COVID-19 Update June 2, 2020

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Gov. Cuomo’s Daily Press Conference

COVID-19:
– Day 94 of the pandemic.
– Hospitalizations down, number of new cases at an all time low (154).
– Deaths 6/1: 58 – 47 in hospitals, 11 in nursing homes.

REOPENING:
– WNY enters Phase II today, Cap Region enters Phase II tomorrow.
– NYC on track to enter Phase I on June 8.
– Summer day camps can open June 29, no final decision on sleep-away camps yet.

Q&A:
NURSING HOMES:
– On accusations of NYS not following Federal guidelines regarding nursing
homes, DeRosa said these were “just wrong,” arguing that the March 13th
order from CMS allowed all actions taken and outlined response.
– Gov claimed there is an attempt to politicize the response to COVID-19,
especially concerning nursing homes. Argued Federal and State guidance are
the same.


COVID-19: Evidence on Physical Distancing / Remdesivir & Moderate Disease
Physical distancing of at least 1 meter (3.3 feet) is associated with lower risk for spread of coronaviruses, according to a meta-analysis in the Lancet.

Researchers examined 44 studies on the effects of nonpharmaceutical interventions on the risk for transmitting SARS-CoV, SARS-CoV-2, and MERS-CoV in healthcare and non-healthcare settings. Risk for transmitting the viruses was lower when exposure was at 1 meter or more, compared with less than 1 meter (adjusted odds ratio, 0.18). Risk was lower with increasing distance. N95 masks provided greater protection than surgical face masks, but both were protective. Specifically, for SARS-CoV-2, mask use was associated with a 60% reduced risk for infection, compared with no mask use. Eye protection was also associated with lower infection risk.

The researchers say the analysis provides “the best available evidence that current policies of at least 1 m physical distancing are associated with a large reduction in infection, and distances of 2 m might be more effective.”

In other COVID-19 news, unpublished results of a phase 3, manufacturer-conducted trial suggest that remdesivir had an effect on patients with moderate COVID-19 who were hospitalized with pneumonia but did not have reduced oxygen levels. Patients who received 5 days of remdesivir had a higher rate of improving at least one point on a 7-point ordinal scale by day 11, compared with those who received standard care alone (76% vs. 66%). Findings for 10 days’ remdesivir were not statistically significant.

Physical distancing meta-analysis in the Lancet; Remdesivir & moderate COVID-19 news release; NEJM COVID-19 page

PCPs Report Status as Lockdown Lifts: Results from a National Survey

Among patients with COVID-19 and diabetes, one in 10 died within week of hospitalization, study shows Remdesivir helped patients with moderate COVID-19 infection recover quicker than patients not taking the drug, Gilead said June 1.

In its phase 3 trial, the drugmaker found remdesivir helped patients with moderate COVID-19 infection recover quicker when they received it for five days, but the benefit wasn’t statistically significant when the drug was given for 10 days, STAT reported.

The new data support evidence that remdesivir is at least somewhat effective in treating COVID-19, but will likely add to the debate over which patients should get it, according to STAT.

In the trial, moderate COVID-19 infection was defined as being hospitalized but not needing mechanical ventilation. The trial did not include a placebo group.

Patients who were given remdesivir for five days were 65 percent more likely to show improvement. Those who received the drug for 10 days were just 31 percent more likely to show improvement, but the study’s authors said that the difference was not statistically significant, meaning it may have happened by chance, STAT reported.

There were no deaths in the five-day group and two in the 10-day group.

Nahid Bhadelia, the medical director of the special pathogens unit at Boston Medical Center, told STAT that it was frustrating to get the data from a news release rather than to see the actual data. She said until the actual data is published, many physicians will be in a “gray area” where they are not quite sure how to use the drug.

Read the full article hereBecker’s Hospital Review June 2, 2020


N95 Respirators Offer Greater Protection v. COVID-19 Surgical or Cloth Masks|
N95 respirators offer greater protection against COVID-19 than surgical or cloth masks, according to a study published June 1 in The Lancet. The World Health Organization funded the study, which analyzed 172 existing studies on the use of face masks to prevent virus transmissions. N95s offered 96 percent protection, compared to just 77 percent protection for surgical masks. Based on these findings, the WHO and CDC should recommend all essential workers wear N95s instead of surgical masks, health experts told The New York Times.


FDA Asks 5 Drugmakers to Recall Metformin Products
The FDA has asked five drugmakers to voluntarily recall their metformin products after it found unacceptable levels of a carcinogen in the drug, The Wall Street Journal reported. The agency said May 28 that after months of testing, it found unacceptable levels of N-nitrosodimethylamine, or NDMA, a cancer-causing chemical when ingested at high levels, in extended-release versions of metformin.

Metformin is used by millions of Americans to treat Type 2 diabetes and sold under brands including Fortamet, Glucophage, Glumetza and Riomet.

Apotex and Amneal Pharmaceuticals have both recalled their extended-release tablets after being asked to do so by the FDA. An FDA spokesperson declined to tell the Journal which other drugmakers were asked to recall their metformin products because they have not formally filed a recall action.

The FDA told the Journal it didn’t ask drugmakers that sell a large percentage of extended-release metformin in the U.S. to recall their products, but to test their products for NDMA and not release any batches if the chemical is above acceptable levels.

The agency also told the Journal that it is assessing whether any of the recalls would cause shortages and is working with manufacturers to limit the effects of any potential shortages.


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Can Coronavirus Be Transmitted Sexually?
The gateway into the body for this virus is the ACE2 receptor, present in the lungs, heart, intestines, kidneys, and testis.Studies show that 20% of men with asymptomatic COVID infection may have orchitis, an infection in one or both testes.

Researchers in Florida are hoping to learn if the SARS-CoV-2 virus that causes COVID-19 can be detected in semen and transmitted sexually.

“We hypothesize that SARS-CoV-2 may be present in the semen and be a source of transmission,” said Ranjith Ramasamy, MD, associate professor of urology at the Miller School of Medicine and director of male reproductive medicine and surgery at the University of Miami Health System and the Miller School.

“Understanding the potential for COVID sexual transmission is critical because of the tremendous potential ramifications,” he said.

The UM researchers are hoping to find at least 200 men who tested positive for COVID-19 to enroll in a study to determine the interaction of the virus with semen. So far, 30 men are enrolled in the study.

Ramasamy said that a critical first step in understanding the potential routes of transmission — and their ramifications — is knowing which tissues the virus is capable of infecting.

“Previous SARS strains have shown an ability to cross into the male reproductive tract, where it can be sexually transmitted,” he said.

Ramasamy cited studies that estimate that 20% of men with asymptomatic COVID infection may have orchitis, an infection in one or both testes.

“We want to identify how long the presence lasts in semen and investigate whether COVID infection leads to orchitis and male infertility,” he said.

The gateway into the body for this virus is the ACE2 receptor, present in the lungs, heart, intestines, kidneys, and testis.

“The COVID receptor is present in a lot of testes. The testis is responsible for sperm and testosterone production,” Ramasamy said. “So, we not only want to check testosterone levels, but also research if young men have changes in their sperm counts.” Health Leaders May 29


COVID-19 Will Circulate for Decades, Experts Predict
COVID-19 will likely persist for decades, even after a vaccine is created and widely disseminated, experts told The Washington Post. 

Many vaccine, epidemiology and disaster planning experts said they believe COVID-19 will become an endemic disease similar to HIV or chickenpox. Four other types of coronaviruses already circulate the globe and cause the common cold. Some experts predict SARS-CoV-2 will become the fifth, eventually posing milder health risks as immunity increases.

“This virus is here to stay,” Sarah Cobey, PhD, an epidemiologist and evolutionary biologist at the University of Chicago, told the Post. “The question is, how do we live with it safely?”

Experts said leaders must start thinking about long-term solutions for COVID-19, instead of focusing on short-term crisis management. They said the first priority should be developing more sophisticated testing and data management strategies for the virus.

COVID-19 may also require lasting changes to many aspects of everyday life, according to the experts. For example, cities may want to implement automatic doors and touch-free crosswalk buttons to promote hand hygiene, according to Dr. Eleanor Murray, an epidemiologist at Boston University. Families may need to get routine COVID-19 tests before visitng elderly loved ones, and employers may need to abandon open floor plans for cubicles.


 

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