September 15, 2020

On today's episode we discuss: —Epidemiology: Random COVID-19 testing of 200 people in Chelsea, MA using the BioMedomics SARS-CoV-2 combined IgM/IgG LFA to determine seropositivity in a group of asymptomatic patients showed that 24.7% of seropositive participants were asymptomatic, suggesting that better safety precautions such as improved testing, isolation, contact-tracing, and distancing are needed as a high number of individuals can be carrying the virus asymptomatically. · A systematic review of 97 studies exploring COVID-19 in 230,398 health care workers (HCW) showed COVID-19 prevalence of 11% by RT-PCR (95% CI: 7-15%) and 7% by antibody detection (95% CI: 4-11%) with serious complications seen in 5% (95% CI: 3-8%) and mortality in 0.5% (95% CI: 0.02-1.3%). Overall, those working in nursing or in a non-emergency setting were found to be at highest risk. Because 40% of HCW were asymptomatic at diagnosis, they suggest HCW simultaneously risk spreading and contracting COVID-19 and emphasize the need to screen HCW and implement standard procedures for the use of personal protective equipment. —Management A multidisciplinary coalition of Brazilian investigators conducted a multi-center, randomized open-label clinical trial (CoDEX) exploring the clinical impact of dexamethasone on COVID-19 patients in 41 ICUs in Brazil (n=299). Adult patients presenting with moderate to severe ARDS who received dexamethasone (n=151) spent fewer days on mechanical ventilation within a 28 day period compared to those receiving standard care (mean 6.6 days [95% CI: 5.0-8.2] vs 4.0 days [95% CI: 2.9-5.4], difference 2.26 days [p=0.04])). This adds to a growing body of research suggesting dexamethasone improves outcomes in moderate to severe COVID-19. —R&D: Diagnosis & Treatments: Investigators affiliated with International Medical University, Malaysia and the University of Huddersfield, UK performed a systemic review and meta-analysis with a total of 8,121 hospitalized patients with COVID-19 showing significantly lower odds for mortality with metformin use in diabetic, COVID-19 cases (pooled analysis OR: 0.62) than cases without use of metformin. The authors hypothesize that this finding may be due to anti-inflammatory mechanisms of metformin dampening the cytokine storm in COVID-19. However, as this finding was only seen in patients with pre-existing diabetes, further research is needed to provide evidence of the morbidity and mortality benefit in repurposing metformin for COVID-19 patients without concomitant diabetes.