COVID-19 Alaska Daily Clinical Update, May 27

Alaska DOH sent this bulletin at 05/27/2020 07:36 PM AKDT

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Wednesday, May 27, 2020
Liz Conway Ohlsen, MD
With information from Anne Zink, MD, FACEP, Alaska Chief Medical Officer

May 27

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, 0.3% 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. 15 nonresident cases are known. 


National public health news: Total known US cases: 1.7 million; 98 thousand US deaths. There are now 5.5 million COVID-19 cases diagnosed worldwide and nearly 350,000 confirmed deaths- around 7% of the total confirmed cases.

 

Hydroxychloroquine and chloroquine were tied to a higher risk of death and increased frequency of heart arrhythmias in COVID-19 in an observational study published last week in the Lancet. The study looked at data from 96,032 patients in 671 hospitals across six continents and included patients started on these treatments within 48 hours of diagnosis, excluding anyone already receiving mechanical ventilation. They controlled for confounding factors such as age, sex, and comorbidities when comparing 14,888 patients who received one of these treatments to the 81,144 patients in the control group. Hydroxychloroquine and chloroquine, with and without a macrolide, were independently associated with a more than tenfold increased risk of new ventricular arrhythmia and overall more than doubled mortality during hospitalization. 

 

Treatment

New ventricular arrhythmia (hazard ratio [95% confidence interval])

In-hospital mortality (hazard ratio [95% confidence interval])

Hydroxychloroquine

6.1% (2.37 [1.94-2.90])

18.0% (1.34 [1.22-1.46])

Hydroxychloroquine + macrolide

8.1% (5.11 [4.11-5.98])

23.8% (1.45 [1.37-1.53])

Chloroquine

4.3% (3.56 [2.76-4.60])

16.4% (1.37 [1.22-1.53])

Chloroquine + macrolide

6.5% (4.01 [3.34-4.81])

22.2% (1.37 [1.27-1.47])

Control group

0.3%

9.3%

 

These side effects were previously recognized for hydroxychloroquine and chloroquine, as QT lengthening and increased risk of arrhythmias had previously been observed in patients taking the drugs for malaria or autoimmune diseases, so arrhythmogenic effects observed in COVID-19 patients are not surprising. However, since the medicines have not been shown to have any benefit in COVID-19 and are now tied to higher mortality, the World Health Organization paused the use of hydroxychloroquine in their global randomized trial of COVID-19 treatments pending further safety review. Chloroquine was not part of the trial. The WHO is continuing trial use of remdesivir, lopinavir+ritonavir, and lopinavir+ritonavir+interferon beta-1z. 

 

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.