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COVID-19 Update: Remdesivir Mixed Results, Studying Asymptomatics COVID-19 Update: Remdesivir Mixed Results, Studying Asymptomatics

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Mixed Results for Remdesivir in Moderate Disease

A 5-day course of remdesivir (Veklury) for hospitalized patients with moderate COVID-19 was associated with a statistically significant improvement compared with standard care in a company-sponsored randomized trial. However, experts said the clinical benefit of the drug in these patients is ambiguous given the small difference between trial groups. 

In addition, patients randomly assigned to receive a longer, 10-day remdesivir course did not improve significantly, compared with those who received standard care, when they were assessed 11 days after treatment started.

This trial and two previously reported randomized trials all showed varied results with remdesivir, “raising the question of whether the discrepancies are artifacts of study design choices, including patient populations, or whether the drug is less efficacious than hoped,” wrote two experts in an accompanying editorial. 

Understanding Asymptomatic Infections 

According to various estimates, between one fifth to nearly one half of people infected with SARS-CoV-2, and possibly more, never develop symptoms. Scientists don’t know why. 

The prevailing theory is that the immune systems of asymptomatic people fight off the virus so efficiently that they never get sick. But some scientists are also looking into a phenomenon called disease tolerance, in which an organism may accommodate an infection so seamlessly that no symptoms emerge, Undark reports

More Clues on How COVID-19 Can Turn Immune System Against Us 

A history of age-related macular degeneration or thrombocytopenia, thrombosis, or hemorrhage are associated with greater risk for COVID-19 morbidity and mortality, new evidence suggests.

The findings emerge from research aimed at uncovering specific ways immune dysregulation contributes to more severe COVID-19. This deeper dive into mechanisms lurking behind poorer clinical outcomes implicates differences in complement and coagulation components of the immune system — both of which are involved in inflammation.

Famotidine Associated With Benefit for Hospitalized Patients 

Administering famotidine to hospitalized COVID-19 patients was associated with a reduction in death and a composite endpoint of either death or intubation, according to an observational study published in the American Journal of Gastroenterology. Of the 878 patients included in the study, 83 (9.5%) received famotidine, and those patients were slightly younger than the patients who did not receive the drug.

Two More Patients Reinfected 

Scientists have reported additional cases of patients reinfected with different strains of SARS-CoV-2 after yesterday’s initial report of a reinfected patient in Hong Kong. The two new reinfections were reported in Belgium and the Netherlands. 

“People are worried and ask if reinfection is ‘standard,’ ” said Marion Koopmans, a leading virologist in the Netherlands and a member of the World Health Organization’s scientific advisory group. “I don’t think it is.”

Boston Outbreak Genomic Postmortem

Researchers at the Broad Institute, Massachusetts General Hospital, the Massachusetts Department of Public Health, and other institutions sequenced and analyzed nearly 800 complete SARS-CoV-2 genomes to investigate how the virus spread in the Boston area earlier this year. They posted the results of their analysis to the preprint server medRxiv.org. It included nearly all confirmed cases from the first week of the epidemic and hundreds of cases from major outbreaks at a conference, a nursing facility, and among homeless shelter guests and staff.

With more funding and infrastructure, sequencing SARS-CoV-2 genomes from an ongoing outbreak could be helpful for health officials and contact tracers, experts told The Washington Post . “If you’re spending whatever money large organizations seem to be putting into large-scale testing,” said one of the scientists, “throwing away that very same extracted [RNA] that could tell you about how cases are connected within your organization or within communities is just throwing away the crown jewels of what you really want to know.”

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Thousands throughout the world have died. Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form. If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

Ellie Kincaid is Medscape’s associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine. She can be reached at [email protected] or on Twitter @ellie_kincaid . 

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