Solving COVID: September 9, 2020

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1. 7 trials suggest common steroids can reduce coronavirus death risk
2. Drug makers release joint safety pledge in COVID-19 vaccine process
3. AstraZeneca pauses COVID-19 vaccine trial after volunteer falls ill
4. Chest X-rays could offer fast and cheap COVID-19 diagnosis where testing is unavailable
5. Researchers speculate face masks act as a crude coronavirus proto-vaccine

published 9 September 2020

1. 7 trials suggest common steroids can reduce coronavirus death risk

A collection of studies have discovered another viable — and easily accessible — coronavirus treatment. Common steroids have proven effective in reducing the risk of death for severely ill COVID-19 patients, a World Health Organization analysis of seven clinical trials published in the Journal of the American Medical Association found. Thanks to these positive results, the WHO is recommending these steroids be part of "standard care" for "severe and critical" COVID-19 cases. The seven randomized clinical trials used three common steroids to treat 1,700 severely ill COVID-19 patients, seemingly resulting in a one-third reduction in the death rate among them. Dexamethasone led to a 36 percent drop in the death rate among 1,282 patients in three trials, while hydrocortisone reduced the death rate by 31 percent in 274 patients. An additional editorial in JAMA from two American medical professors added to the WHO's findings, saying the corticosteroids should be "first-line treatment for critically ill patients with COVID-19."

Companies behind a number of COVID-19 vaccine candidates have released a joint pledge in an effort to "ensure public confidence" in the process. Johnson & Johnson, Moderna, and Novavax were among the nine drug companies working on potential COVID-19 vaccines whose CEOs signed an unusual joint pledge released on Tuesday, saying they won't submit for approval until "after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA," also promising to "always make the safety and well-being of vaccinated individuals our top priority." This pledge came amid concerns over cut corners in the vaccine approval process, especially so that a potential candidate could be ready before the presidential election.

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AstraZeneca on Tuesday announced it has temporarily suspended global trials of a possible COVID-19 vaccine after a volunteer experienced a "potentially unexplained illness." The pharmaceutical company is testing the Oxford vaccine, developed by the University of Oxford, in the United States, United Kingdom, Brazil, and South Africa. It is one of three potential coronavirus vaccines now in Phase 3 trials in the U.S. It is standard procedure for experimental trials to pause in order to determine if the vaccine is causing serious reactions in volunteers. AstraZeneca said in a statement that during large trials, "illnesses will happen by chance but must be independently reviewed to check this carefully. We are working to expedite the review of the single event to minimize any potential impact on the trial timelines."

Chest X-rays "could provide a rapid, cost-effective diagnosis of COVID-19," a team of radiologists at Louisiana State University Health New Orleans found, Science Daily reports. When cases were spiking in New Orleans back in March, the LSU team recognized an unusual pattern on chest X-rays — "the presence of patchy and/or confluent, band-like glass opacity or consolidation in a peripheral and mid-to-lower lung zone distribution" — and discovered that it was "highly suggestive" of a coronavirus infection. Indeed, the chest X-rays characteristic in appearance for COVID-19 had a predictive value of nearly 84 percent. The X-rays, which are low in sensitivity, shouldn't be a substitute for PCR tests, but they're fast and affordable, and could be useful for health-care workers, "especially when adequate testing is lacking," the radiologists said.

Face masks might stand in as a crude substitute until a COVID-19 vaccine is available, researchers suggest in a New England Journal of Medicine commentary. The unproven theory "is inspired by the age-old concept of variolation, the deliberate exposure to a pathogen to generate a protective immune response," The New York Times reports. Before the smallpox vaccine, for example, some doctors would rub smallpox scabs or pus on healthy people to stimulate a more mild case and an immune response to protect against re-infection. With COVID-19, the speculation is that a mask cuts down on the number of viruses that enter a person's airway, and if a small number slip through or around the mask, it may prompt strong and enduring immunity. There is some research that lends credence to this idea, but trying to prove the theory through clinical trials would be unethical, the Times reports. Dr. Monica Gandhi, an infectious disease doctor at U.C. San Francisco and coauthor of the NEJM commentary, said people should wear masks anyway.

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