COVID-19: Ivermectin & Mild Illness / Seroprevalence in Children / Conjunctival Swabs? / Cardiac Screening in Pro Athletes

By Amy Orciari Herman

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

Here are some of the latest developments in COVID-19:

Ivermectin & mild illness: The antiparasitic ivermectin does not seem to improve outcomes in mild COVID-19, according to a randomized, single-center trial in JAMA. Previous research has suggested a potential effect against SARS-CoV-2. In the new trial, roughly 400 adults in Colombia with mild COVID-19 who were within 7 days of symptom onset were randomized to receive ivermectin oral solution or placebo daily for 5 days. Patients could be at home or hospitalized without needing high-flow oxygen or mechanical ventilation. The primary outcome — time to resolution of symptoms — did not differ significantly between the groups (median: 10 days with ivermectin, 12 with placebo). By day 21, symptoms had resolved in roughly 80% of patients in each group. Some 7.5% of patients in the ivermectin group and 2.5% in the placebo group discontinued treatment because of adverse events.

Seroprevalence in children: The number of children infected with SARS-CoV-2 in Mississippi could be 13 times higher than reported, according to a seroprevalence study in MMWR. Researchers performed SARS-CoV-2 antibody testing on some 1600 residual serum samples that were collected in Mississippi for routine testing between May and September 2020. All were from patients under age 18 years. Roughly 11% tested positive for SARS-CoV-2 antibodies. Seropositivity increased from 2.5% in May to 16.3% in September. Overall, Hispanic children were most likely to test positive, followed by Black children. After extrapolating the findings to the state's population, the researchers estimated that nearly 114,000 children in Mississippi might have been infected by mid-September, whereas fewer than 9000 pediatric cases had been reported through the end of August.

Conjunctival swabs: Among 91 patients hospitalized with COVID-19 in Italy who had conjunctival swab specimens taken for PCR testing, 57% had positive test results. Overall, conjunctival swabs were positive from one eye but not the other in 23% of patients. In a subset of 41 patients who had nasopharyngeal and conjunctival swab specimens taken within 2 days of each other, 10 had negative nasopharyngeal PCR results but positive conjunctival results. In JAMA Ophthalmology, researchers suggest that "use of the slightly invasive conjunctival swab may be considered as a supplementary diagnostic test." They add that the findings "support the use of eye protection for people working in environments where infection through the ocular route is feasible."

Cardiac screening in pro athletes: In JAMA Cardiology, U.S. researchers report on cardiac findings in professional athletes after COVID-19. Nearly 800 pro athletes who tested positive for COVID-19 underwent return-to-play cardiac screening — troponin testing, electrocardiogram, and resting echocardiogram — between May and October 2020. Most participants were men, and the mean age was 25; none had severe disease. Screening suggested potential cardiac injury in 4% of the athletes, who then underwent additional testing. Ultimately, five athletes (0.6% of the entire cohort) were diagnosed with inflammatory heart disease (myocarditis or pericarditis) and were held back from returning to play. As of December 2020, no cardiac events had occurred in any of the athletes who had returned to play.