Impact of Fluvoxamine on outpatient treatment of COVID-19 in Honduras (preprint)

Background: COVID-19 pandemic has impacted lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard-of when early outpatient treatment with repurposed drugs in Latin American countries showed promising results. One such drug is fluvoxamine, that has shown tremendous potential in two major studies, following which fluvoxamine was added to the standard of care in Honduras. Methods: This is a prospective observational study performed at the Hospital Centro Medico Sanpedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients fifteen years of age or older, with mild or moderate signs and symptoms of COVID-19, and a positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study and prescribed fluvoxamine. Cohort of patients who decided to take fluvoxamine were compared to the cohort who did not take fluvoxamine for mortality risk and risk of hospitalization as primary endpoints. Patient were monitored for 30 days with first follow up at 7 days and second follow up at 10-14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Odds ratio was calculated using univariate and multivariate logistic regression. Continuous variables were compared by t-test and Wilcoxon rank-sum tests. Results: Of 657 total COVID-19 cases, 594 patients took fluvoxamine and 63 did not. A total of five patients (0.76 percent) died, of which only one death occurred in the fluvoxamine group. Patients who did not receive fluvoxamine had a significantly higher mortality (OR 24, p0.005, CI 2.6 to 233.5). Odds ratio of hospitalization in patients who did not take fluvoxamine was 2.38 (30 vs 10 hospitalizations, p 0.040, CI 1.04-5.47). The odds ratio of requiring oxygen in patients in the non-fluvoxamine group was 5.08 (p<0.001, CI 2.18- 11.81). Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, {Delta} 0.33, p 0.007, CI 0.09 to 0.58). Conclusion: The results of our study suggest lowers odds of mortality and hospitalization in patients who took fluvoxamine vs fluvoxamine non-takers. Non-fluvoxamine group had higher odds of oxygen requirement than fluvoxamine group as well.

Spatial Distribution of COVID-19 in Honduras at the Early Phase of the Pandemic Using Geographic Information Systems (GIS) (preprint)

The epidemic of Coronavirus Disease 2019 (COVID-19) have affected all the regions of the world, nevertheless, in some countries there is a lack of studies on its main clinical and epidemiological features. We analyzed the incidence, incidence rates, and evolution of COVID-19 cases in Honduras from February 18-April 24, 2020.Methods: Using daily epidemiological data from surveillance about COVID-19 in Honduras, we calculated the rates of incidence (cases/100,000 population), and developed at national, departmental, and municipal levels GIS-based maps.Results: February 18 - April 24, 2020, a sum of 3,169 suspected COVID-19 cases have been assessed by RT-PCR, 533 (16.8%) of them were positive, for an incidence rate of 5.73 cases/100,000 pop. The highest peak was reached on March 31 (48 cases). The department with the highest number of cases and incidence rate was Cortes (383 cases, 71.9% of the total, 21.45 cases/100,000 pop). Discussion: The pattern and evolution of COVID-19 epidemic in Honduras has been particularly focused in the major urban areas, San Pedro Sula and Tegucigalpa, the capital city. Studies using geographical information systems linked with clinical disease characteristics are necessary to attain accurate epidemiological data for public health systems. Such information is also useful for assessment of the evolution of the pandemic and monitoring interventions.

Using prenatal blood samples to validate COVID-19 rapid serologic tests (preprint)

IntroductionBackground cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. Blood collected during prenatal care is a unique source of population-based samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. MethodsWe randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018, at least one year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers’ instructions. Pictures were taken for all tests and read by two blinded trained evaluators. Results We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests. The third test had a specificity of 98.9% for IgM and 94.4% for IgG. The fourth test had a specificity of 88.9% for IgM and 100% for IgG.Discussion COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples.