COVID-19: Remdesivir Approved / Close Contact Redefined / Convalescent Plasma / Flu Guidelines / Down Syndrome

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Have a look at some of the most recent developments in COVID-19:

Remdesivir approved: The FDA on Thursday officially approved remdesivir (Veklury) to treat COVID-19 in hospitalized patients aged 12 years and older who weigh at least 40 kg. It is the first treatment to be FDA-approved for COVID-19. Previously, the drug was available under an emergency use authorization.

Close contact redefined: The CDC has redefined what it considers a close contact of someone with COVID-19. Someone is now considered to be a close contact if they were within 6 feet of an infected person for at least 15 minutes over a 24-hour period beginning 2 days before symptom onset (or 2 days before testing in asymptomatic patients). Previously, the 15-minute exposure window was continuous. Close contacts are asked to self-quarantine for 14 days to avoid spreading the virus.

Convalescent plasma: Convalescent plasma was not effective in treating patients hospitalized with moderate COVID-19 in a study in The BMJ. Nearly 500 adults in India were randomized to receive best standard of care with or without convalescent plasma. The plasma group received two 200-mL doses of convalescent plasma — preferably from two different donors — 24 hours apart. Progression to severe disease or all-cause mortality within 28 days occurred in about 18% of patients, with no significant difference between the groups. The plasma group had about a 20% higher rate of conversion to a negative SARS-CoV-2 RNA test result on day 7. An editorialist writes: "In plain English, this means that convalescent plasma did exactly what the investigators hoped it would do, yet there was no net clinical benefit to patients."

Guidelines on flu: The National Institutes of Health has updated its COVID-19 treatment guidelines to include a section on influenza. Among the recommendations: In areas where influenza virus and SARS-CoV-2 are cocirculating, all patients hospitalized with acute respiratory illness should be tested for both viruses, and treatment with oseltamivir should begin without awaiting influenza test results. Oseltamivir can be stopped if the patient tests negative for flu.

Down syndrome: COVID-19 hospitalization and mortality are significantly higher among people with than without Down syndrome, according to a study in the Annals of Internal Medicine. Using a U.K. primary care database of roughly 8 million people, researchers identified some 4000 adults with Down syndrome. After adjustment for potential confounders like residing in a care home or preexisting pulmonary/cardiovascular disease, adults with Down syndrome had roughly 5 times the risk for COVID-19 hospitalization and 10 times the risk for COVID-19 mortality.