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3.
Antimicrob Agents Chemother ; 64(12)2020 11 17.
Article in English | MEDLINE | ID: covidwho-939841

ABSTRACT

Favipiravir is an oral broad-spectrum inhibitor of viral RNA-dependent RNA polymerase that is approved for treatment of influenza in Japan. We conducted a prospective, randomized, open-label, multicenter trial of favipiravir for the treatment of COVID-19 at 25 hospitals across Japan. Eligible patients were adolescents and adults admitted with COVID-19 who were asymptomatic or mildly ill and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Patients were randomly assigned at a 1:1 ratio to early or late favipiravir therapy (in the latter case, the same regimen starting on day 6 instead of day 1). The primary endpoint was viral clearance by day 6. The secondary endpoint was change in viral load by day 6. Exploratory endpoints included time to defervescence and resolution of symptoms. Eighty-nine patients were enrolled, of whom 69 were virologically evaluable. Viral clearance occurred within 6 days in 66.7% and 56.1% of the early and late treatment groups (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [95% CI], 0.76 to 2.62). Of 30 patients who had a fever (≥37.5°C) on day 1, times to defervescence were 2.1 days and 3.2 days in the early and late treatment groups (aHR, 1.88; 95% CI, 0.81 to 4.35). During therapy, 84.1% developed transient hyperuricemia. Favipiravir did not significantly improve viral clearance as measured by reverse transcription-PCR (RT-PCR) by day 6 but was associated with numerical reduction in time to defervescence. Neither disease progression nor death occurred in any of the patients in either treatment group during the 28-day participation. (This study has been registered with the Japan Registry of Clinical Trials under number jRCTs041190120.).


Subject(s)
Amides/administration & dosage , Antiviral Agents/administration & dosage , COVID-19/drug therapy , Pyrazines/administration & dosage , SARS-CoV-2/drug effects , Viral Load/drug effects , Adolescent , Adult , Amides/adverse effects , Antiviral Agents/adverse effects , Asymptomatic Diseases , COVID-19/physiopathology , COVID-19/virology , Female , Hospitalization , Humans , Hyperuricemia/chemically induced , Hyperuricemia/diagnosis , Hyperuricemia/physiopathology , Japan , Male , Middle Aged , Prospective Studies , Pyrazines/adverse effects , Random Allocation , SARS-CoV-2/pathogenicity , Secondary Prevention/organization & administration , Severity of Illness Index , Time-to-Treatment/organization & administration , Treatment Outcome
5.
J Am Soc Nephrol ; 31(7): 1398-1408, 2020 07.
Article in English | MEDLINE | ID: covidwho-459123

ABSTRACT

BACKGROUND: Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS: Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS: As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS: The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Disease Transmission, Infectious/prevention & control , Kidney Failure, Chronic/therapy , Patient Isolation/organization & administration , Pneumonia, Viral/epidemiology , Renal Dialysis/methods , Adult , COVID-19 , Chi-Square Distribution , Cohort Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Health Personnel/statistics & numerical data , Humans , Incidence , Infection Control/organization & administration , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Occupational Health , Pandemics , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Program Evaluation , Renal Dialysis/statistics & numerical data , Republic of Korea/epidemiology , Retrospective Studies , Risk Assessment , Secondary Prevention/organization & administration , Statistics, Nonparametric , Survival Rate
6.
Curr Opin Otolaryngol Head Neck Surg ; 28(4): 228-234, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-620215

ABSTRACT

PURPOSE OF REVIEW: The SARS-CoV-2 coronavirus pandemic, referred to as COVID-19, has spread throughout the globe since its first case in China in December 2019, leaving a significant number of people infected and clinically ill. The purpose of this review is to provide the current known clinical characteristics of and management for COVID-19 as it relates to otolaryngology. RECENT FINDINGS: COVID-19 is a highly transmissible respiratory disease with common presenting symptoms of fever, cough, and fatigue. In the absence of available vaccines or antiviral therapies, symptomatic and respiratory support is the current standard of therapy. Measures to prevent further transmission have been enacted globally including social distancing and cancellation of public events. Given elevated viral load in the upper aerodigestive tract, extra precautions in patients with otolaryngology needs have been recommended for protection of both healthcare workers and patients. SUMMARY: Otolaryngologists face unique risk from COVID-19. Maintaining appropriate preventive health measures and remaining updated on institutional clinical guidelines is paramount for both caretaker safety and patient care.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Infection Control/organization & administration , Occupational Health , Pandemics/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Female , Humans , Male , Otolaryngologists/statistics & numerical data , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Secondary Prevention/organization & administration
9.
Heart Lung Circ ; 29(7): e99-e104, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-155330

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has introduced a major disruption to the delivery of routine health care across the world. This provides challenges for the use of secondary prevention measures in patients with established atherosclerotic cardiovascular disease (CVD). The aim of this Position Statement is to review the implications for effective delivery of secondary prevention strategies during the COVID-19 pandemic. CHALLENGES: The COVID-19 pandemic has introduced limitations for many patients to access standard health services such as visits to health care professionals, medications, imaging and blood tests as well as attendance at cardiac rehabilitation. In addition, the pandemic is having an impact on lifestyle habits and mental health. Taken together, this has the potential to adversely impact the ability of practitioners and patients to adhere to treatment guidelines for the prevention of recurrent cardiovascular events. RECOMMENDATIONS: Every effort should be made to deliver safe, ongoing access to health care professionals and the use of evidenced based therapies in individuals with CVD. An increase in use of a range of electronic health platforms has the potential to transform secondary prevention. Integrating research programs that evaluate the utility of these approaches may provide important insights into how to develop more optimal approaches to secondary prevention beyond the pandemic.


Subject(s)
Cardiac Rehabilitation , Cardiology , Cardiovascular Diseases , Coronavirus Infections , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Secondary Prevention , Australia/epidemiology , Betacoronavirus , COVID-19 , Cardiac Rehabilitation/methods , Cardiac Rehabilitation/trends , Cardiology/methods , Cardiology/organization & administration , Cardiology/trends , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Humans , New Zealand/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Secondary Prevention/methods , Secondary Prevention/organization & administration , Societies, Medical
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