COVID-19: Data Under Scrutiny / Air Hunger & Psychological Trauma / Successful Nonpharmaceutical Interventions

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Take a look at some of the latest developments in COVID-19:

Data under scrutiny: The reliability of data from two recent COVID-19 studies that used the international Surgisphere database is being called into question. One is a Lancet study that showed increased risks for mortality and arrhythmias with hydroxychloroquine and chloroquine. The other is a New England Journal of Medicine study examining the relationship between hypertension drugs and mortality in COVID-19 patients. In open letters to the researchers, "clinicians, medical researchers, statisticians, and ethicists from across the world" call for access to the data, as well as independent confirmation of the findings. NEJM's editor-in-chief on Tuesday issued an "expression of concern" about the reliability of the data. Surgisphere published a response regarding the Lancet study, stating that it stood by its data but would be pursuing an "independent academic audit" to validate "where the data comes from, the database, and the statistical analysis." Follow the links below to read the open letters, expression of concern, studies in question, and response from Surgisphere.

Air hunger & psychological trauma: In the Annals of the American Thoracic Society, pulmonary and critical care specialists urge physicians "to attend to the possibility of extreme air hunger in ventilated COVID-19 patients with [acute respiratory distress syndrome], and to consider the known pharmacologic benefits of opiates in their management." They note that air hunger can cause fear and anxiety and has been linked to post-traumatic stress disorder in ICU survivors. "Opiates are the most reliable agent[s] for symptomatic relief of air hunger," they write, noting that "they seem to act both through depression of ventilatory drive and ascending perceptual pathways, as they do with pain."

Successful nonpharmaceutical interventions: Nonpharmaceutical interventions (NPIs) limited COVID-19 cases at basic training at a U.S. Air Force base to just five, researchers report in MMWR. The analysis included nearly 11,000 trainees at a Texas base from early March until mid-April. Trainees were tested for SARS-CoV-2 only if they showed symptoms. The base also quarantined new arrivals for 2 weeks in a separate area, instructed trainees to stay 6 feet apart, and mandated universal use of cloth face coverings. Some 3% of trainees underwent testing. All five who tested positive were in arrival quarantine at the time; three were contacts of the first patient. No additional cases were reported. "These findings demonstrate the success of widespread implementation of NPIs," the researchers write.