequences during treatment, whereas the placebo group included four people who had to be rehospitalized. (The one serious adverse event in the treatment group was a headache that required hospitalization during the 30-day follow-up period.) Adverse effects such as muscle aches, nausea, pneumonia, and vomiting were reported 11 times in the treatment group and 12 times in the placebo group, but patients may have experienced more than one adverse event.
Patients from the St. Louis area participated in the remote study from Apr 10 to Aug 5, with Sep 19 as the final 30-day follow-up date. Median time between symptom onset and first treatment dose was 4 days, and those on fluvoxamine took 100-milligram doses three times a day for 15 days. Although 18.1% of people (18 in the treatment and 19 of the placebo group) stopped responding to surveys before the treatment cycle was complete, none visited a major regional hospital or emergency department.
"There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules," said senior author Angela M Reiersen, MD, MPE, in a Washington University School of Medicine press release. "Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients."
In an editor's note, JAMA editors wrote that the study "presents only preliminary information, and requires confirmation in larger trials. But at the same time, it is a double-blind, placebo-controlled, randomized clinical trial, which is generally considered a design that minimizes bias and can support causal inference."
Nov 12 JAMA study
Nov 12 Washington University press release
CDC: Symptom-based COVID-19 airport screening ineffective
Data published today in Morbidity and Mortality Weekly Report (MMWR) shows that resource-intensive, symptom-based airline passenger entry screening identified few laboratory-diagnosed COVID-19 cases—only 1 case for every 85,000 travelers screened. The researchers also highlight the inadequacy of electronic airline data for contact tracing, finding that only 22% of records contain both the traveler's phone number and physical address.
In January, the Centers for Disease Control (CDC) instituted enhanced, symptom-based screening for air passengers returning from certain countries with widespread transmission of SARS-CoV-2, the virus that causes COVID-19. Initial screening for passengers arriving from Wuhan, China, at three major US airports was expanded over time to include travelers arriving from mainland China, Iran, Europe, United Kingdom, Ireland, and Brazil at 15 US airports.
From Jan 17 to Sep 13, a total of 766,044 travelers were screened, with 298 (0.04%) who met criteria for public health assessment, 35 (0.005%) tested for SARS-CoV-2, and 9 (0.001%) having a positive test result. Manual data collection resulted in 98.1% complete records—containing both the traveler's phone number and address.
"Symptom-based screening programs are ineffective because of the nonspecific clinical presentation of COVID-19 and asymptomatic cases," the CDC experts wrote.
The low yield of positive cases led to discontinuation of enhanced screening on Sep 14, replaced by recommendations for traveler mask use, hand hygiene, self-monitoring for symptoms, and physical distancing during and after travel. CDC experts also recommend additional traveler precautions such as predeparture and postarrival testing, avoiding contact with high-risk people, and quarantine as recommended by local public health authorities at travelers' destinations.
After discontinuation of enhanced screening and manual data collection, only 22% of traveler contact information records were complete.
"CDC is working with government and industry partners to develop a framework to collect reliable contact information electronically for airline passengers before arrival in the United States and enable secure, real-time data transfer for any public health follow-up, including air travel-related contact tracing, when indicated," the authors wrote.
Nov 13 MMWR study
Study spotlights children's mental health emergencies during pandemic
Another MMWR study today found that emergency department (ED) visits for mental health declined for people of all ages during the early months of the US COVID-19 pandemic, but the proportion of children's mental health–related visits relative to overall pediatric ED visits increased in April and remained elevated through October. Adolescents ages 12 to 17 accounted for the largest proportion of visits.
Compared with mid-March to October 2019 data, the proportion of 2020 mental health–related ED visits for children ages 5 to 11 and adolescents ages 12 to 17 increased 24% and 31%, respectively. The proportion of mental health–related ED visits among all children increased 66%, from 1,094 per 100,000 in April 2019 to 1,820 per 100,000 in April 2020.
"The average proportion of children's mental health–related ED visits was approximately 44% higher in 2020 (1,673 per 100,000) than that in 2019 (1,161 per 100,000)," the study authors found.
"Many mental disorders commence in childhood, and mental health concerns in these age groups might be exacerbated by stress related to the pandemic and abrupt disruptions to daily life associated with mitigation efforts, including anxiety about illness, social isolation, and interrupted connectedness to school," they added.
CDC and US health experts noted that emergency departments—often the first point of care for children's mental health emergencies—may have experienced increased pediatric mental-health visits because of pandemic-related barriers to non-emergency services.
"Monitoring indicators of children's mental health, promoting coping and resilience, and expanding access to services to support children’s mental health are critical during the COVID-19 pandemic," the authors concluded.
Nov 13 MMWR study
COVID-19 Scan for Nov 13, 2020
Mild-to-moderate COVID treatment; Airline COVID-19 screening; Pandemic mental health in kids
Filed Under:
COVID-19
Fluvoxamine possible treatment for mild-to-moderate COVID
In a preliminary study conducted on 152 patients with mild-to-moderate COVID-19 infections, no patient in a group of 80 people who took a 15-day course of fluvoxamine, an antidepressant, reported clinical deterioration, as opposed to 6 (8.3%) of 72 who took a placebo.
The study, published yesterday in JAMA, defined clinical deterioration as severe shortness of breath, hospitalization for shortness of breath or pneumonia, or when oxygen saturation fell below 92% without aid.
While both groups had lesser symptoms of adverse events, the fluvoxamine group reported no serious consequences during treatment, whereas the placebo group included four people who had to be rehospitalized. (The one serious adverse event in the treatment group was a headache that required hospitalization during the 30-day follow-up period.) Adverse effects such as muscle aches, nausea, pneumonia, and vomiting were reported 11 times in the treatment group and 12 times in the placebo group, but patients may have experienced more than one adverse event.
Patients from the St. Louis area participated in the remote study from Apr 10 to Aug 5, with Sep 19 as the final 30-day follow-up date. Median time between symptom onset and first treatment dose was 4 days, and those on fluvoxamine took 100-milligram doses three times a day for 15 days. Although 18.1% of people (18 in the treatment and 19 of the placebo group) stopped responding to surveys before the treatment cycle was complete, none visited a major regional hospital or emergency department.
"There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules," said senior author Angela M Reiersen, MD, MPE, in a Washington University School of Medicine press release. "Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients."
In an editor's note, JAMA editors wrote that the study "presents only preliminary information, and requires confirmation in larger trials. But at the same time, it is a double-blind, placebo-controlled, randomized clinical trial, which is generally considered a design that minimizes bias and can support causal inference."
Nov 12 JAMA study
Nov 12 Washington University press release
CDC: Symptom-based COVID-19 airport screening ineffective
Data published today in Morbidity and Mortality Weekly Report (MMWR) shows that resource-intensive, symptom-based airline passenger entry screening identified few laboratory-diagnosed COVID-19 cases—only 1 case for every 85,000 travelers screened. The researchers also highlight the inadequacy of electronic airline data for contact tracing, finding that only 22% of records contain both the traveler's phone number and physical address.
In January, the Centers for Disease Control (CDC) instituted enhanced, symptom-based screening for air passengers returning from certain countries with widespread transmission of SARS-CoV-2, the virus that causes COVID-19. Initial screening for passengers arriving from Wuhan, China, at three major US airports was expanded over time to include travelers arriving from mainland China, Iran, Europe, United Kingdom, Ireland, and Brazil at 15 US airports.
From Jan 17 to Sep 13, a total of 766,044 travelers were screened, with 298 (0.04%) who met criteria for public health assessment, 35 (0.005%) tested for SARS-CoV-2, and 9 (0.001%) having a positive test result. Manual data collection resulted in 98.1% complete records—containing both the traveler's phone number and address.
"Symptom-based screening programs are ineffective because of the nonspecific clinical presentation of COVID-19 and asymptomatic cases," the CDC experts wrote.
The low yield of positive cases led to discontinuation of enhanced screening on Sep 14, replaced by recommendations for traveler mask use, hand hygiene, self-monitoring for symptoms, and physical distancing during and after travel. CDC experts also recommend additional traveler precautions such as predeparture and postarrival testing, avoiding contact with high-risk people, and quarantine as recommended by local public health authorities at travelers' destinations.
After discontinuation of enhanced screening and manual data collection, only 22% of traveler contact information records were complete.
"CDC is working with government and industry partners to develop a framework to collect reliable contact information electronically for airline passengers before arrival in the United States and enable secure, real-time data transfer for any public health follow-up, including air travel-related contact tracing, when indicated," the authors wrote.
Nov 13 MMWR study
Study spotlights children's mental health emergencies during pandemic
Another MMWR study today found that emergency department (ED) visits for mental health declined for people of all ages during the early months of the US COVID-19 pandemic, but the proportion of children's mental health–related visits relative to overall pediatric ED visits increased in April and remained elevated through October. Adolescents ages 12 to 17 accounted for the largest proportion of visits.
Compared with mid-March to October 2019 data, the proportion of 2020 mental health–related ED visits for children ages 5 to 11 and adolescents ages 12 to 17 increased 24% and 31%, respectively. The proportion of mental health–related ED visits among all children increased 66%, from 1,094 per 100,000 in April 2019 to 1,820 per 100,000 in April 2020.
"The average proportion of children's mental health–related ED visits was approximately 44% higher in 2020 (1,673 per 100,000) than that in 2019 (1,161 per 100,000)," the study authors found.
"Many mental disorders commence in childhood, and mental health concerns in these age groups might be exacerbated by stress related to the pandemic and abrupt disruptions to daily life associated with mitigation efforts, including anxiety about illness, social isolation, and interrupted connectedness to school," they added.
CDC and US health experts noted that emergency departments—often the first point of care for children's mental health emergencies—may have experienced increased pediatric mental-health visits because of pandemic-related barriers to non-emergency services.
"Monitoring indicators of children's mental health, promoting coping and resilience, and expanding access to services to support children’s mental health are critical during the COVID-19 pandemic," the authors concluded.
Nov 13 MMWR study