COVID-19 research focuses on at-home testing, steroids, hydroxychloroquine, zinc

Nasal swabs collected at home by symptomatic patients were effective at detecting SARS-CoV-2 infection, according to a research letter published on July 22 by JAMA Network Open. The study included 185 participants (85% health care workers), 22.2% of whom had positive results on clinician-collected nasopharyngeal swab, home self-collected midnasal swab, or both. Compared with clinician swabs, home swabs had a sensitivity of 80.0% (95% CI, 63% to 91%) and a specificity of 97.9% (95% CI, 94% to 99.5%). The authors noted that the observed sensitivity of the home swabs was lower than previously described but said that this approach is “safe and scalable in the pandemic setting” and “should be targeted toward individuals early in illness, when risk of transmission is highest and care seeking less likely.”

More data on the efficacy of glucocorticoids for some hospitalized patients with COVID-19 was provided by a brief report published by the Journal of Hospital Medicine on July 22. The observational study looked at 1,806 hospitalized COVID-19 patients, 140 of whom were treated with glucocorticoids within 48 hours of admission. Overall, glucocorticoids were not associated with any difference in mortality or mechanical ventilation. However, in the subgroup of patients with initial C-reactive protein (CRP) levels of 20 mg/dL or above, steroids were associated with significantly decreased risk of mortality or mechanical ventilation (odds ratio [OR], 0.23; 95% CI, 0.08 to 0.70), whereas in patients with CRP levels less than 10 mg/dL, they were associated with increased risk (OR, 2.64; 95% CI, 1.39 to 5.03). The authors noted that their findings agree with the recent RECOVERY trial and add to it by offering a method for identifying which patients are likely to get benefit or harm from steroids. Results should be confirmed in prospective, randomized trials, they said.

Hydroxychloroquine failed to show benefit in a new study, published by the New England Journal of Medicine on July 23. The Brazilian trial, which was funded in part by EMS Pharma, randomized hospitalized patients with mild to moderate COVID-19 (a maximum of 4 L/min supplemental oxygen) to standard care, standard care plus hydroxychloroquine, or standard care plus hydroxychloroquine and azithromycin. Among the 504 patients included in the modified intention-to-treat analysis, clinical status at 15 days did not differ with hydroxychloroquine alone (OR, 1.21; 95% CI, 0.69 to 2.11; P=1.00) or hydroxychloroquine plus azithromycin (OR, 0.99; 95% CI, 0.57 to 1.73; P=1.00) compared to standard care. The authors noted that the trial could not definitively rule out either a substantial benefit or harm from the drugs, that it was not blinded, that some patients in the standard care group had received the drugs for up to 24 hours before enrollment, and that although the median time from symptom onset to randomization was seven days, some patients were randomized as late as 14 days.

Zinc also failed to show a beneficial effect on hospitalized patients in a study published by CHEST on July 22. The retrospective study looked at all 242 patients admitted to one U.S. medical center with COVID-19, 81.0% of whom received zinc sulfate. The study found no significant difference in days to inpatient mortality between patients who did and didn't receive zinc, including in subgroups stratified by severity of illness. The authors cautioned that an effect could not be ruled out since the study was limited by its small size and risk of confounding and noted that randomized trials are needed to establish the efficacy of zinc in COVID-19.