COVID-19 Update: Pleading for PPE, Testing Surge Needed

Jake Remaly

July 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:

AMA: Federal Help Needed With PPE for Physician Practices

The American Medical Association (AMA) is asking the Trump administration to use the Defense Production Act to generate an adequate supply of personal protective equipment (PPE) for physicians in all settings, including ambulatory care offices.

The "ongoing shortages of PPE, especially N95 masks and gowns," is the biggest challenge to reopening practices, said James L. Madara, MD, the group's chief executive officer, in a June 30 letter. Many physicians previously did not need this gear and do not have relationships with PPE vendors. Because ambulatory care practices require less PPE than hospitals and other facilities do, they have less bargaining power to obtain these supplies.

"Without adequate PPE, physician practices may have to continue deferring care or remaining closed, which will continue to have a dramatic impact on the health of their patients," Madara wrote.

Testing Surge Needed in Hotspots

The federal government is working to quickly increase COVID-19 diagnostic testing in Texas, Florida, and Louisiana to keep up with spiking numbers of cases in those states, Medscape Medical News reports. Testing efforts may focus on identifying people younger than 35 years who could be spreading disease, according to the US Department of Health and Human Services (HHS).

Admiral Brett P. Giroir, MD, Assistant Secretary for Health at HHS, told reporters at a briefing that the agency is in discussions with those three states and several others on how the federal government can best support a surge in testing.

That could mean doing a typical month's worth of testing in a few days, with the goal of identifying asymptomatic individuals thought to be behind the current rise in COVID-19 cases in some areas, Giroir said.

"It's very clear that the positives are being driven by the under-35-year-olds, and we presume that most of them are asymptomatic or only very mildly symptomatic," he said.

US Secures Access to Most of Projected Remdesivir Supply

The United States has secured access to more than 500,000 treatment courses of remdesivir for American hospitals through September — most of the drug developer's anticipated supply for the near future, HHS has announced.

The government's agreement with Gilead Sciences covers all of the company's anticipated production of the drug in July (94,200 treatment courses) and 90% of the projected production in August and September (174,900 and 232,800 treatment courses, respectively).

The deal also includes an allocation of the drug for clinical trials. Ensuring access to remdesivir, which is authorized for the treatment of severe COVID-19 under an emergency use authorization by the FDA, has been a concern.

HHS will allocate the drug to state health departments based on COVID-19 hospital burden. To streamline the delivery process, purchased remdesivir will be shipped directly to hospitals rather than to the state health departments first.

A researcher at Liverpool University in the United Kingdom who studies antiretroviral treatments told the Guardian that the agreement "leaves nothing for Europe."

Skin Patterns Vary

At least five dermatologic patterns may signal COVID-19, and the knowledge base continues to evolve, according to research discussed at the virtual annual meeting of the American Academy of Dermatology.

"New studies are coming out daily," said Christine Ko, MD, professor of dermatology and pathology at Yale University, New Haven, Connecticut. "Due to the need for rapid dissemination, a lot of the studies are case reports…. Another caveat for the literature is that a lot of these cases were not necessarily confirmed with testing for SARS-CoV-2, but some were."

Among 375 patients in Spain with suspected or confirmed COVID-19, cutaneous manifestations included early vesicular eruptions mainly on the trunk or limbs (9%), maculopapular (47%) to urticarial lesions (19%) mainly on the trunk, and acral areas of erythema sometimes with vesicles or erosion (perniosis-like; 19%) that seemed to be a later manifestation of COVID-19. Retiform purpura or necrosis (6%) was most concerning in terms of skin disease, with an associated mortality of 10%.

Phase 3 Vaccine Trials to Start in July

Phase 3 COVID-19 vaccine trials are expected to launch in July and enroll 20,000 people in the vaccine treatment arm and 10,000 in the placebo arm, according to Paul A. Offit, MD, director of the Vaccine Education Center at Children's Hospital of Philadelphia in Pennsylvania.

The race to develop a SARS-CoV-2 vaccine has led to 120 Investigational New Drug Applications to the US Food and Drug Administration, and researchers at more than 70 companies are interested in making a vaccine, Offit said during the virtual Pediatric Dermatology 2020: Best Practices and Innovations Conference. The Biomedical Advanced Research and Development Authority has awarded $2.5 billion to five different pharmaceutical companies to make a vaccine.

"I think we can make a vaccine that will last for several years," he said.

Rushed COVID-19 Papers: "Interpret With Caution"

There has been a rush to publish papers on COVID-19 in medical journals, and several highly publicized retractions.

"Medical journals are facing unprecedented times that will test our resolve to adhere to the tenets of good science and responsible reporting," said Stephen A. Cannistra, MD, editor-in-chief of the Journal of Clinical Oncology, in the journal's July 1 issue.

In a special article, Cannistra and two coauthors clarify the journal's publication guidelines on COVID-19 research. They also include a veiled criticism of two major oncology journals and a caution against overinterpretation of evidence, according to 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 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.

Jake Remaly is a staff journalist at Medscape Medical News and MDedge. He has covered healthcare and medicine for more than 5 years. He can be reached at jremaly@mdedge.com .

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