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Weekly Digest: Clinical trials for novel coronavirus treatments progress; Researchers estimate 1.38% death rate among confirmed COVID-19 cases in China; Increased taxation of tobacco, alcohol & sugary beverages may save millions of lives.

Weekly Digest: Clinical trials for novel coronavirus treatments progress; Researchers estimate 1.38% death rate among confirmed COVID-19 cases in China; Increased taxation of tobacco, alcohol & sugary beverages may save millions of lives.

Clinical trials for novel coronavirus treatments progress, but more research is needed. In a small clinical trial of 62 COVID-19 patients at Renmin Hospital of Wuhan University, researchers found that hydroxychloroquine was efficacious in reducing recovery time of symptoms and improving pneumonia. Patients randomized to receive hydroxychloroquine treatment (n=31) had significantly faster body temperature recovery time and cough remission time compared to patients in the control group (n=31). All patients in the trial who progressed to severe illness (4) were controls, and two patients randomized to receive hydroxychloroquine experienced mild adverse reactions. Preliminary findings from an uncontrolled case series including five patients with COVID-19 and acute respiratory distress syndrome suggest that convalescent plasma containing neutralizing antibody may improve patients’ clinical outcomes. Four out of five patients experienced normalized body temperatures three days following plasma transfusion, four patients experienced acute respiratory distress syndrome resolution after 12 days, and three patients were taken off mechanical ventilation after 14 days. Findings from both studies require further evaluation in larger randomized trials. [medRxiv, JAMA]

Researchers estimate 1.38 percent death rate among confirmed COVID-19 cases in China. In a modeling study published in The Lancet Infectious Diseases, researchers estimated that the overall case-fatality ratio for confirmed COVID-19 cases in China was 1.38 percent; however, this rate increased with age up to 13.4 percent among patients 80 years and older. The proportion of COVID-19 infections in mainland China that led to hospitalization also increased with age, from 0.04 percent among cases aged 10-19 years old to 18.4 percent among cases 80 years and older. The study found that the overall infection fatality ratio in China, which includes unconfirmed COVID-19 cases, is approximately 0.66 percent.  [The Lancet Infectious Diseases]

Case investigation details COVID-19 hospitalizations and deaths linked to Seattle area nursing home. A case investigation of a COVID-19 cluster in a long-term care facility in King County, Washington found that there were 167 cases epidemiologically linked to the facility as of March 18, 2020. A majority of infected residents (54.5 percent), half of infected visitors, and 6 percent of infected staff required hospitalization. The preliminary case-fatality rates among residents, visitors, and staff were 33.7 percent, 6.2 percent, and 0 percent, respectively. The authors note the importance of implementing active monitoring and infection prevention and control measures to prevent novel coronavirus outbreaks in long-term care facilities where residents are especially susceptible to severe disease outcomes. [NEJM]

Risk factors for novel coronavirus-associated death in Wuhan, China. In a retrospective analysis of nearly 800 COVID-19 patients in Wuhan, China, older age, male sex, and underlying medical conditions were more common among deceased patients compared to those who recovered from their infections. Symptoms such as difficulty breathing, tightness of chest, and disordered consciousness as well as complications such as acute respiratory distress syndrome, respiratory failure, sepsis, acute cardiac injury, and heart failure also occurred more frequently among individuals who died from the novel coronavirus. Among patients who died, the median time between disease onset and COVID-19 death was 16 days. [BMJ]

Viral shedding observations of novel coronavirus may suggest airborne transmission. In a pre-print publication of 13 individuals with confirmed novel coronavirus disease at the University of Nebraska Medical Center, researchers observed viral shedding from infected patients to commonly used items, bathrooms, and air samples. Although the extent of environmental viral shedding varied by patient, results suggest that COVID-19 may spread through direct and indirect contact, including airborne transmission. [MedRxiv]

Mother-to-child transmission of COVID-19 may be possible, small study finds. In a cohort study of 33 neonates born to mothers with confirmed COVID-19 in Wuhan, China, researchers suggest that mother-to-child transmission of the virus cannot be ruled out. Nine percent of infants tested positive and presented with mild COVID-19 symptoms, and because strict infection prevention and control measures were in place during delivery, the authors hypothesize that vertical transmission was likely. [JAMA Pediatrics]

Increased taxation of tobacco, alcohol, and sugary beverages estimated to save millions of lives. Researchers at CDDEP, the University of the Witwatersrand, Bloomberg Philanthropies, and the University of Chicago used mathematical modelsto simulate the expected global effects of a tax increase on tobacco, alcohol, and sugar-sweetened beverages (SSBs). The models compared the health and economic effects of a tax producing a 20 percent and 50 percent price increase on products, as well as an absolute dollar increase per serving over a 50-year span. The study found that over 50 years, a tax producing a 20 percent retail price increase on tobacco, alcohol, and SSBs could result in a gain of 160.7 million [96.3, 225.2 million], 227.4 million [161.2, 293.6 million], and 24.3 million [15.7, 35.4 million] additional life years worldwide, respectively. [BMJ Global Health]

Decreasing antibiotic use in infancy tied to reduced incidence of childhood asthma. A study from Canada suggests that the recent reduction in childhood asthma incidence may be an unintended benefit of improved antibiotic stewardship among infants. Using data from population-based and prospective cohort studies, the researchers found an association between decreasing antibiotic use among infants (<1 year) and reduced asthma incidence among children (1-4 years old) between 2000 and 2014 (p<0.0001). Antibiotic use in infancy decreased from 1253.8 to 489.1 prescriptions per 1,000 infants between 2000 and 2014, while childhood asthma incidence decreased from 27.3 to 20.2 new diagnoses per 1,000 children in the same time period. The study found that the preservation of the gut microbiota significantly mediates this relationship between outpatient antibiotic exposure during infancy and childhood asthma (p=0·027). [The Lancet Respiratory Medicine]

Malaria vaccine may be co-administered with other routine immunizations in Ghana. In a phase 3b randomized trial including 709 Ghanaian children, researchers found that the malaria vaccine (RTS,S/AS01) can be safely and effectively administered with other routine immunizations at Expanded Programme on Immunization (EPI) visits. In the trial, children randomized to the intervention group received the first dose of the malaria vaccine with Vitamin A at age six months, the second dose at 7.5 months, and the third dose along with the yellow fever and measles and rubella vaccines at nine months. The co-administration of the vaccines did not cause immune response impairment nor any safety effects among participants in the intervention group compared to controls. [Vaccine]

Moderate flu vaccine effectiveness reported among children during 2016-17 season. A systematic review and meta-analysis of five studies from Canada, Finland, Germany, the UK and the US reported moderate consolidated vaccine effectiveness against all influenza strains for the quadrivalent live attenuated influenza vaccine (LAIV4) (69 percent [95% confidence interval: 46, 82]) and the inactivated influenza vaccine (IIV) (47 percent [29, 61]) during the 2016-2017 flu season. The study found that vaccine effectiveness against A/H3N2 was comparable across vaccine types, at 51 percent [33, 64] for LAIV4 and 46 percent [33, 56] for IIV.  This reduced vaccine effectiveness may be a result of an antigenic shift that occurred among influenza A/H3N2 strains. [Vaccine]