Author Interviews, COVID -19 Coronavirus / 07.12.2020
COVID-19: Early Treatment With Zinc Plus Low-dose Hydroxychloroquine and Azithromycin Reduced Hospitalizations
MedicalResearch.com Interview with:
Prof. Martin Scholz
Heinrich-Heine-University
Düsseldorf, Germany
MedicalResearch.com: What is the background for this study?
Response: Primary care physicians should have options available to effectively treat newly diagnosed COVID-19 patients in the outpatient setting to avoid severe COVID-19 progression, hospitalizations, and mortality. Already since the beginning of the pandemic different early treatment options were evaluated. My co-authors, Dr. Zelenko, Dr. Derwand, and myself were keen to confirm retrospectively the observed evidence for beneficial early treatment effects of an already applied triple therapy in combination with a risk stratification approach. The defined risk stratification allowed to differentiate between patients at low and high risk for disease progression and guided treatment decisions.
Dr. Halpern-Felsher[/caption]
Bonnie Halpern-Felsher, PhD, FSAHM (pronouns: she/her)
Professor of Pediatrics
Taube Endowed Research Faculty Scholar
Professor (by courtesy), Epidemiology and Population Health
Professor (by courtesy), Psychiatry and Behavioral Sciences
Director of Fellows’ Scholarship, Department of Pediatrics
Director of Research, Division of Adolescent Medicine
Co-leader, Scholarly Concentrations, Pediatrics Residency Program
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: To examine adolescent and young adult e-cigarette use during the COVID-19 pandemic.
There were 4 main findings:
Dr. Barrett[/caption]
Emily Barrett, PhD
Associate Professor
Department of Biostatistics and Epidemiology
Rutgers School of Public Health
MedicalResearch.com: What is the background for this study?
Response: We started this study in the very early stages of the pandemic to look at SARS-CoV-2 viral transmission and disease severity in health care workers as compared to non-health care workers. There was a tremendous amount of fear and uncertainty about the virus and the early anecdotal reports coming out of China and Italy highlighted the plight of many frontline health care workers who had been infected on the job. We knew that our U.S. health care workers would soon be facing this tremendous challenge. We started this study to examine risks of infection in our vulnerable frontline health care workers and a comparison group of non-health care workers. Our results are from the early stages of the U.S. pandemic in March-April 2020.
Dr. Ganson[/caption]
Kyle T. Ganson, PhD, MSW
Assistant Professor, Factor-Inwentash Faculty of Social Work
University of Toronto
Toronto, Canada
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Dr. Nagata[/caption]
Jason Nagata, MD, MSc
Assistant Professor of Pediatrics
University of California, San Francisco
San Francisco, California, USA
MedicalResearch.com: What is the background for this study?
Response: A quarter of young adults in the US have reported being unemployed during the COVID-19 pandemic. Young adults may be especially affected by employment loss as they often work in industries most adversely affected by social distancing.
MedicalResearch.com: What are the main findings?
Response: Among a sample of nearly 5,000 young adults age 18 to 26 in the US, we found that since March 2020, young adults who lost their job or were part of a household that experienced employment loss were more likely than those with secure employment to experience four common symptoms of anxiety and depression. This was also true of young adults who expected an employment loss in the next four weeks. The study also found that symptoms of anxiety and depression were common among the sample of young adults. In the seven days prior to the survey, 75% reported being nervous, anxious or on edge, 68% reported not being able to stop or control worrying, 67% reported having little interest or pleasure in doing things, and 64% reported feeling down, depressed, or hopeless.
Dr. Sachdev[/caption]
Darpun D. Sachdev, M.D.
Case investigation and Contact tracing Branch Chief
SFDPH Covid Command Center
San Francisco Department of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ultimate goal of contact tracing is to rapidly identify and isolate contacts who are COVID-19 positive before they have time to transmit to others. As mentioned in the published research letter by SFDPH, through JAMA, during early shelter-in-place (from April to June 2020), our contact tracing program successfully reached greater than 80% of cases and contacts within a median timeframe of 6 days from the onset of their case’s symptoms. Approximately 10% of named contacts were newly diagnosed with COVID-19 (compared to 2% positivity during this time period). Household contacts made up approximately 80% of all identified contacts, but 90% of contacts who tested positive lived in the same household as the case. Secondary cases (contacts who were found to be newly diagnosed with COVID-19) were traced and quarantined within 6 days of the case’s symptom onset.
With that said, the 6-day time difference between symptom onset and contact notification raises concern regarding the overall effectiveness of tracing in preventing onward transmission by infected contacts. We are working with community-based organizations to scale up access to testing and culturally competent tracing and wraparound services. Currently, we have now decreased the time difference to 5 days. Moreover, given that the majority of contacts resided in the same household, transmission could have occurred presymptomatically such that by the time infected contacts were identified, they might have already transmitted the virus. Hence, why SFDPH, on May 5, 2020, implemented the recommendation of universal testing for COVID-19 contacts, regardless of symptoms.
We recommend that testing should be offered to all contacts regardless of symptoms and encourage local health departments to adopt novel ways of increasing testing access for contacts.
Dr. Adnan[/caption]
Darbaz Adnan, MBChB
Lab Research Assistant
Department of Internal Medicine - Section of Gastroenterology
Rush University Medical Center
Chicago, Illinois 60612
MedicalResearch.com: What is the background for this study?
Response: - We have conducted a large study of over 1000 patients at a major COVID-19 response center in Chicago at Rush University Medical Center, to assess for the frequency of initial GI symptoms (diarrhea, vomiting, abdominal pain) and evaluate whether these symptoms in adult COVID-19 positive could predict the disease course. Overall, 22.4% of our patients reported at least one GI symptom at the onset of their infection, with nausea/vomiting being the most common complaint. GI symptoms in COVID-19 patients were associated with worse outcomes.
Dr. Curtis J. Donskey[/caption]
Curtis J. Donskey, MD
Professor of Medicine
Case Western Reserve University
Staff Physician, Infectious Diseases Section,
Louis Stokes Cleveland VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: The goal of the study was to obtain a better understanding of how healthcare-associated pathogens are transmitted. Infection control efforts tend to emphasize hand hygiene and cleaning of high-touch surfaces in patient rooms. However, there is evidence that portable equipment and floors could be underappreciated sources of transmission.
We previously found that a nonpathogenic virus inoculated onto floors in patient rooms spread rapidly to the hands of patients and to surfaces in the room and throughout the ward. This raised concern that pathogens could spread by the same route.
Dr. Batool-Anwar[/caption]
Salma Batool-Anwar, MBBS, MPH
Instructor, Harvard Medical School
Pulmonary and Critical Care, Sleep Medicine
Brigham and Women's Faulkner Hospital
MedicalResearch.com: What is the background for this study?
Response: A well functioning sleep-wake cycle is vital to our health and prevention of chronic diseases.
During previous disaters sleep disturbances have been reported.
When Massachusetts governor declared a state of emergency in March’20, we hypothesized that sleep duration would be adversely affected by covid-19 related lockdown and stress.
The study was approved by the institutional review board and information was collected retrospectively using the electronic medical records. 
Mr. Olin[/caption]
Steve Olin
Chief Product Officer
Rally Health, Inc., part of the Optum business of UnitedHealth Grou
MedicalResearch.com: Can you please elaborate on Rally Health’s mission?
Mr. Olin: Our founding mission 10 years ago and still to this day is to put health in the hands of the individual. As a digital health company, we live this mission through our focus in three key areas:
1) Providing digital-first access to care by giving individuals easy-to-use digital tools and support to navigate their health care and take full advantage of their health benefits;
2) Engaging people in their daily health by creating experiences that people enjoy and that inspire them to perform healthy actions, and by giving them access to resources that help them achieve their health goals;
3) Saving people time and money by providing digital tools that help them understand health care costs and guide them to lower-cost, high-quality care options.
Dr. Mazzeffi[/caption]
Michael Mazzeffi MD MPH MSc
Associate Professor of Anesthesiology
Division Chief Anesthesiology Critical Care Medicine
Medical Director Rapid Response Team
MedicalResearch.com: What is the background for this study?
Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting. In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza. Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that "micro clots" form in multiple organs. Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19.
For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19. In prior observational research studies, aspirin was found to be protective in patients with severe lung injury. The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome. Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome. Nevertheless, COVID19 has unique features that make aspirin more likely to be effective. Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses. 
Dr. Leaf[/caption]
David E. Leaf, MD, MMSc, FASN
Assistant Professor of Medicine, Harvard Medical School
Director of Clinical and Translational Research in Acute Kidney Injury
Division of Renal Medicine, Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: The data for this study were derived from a multicenter cohort study of over 4,000 critically ill patients with COVID-19 admitted to ICUs at 68 sites across the US, as part of the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID). STOP-COVID was initiated by David E. Leaf, MD, MMSc and Shruti Gupta, MD, MPH, from the Division of Renal Medicine at Brigham and Women’s Hospital and Harvard Medical School. It was initiated in March, 2020 as an unfunded, grassroots network, and now includes over 400 collaborators from 68 sites across the US.
Using this data, we used a ‘target trial emulation’ approach to examine whether early administration of the monoclonal antibody, tocilizumab, reduces mortality in critically ill patients with COVID-19. Target trial emulation, a novel method of analyzing observational data, is the idea of simulating a randomized control trial to reduce bias. 
Dr. Meyers[/caption]
Craig Meyers, PhD
Department of Microbiology and Immunology
Pennsylvania State College of Medicine
Hershey, PA
MedicalResearch.com: What is the background for this study?
Response: As nasal and oral cavities are major points of entry and transmission for human coronaviruses our team of physicians and scientists (Craig Meyers, Janice Milici, Samina Alam, David Quillen, David Goldenberg and Rena Kass of Penn State College of Medicine and Richard Robison of Brigham Young University) were interested in testing common over-the-counter oral antiseptics and mouthwashes for their efficacy to inactivate infectious human coronavirus, which is structurally similar to SARS-CoV-2, the virus that causes COVID-19. While we wait for a vaccine for COVID-19 to be developed, methods to reduce transmission are needed. We chose products that are readily available and often already part of people’s daily routines.
Dr. Kriner[/caption]
Douglas L. Kriner, PhD
The Clinton Rossiter Professor in American Institutions
Department of Government
Cornell University
MedicalResearch.com: What is the background for this study?
Response: When a safe and effective vaccine for COVID-19 reaches the market, the world will not change overnight. Rather, government and public health individuals will have to develop a comprehensive plan to distribute the vaccine and to convince potentially wary Americans to take it.
Our study examined the influence of both specific vaccine characteristics and the politics surrounding it on public willingness to vaccinate. Both matter in important ways. For example, efficacy is unsurprisingly a major driver of public opinion; Americans are more willing to take a vaccine that is more efficacious.