COVID-19 Update: Possible PPI Risk, Co-Infection in Hospital

Damian McNamara

July 09, 2020

UPDATED July 10, 2020 // Editor's note: The original text has been changed to clarify that household, not individual, income was reported in the study on proton pump inhibitors.

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: 

PPIs Tied to COVID-19 Risk

A report suggesting people who take proton pump inhibitors (PPIs) are at higher risk for COVID-19 was quickly met with some criticism on social media concerning the study's design. 

The controversy revolves around what some call inconsistencies in the study population, including a majority of people with a high school degree or less who also report annual household incomes exceeding $200,000.

Furthermore, others pointed out that study researcher Brennan Spiegel, MD, MSHS, is also co-Editor in Chief of the American Journal of Gastroenterology, the publication in which the findings were reported July 7. 

The study shows that 6.4% of 53,130 people surveyed nationwide were COVID-19 positive. After adjusting for other factors, Spiegel and colleagues found that those taking PPIs once daily were at about twice the risk for COVID-19 infection, a rate that rose to about fourfold for people who took PPIs twice a day. 

Co-infections Relatively Rare in Hospitalized COVID-19 Patients

Only a few clinically meaningful co-infections emerged in a study of 836 patients in the UK hospitalized with COVID-19. Other reported infections included two linked to a respiratory source, six cases attributed to a central line source, and one linked to use of a urinary catheter. 

Community onset and infections attributable to nonrespiratory causes accounted for the rest of bacteremias reported. The rates of positive co-infection in a control group of people with influenza were comparable in the report, which was published in the journal Clinical Microbiology and Infection .

Back and Forth on Back to School Recommendations 

The Centers for Disease Control and Prevention (CDC) recommendations aimed at maximizing the safety of students when and if they return to school in person continue to generate some controversy. Initial news reports cited a tweet from President Trump that guidance from the CDC was too expensive and impractical

It was widely reported yesterday that the agency would revise its approach. However, today CNN reports that CDC Director Robert Redfield, MD, will not revise the guidelines, and instead plans to supply more documentation to support their position. 

In the meantime, there is other guidance — this time collected from multiple sources by F. Perry Wilson, MD, MSCE. In his Impact Factor video commentary, Wilson shares his "12 Ideas for Getting Kids Back to School." 

Suggestions include having students remain in one classroom while teachers move throughout the day, batch testing entire classes for COVID-19 about once a week, and promoting more recess and time outdoors when possible.

Optimal Time to Collect Convalescent Plasma

As more evidence points to the benefits of convalescent plasma transfusions from people who have recovered from COVID-19, less consensus on the ideal timing for these transfusions remains. However, 4 weeks after symptom onset could be the best time to collect this potentially lifesaving therapy from donors, a team of Chinese researchers report. According to their analysis of 49 donors, this timing aligns with the highest levels of IgG antibodies.  

Fatality Rates Remain a "Big Deal"

Recent data showing large increases in COVID-19 positive case numbers in the US have been accompanied by numbers showing a decrease in associated death rates. However, Ashish K. Jha, MD, MPH, director of Harvard Global Health, argues in this commentary for Medscape that a closer look at the data reveals a more concerning story. 

Deaths from COVID-19 remain a lagging indicator, he emphasizes, and fatality rates are now increasing in the five states with the largest outbreaks (Arizona, Florida, Louisiana, South Carolina and Texas). Furthermore, it is important to consider state numbers, he adds, because the national picture includes states where COVID-19 related deaths are decreasing, which can make the overall picture look more reassuring. 

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 1700 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.

Damian McNamara is a journalist at Medscape Medical News and MDEdge, focusing on GI, surgery, dermatology, rheumatology, primary care, obstetrics & gynecology, pediatrics and more. Follow Damian McNamara on Twitter @MedReporter

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