COVID-19 Update: Shelter-in-Place Orders, Hyperglycemia Predicts Death

Victoria Giardina

July 13, 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.

Shelter-in-Place Orders

Shelter-in-place orders (SIPOs), also known as stay-at-home orders, were associated with reduced growth rates for COVID-19–related hospitalizations and deaths during the pandemic's first phase, a new study shows. 

The researchers estimate that 42 days after most states enacted SIPOs, the daily mortality growth rate declined by up to 6.1 percentage points in those states. They estimate the daily hospitalization growth rate declined by up to 8.4 percentage points on average in the 19 states with SIPOs. 

"I'm not advocating for SIPOs because we know they impose dramatic effects on economic outcomes and on other aspects of health and life," a study coauthor said. "But if you are purely focused on just flattening growth rates for hospitalizations and deaths, they are one of the tool kits that policymakers are already talking about — they're not taking them off the table."

In related news, some states are starting to roll back their reopening plans. California governor Gavin Newsom announced Monday a statewide closure of indoor operations for restaurants and bars, and ordered churches, gyms, hair salons, indoor malls, and offices for noncritical industries to shut down in counties with rising COVID-19 case numbers, the Associated Press reports. In Oregon, Gov. Kate Brown is banning private indoor gatherings of more than 10 people, and requiring face coverings to be worn outside, according to the Washington Post.

Hyperglycemia Predicts Death

Hyperglycemia is present in nearly half of hospitalized COVID-19 patients without a prior diabetes diagnosis and is an independent predictor of mortality at 28 days, new research suggests. In a retrospective analysis of 605 patients with COVID-19 seen at two hospitals in Wuhan, China, researchers found a fasting blood glucose of 7.0 mmol/L (126 mg/dL) or greater on admission to be present in more than 45% of those without preexisting diabetic conditions.

"Glycemic testing and control should be recommended for all COVID-19 patients even if they do not have preexisting diabetes, as most COVID-19 patients are prone to glucose metabolic disorders," the researchers recommend.

Hep C Combo for COVID-19

Preliminary data indicate the combination of sofosbuvir and daclatasvir significantly reduced recovery time and improved survival in COVID-19 patients hospitalized with severe disease, according to researchers who conducted an open-label study in Iran. 

The treatment combination "already has a well-established safety profile in the treatment of hepatitis C," said investigator Andrew Hill, PhD, from the University of Liverpool, United Kingdom.

Anthony Fauci, MD, the nation's leading infectious disease expert, said these findings are hopeful, "provocative, and encouraging," echoing Hill's call to "get these kinds of studies into randomized controlled trials." But he cautioned that more data are needed before the sofosbuvir and daclatasvir combination can be added to the National Institutes of Health COVID-19 Treatment Guidelines.

Remdesivir Shows Improved Clinical Recovery

Gilead Sciences announced that additional data on its antiviral remdesivir showed improved clinical recovery and reduced risk of death in COVID-19 patients who received the drug in a clinical trial compared with a real-world retrospective cohort of similar patients who did not get the drug, Reuters reported. 

Of remdesivir-treated patients, about 75% recovered by Day 14, vs 59% of patients receiving standard of care treatment, the company said.

Doctors Getting Worn Out

Doctors in Arizona, Florida, and Texas, the new COVID-19 hot spots in the US, credit healthcare workers in New York City for valuable lessons learned during the surge of cases there, they told Medscape Medical News . But still, the new front line is suffering from built-up fatigue and anxiety, plus frustration with people who are not following social distancing guidelines.

"It's amazing what human beings can accomplish when they have an end point," said one Houston emergency physician. "You can deal with a lot: study for a test, lose weight for a wedding, train for a marathon. We're really good at defined goals. Having no defined end point is very destructive. And there's no end in sight."

Higher Mortality in Younger People of Color

People of color are dying from COVID-19 at younger ages than the White population, a Centers for Disease Control and Prevention (CDC) analysis suggests. The research team analyzed standardized case-based surveillance reports on deaths of people with laboratory-confirmed COVID-19 from February 12 to May 18. They found that among non-White people, about 30% of those who died were younger than age 65, compared with about 13% of the White people who died.

"It is possible that rates of SARS-CoV-2 transmission are higher among Hispanic and nonwhite persons aged <65 years than among white persons," they write. "One potential contributing factor is higher percentages of Hispanic and nonwhite persons engaged in occupations (e.g., service industry) or essential activities that preclude physical distancing."

Immunity "Could Disappear in Months"

COVID-19 immunity may disappear in months, a preprint of a new longitudinal study from King's College London suggests. Researchers found that levels of antibodies peaked about 3 weeks after symptom onset and then declined. But even without detectable antibodies, "that doesn't necessarily mean you have no protective immunity," a physician and professor of viral immunology told Medscape UK.

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.

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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