Everything We Learned About COVID-19 in April

As April comes to an end, we’re looking back at a fast-paced month in infectious disease developments. New information about coronavirus disease 2019 (COVID-19) was released daily, as the pace of scientific publishing has rapidly increased due to the outbreak.

As information about the origins of SARS-CoV-2 continued to be examined, more facts about the evolutionary history of the virus is available, though there are still many unknowns.

More evidence also emerged to back loss of smell as an early symptom of COVID-19.

The supply of diagnostics increased across April, though there are calls for increased testing. While positive results from diagnostics can be very helpful, the specter of negative COVID-19 test results has led to concerns about the quality of some of the many tests which have been granted emergency use authorization.

A serological assay diagnostic also emerged in the United States during the month.

Stephen Klasko, MD, Chief Executive Officer of Thomas Jefferson University Hospitals, talked to Contagion® about the complexity of balancing hospital treatment priorities during the COVID-19 pandemic.

As much of the American economy has been restricted, economic impacts are also beginning to translate into food insecurity.

As clinical cases rose throughout the month, more information emerged about the most common co-morbidities and underlying health conditions seen in US COVID-19 patients.

A hospital case series of patients with both COVID-19 and HIV describes recovery, but highlights the need to refine treatment.

Nursing homes have been particularly hard hit by cases of COVID-19, as data begin to reveal a large share of the COVID-19 associated mortality pertains to outbreaks in these facilities.

Prisons are also now a potential hotspot in the US, with rapid and severe virus spread in at-risk facilities.

The debate on whether age should play a role in deciding who qualifies for life-saving coronavirus treatments intensified as management of limited supplies became a critical issue.

While COVID-19 spread has varied widely by locality, some cities also experienced what epidemiologists believe to be the peak of new COVID-19 infections. While the outbreak continues in these areas, the peak of new infections is widely recognized as one of the most difficult times for health care workers in COVID units.

A New York City nurse shared reflections from her journal on Contagion® on what she went through during the period she called “peak-week.”

In its first treatment guidelines for patients with COVID-19, the National Institutes of Health emphasized this month that no specific therapy or prevention has yet been proven effective against the illness.

The newly announced "Operation Warp Speed" seeks to develop and disburse 100 million doses of a COVID-19 vaccine to the public by year’s end. In addition, a variety of clinical trials are underway to find a safe and effective COVID-19 treatment.

The politically-charged debate on hydroxychloroquine continued with particular intensity over the course of the month. Mixed results led the authors of a retrospective analysis to caution use of hydroxychloroquine outside of clinical trials.

The US Food and Drug Administration also released a drug safety communication cautioning against the use of hydroxychloroquine or chloroquine for COVID-19 outside of hospital and clinical trial settings.

The month ended with confusing revelations about another experimental therapeutic, as clinicians scrambled to reconcile contradictory information from a trio of remdesivir trials, with the investigational antiviral ultimately praised by National Institutes of Allergy and Infectious Diseases director Anthony Fauci, MD.

As always, use the Contagion® Outbreak Monitor to learn more about infectious disease outbreaks in your area and around the world.

Here’s a look at the top 5 web articles from the month of April:

#5: Chinese Study Suggests Second COVID-19 Wave Would be Harder to Contain

An epidemiologic modelling study to forecast the potential spread of coronavirus disease 2019 in China predicts that a second surge would be harder to contain. The model was also designed to inform decisions on relaxing restrictions and found that a second wave could require more extensive restrictions than were initially imposed.

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#4: Coronavirus Lingers After Symptoms Resolve in Some Patients

Coronavirus disease 2019 patients can still spread the virus after their infection and even once their symptoms clear up, according to a paper published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

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#3: Spanish Flu Pandemic Proves Social Distancing Works

As Americans enter their second month of homebound social-distancing, politicians and other public health officials are pondering the question of just how long it will be necessary to cancel public gatherings. Some have wondered aloud whether long-term isolation is even necessary to stop the spread of the coronavirus disease 2019.

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#2: The Eyes Have It: Novel Coronavirus in Eye Can be Communicable

One-third of patients in a series of 38 hospitalized for coronavirus disease 2019 were found to have symptoms consistent with conjunctivitis. Two of the patients yielded positive RT-PCR tests for the SARS-CoV-2 virus from both conjunctival and nasopharyngeal swabs, and 1 patient manifested the excessive tearing of epiphora as the first symptom of the viral illness.

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#1: Results from a Controlled Trial of Hydroxychloroquine for COVID-19

The initial results from a placebo-controlled trial of hydroxychloroquine for COVID-19 indicate that patients hospitalized with mild illness recovered more quickly with addition of the drug than with placebo at the start of a standard treatment. The results also suggest that hydroxychloroquine might convey some protection against the illness worsening.

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