COVID-19 Alaska Daily Clinical Update, May 25

Alaska DOH sent this bulletin at 05/25/2020 08:36 PM AKDT

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Monday, May 25, 2020
Liz Conway Ohlsen, MD
With information from Anne Zink, MD, FACEP, Alaska Chief Medical Officer

May25

Alaska public health news: Fewer than 1.2% of all AK tests have been positive, decreased from around 3.4% in late March, likely because we are increasing testing faster than cases are increasing. Over the last 3 days, 0.2% of tests performed have been positive, and the percent of tests positive has been below 1% since late April. Continuing to increase testing will be critical as Alaska reopens, and more than 40,000 tests have been performed in AK already. More than 85% of the Alaskans known to have had COVID-19 have now recovered, and only 45 have required hospitalization, around 11%. DHSS also tracks cases discovered in Alaska in residents of other states. 13 nonresident cases are known. 


National public health news: Total known US cases: 1.6 million; 97 thousand US deaths. There are now 5.4 million COVID-19 cases diagnosed worldwide and over 340,000 confirmed deaths- around 7% of the total confirmed cases.

 

A study of 16 placentas from patients who had COVID-19 during pregnancy found an unusually high occurrence of perfusion problems and clots compared to placentas examined before the pandemic. In particular, a high prevalence of maternal vascular malperfusion, decidual arteriopathy and intervillous thrombus compared to controls was found. Only ten of the 16 women had symptoms at any time associated with COVID-19 and none became severely ill. 

15 women had live births in the third trimester (14 at term, one at 34 weeks), and one delivered in the second trimester after intrauterine fetal demise; the last of which was excluded from broader statistical analysis. 

 Only one patient was hypertensive. This pattern of placental injury is also seen in hypertensive disorders of pregnancy, and authors suggest that these changes in the placenta may reflect a systemic inflammatory or hypercoagulable state. While this is insufficient evidence to justify major changes in clinical practice, increased antenatal surveillance may be warranted for pregnant women with COVID-19. 


A preliminary report from a double-blind, randomized, placebo-controlled trial of IV remdesivir in adults hospitalized with COVID-19 pneumonia was unblinded early on the basis of an analysis showing shortened time to recovery in the remdesivir group. Of 1059 patients, the 538 assigned to remdesivir had a median recovery time of 11 days (95% CI 9-12 days) while the 521 assigned to placebo had a median recovery time of 15 days (95% CI 13-19 days). Mortality at 14 days was also lower in the group randomized to remdesivir (7.1% vs 11.9%) but these results were not statistically significant- hazard ratio for death 0.7 (95% CI 0.47-1.04). Benefit seemed to be least pronounced among patients requiring mechanical ventilation or ECMO at time of enrollment, with nearly the same rates of recovery whether a patient received remdesivir or not. While remdesivir is still currently only recommended as part of a clinical trial, we may see use expand in the coming weeks on the basis of these data. These data suggest that while remdesivir may not help once patients are critically ill, it may shorten the hospital stay of patients who receive the drug. More data may help distinguish whether there is also a mortality benefit in patients when started before the patient develops critical illness.

AK Clinical Reminders:

COVID-19 testing guidelines and  testing site locator

Report any positive test to the state Section of Epidemiology using the COVID Reporting Hotline at 1-877-469-8067 or by faxing in the Infectious Disease report form. If you suspect COVID-19 in an outpatient who cannot isolate in their own home (for example they are unsheltered or from out of town) or for another urgent situation call SOE at 907-269-8000 or 800-478-0084 (after-hours).

DHSS hosts an AK COVID-19 Update on Zoom Tuesdays at 7PM. Register here for the link to join.

AK COVID-19 clinical information hotline for physicians: 883-751-4212. Staffed 24/7. 8PM-8AM is for urgent/emergent questions only.