COVID-19 Daily: Hydroxychloroquine RCT Data, Furloughs and Layoffs

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APRIL 16, 2020 -- Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Hydroxychloroquine RCT Data Show No Benefit, but Inconclusive

Hydroxychloroquine does not help clear the SARS-CoV-2 virus or relieve symptoms for COVID-19 patients more than standard care alone and has more side effects, according to the results of a randomized controlled trial of 150 hospitalized adults in China posted to a preprint server. 

But the trial results don't definitively answer the question of whether the drug may be a helpful treatment for COVID-19, experts say. "It's another muddy study," one told Medscape Medical News 

Medical Practices Have Furloughs and Layoffs

The results of a survey of physician practices by the Medical Group Management Association (MGMA) put some national numbers to the reports of financial trouble many clinicians are experiencing as patient volumes decline with stay-at-home orders and authorities order elective procedures canceled. Nearly half of more than 700 medical practices surveyed had furloughed employees, and about one fifth said they had laid off staff.   

Halee Fischer-Wright, MD, president and CEO of MGMA, told Medscape Medical News that single-specialty groups that perform elective procedures have seen "dramatic decreases in volume."

Published: New Clinical Details of COVID-19 Pneumonia

Italian clinicians who warned that protocol-driven ventilator use could be doing more harm than good for some patients have published more clinical details of the two different phenotypes of COVID-19 pneumonia they've seen. They report that, in their series of 150 patients, only 20% to 30% showed disease that fit the criteria for severe acute respiratory distress syndrome (ARDS).

"Stronger Evidence" for Myocardial Injury

The clinical features of four end-stage heart failure patients with COVID-19 provide strong supportive evidence that the virus can cause cardiac injury, researchers from China conclude in a small study. The exact mechanism of how SARS-CoV-2 causes myocardial injury is not completely clear, they say.

First Data On Prevalence of Neurologic Symptoms With COVID-19

Following case reports and anecdotes suggesting possible neurologic symptoms of COVID-19, researchers based in Wuhan, China have published the first study to back these observations with more substantial evidence. The investigators analyzed data from more than 200 adult patients with COVID-19 and found that about one third had neurologic manifestations. 


"It should raise the eyebrows of first-line responders and physicians who are seeing patients with neurologic conditions to consider if those could also be a manifestation of COVID-19," said one expert, though another pointed out that the coexistence of COVID-19 with a patient's neurologic symptoms doesn't establish a link. 

"It is too early to say that we know definitively that COVID-19 causes neurological symptoms, although we think it does," he said.

What You Think of the Reaction to COVID-19

Yesterday we asked readers to tell Medscape what they thought of how their fellow clinicians, patients, and national governments have reacted
to COVID-19. 

As of this afternoon, 828 physicians had responded. Sixty-six percent said they think other clinicians' reaction to COVID-19 is proportionate to the threat, 55% think their patients' reaction to COVID-19 is proportionate to the threat, and 26% think their governments' response is proportionate to the threat. Forty-seven percent said they think their national governments' response is an underreaction, and the rest think their government is overreacting. 

A little about the demographics of the physicians who responded to our poll: 74% primarily practice in the US, 58% are older than age 55, 37% work in an office-based practice compared to 29% in a hospital, and 48% describe their current work situation as employed, vs an owner, partner, or independent contractor. 

COVID-19 Ventilation Protocol Tool

Adapted from an algorithm developed by the Toronto Centre of Excellence in Mechanical Ventilation (CoEMV), this tool provides guidance to optimize ventilatory management of critically ill patients with COVID-19. 

In addition to guiding HCPs through the CoEMV algorithm, it provides brief videos that clearly show how to perform the advanced ventilatory techniques being described. The tool is also available on Medscape's smartphone app. 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Hundreds throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

Medscape Medical News
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