WHO UPDATES MASK GUIDANCE
The WHO released updated guidance on mask usage last Friday, including information on who should use a mask and when masks should be worn, as well as the materials or type of mask that should be used. The new recommendations deviate from previous guidance in a few key areas, particularly for areas experiencing widespread SARS-CoV-2 transmission. The WHO now recommends that masks be worn by all health personnel seeing patients in areas of widespread transmission, not just clinicians treating COVID-19 patients. In areas experiencing community transmission (a step below widespread transmission), individuals at elevated risk of severe COVID-19 disease or death, including those over the age of 60 or those with underlying health conditions, should wear medical masks whenever physical distancing from other people is not possible. The general public should wear masks in crowded areas when physical distancing from other people is not possible in areas experiencing widespread transmission.
The WHO released updated guidance on mask usage last Friday, including information on who should use a mask and when masks should be worn, as well as the materials or type of mask that should be used. The new recommendations deviate from previous guidance in a few key areas, particularly for areas experiencing widespread SARS-CoV-2 transmission. The WHO now recommends that masks be worn by all health personnel seeing patients in areas of widespread transmission, not just clinicians treating COVID-19 patients. In areas experiencing community transmission (a step below widespread transmission), individuals at elevated risk of severe COVID-19 disease or death, including those over the age of 60 or those with underlying health conditions, should wear medical masks whenever physical distancing from other people is not possible. The general public should wear masks in crowded areas when physical distancing from other people is not possible in areas experiencing widespread transmission.
In terms of materials, the WHO now recommends that cloth masks be made out of at least 3 layers of different materials, ideally an inner layer of absorbent material (e.g., cotton), a middle layer of non-woven material (e.g., polypropylene), and an outer layer of non-absorbent material (e.g., polyester). WHO Director-General Dr. Tedros Adhanom Ghebreyesus emphasized that mask use alone does not protect against SARS-CoV-2 infection and that masks should be used as part of a “comprehensive strategy” of protective measures.
HYDROXYCHLOROQUINE TRIAL TERMINATED The United Kingdom terminated the hydroxychloroquine arm of its RECOVERY clinical trial after finding no evidence of treatment benefit for COVID-19 patients. The UK’s Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, a national clinical trial to test the efficacy of potential COVID-19 treatments, has stopped enrolling new patients in a trial arm testing hydroxychloroquine. In a statement released Friday, the study’s chief investigators stated that preliminary findings from 1,542 patients demonstrated that there was no clinical benefit from the use of hydroxychloroquine. The trial participants in the hydroxychloroquine treatment arm showed no significant improvements in mortality or hospital stay length compared to other participants receiving usual medical care. The statement committed to publishing the full results in the near future.
PEDIATRIC MULTISYSTEM INFLAMMATORY SYNDROME Two recently published studies provide new analysis of pediatric multisystem inflammatory syndrome (PIMS) associated with COVID-19 in children. The first study, published in Eurosurveillance, describes the results of a nationwide surveillance effort in France conducted March 1-May 7. The researchers identified 156 potential cases of PIMS over that period, including 79 confirmed, 16 probable, and 13 possible cases (48 were ruled out based on the study’s case definition). The PIMS incidence in France peaked several weeks after the national COVID-19 peak, which suggests that PIMS may be a “post-infectious manifestation” of COVID-19, and the geographic distribution of PIMS cases largely correlated with COVID-19 incidence. Based on a maximum estimated COVID-19 incidence in French children (defined as those under the age of 15) of 5%, the researchers estimate the risk of PIMS to be fewer than 2 cases per 10,000 children.
The second study, published in The BMJ, looked at the clinical presentation of PIMS in Paris, France. The prospective study identified 21 PIMS patients in Paris between April 27 and May 11. Of these children, 12 presented with Kawasaki disease, and 16 presented with myocarditis. Among these patients, 9 reported previously experiencing “viral-like symptoms” (e.g., fever, headache), and the mean duration between these symptoms and the onset of Kawasaki disease was 45 days. In total, 8 (38%) of the PIMS patients tested positive for SARS-CoV-2 infection during the study, and only 1 had symptoms consistent with COVID-19 during the study. In contrast, 19 of the 21 (90%) patients tested positive for IgG antibodies, indicating prior infection. The delay following viral symptoms and the prevalence of IgG antibodies relative to active infection further support the idea that PIMS is a post-infectious manifestation of COVID-19. The researchers also observed disease severity in these patients, with 17 (81%) of them requiring intensive care and 11 (52%) requiring mechanical ventilation. Notably, 57% of the patients were of African ancestry, but further data and analysis are needed to characterize any potential association.
COVID-19 ELIMINATED IN NEW ZEALAND New Zealand Prime Minister Jacinda Ardern announced that New Zealand has eliminated COVID-19, following 17 days with no new reported cases and the discharge of the country’s last remaining active COVID-19 patient. New Zealand subsequently transitioned to Alert Level 1 and lifted nearly all remaining COVID-19 restrictions. The notable exception is continued strict border controls, including mandatory 14-day quarantine for arriving travelers, to mitigate the risk of imported cases and travel-associated outbreaks. Additionally, New Zealand shifted its COVID-19 mindset from “Unite Against COVID-19” to “Unite for Recovery,” which will focus on economic recovery while maintaining vigilance and enhanced hygiene to mitigate the risk of COVID-19. Prime Minister Arden emphasized that the dedication and commitment to the successful response has placed New Zealand at an advantage in terms of economic recovery, particularly as many countries remain under restrictive social distancing measures. In total, New Zealand reported only 1,154 confirmed infections and 22 deaths.
SOCIAL DISTANCING IMPACT Two new articles were published in Nature today that describe the effects of social distancing and other interventions on the COVID-19 pandemic. One article used data from 1,717 different interventions at the local, regional and national level in the United States, France, Iran, Italy, South Korea, and China. Based on econometric modeling techniques, which are typically used to evaluate economic impact of events and policies, the researchers evaluated the impact of various non-pharmaceutical interventions (NPIs), including large-scale social distancing policies, on the epidemic growth. They concluded that interventions in these countries may have prevented 62 million confirmed COVID-19 cases worldwide, which corresponds to an estimated 530 million total SARS-CoV-2 infections. These include 4.8 million confirmed cases (60 million infections) in the United States alone.
The other article focused on interventions in Europe through May 4, 2020, when some countries began to relax national social distancing measures. Considering available data from serological studies, the researchers estimated the true number of infections in order to evaluate the effects of social distancing policies on transmission and mortality. This study found that nonpharmaceutical interventions, including national “lockdowns,” could have averted approximately 3.1 million COVID-19 deaths across 11 European countries.
State and local governments across the United States continue to relax social distancing measures. Notably, New York City and Las Vegas are expanding business and social activities. The changes in Las Vegas, in particular, have raised concern about increased transmission risk as videos and photos have circulated showing individuals crowding into casinos with questionable social distancing and many people not wearing face masks.
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