COVID-19 Update: HCQ Study Questioned, Protests and Outbreaks

Ellie Kincaid

June 01, 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: 

Scientists Question Data, Ethics, Findings of The Lancet HCQ Study 

More than 140 scientists and physicians are challenging the validity of an influential study that found an association between prescribing the antimalarial drugs hydroxychloroquine and chloroquine for COVID-19 patients and increased in-hospital mortality. 

After the observational study's results were published in The Lancet on May 22, the World Health Organization temporarily suspended enrollment into an ongoing randomized clinical trial testing hydroxychloroquine for COVID-19. 

An open letter to the observational study's authors and The Lancet's editor-in-chief posted on May 28 lists 10 concerns. The signatories, who identify themselves as "clinicians, medical researchers, statisticians, and ethicists from across the world," say the researchers failed to account sufficiently for factors that may have influenced their results, including disease severity, and raise concerns about a lack of ethical review and errors in the underlying database. 

They also charge that the study's authors are being unduly secretive about their data sources and methods, despite the fact that The Lancet signed a pledge to support open data sharing during the coronavirus pandemic. 

Mass Protests and Risk of COVID-19 Outbreaks

As mass protests continued in large and small cities across the country over the death of George Floyd, officials expressed concerns on Sunday news shows about a potential spike in coronavirus cases in coming days.

"There's going to be a lot of issues coming out of what's happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings," said former FDA commissioner Scott Gottlieb, MD, on the CBS News show "Face the Nation."

Chanting, singing, and shouting may spread the virus through respiratory droplets. In addition, people who have the virus but don't show symptoms may infect others without knowing it. "If you were out protesting last night, you probably need to go get a COVID test this week," Atlanta Mayor Keisha Lance Bottoms said Saturday, according to the Associated Press.

Where Doctors in Emotional Distress Can Get Help

Frustrated that governments weren't doing enough to support healthcare workers during the pandemic, Nisha Mehta, MD, a radiologist in Charlotte, North Carolina, decided there needed to be change. 

On April 4, Mehta and two physician colleagues submitted to Congress the COVID-19 Pandemic Physician Protection Act (CPPPA), which requests, among other provisions, insurance of mental health coverage for healthcare workers. An accompanying petition on the website change.org had received nearly 300,000 signatures as of May 29.

"We need better support structures at baseline for physician mental health," said Mehta. "That's something we've always been lacking because it's been against the culture of medicine for so long to say, 'I'm having a hard time.' " 

Medscape has pulled together a list of the many resources the medical community has created to help its own during the pandemic.  

Corticosteroid Controversy 

The most commonly invoked rationale for giving steroids in patients with severe COVID-19 is to modulate the destructive inflammatory immune response that occurs with advancing disease. Another is to treat suspected adrenal insufficiency in those with refractory shock. 

Both of these practices are endorsed in the recent Surviving Sepsis Campaign guidelines on management of critically ill patients with COVID-19, but they should never have been made, according to an intensive care physician speaking at a webinar on COVID-19 sponsored by the European Society of Intensive Care Medicine. 

He said the only reason to use corticosteroids in critically ill patients with COVID-19 outside of formal randomized trials is in the hope of preventing lung fibrosis in patients with unresolved acute respiratory distress syndrome

More Diabetes Data

More than 1 in 10 people with diabetes hospitalized with COVID-19 die within a week, while nearly one third require mechanical ventilation, according to new data from the French Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) study. 

Previous studies have linked diabetes to worse outcomes in COVID-19, but this is the first to examine specific characteristics before and at the time of hospital admission that predict worse outcomes among people with diabetes, a study coauthor told Medscape Medical News

"Now we can surely consider more precisely the risk, taking age, sex, BMI, complications, and [obstructive sleep apnea] as clear 'very high-risk situations,' " he said.

Docs' Group Confronts ICE Over "Dangers of Detention" From COVID-19

Concerned about the spread of COVID-19 among the occupants of immigrant detention centers, activists have held vigils outside facilities in California, Colorado, Maryland, Massachusetts, Michigan, and Oregon over the past several weeks. 

"Overall, I think the actions were successful in our goal of bringing attention to the dangers of detention," says Marie DeLuca, MD, an emergency medicine research fellow and cofounder of Doctors for Camp Closure, a nonpartisan advocacy group of more than 2200 physicians and other healthcare professionals.

As of May 26, at least two people have died of COVID-19 while in custody of US Immigration and Custom Enforcement (ICE), according to the American Immigration Lawyers Association. At least three guards who worked at ICE facilities have also reportedly died from COVID-19. 

More will occur unless policies change, says the physician director of the New York University Center for Health and Human Rights. "Detention facilities are a horrifically ideal environment for the spread of COVID-19," Allen Keller, MD, told Medscape Medical News.

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. 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.

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

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