COVID-19: Plasma Approval Halted / Breast Milk / Less Severe Variant? / Updated School Guidance

By Amy Orciari Herman

Edited by Susan Sadoughi, MD

Take a look at some of the latest news on COVID-19:

Plasma authorization halted: FDA emergency authorization for convalescent plasma as a treatment for COVID-19 is now on hold, the New York Times reports. National Institutes of Health leaders, including Drs. Francis Collins, Anthony Fauci, and H. Clifford Lane, said data from the largest trial to date — encompassing over 35,000 infused patients — are insufficient to justify approval, according to the Times. The results suggested that plasma lowered mortality in hospitalized patients when given within 3 days of diagnosis, but whether treating patients that early is realistic remains to be seen. In addition, there was no placebo group. The trial has enrolled over 66,000 patients thus far.

Breast milk: SARS-CoV-2 seems unlikely to be transmitted via breast milk, a JAMA study finds. Eighteen U.S. women with COVID-19 who were breast-feeding provided 64 breast milk samples for analysis (nearly all women were symptomatic). RT-PCR detected SARS-CoV-2 RNA in one sample, which was collected on the day of symptom onset. However, culture to detect replication-competent virus was negative for all samples, including the one with positive RT-PCR results. The researchers write, "These data suggest that SARS-CoV-2 RNA does not represent replication-competent virus and that breast milk may not be a source of infection for the infant."

Less severe variant? Patients infected with a SARS-CoV-2 variant with a 382-nucleotide deletion (Δ382) appear to have a milder clinical course than those infected with wild-type virus, according to a retrospective study in The Lancet. Researchers in Singapore identified 29 patients infected with Δ382 virus only, 92 infected with wild-type only, and 10 infected with both. The primary outcome — hypoxia requiring supplemental oxygen — occurred in no patients infected with Δ382 virus alone but in roughly 30% of those in the other two groups. After multivariable adjustment, Δ382 virus was associated with over a 90% reduction in the odds of hypoxia requiring oxygen. Additionally, patients with the variant had lower levels of inflammatory markers typically seen with severe COVID-19.

Updated return-to-school guidance: The American Academy of Pediatrics (AAP) now says cloth face coverings should be required for all children over age 2 years in school settings. In addition, updated guidance from the group places a greater emphasis on equity in education. The AAP's president said in a news release: "The persistent racial and social inequities in our educational system, including disparities in funding, quality of school buildings, and resources for curriculum and teachers have only been exacerbated by the pandemic. ... Whatever school looks like this fall, we must be innovative and promote the well-being of all children, particularly children living in marginalized communities."