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Take a look at a selection of our recent media coverage:

Casirivimab and imdevimab combination reduces incidence of symptomatic COVID-19

19th January 2022

Casirivimab and imdevimab in combination have been found to reduce the development of symptomatic COVID-19 over 28 days compared with placebo

Casirivimab and imdevimab used together lead to a significant reduction in the proportion of patients who develop symptomatic COVID-19 compared to those given placebo. This was the conclusion of a randomised trial by researchers from the manufacturer of the combination, Regeneron Pharmaceuticals, New York, US.

Although the arrival of effective COVID-19 vaccines have been shown to boost individuals’ immunity against the virus, therapy with monoclonal antibodies remains an alternative for those who develop an inadequate response to vaccination. However, a recent Cochrane systematic review of monoclonal antibody therapy in COVID-19, concluded that ‘our certainty in the evidence for all non‐hospitalised individuals is low, and for hospitalised individuals is very low to moderate. We consider the current evidence insufficient to draw meaningful conclusions regarding treatment with SARS‐CoV‐2‐neutralising mAbs‘ (monoclonal antibodies).

Casirivimab and imdevimab are two mAbs that bind to different parts of the spike protein present on the surface of COVID-19. Furthermore, trial data has revealed how this combination reduced the risk of COVID-19–related hospitalisation and all-cause mortality, as well as resolving symptoms and decreasing viral load, more quickly than placebo.

The Regeneron Pharmaceuticals team undertook a two phase study of their combination. In part A, casirivimab and Imdevimab were found to prevent both symptomatic and asymptomatic COVID-19 infection among previously uninfected household contacts of infected individuals. The present study relates to part B of their trial, in which asymptomatic, infected close contacts were treated with subcutaneous casirivimab and imdevimab.

Part B was a randomised, double-blind, Phase III trial, designed to determine whether subcutaneous casirivimab and imdevimab could prevent progression from asymptomatic to symptomatic infection. Enrolled participants were adults with a PCR confirmed COVID-19 infection, identified within 96 hours of another household contact testing positive. Included participants were then randomised 1:1 to casirivimab and imdevimab or placebo and the primary endpoint of the trial was the proportion of individuals who developed signs and symptoms of COVID-19 within 14 days of their positive PCR result and this was reviewed over a 28 day period following randomisation.

Findings

A total of 314 individuals with a mean age of 41 years (51.6% female) were included of whom, 204 (66%) were asymptomatic and randomised to either casirivimab and Imdevimab (100) or placebo.

Among asymptomatic individuals assigned to treatment, 29% became symptomatic compared to 42.3% of those given placebo (odds ratio, OR = 0.54, 95% CI 0.30 – 0.97, p = 0.04). Participants on treatment also experienced a 5.6 day reduction in the mean duration of symptoms compared to placebo and the total number of weeks with a high viral load was significantly reduced (489.9 weeks vs 811.9 weeks per 1000 participants, treatment vs placebo, p = 0.01).

The authors concluded that treatment with casirivimab and imdevimab for asymptomatic COVID-19 positive individuals living with an infected household contact, significantly reduced the incidence of symptomatic infection over a period of 28 days.

Citation

O’Brien MP et al. Effect of Subcutaneous Casirivimab and Imdevimab Antibody Combination vs Placebo on Development of Symptomatic COVID-19 in Early Asymptomatic SARS-CoV-2 Infection. A Randomized Clinical Trial JAMA 2022

Vaccination leads to smaller reduction in transmission of delta compared to alpha COVID-19 variants

13th January 2022

Vaccination against COVID-19 leads to a higher level of transmission for the delta compared to the alpha variant

Vaccination has been found to result in a smaller reduction in the transmission of the Delta compared to the alpha variant according to a study by researchers from Oxford University, UK.

Vaccination against COVID-19 has been shown to reduce symptomatic infection and even onward transmission of the virus among household contacts. Furthermore, some data indicates that this reduced risk of onward transmission is because of a lower viral load among vaccinated individuals although other evidence points to a similar viral load among those who are vaccinated but infected with the Delta variant.

For the present study, the Oxford team used national contact testing data in England for adults (> 18 yeas of age) with both symptomatic and asymptomatic infections. Their analysis included vaccination with either BNT162b2 or ChAdOx1 to investigate differences in transmission from index patients infected with either variant. The analysis included regression models to determine any associations between onward transmission and the vaccination status of the index patient.

Findings

Among 146,243 tested contacts from a total of 108,498 index patients, with a median age of 34 years (51% female), 37% had a positive PCR test.

Using regression modelling, among index patients doubly vaccinated with BNT162b2 and who became infected, there was a significantly reduced risk of onward transmission of the Alpha variant (adjusted rate ratio, aRR = 0.32, 95% CI 0.21 – 0.48) compared unvaccinated individuals. Similarly, those with two vaccinations of ChAdOx1, also had a reduced risk of onward transmission (aRR = 0.48, 95% CI 0.30 – 0.78) compared to the unvaccinated.

In contrast, the extent of onward transmission of the Delta variant was reduced compared to Alpha by both vaccines but was greater among those doubly vaccinated with BNT162b2 (aRR = 0.50, 95% CI 0.39 – 0.65) compared to ChAdOx1 (aRR = 0.76, 95% 0.70 – 0.82). In other words, index patients vaccinated with BNT162b2 were less likely to have contacts with a positive PCR test for Delta compared to those given the ChAdOx1 vaccine.

The Delta variant was also associated with more onward transmission from both symptomatic index patients (aRR = 1.24, 95% CI 1.12 – 1.38) and from asymptomatic individuals (aRR = 1.40, 95% CI 1.22 – 1.59) and this was independent of both index and contact vaccination status.

Interestingly, the risk of infection with the Alpha variant among fully vaccinated contacts, was much lower among those given BNT162b2 (aRR = 0.15, 95% CI 0.11 – 021) compared to those fully vaccinated with ChAdOx1 (aRR = 0.40, 95% CI 0.27 – 0.59) and the magnitude of these reductions were similar for infections with the Delta variant.

Both symptomatic and asymptomatic index patients infected with the Delta variant had lower Ct values (i.e., higher viral loads) compared to those infected with the Alpha variant. When including Ct values in their regression models, the authors reported that lower Ct values were independently associated with increased transmission of either variant.

The authors concluded that vaccination was associated with a smaller reduction in transmission of the Delta compared to the Alpha variant.

Citation

Eyre DW wt al. Effect of Covid-19 Vaccination on Transmission of Alpha and Delta Variants. N Eng J Med 2022

Cross-reactive T cells offer protection against COVID-19 infection

12th January 2022

Cross-reactive T cells developed in response to coronaviruses before the pandemic appear to provide immunity against infection with COVID-19

Cross-reactive T cells that have developed in response to earlier infections with a coronavirus appear to offer protection against infection with COVID-19. This was the conclusion of a small study by a team led by researchers from the NIHR HPRU in Respiratory Infections, Imperial College London, UK.

Although the current COVID-19 pandemic has, as of January 9th 2022, resulted in nearly 5.5 million worldwide deaths, studies suggest that 20 to 50% of people who had not been exposed to COVID-19 had significant T cell reactivity directed against COVID-19 peptides.

However, no studies have considered the possible association between cross-reactive T cells with the outcomes after exposure to COVID-19. For the present study, the UK team speculated that infection with pre-existing and circulating human coronaviruses, such as the common cold, might help explain why some individuals do not become infected with COVID-19 after contact with someone already infected.

The team created a specific COVID-19 peptide pool and used peripheral blood mononuclear cell (PBMC) samples obtained from 52 patients with a median age of 33 years, with confirmed exposed contacts from the INSTINCT study, between 1 and 6 days after onset of COVID-19 symptoms. The PNMC samples were assayed for interferon-gamma (IFN-G) and interleukin-2 (IL-2) secreting T cells responses to proteins in the peptide pool. The results showed that 26 PCR positive and PCR negative samples reacted to peptides in the pool and that there was no statistical difference (p = 0.42) in the response from either IFN-G or IL-2 secreting T cells from PCR positive and negative samples.

Interestingly, the team observed that among those who were PCR negative, following exposure to COVID-19, there was a decrease in cross-reactive T cells secretion of IL-2 which they felt implied an active response to the temporary COVID-19 exposure. A further observation was how PCR negative samples, had a higher prevalence of seropositivity to other coronavirus viral strains, which supported the notion that these pre-existing T cells were induced by prior exposure.

Discussing their findings, the authors suggested that the presence of IL-2 secreting cross-reactive T cells was associated with protection from infection among COVID-19 contacts. They believed that this protection was most likely to have developed through priming of these T cells after exposure to other coronaviruses in the past. Although based on a small number of patients, the authors concluded that their results are consistent with the notion of pre-existing non-spike cross-reactive memory T cells which protected COVID-19 naive patients.

Citation

Kundu R et al. Cross-reactive memory T cells associate with protection against SARS-CoV-2 infection in COVID-19 contacts. Nat Commun 2022

Immunosuppressive biologics not linked to higher risk of COVID-19 infection or mortality

11th January 2022

Immunosuppressive biologics have been found to be not linked to both a greater risk of COVID-19 infection or subsequent mortality

Immunosuppressive biologics are not associated with an increased risk of either infection with COVID-19 or a higher incidence of death according to the findings from a team from the Department of Dermatology, Massachusetts General Hospital, Boston, US.

Whether immunosuppressive biologics would heighten the risk of infection with COVID-19 seems, at least from some evidence, to be unfounded. Despite this, other work has revealed an increased risk of mortality among patients with rheumatic diseases prescribed non-biologic immunosuppressants such as azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus.

With a potential risk for viral reactivation of an underlying chronic viral infection during immunosuppressive therapy, some have questioned whether patients with psoriasis, for example, should be started on immunosuppressive biologics.

In the present analysis, the US team focused on adult patients (18 years and over) and given at least one prescription for a biologic between July 2019 and February 2020 at their hospital. They undertook a retrospective, matched cohort study and set the primary outcome as the risk of COVID-19 infection and the secondary outcome as subsequent mortality. Using multivariable logistic regression, they calculated the odds ratio (OR) for a COVID-19 diagnosis between those prescribed immunosuppressant biologics and the control group and examined other potential factors associated with either infection or mortality.

Findings

A total of 7361 patients receiving immunosuppressant biologics were matched with 74,910 controls. The most common biologic agents were tumour necrosis factor inhibitors including adalimumab (28.4%), infliximab (15.6%) and etanercept (11.9%), CD20-directed antibodies including rituximab (15.6%) and interleukin-4A inhibitors such as dupilumab (8.6%).

Among the 7361 patients, the primary indication for the immunosuppressive biologics were mainly dermatological diseases such as psoriasis (27.3%) and atopic dermatitis (27.5%), although patients also received these drugs for rheumatoid arthritis (27.5%) and asthma (19.4%).

After adjustment for demographics and co-morbidities, overall, biologics were not associated with COVID-19 (OR = 0.88, 95% CI 0.71-1.09, p = 0.25). Patients prescribed tumour necrosis factor inhibitors were less likely to be diagnosed with COVID-19 compared to matched controls (OR = 0.69, 95% CI 0.48 – 0.98, p = 0.05). Similarly, those treated with dupilumab also had lower risk of being diagnosed, but this difference was non-significant (OR = 0.38, 95% CI 0.12 – 1.18, p = 0.10).

For the secondary outcome of mortality, after adjustment, the difference in rates between the those taking immunosuppressive biologics and controls were non-significant (OR = 1.13, 95% CI 0.57 – 2.76, p = 0.57).

In their regression analysis, the odds of mortality was significantly associated only with age (OR = 1.06, 95% CI 1.04 – 1.09, p < 0.001) with female patients having a much lower odds of mortality (OR = 0.53, 95% CI 0.34 – 0.83, p < 0.01).

They concluded that dermatologists and patients should prioritise the recognised risk factors for infection when making therapy decisions, given how immunosuppressive biologics do not appear to be a risk factor for either infection or mortality.

Citation

Pahalyants V et al. Immunosuppressive biologics did not increase the risk of COVID-19 or subsequent mortality: A retrospective matched cohort study from Massachusetts J Am Acad Dermatol 2021

Point-of-care COVID-19 test in ED significantly reduces turnaround-time

7th January 2022

Point-of-care COVID-19 testing in an emergency department has been found to be highly accurate and significantly reduces turnaround-time

The use of a point-of-care (POC) COVID-19 test within an emergency department (ED) has been found to significantly reduce the turn-around- time compared to PCR tests among patients in need of hospital treatment. This was the key finding of an analysis by a team from the Department of Emergency and Acute Medicine, Charite Universitatsmedizin, Berlin, Germany.

The COVID-19 pandemic has placed enormous strain on healthcare systems across the globe and this has been particularly true for emergency departments (EDs) since patients, even with mild symptoms tend to intuitively present at an ED when they believe they have a serious disease. An ED therefore requires access to a fast and accurate means of testing patients for COVID-19 when they present at the department. The gold standard test for COVID-19 is a PCR test although results are not available for between 4 and 24 hours . The use of rapid antigen tests offers a potentially faster alternative but research has shown that while these tests are useful for symptomatic patients in the emergency setting, patients testing negative require confirmation by PCR test and should isolate until this result becomes available.

With a need for a rapid COVID-19 test result among all patients potentially requiring urgent inpatient care, for the present study, the German team set out to evaluate the role of a POC COVID-19 test for use in the ED. All inpatients were routinely screened at the researcher’s hospital for COVID-19 and they retrospectively examined the clinical characteristics and in-hospital follow-up data for all patients from the electronic medical records. For the study, the team set the primary outcome measure as the turn-around-time (TAT) for the POC compared to the standard PCR test result as well as examining the diagnostic performance of the device which was integrated with the hospital LAN system and ordered via the laboratory channel and ED.

Findings

A population of 160 patients with a mean age of 68 years (69% female) were included and of whom, 16 tested positive for COVID-19 using the POC. The most common symptoms of COVID-19 were dyspnoea (37.5%), fever and cough (both 25%).

The POC had a sensitivity and specificity of 100% and the test result was available within a median of 102 minutes after admission compared to a median of 811 minutes for the PCR test (p < 0.001). Among patients requiring an intervention within 6 hours of presentation (e.g., severe trauma, myocardial infarction), the POC test result was available before the intervention in 92.1% of patients compared to only 5.4% of those with a PCR test result.

The authors concluded that the device could be easily incorporated into an ED and that it showed a high diagnostic performance.

Citation

Mockel M et al. SARS-CoV-2 screening in patients in need of urgent inpatient treatment in the Emergency Department (ED) by digitally integrated point-of-care PCR: a clinical cohort study. MedRxiv 2022

Self-reported long COVID affecting 2% of the UK population

Self-reported ongoing symptoms, or long COVID, have been estimated to affect 2% of the UK population according to recent estimate

Self-reported symptoms after an acute infection with COVID-19 appears to currently affect around 2% of the UK according to data from the Office for National Statistics (ONS).

According to guidance in the UK issued by NICE, symptoms associated with infection with COVID-19 can be categorised as ‘acute’ when lasting up to four weeks and ‘ongoing’, when persisting for up to 12 weeks. The final category is termed ‘post-COVID-19 syndrome, in which signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis.

The ONS current data comes from an ongoing infection survey which measures the number of people across England, Wales, Scotland and Northern Ireland, who test positive for COVID-19 infection at a given point in time, regardless of whether they report experiencing symptoms. Data are collected on the results of a random sample of swab tests conducted on a fortnightly basis from private households and includes children over the age of 2 years, adolescents and adults.

The latest data from the ONS relates to self-reported long covid symptoms, as opposed to a clinical diagnosis, and for the purposes of the survey, this has been defined as symptoms persisting for more than four weeks after the first suspected COVID-19 infection that were not due to something else.

Findings

Based on a sample of 351,850 responses, an estimated 1.3 million people living in private households in the UK, which amounts to 2% of the population, self-reported symptoms persisting for longer than four weeks after their first suspected coronavirus (COVID-19) infection and which were not due to anything else, as of 6 December 2021.

Among this total, 21% first had COVID-19 (or suspected that they had it) less than 12 weeks previously, 70% first had COVID-19 at least 12 weeks before and 40% had COVID-19 at least one year ago. With respect to the impact of these symptoms, 64% stated that their symptoms adversely affected day-to-day activities with 20% reporting that their ability to undertake their day-to-day activities had been “limited a lot”.

The range of reported symptoms included fatigue (51%), followed by loss of smell (37%), shortness of breath (36%), and difficulty concentrating (28%). Furthermore, these symptoms and their impact were greatest in people aged 35 to 69 years, females, people living in more deprived areas, those working in health care, social care, or teaching and education.

Whether the number of people affected will increase over time remains to be seen but with the most recent ONS infection survey data estimating that in England, around 1 in 15 people (3,270,800) had COVID-19 at the end of December 2021, there is a real concern that the proportion of affected individuals will undoubtedly increase.

Study shows third COVID-19 vaccine dose 37% effective against Omicron after 7 days

5th January 2022

A third COVID-19 vaccine dose appears to offer only limited protection against the Omicron compared with infection with the Delta variant

A third COVID-19 vaccine dose appears in practice to be unlikely to offer much protection against the Omicron compared to Delta variant. This was the finding of a preprint from a large Canadian study by a team led by Public Health Ontario, Toronto, Canada.

The Omicron COVID-19 variant was first reported to the World Health Organisation (WHO) from South Africa on 24 November 2021 and WHO has since designed it as a variant of concern due to an increased transmissible nature and the potential for immune evasion. Moreover, early data suggests that while a third COVID-19 vaccine dose offers higher protection against Omicron, the authors added that ‘even with three vaccine doses, neutralisation against the omicron variant was lower (by a factor of 4) than that against the delta variant.’

In trying to provide some much needed data on the real-world effectiveness of vaccine effectiveness (VE) against the Omicron or Delta variant, the Canadian team examined individuals 18 years and over, with a positive PCR test result between November 2021 and December 2021, excluding long-term residents and those who had received only a single COVID-19 vaccine dose or a second dose less than 7 days prior to testing.

The researchers identified confirmed cases of infection, irrespective of symptoms or severity using provincial reportable data. Any positive samples with an S-gene Target failure (SGTF), were considered to be due to infection with Omicron since this failure is absent in those with the Delta variant. They compared infection rates (compared to those who were unvaccinated and which served as the reference group) for individuals with either two or a third COVID-19 vaccine dose.

Findings

The team identified 3,442 Omicron positive, 9,201 Delta positive and 471,545 negative controls. Omicron infected individuals were generally younger, mean age 34.8 years (49.2% male) compared to 43.7 years (same gender proportion) for Delta infections.

After two doses of a COVID-19 vaccine, VE efficacy against Delta was 71% (95% CI 66 – 75%) > 240 days after the second dose but this figure increased to 93% (95% CI 92 – 94%) > 7 days after a third dose. In contrast, two vaccine doses was not protective against Omicron at any point in time and the VE was – 38% (95% CI – 61 to – 18%) after the second dose. However, VE against Omicron was 37% (95% CI 19 – 50%) > 7 days after a third COVID-19 vaccine and these findings were consistent for all combinations of the vaccines used.

The authors discussed how their findings have potentially important implications in so far as proof of vaccination (defined by at least two doses) should no longer be considered as fully vaccinated. They concluded that protection from three vaccine doses offers some protection against the variant but the effectiveness against severe disease remains uncertain.

Citation

Buchan SA et al. Effectiveness of COVID-19 vaccines against Omicron or Delta infection MedRxiv 2021.

Omicron infection causes fewer hospitalisations and severe disease compared with Delta variant

24th December 2021

Omicron infection appears to be associated with a lower risk of hospitalisation and less severe disease than the Delta COVID-19 variant, according to a recent study

According to a preprint study by researchers from the Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa, Omicron infections appear to be associated with reduced risk of hospitalisation and after admission, less severe disease than the Delta variant.

While the Omicron COVID-19 variant was only identified in November 2021, there has been a flurry of research activity directed at trying to understand its transmissibility, the level of disease severity and effect on healthcare services. While initial laboratory studies have indicated that the variant can escape neutralisation by antibodies generated in fully vaccinated and boosted sera samples, these studies cannot foretell the clinical impact of the variant.

The South African researchers undertook a data linkage study of COVID-19 infections, case data and genomic information to establish whether an Omicron infection was associated with higher rates of hospitalisation and more severe disease among those who were hospitalised in comparison to the Delta COVID-19 variant. Although whole genome sequencing was not used, they utilised the presence of a S Gene Target Failure (SGTF), which serves as a proxy for Omicron and samples were examined between 1st October 2021 and 6th December 2021. Positive infections were therefore classified as either an SGTF or non-SGTF. The severity of an Omicron infection was assessed by comparison of SGTF and non-SGTF infections and to infections known to be caused by the Delta variant and regression models created and adjusted for several factors known to be associated with hospitalisation (e.g., age, sex, co-morbidities).

Findings

During the period of study there were 161,328 COVID-19 cases recorded and the proportion of SGTFs increased from 3% (early October 2021) to 98% (early December).

A total of 11,495 hospital admissions occurred with 2.5% due to an SGTF compared to 12.8% with a non-SGTF (p < 0.001). Multivariate analysis revealed that individuals with a SGTF had a lower odds of hospitalisation (adjusted odds ratio, aOR = 0.2, 95% CI 0.1 – 0.3, p < 0.001). In addition, once hospitalised, the odds of having severe disease were also reduced in those with SGTF although there was uncertainty over this estimate given the wide confidence intervals (aOR = 0.70, 95% CI 0.30 – 1.40).

Finally, the researchers found that compared to infection with the Delta variant, those with an SGTF had a significantly lower risk of severe disease (aOR = 0.30, 95% CI 0.20 – 0.50, p < 0.001).

The authors suggested that these data suggested that an Omicron infection was probably less severe than other variants such as Delta but recognised that this reduced severity might be accounted for by the higher levels of population immunity due to either natural infection and/or vaccination.

These results are broadly similar to those of a second recently published preprint from Scotland which found a nearly 70% reduced risk of hospitalisation (expected ratio = 0.32, 95% CI 0.19 – 0.52) for those with an Omicron infection. The study also found that giving a third or booster dose was associated with a 57% reduced risk of symptomatic infection.

Although both studies are preliminary, they do suggest the possibility that infection with the new variant is potentially less severe than other forms.

Citation

Wolter N et al. Early assessment of the clinical severity of the SARS-CoV-2 Omicron variant in South Africa. MedRxiv 2021

Molnupiravir treatment halves rate of hospitalisation in unvaccinated COVID-19 patients

20th December 2021

Molnupiravir treatment initiated within 5 days of symptom onset in unvaccinated individuals with COVID-19 halved the risk of hospitalisation

The use of oral molnupiravir treatment within 5 days of COVID-19 symptom onset, led to a 50% reduction in the risk of hospitalisation for any cause of death among unvaccinated patients. This was the main finding of a study by the MOVe-OUT group which was supported by the manufacturer of the drug, Merck Sharp and Dohme.

Molnupiravir is a small-molecule ribonucleoside pro-drug of N-hydroxycytidine (NHC) and which has been shown to inhibit the influenza virus and is phosphorylated in vivo and incorporated into viral RNA, rendering the virus non-infectious. Early trial data suggested that the drug was efficacious and safe in patients infected with COVID-19 which formed the basis for the current MOVe-OUT trial.

For the Phase II-III trial, non-hospitalised patients with mild or moderate, laboratory confirmed COVID-19, symptom onset of no more than 5 days and at least one risk factor for more severe disease, were enrolled in the study. Risk factors included age (> 60 years), active cancer, chronic kidney disease, COPD, obesity, diabetes or serious heart conditions such as heart failure and coronary artery disease. Patients were excluded where there was an anticipated need for hospitalisation (due to COVID-19) within the next 48 hours.

Those enrolled were randomised 1:1 to molnupiravir treatment (800 mg) twice daily for five days or identical placebo. The primary efficacy endpoint was the incidence of hospitalisation for any cause, which the researchers defined as > 24 hours of acute hospital care or death through to day 29. The researchers also included a primary safety outcome as the incidence of adverse events.

Findings

A total of 1433 participants with a median age of 42 (53.6% female) were assigned to molnupiravir treatment (716) or placebo. Overall, 99.4% of these individuals had at least one risk factor for severe COVID-19, most commonly obesity (73.7%), age > 60 (17.2%) and diabetes (15.9%) with disease severity classed as mild in more than half (55.2%) of all cases.

The percentage of patients meeting the primary endpoint was 7.3% (molnupiravir) and 14.1% (placebo), a treatment difference of 6.8% (95% CI -11.3 to – 2.4, p = 0.001). Patients receiving molnupiravir had a lower risk of hospitalisation or death through to day 29 (6.8% vs 9.7%). There was one death reported in the molnupiravir group and 9 in the placebo group, all of which were considered to be COVID-19-related.

In terms of safety, 30.4% vs 33% of participants in the molnupiravir treatment arm vs placebo, experienced > 1 adverse event including diarrhoea, nausea and dizziness.

Since the trial was undertaken among unvaccinated participants, the potential value of the drug in preventing breakthrough infections could not be evaluated. Nevertheless, authors concluded that molnupiravir treatment was effective for the treatment of COVID-19 and that it did not appear to have any major safety concerns.

Citation

Bernal AJ et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients N Engl J Med 2021

Sickle cell disease patients’ awareness of COVID-19 risks likely responsible for reduced cases

16th December 2021

Sickle cell disease patients’ awareness of COVID-19 risks and acceptance of virtual appointments led to a reduction in the number of reported cases

In patients with sickle cell disease, an early awareness of the risks associated with COVID-19 infection and acceptance of virtual appointments, resulted in a significant reduction in morbidity and mortality among those with the condition. This was the finding of a study by researchers from the Department of Haematology and Medical Oncology, Emory University School of Medicine and Georgia Comprehensive Sickle Cell Centre at Grady Health System, Atlanta, US presented at ASH 2021.

The Grady Comprehensive Sickle Cell (SC) Center is the largest adult sickle cell centre in the US with the first 24/7 acute care unit for the management of sickle cell vaso-occlusive events (VOE). In 2019, the centre provided 3077 outpatient appointments for patients with sickle cell disease (SCD) and 3695 acute care visits. However, the arrival of the COVID-19 pandemic led to a huge drop in the number of both outpatient and acute care visits. But how the virus impacted on patients who were registered with the centre was the subject of the study presented by the Atlanta researchers at the ASH Conference 2021. The team made use of the Grady centre’s database, which was used for tracking the outcomes of registered patients during the COVID-19 pandemic and to date, represents the largest single-centre study on COVID-19 in people with SCD between March 2020 and March 2021.

Findings

From a total of 1343 patients in the database, 55 patients with average age of 28 years (51% female) contracted COVID-19. Among the 55 who tested positive for COVID-19, only 16 required treatment and of whom, 2 died.

In terms of COVID-19 symptoms, 58% experienced pain as the main symptom, followed by cough and fever (40%), dyspnoea (31%), and pneumonia with chest x-ray evidence (25%). Two patients developed acute respiratory distress syndrome (ARDS) and were intubated. Interestingly, the two deaths occurred early in the course of the pandemic in June and July 2020 when 20 total cases were diagnosed and there were no deaths recorded between October 2020 and March 2021. Due to the COVID-19 restrictions, the Grady centre quickly adopted virtual visits to deliver healthcare to their patients.

Commenting on their findings, the authors considered that the early adoption of virtual visits aided in protecting patients against COVID-19 as witnessed by the absence of any deaths during second peak in the winter of 2021. The authors felt that this indicated how patient’s diligence and awareness to stay home during the pandemic, proved to be crucial in reducing morbidity and mortality. They concluded that the option of virtual visits for healthcare delivery was key and should be utilised further in sickle cell care.

Citation

El Rassi F et al. COVID-19 Infection and Outcomes at a Comprehensive Sickle Cell Center. ASH Conference 2021