Top Infectious Disease News of the Week—March 22, 2020

#5: High-Dose IVIg Reversed Worsening COVID-19 in Case Reports

High-dose intravenous immunoglobulin (IVIg) appeared to reverse the deteriorating course of 3 patients with coronavirus disease 19 (COVID-19), in case reports from a hospital at the center of the outbreak in Wuhan, China.

Two of the patients admitted to the Jin Yin-tan Hospital in Wuhan were initially diagnosed with COVID-19 common type, but quickly deteriorated to severe type, and the third patient met that criteria on admission. IVIg was administered subsequent to the increased severity.

"Strategies against COVID-19 should...be specified according to the course of infection," explained Taisheng Li, MD, PhD, Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Bejing, China, and colleagues.

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#4: COVID-19 Treatment: Updates March 19-24, 2020

Clinicians and researchers across the globe are working with fervor to mitigate the world pandemic caused by SARS-CoV-2, the virus responsible for coronavirus disease 2019 (COVID-19). New data emerge daily, and it is imperative we embrace a deliberate calm to scrutinize the evidence and report it intentionally, despite our overwhelming desire to find an effective treatment. We previously reviewed published literature on experimental treatments for COVID-19 from December 31, 2019 through March 19, 2020. Here, we provide updates from the past 6 days (!!) as we strive to continually analyze data and optimize patient care. We also encourage readers to check out resources from the Society of Infectious Diseases Pharmacists (SIDP) regarding previously reviewed agents with therapeutic potential for COVID-19.

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#3: With 'Containment' Increasingly Infeasible, Physicians Offer a COVID-19 Mitigation Strategy

As SARS-CoV-2 continues to spread around the world and rates of testing vary widely from state to state and country to country, a new article in the Journal of the American Medical Association argues public health officials need to shift from a “containment” mindset to a “mitigation” mindset.

Stephen M. Parodi, MD, and Vincent X. Liu, MD, MSc, both of Kaiser Permanente’s Permanente Medical Group, say a containment strategy becomes increasingly difficult as officials are less and less able to identify the sources of particular cases.

“When a small number of infected patients are in concentrated locales, containment strategies (ie, quarantine) can halt the spread of infection by isolating infected or exposed individuals from the general population,” they write.

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#2: FDA Issues Alert on Potential Risk of SARS-CoV-2 Transmission Through FMT

The US Food and Drug Administration (FDA) has issued a safety alert on the potential risk of transmitting SARS-CoV-2, the virus that causes coronavirus diseases 2019 (COVID-19), through fecal microbiota transplantation.

In the alert, published today, the FDA indicates that additional safety measures are needed after multiple studies reported that SARS-CoV-2 ribonucleic acid and/or SARS-CoV-2 virus was present in the stool of infected individuals.

Based on these studies, the virus may potentially be transmitted through fecal microbiota transplantation; however, the risk of transmission is unknown at this time.

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#1: How Does Hydroxychloroquine and Azithromycin Combination Therapy Measure Up For COVID-19 Treatment?

Jason Pogue, PharmD, BCPS, BCIDP, clinical professor of infectious diseases, at the University of Michigan College of Pharmacy, speaks with Contagion®’s Senior Editor Michaela Fleming to share his thoughts on the recently published study “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open label non-randomized clinical trial.”

Interview transcript (modified slightly for readability):

Contagion®: Thanks for joining me to talk about this really important topic. We're going to jump into the article that was published in the International Journal of Antimicrobial Agents about hydroxychloroquine and azithromycin as a treatment for COVID-19. Why don't we talk about this? It's getting a lot of attention. We can start with you telling us a little bit about the study and what exactly the investigators were looking at here.

Pogue: Yeah, absolutely. And thanks for having me. Pleasure to be here.

Just to orient, this study included 36 patients, who were SARS-CoV-2 positive. These weren't necessarily infected patients, a few of them were asymptomatic. Some had upper respiratory tract infections, some had lower respiratory tract infections. There were 2 groups in this study; 20 patients got hydroxychloroquine and 16 patients got standard of care. So just supportive management, no therapy that was actually directed toward the viral infections.

Watch the full interview.