COVID-19 Update: Stages to Brain Damage, Remdesivir Pricing

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:

Stages to Brain Damage

Neurologists propose a three-stage description of COVID-19's impact on the central nervous system in a new review, and they recommend hospitalized COVID-19 patients receive a neurological evaluation and brain MRI before leaving the hospital.

"Our major take-home points are that patients with COVID-19 symptoms, such as shortness of breath, headache, or dizziness, may have neurological symptoms that, at the time of hospitalization, might not be noticed or prioritized, or whose neurological symptoms may become apparent only after they leave the hospital,” one of the lead authors told Medscape Medical News .

In a separate study, researchers catalogued a wide variety of neurologic and neuropsychiatric complications of COVID-19 infection, including stroke, psychosis, altered mental state, and dementia-like syndrome.

Remdesivir Pricing

Gilead Sciences has announced the price tag for its antiviral drug remdesivir: $520 per vial for US patients with private insurance, and $390 per vial for the US and other developed countries' governments. A 5-day, six-vial treatment course would add up to a total of $3120 for US patients with private insurance and $2340 per patient for the others. This new price is below the $5080 amount the Institute for Clinical and Economic Review recommended last week.

Risk for Thoracic Cancer Deaths

Past treatment with steroids, anticoagulants, chemotherapy, and chemotherapy plus immunotherapy may affect the risk for death among patients with thoracic malignancies who develop COVID-19, according to registry data. No COVID-19–directed treatments seemed to affect the risk of death.

"When we look at therapies administered to treat COVID-19…including anticoagulation, antibiotics, antivirals, hydroxychloroquine, we found that no particular therapy was associated with increased chance of recovery from COVID-19," one of the study authors said.

"No Evidence" to Use Vitamin D

There is no evidence to support using vitamin D supplements to reduce the risk for, or severity of, COVID-19, according to a rapid evidence review from the UK's National Institute for Health and Care Excellence (NICE).

"We know that the research on this subject is ongoing, and NICE is continuing to monitor new published evidence,” NICE's Centre for Guidelines director said.

The UK Scientific Advisory Committee on Nutrition (SACN) also weighed evidence on vitamin D and acute respiratory tract infections, and concluded that evidence currently does not support vitamin D supplementation to prevent these infections in the general population.

Endothelial Injury

Endothelial injury plays a major role in the pathogenesis of COVID-19–associated coagulopathy (CAC), and blood levels of soluble thrombomodulin correlate with mortality, a new study suggests. The study assessed endothelial cell damage, platelet activation, and hemostatic and fibrinolytic cascade effects of CAC in hospitalized COVID-19 patients.

"These findings suggest the prothrombotic state occurs early in the pathogenesis of SARS-CoV-2 infection, is driven by platelet activation and endotheliopathy, and becomes more pronounced with worsening severity of infection,” writes Alan P. Lyss, MD, in a perspective.

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.

Victoria Giardina is Medscape's editorial intern. She has previously written for The Dr. Oz Show and is currently a national lifestyle writer for Her Campus . She can be reached at vgiardina@webmd.net or on Twitter @VickyRGiardina .

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