COVID-19 Daily: New Hydroxychloroquine Data, Dire PPE Shortages

What your doctor is reading on Medscape.com:

MARCH 30, 2020 -- Here are the latest coronavirus stories Medscape's editors around the globe think you need to know about today: 

More Hydroxychloroquine (HCQ) Data

The same French researchers who created buzz over a potential treatment for COVID-19 released new data that they say bolsters the idea that HCQ with azithromycin is effective in battling the virus. The uncontrolled study of 80 patients found a significant decrease in viral load, but it failed to convince skeptics who want to see studies that include a comparator group.

The new data are "complementary," said Benjamin Davido, MD, a French infectious diseases expert, but they do not provide new information or new statistical evidence. He told Medscape France that he personally believes in HCQ, but it would be "a shame to think that we have found the fountain of youth and to realize, in four weeks, that we have the same number of deaths."

Perry Wilson, MD, provided further context by describing data from the earlier French study as "equivocal at best," arguing for complete transparency about what is known and what is not. "If we want to use hydroxychloroquine, that is a reasonable choice, but we need to tell the public the truth: We're not too sure it will work, and it may even be harmful," he said. 

Rethinking Routine Mask Usage

US and global authorities have said there is no evidence to support wearing masks in the community setting, but one cardiologist is alarmed to see healthcare workers and patients roaming the hospital without masks. 

Some experts argue that asymptomatic or "stealth transmission" may be a major driver of the epidemic, he notes. But why advocate for widespread mask usage when masks are already in short supply? Broader acceptance of the value of masks could convince authorities to ramp up efforts to produce more protective equipment, he says.

'Dire' Shortages of PPE

Speaking of shortages, nearly half of US healthcare facilities are already or almost out of essential supplies, according to a new survey. The shortages in personal protective equipment (PPE) include masks, face shields, respirators, and gowns, reported the Association for Professionals in Infection Control and Epidemiology. More than 17% of respondents said they had resorted to DIY approaches such as sewing their own masks.

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Preparing for the Surge

How can clinicians and hospitals get ready for the expected uptick in COVID-19 cases? Repurposing hospital staff is one strategy, Medscape Medical News reports, which may require state and federal governments to relax some existing health codes. At Kaiser Permanente, for example, they plan to use critical care specialists to act as consultants to front-line hospitalists; other specialists will "backfill" the hospitalists, and family medicine physicians will help out in emergency departments.

Lessons From Europe

new study from Italian clinicians who have been battling the coronavirus shares their experience and provides recommendations for clinical practice. They describe key elements of clinical management, including oxygen therapy and airway management, as well as nontechnical aspects of caring for patients with COVID-19.

New guidance from the European Society of Intensive Care Medicine provides precautions for medical staff to avoid becoming infected themselves. In Italy, almost 9% of positive coronavirus cases are health workers. A panel of 36 experts from 12 countries produced the guidance to "avoid unproven strategies."

Somber Predictions From Experts

Anthony Fauci, MD, is predicting "millions" of coronavirus cases in the United States, with 100,000 to 200,000 deaths, reports the Associated Press. Appearing on Sunday television news shows, the National Institute of Allergy and Infectious Diseases director delivered a prognosis that would surpass the death toll of the annual seasonal flu. Meanwhile, parts of the country that have been relatively untouched by the virus should prepare for that to change, said Deborah Birx, MD, head of the White House coronavirus task force. "No state, no metro area, will be spared," she said.

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