COVID-19 Daily: VA Hydroxychloroquine Study, Relief Funds

Ellie Kincaid

April 23, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

VA Hydroxychloroquine Study 

A retrospective study of Veterans Affairs (VA) patients hospitalized with COVID-19 found that hydroxychloroquine treatment, with or without azithromycin, was not associated with a lower risk of requiring mechanical ventilation compared with standard supportive care alone. The risk of death from any cause was also higher in the group of patients that received hydroxychloroquine.

"Until we have good, prospective randomized trials, it's hard to know what to make of this," said one expert who was not involved with the study. "But this is more evidence that there's not a good reason to use [hydroxychloroquine]." 

Next Round of COVID-19 Relief Funds

The federal department of Health and Human Services will begin distributing a second tranche of money from the $100 billion COVID-19-related Provider Relief Fund as soon as tomorrow, officials said Wednesday. It will also soon initiate a process for hospitals and clinicians to be reimbursed for testing and treating uninsured patients. 

The new round of payments will be split a few ways: $20 billion for Medicare facilities and clinicians; $10 billion to hospitals in COVID-19 hot spots; $10 billion for rural health clinics and hospitals; and $400 million for the Indian Health Service. A total of $30 billion was distributed earlier this month, and about $27 billion of the $100 billion has not yet been allocated.

Noninvasive Ventilation and Respiratory Support Advice

European physicians with experience treating COVID-19 patients discussed the merits of helmet CPAP as a method for noninvasive ventilatory assistance, the importance of monitoring for hypercoagulation, pronation for patients with a subtype of disease characteristics, and the necessity of detailed respiratory physiotherapy protocols in a European Society of Anaesthesiology webinar

At one point, panelists wiped away tears as one sobbed, remembering the strain on hospital resources during the surge: "I completely agree with [the] idea to intubate early when we cannot control the respiratory drive that's due to the disease. But we couldn't do it because we had too many patients. So we had to triage."

A New "Great Imitator"

As researchers learn more about COVID-19, it's clear it can be more than just a respiratory disease. It has joined the ranks of other "great imitators" — diseases that can look like almost any condition, Neha Pathak, MD, writes for WebMD Health News.

Besides the more typical respiratory symptoms, it's been reported SARS-CoV-2 can cause conjunctivitis, loss of taste and smell, muscle aches, fatigue, diarrhea, abdominal pain, loss of appetite, nausea and vomiting, whole-body rashes, and areas of swelling and redness in just a few spots. 

In a more severe disease, doctors have also reported heart rhythm problems, heart failure, kidney damage, confusion, headaches, seizures, Guillain-Barré syndrome, and fainting spells, along with new blood sugar control problems.

"This is a disease progression we have never seen for any infection that I can think of, and I've been doing this for a couple of decades," says one infectious disease specialist.

Remdesivir Data Published Accidentally

Data from a randomized controlled trial of Gilead Sciences' experimental drug remdesivir for patients with severe COVID-19 disease in China was "inadvertently" published to the World Health Organization's (WHO) website Thursday, then removed, a WHO spokesperson told STAT News

The summary of the study stated that remdesivir "was not associated with a difference in time to clinical improvement," or a difference in 28-day mortality rates, compared with the control group of patients. 

The trial was ended early because of low enrollment, according to a Gilead official's statement, and is therefore "underpowered to enable statistically meaningful conclusions." The company expects data from other studies of remdesivir to be available later this month and in May. 

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

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube, and follow Ellie Kincaid on Twitter @ellie_kincaid.

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