COVID-19 Update: Dexamethasone Use, Don't Forget the Fomites

Ellie Kincaid

June 19, 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:

Some US Hospitals Waiting to Add Dexamethasone

Following the announcement earlier this week that dexamethasone reduced mortality for severely ill COVID-19 patients in a randomized clinical trial, doctors at some US hospitals are hesitant to change treatment protocols, while others say they have been prescribing steroids for months already. 

"To me it is not a surprise, but a relief," says Hugh Cassiere, MD, director of critical care medicine at Northwell Health's North Shore University Hospital in New York. "It validates some of the therapies I've given and gives us something, finally, that decreases mortality."

But James Town, MD, medical director of the medical intensive care unit at Harborview Medical Center and assistant professor at the University of Washington, says he and his colleagues are waiting to see if the data are enough to make a practice-changing decision or if more trials and replication are needed. 

"I am personally a little more wary over changing practice based on just a press release at this point," he said. 

Don't Forget the Fomites 

As nonurgent outpatient care reverts from telemedicine to in-person consultations, many practices are focusing on measures to prevent respiratory transmission of SARS-CoV-2, which causes COVID-19. But experts emphasize that clinics shouldn't ignore the role fomites can play in transmission.

"Personal protective equipment in itself is not a substitute for weak infection prevention and control systems and practices," an infectious disease specialist told Medscape Medical News . "This virus spreads very easily and quickly in a healthcare environment and will exploit any gap or weakness in your [infection prevention and control]."

Disappearing Antibodies 

People who develop antibodies after becoming infected with the coronavirus may not keep them for more than a few months, especially if they showed no symptoms to begin with, a new study suggests.

Scientists in the Wanzhou district of China studied 37 people who had mild COVID-19 symptoms and another 37 people who were infected with SARS-CoV-2 but showed no symptoms. Eight weeks after recovery, IgG antibody levels fell to undetectable levels in 40% of asymptomatic people and 13% of symptomatic people, the researchers reported in an article published online in the journal Nature Medicine

"Together, these data might indicate the risks of using COVID-19 'immunity passports' and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups and widespread testing," the scientists wrote.

Meanwhile, the most comprehensive study yet looking for SARS-CoV-2 antibodies in the population of Sweden, which has not adopted the strict lockdown policies of other European countries, found just about 6% of Swedes had developed antibodies, well below levels deemed enough to achieve even partial herd immunity. 

Headaches as Another Symptom

An observational study of more than 100 patients suggests that headache onset could occur during the presymptomatic or symptomatic phase of COVID-19. These headaches could resemble tension-type or migraine headaches, and experiencing headache was associated with a shorter symptomatic period.

"It seems that those patients who start early on, during the asymptomatic or early symptomatic period of COVID-19, with headache have a more localized inflammatory response that may reflect the ability of the body to better control and respond to the infection by SARS-CoV2," said the study's lead investigator

Government Contractor Supplied Soda Bottles, Not Test Tubes

Since May, the US government has paid a Texas company $7.3 million for test tubes needed in tracking the spread of SARS-CoV-2 nationwide. But, instead of standard vials, Fillakit LLC has supplied plastic tubes made for bottling soda, ProPublica reports.

The state officials say that these "preforms," which are designed to be expanded with heat and pressure into 2-liter soda bottles, don't fit the racks used in laboratory analysis of test samples. Even if the bottles were the right size, experts say, the company's process likely contaminated the tubes and could yield false test results. 

Convalescent Plasma Safety Study

More than 20,000 COVID-19 patients have now received convalescent plasma through an expanded access program led by the Mayo Clinic, backed by the US Food and Drug Administration, with the plasma paid for by the US Department of Health and Human Services. 

It's not a randomized controlled trial, but researchers have been collecting safety and outcomes data. From the initial data, published in Mayo Clinic Proceedings, "convalescent plasma is safe and carries no excess risk of complications," the researchers conclude. 

The Week That Wasn't

This week in COVID-19 news, researchers suggested that baldness is a sign of higher risk for severe disease, a biotech company is trialing a therapy inspired by the virus' effect on ACE2 receptors, and Amazon debuted a novel method to encourage safe social distancing. But you didn't see these headlines on Medscape Medical News. Here's why.

Trending Clinical Topic: Thrombotic Storm

Interventional cardiologists in Spain published a study detailing four cases of what has been called a "thrombotic storm" in COVID-19 patients, raising concern about stent thrombosis in these patients. Our Reference team sums up what you need to know.

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 for infection. More than 1500 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

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine. She can be reached at ekincaid@medscape.net or on Twitter @ellie_kincaid .

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