COVID-19 Daily: HCQ Trial Halted, Autopsy Lung Damage

Ellie Kincaid

May 26, 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: 

WHO Pauses Hydroxychloroquine Trial 

The World Health Organization (WHO) has suspended testing the malaria drug hydroxychloroquine in COVID-19 patients because of safety concerns, WHO Director-General Tedros Adhanom Ghebreyesus said on Monday.

"The executive group has implemented a temporary pause of the hydroxychloroquine arm within the Solidarity trial while the safety data is reviewed by the data safety monitoring board," Tedros told an online briefing. He said the other arms of the trial were continuing, Reuters reported.

Autopsy Data Show Extensive Lung Damage

A small but detailed histologic study of lungs obtained at autopsy from COVID-19 patients compared with those of patients who died from acute respiratory distress syndrome (ARDS) secondary to the H1N1 influenza in 2009 reveals some distinctive features of COVID-19, researchers reported in the New England Journal of Medicine

"I think the take-home message here is that this is a respiratory virus that causes a vascular disease, and the damage to the blood vessels explains a lot of the systemic organ failure and death that we've seen in these patients," one study author told Medscape Medical News

But some experts weren't convinced. Pointing to clinical differences between the groups of patients, authors of an accompanying editorial suggest that the findings describe the heterogeneity of the clinical syndrome of ARDS, rather than differentiate COVID-19 from the H1N1 influenza. 

Nitric Oxide

Inhaled nitric oxide (NO) is another among many interventions being tested for COVID-19 treatment. One investigator, anesthesiologist Lorenzo Berra, MD, medical director of respiratory care at Massachusetts General Hospital, spoke with Medscape about why. 

During the 2003-2004 severe acute respiratory syndrome (SARS) outbreak in China, a group of clinicians used NO in patients with SARS ARDS and found that the chest X-rays of patients who had been given inhaled NO cleared much faster, while oxygenation improved, and the effect was lasting. "In their report, the authors said they had never seen anything like that before with NO," Berra said. "We began to question whether NO actually might have virucidal effects in COVID-19."

"We don't have direct proof that NO will have antiviral effects in CoV-2, but because this coronavirus is 80% similar to CoV-1, we decided to test the hypothesis of whether a high dose of NO is virucidal," he said. Berra and colleagues are running four ongoing NO trials aimed at preventing COVID-19 symptoms or severity of disease in several patient groups, with more than 200 patients in each trial.

Nurse Fired for Wearing Hospital-Issued Scrubs

At a hospital in St. Paul, Minnesota, nurses allege that they were retaliated against for speaking out about safety concerns, including inadequate personal protective equipment (PPE). One nurse, Cliff Willmeng, RN, was fired after he and some colleagues started wearing hospital-issued scrubs and changing at work, rather than wearing personal scrubs and laundering them at home as hospital policy prescribed. "I may or may not survive this job, but I've got to do everything I can to protect my family," Willmeng told Medscape Medical News

The scrubs are just the most conspicuous example of nurses' concern about PPE and safety policies at the hospital, Willmeng and his colleagues said. 

Most experts don't believe there's any infection control problem associated with laundering scrubs at home, said a nurse manager in the Biocontainment Unit at Johns Hopkins School of Nursing. But, she said, "COVID-19 is so novel that 'psychological safety' is extremely important.... For many frontline providers, changing in and out [of], and wearing, hospital-laundered scrubs reduces concerns about bringing COVID home."

COVID-Related MIS in Kids: What We Know

Early data on COVID-19 seemed to say that kids were less likely to get the coronavirus and, if they did, less likely to die. But recently, new reports have called this into question, and, on May 14, the Centers for Disease Control and Prevention issued a health advisory regarding multisystem inflammatory syndrome in children associated with COVID-19.

What's going on? And how much of a risk is it? Medscape contributor F. Perry Wilson, MD, MSCE, explains the current evidence

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 1000 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.

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