Remdesivir for COVID-19 and acute kidney injury: disproportionality analysis of data from the U.S. Food and Drug Administration Adverse Event Reporting System.

BACKGROUND: Evidence about remdesivir-associated acute kidney injury (AKI) among patients with novel coronavirus disease 2019 (COVID-19) was controversial. AIM: To investigate the signal of disproportionate reporting of remdesivir-related AKI in COVID-19 patients over time with data from US Food and Drug Administration Adverse Event Reporting System. METHOD: Adverse events in COVID-19 patients reported between April 2020 and September 2022 were included. Reporting odds ratios (RORs) of AKI and renal disorders (a more sensitive definition for AKI) were estimated to compare remdesivir with other medications prescribed in comparable situations of COVID-19. RESULTS: During the entire study period, significant signals were identified for remdesivir-related AKI (ROR 2.00, 95% CI: 1.83-2.18) and renal disorder (ROR 2.35, 95% CI: 2.17-2.54) when compared to all comparable drugs. However, in the third quarter of 2022 (the most recent quarter) signals disappeared as the ROR of AKI was 1.50 (95% CI 0.91-2.45) and ROR of renal disorder was 1.69 (95% CI 1.06-2.70). Number of signals in sensitivity analyses and the proportion of AKI in remdesivir-associated events decreased over time. CONCLUSION: In COVID-19 patients, we observed diminishing signals of remdesivir-associated AKI over time and no significant signal in the most recent quarter, suggesting remdesivir might not be nephrotoxic.

A latent class analysis of hopelessness in relation to depression and trauma during the COVID-19 pandemic in China.

BACKGROUND: Hopelessness is closely related to depression, trauma, and some organic diseases. Yet our understanding of the heterogeneity of hopelessness is limited. This study aimed to explore the heterogeneity of hopelessness, how it corresponds to the severity of depression, and the effect of traumatic experiences on it during COVID-19. METHOD: The current study measures 28,360 Chinese college students (67.4 % of women) with the Beck Hopelessness Scale (BHS), Trauma Experience Questionnaire, and Patient Health Questionnaire-9 (PHQ-9). The method of latent class analysis (LCA) was used to identify different sub-groups of hopelessness with differences in emotion, motivation, and cognition. Logistic regression and analysis of variance were used to determine the characteristics of different sub-groups. RESULTS: Three latent classes were identified: Negative affective cognition class (C1, N = 5940, 20.9 %), Negative thought cognition class (C2, N = 1358, 4.8 %), and Low hopelessness class (C3, N = 21,062, 74.3 %). Gender, only child or not, birthplace, family economic status, and grade are predictors of the latent category of hopelessness. There are significant differences in depression among different latent classes, and C1 > C2 > C3 (p < 0.001). Traumatic experience is a risk factor for the hopeless latent classes (OR > 1, P < 0.001). LIMITATIONS: Research findings may not be applied to other populations and rely on subjective reports. Ignore the effects of other protective and risk factors. Lack of longitudinal research, unable to explore causality. CONCLUSIONS: The current study provides evidence for the heterogeneity of hopelessness and informs targeted interventions for mental health problems (hopelessness) in college students.

Effect of Lockdown and Mass Testing for the SARS-CoV-2 Omicron Epidemic on Reducing New Infections in Shenzhen, China.

On 14 March 2022, China's tech hub Shenzhen, a mega-city with more than 18 million inhabitants, imposed a one-week citywide lockdown immediately after it observed a surge in infections. We assessed the effect of this one-week lockdown, coupled with mass testing, on reducing the daily number of new confirmed cases and asymptomatic cases during the Omicron wave, using an interrupted time series analysis approach. Our analysis suggests that the one-week citywide lockdown in Shenzhen was effective at lowering both daily new confirmed cases and asymptomatic cases during the Omicron wave. Early detection ensures timely isolation and treatment of infected patients in designated hospitals, and therefore helps lower the prevalence of confirmed cases and asymptomatic cases. Our findings of the immediate increase in asymptomatic cases after lockdown warrant further verifications in other city epidemic scenarios.

Government dissemination of epidemic information as a policy instrument during COVID-19 pandemic: Evidence from Chinese cities.

COVID-19 has given rise to a surge in the number of policy instruments used to deal with the pandemic at different levels of governments globally. While much attention has been placed on travel bans, lockdown, social distancing, and economic stimulus packages, government dissemination of epidemic information as a policy instrument has received less attention. Based on 14,637 news items collected from the portals of 79 municipal governments in China, this study aims to 1) conduct a content analysis of news items and construct three key attributes of governments' practices of epidemic information dissemination, namely, comprehensiveness, responsiveness, and the protection of privacy, and 2) study the patterns and determinants of the dissemination of epidemic information. Our results show that these cities vary substantially in how they disseminate statistical data and information on individual cases of COVID-19 infections within their localities, which are shaped by government performance in open data, severity of the pandemic, cities' administrative level, population, and health sector capacities. The findings generate theoretical and policy implications for government dissemination of epidemic information.

Drug-induced liver injury associated with lopinavir-ritonavir in patients with COVID-19: a disproportionality analysis of U.S. food and drug administration adverse event reporting system (FAERS) data.

Background Liver injury has been documented independently in novel coronavirus disease 2019 (COVID-19) patients and patients treated with lopinavir-ritonavir. Objective to investigate the drug-induced liver injury associated with lopinavir-ritonavir among the patients with COVID-19. Methods We conducted a disproportionality analysis of US Food and Drug Administration Adverse Event Reporting System (FAERS) between 2020Q1 and 2021Q1 to evaluate the association between lopinavir-ritonavir and risk of drug-induced liver injury (or severe drug-induced liver injury) and calculated their reporting odds ratios (RORs) with 95% confidence intervals (CIs). Results A total of 3,425 cases of drug-induced liver injury were reported in 19,782 patients with COVID-19. The ROR for drug-induced liver injury was 2.99 (2.59-3.46), 3.16 (2.68-3.73), and 5.39 (4.63-6.26) when comparing lopinavir-ritonavir with all other drugs, hydroxychloroquine/chloroquine only, and remdesivir, respectively. For severe drug-induced liver injury, RORs for lopinavir-ritonavir provided evidence of an association compared with all other drugs (3.98; 3.15-5.05), compared with hydroxychloroquine/chloroquine only (5.33; 4.09-6.94), and compared with remdesivir (3.85; 3.03-4.89). Conclusions In the FAERS, we observed a disproportional signal for drug-induced liver injury associated with lopinavir-ritonavir in patients with COVID-19.

Enhancing Traceability of Infectious Diseases: A Blockchain-Based Approach.

The global pandemic of COVID-19 has brought significant attentions to three important features of disease direct reporting systems: traceability, reliability, and effectiveness. A traditional disease direct reporting system has a central node of control, with a hierarchical structure that goes up from locals (cities and counties) to regions and eventually reaches a central data repository. Such systems are often prone to easy data loss, arbitrary or unauthorized data changes, and unreliable traceability to individual nodes. Blockchain, as a new disruptive technology, provides a potential solution. Leveraging blockchain's features of decentralization, unforgeability, whole-process traceability, we develop a method for disease information tracing with key components including infectious disease information collection, information chain-style storage, and information query. Our blockchain-based infectious disease traceability method can promptly collect disease information and form the disease information time series blockchain. We demonstrate that the information chain constructed is authentic and transparent, and it can be queried and maintained at any node in the system. Consequently, the infectious disease information on the blockchain can be monitored and queried any time, thereby greatly facilitating the tracing of the propagation paths of infectious diseases.

Efficacité et innocuité des agents antiviraux contre le SRAS-CoV-2, selon des données d'études sur la COVID-19 et d'autres infections virales aiguës : revue systématique et méta-analyse.

CONTEXTE: On donne de façon empirique des agents antiviraux à certains patients atteints de la maladie à coronavirus 2019 (COVID-19). Dans le but d'appuyer la rédaction de lignes directrices sur la prise en charge de la COVID-19, nous avons réalisé une revue systématique des bénéfices et des préjudices associés à 7 traitements antiviraux contre cette infection. MÉTHODES: Nous avons effectué des recherches dans MEDLINE, Embase, le Cochrane Central Register of Controlled Trials (CENTRAL), PubMed et 3 bases de données chinoises (CNKI, Wanfang Data et SinoMed) jusqu'au 19 avril 2020, dans medRxiv et ChinaXiv jusqu'au 27 avril 2020, ainsi que dans Chongqing VIP jusqu'au 30 avril 2020. Nous avons sélectionné des études sur la ribavirine, la chloroquine, l'hydroxychloroquine, l'umifénovir (Arbidol), le favipiravir, l'interféron et le lopinavir/ritonavir. Lorsqu'il n'y avait pas de données directes d'études sur la COVID-19, nous avons retenu des données indirectes d'études sur le syndrome respiratoire aigu sévère (SRAS) et le syndrome respiratoire du Moyen-Orient (SRMO) pour l'analyse de l'efficacité, et d'études sur d'autres infections respiratoires virales aiguës pour l'analyse de l'innocuité. RÉSULTATS: Le taux de décès chez les patients atteints d'une forme sans signe clinique de gravité de COVID-19 était extrêmement bas, ce qui ne permet pas de conclure à un effet important sur la mortalité. Nous n'avons obtenu que des données de très faible qualité indiquant que la plupart des traitements avaient peu ou pas de bénéfices sur les paramètres à l'étude, quelle que soit la gravité de la COVID-19. Seule exception : le traitement au lopinavir/ritonavir, pour lequel nous avons obtenu des données de faible qualité faisant état d'une réduction de la durée du séjour en unité de soins intensifs (différence des risques [DR] 5 jours de moins, intervalle de confiance [IC] de 95 % 0 à 9 jours) et de la durée d'hospitalisation (DR 1 jour de moins, IC de 95 % 0 à 2 jours). En ce qui concerne l'innocuité, les données étaient de faible ou de très faible qualité, sauf pour le traitement au lopinavir/ritonavir, où des données de qualité moyenne laissaient supposer une augmentation probable de la diarrhée, des nausées et des vomissements. INTERPRÉTATION: À l'heure actuelle, rien ne prouve de façon convaincante que les traitements antiviraux apportent des bénéfices importants dans la lutte contre la COVID-19, bien que les données propres à chaque traitement n'excluent pas cette possibilité. D'autres essais randomisés et contrôlés menés auprès de patients atteints de la COVID-19 sont nécessaires avant de pouvoir recourir à ces traitements en toute confiance.

Efficacy and safety of antiviral treatment for COVID-19 from evidence in studies of SARS-CoV-2 and other acute viral infections: a systematic review and meta-analysis.

BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes. RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting. INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.