COVID-19 Update: Unexpected Viral Load, Early HCQ No Help

Victoria Giardina

July 17, 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:

Unexpected Viral Load

People with higher viral loads of COVID-19 were less likely to require hospital admission, according to a new study. Investigators studied 205 adults with confirmed COVID-19 in the emergency department at New York University Langone Medical Center, took nasopharyngeal swabs, and measured SARS-CoV-2 viral load using RT-PCR assays. 

"Patients with severe symptoms and requiring hospitalization displayed lower diagnostic viral loads but their samples were taken at a later time point in the disease course,'' colead investigator Paolo Cotzia, MD, said. "We believe that the viral load reflects the time from onset of infection."

Early Hydroxychloroquine Treatment No Help

A randomized control trial of the malaria drug hydroxychloroquine for nonhospitalized patients with mild symptoms of COVID-19 did not show the drug had any benefit, Reuters reported. About 24% of the patients given hydroxychloroquine in the study had persisting symptoms for 14 days compared with 30% of the group given a placebo, but this difference was not statistically significant. 

The study "provides strong evidence that hydroxychloroquine offers no benefit in patients with mild illness,"  Neil Schluger, MD, from New York Medical College, said in an editorial on the study.

In related news, data from a randomized, controlled trial in Spain of nearly 300 nonhospitalized patients with less than 5 days of symptoms also showed no benefit for hydroxychloroquine. Results of the UK RECOVERY trial's test of hydroxychloroquine for more than 4500 hospitalized patients, posted to a preprint server Wednesday, found that the drug did not reduce mortality, but was associated with longer hospital stays and increased risk of dying or needing mechanical ventilation

CDC Against Repeat Testing

The Centers for Disease Control and Prevention is preparing guidance that will advocate against repeated diagnostic testing for SARS-CoV-2 in individuals who have been infected and have had a resolution of symptoms, Admiral Brett P. Giroir, MD, Assistant Secretary for Health at the US Department of Health and Human Services, said on a call with reporters. 

"We know that if you are 10 days since the onset of your symptoms and at least 3 days [asymptomatic], and that may actually go down in the future, but 3 days asymptomatic, you are no longer contagious," Giroir said.

Some individuals are being tested three or six times, which Giroir said is "not necessary," at least for the average individual who has been isolating at home. Repeat testing will still be recommended for the critically ill and individuals with immunosuppression or immune deficiencies, said Giroir. People who fall into a gray area will need to consult with their clinicians, he said. 

Telehealth Waivers Permanent?

Members of the US House of Representatives introduced a bill on Thursday that would make permanent some temporary changes that the Centers for Medicare & Medicaid Services has initiated in its telehealth coverage during the COVID-19 pandemic. 

The bipartisan legislation would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare, allow telehealth visits to be conducted in a patient's home, and permit rural health clinics and federally qualified health clinics to furnish telehealth services.

The Week That Wasn't

This week in COVID-19 news, a new study said that silent transmission may be responsible for half of cases, another study suggested that people who practice social distancing may be more intelligent, and a squirrel tested positive for the bubonic plague. But you didn't see these headlines on Medscape Medical News. Here's why.

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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