This Georgia AAP (virtual) board meeting started with a brief review from Dr. Kathleen Tomey (Department of Health)
AAP Update from Dr. Scornik:
Safe sleep initiatives briefly discussed by Dr. Sarah Lazarus which aligns with Strong4Life campaign:
Update on E-Cigarettes Webinar*+: Wednesday, October 28 at 12:30 pm
Please note new date! Here’s a chance to still register.
First in a series of three webinars offered to Georgia Pediatricians on the growing epidemic of youth e-cigarette use
Faculty: Alice Little Caldwell, MD, FAAP
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A recent study (DE Freedberg et al. Gastroenterol 2020; DOI:https://doi.org/10.1053/j.gastro.2020.05.053. Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study, highlighted on AGA blog, indicates that famotidine may improve outcomes in those with COVID-19.
Methods: Freedberg et al collected data from 1620 patients who tested positive for SARS-CoV-2 no more than 72 hours following admission; 84 of the patients (5.1%) had received famotidine (any dose, form of administration, or duration; median dose of 136 mg) within 24 hours of hospital admission.
Key finding: After the authors adjusted for baseline patient characteristics, use of famotidine was independently associated with risk for death or intubation (adjusted hazard ratio 0.42, 95% CI, 0.21–0.85). This did not change after propensity score matching to balance covariables (hazard ratio 0.43, 95% CI 0.21–0.88).
My take: While these results indicate that famotidine may improve outcomes with COVID-19, a randomized controlled trial is needed to confirm these findings (currently one is underway to determine whether famotidine can improve clinical outcomes in hospitalized patients with COVID-19 (NCT04370262)).
Related blog posts:
Multiple prestigious journals have weighed in on the U.S. pandemic response.
From The Lancet:
“If logic and justice prevail in the next presidential
administration, universal health coverage, a fairer society,
stronger health institutions, more energetic global
engagement, and a robust research agenda will be the
foundations for America’s renewal. We all have a stake in
When analyzing health care expenditures, it has been well-recognized that many patients/families cut back on both necessary and unnecessary care when faced with increased costs; that is, individuals are not very good at selecting care that is truly essential. This is one reason why many health care policy advisors are opposed to high copays and deductibles as a way of reducing health care costs.
I have seen the same type of problem amidst the pandemic. Due to fears of contracting SARS-CoV-2 (rather than mainly cost), individuals/families are deferring routine medical care. This is leading to delays in diagnosis of many serious illnesses and missing opportunities to prevent illnesses (eg. vaccines). A recent study has shown some of the impact with regard to cancer that happened early in the pandemic (and may be ongoing).
Introduction/Background: In this study, we analyzed weekly changes in the number of patients with newly identified cancer before and during the COVID-19 pandemic.
Methods: This cross-sectional study included patients across the United States who received testing for any cause by Quest Diagnostic; data was compared between baseline period (January 6, 2019, to February 29, 2020) and the COVID-19 period (March 1 to April 18, 2020). n=278 778 patients. Study evaluated breast cancer, colorectal cancer, lung cancer, pancreatic cancer, gastric cancer, and esophageal cancer.
- During the pandemic period, the weekly number fell 46.4% (from 4310 to 2310) for the 6 cancers combined, with significant declines in all cancer types, ranging from 24.7% for pancreatic cancer (from 271 to 204; P = .01) to 51.8% for breast cancer (from 2208 to 1064; P < .001)
The authors noted a similar problem has been reported with cardiovascular disease. A study from 9 high-volume US cardiac catheterization laboratories found a 38% decrease in patients treated for ST-elevation myocardial infarction, considered a life-threatening condition.
My take: It is difficult to calculate the actual toll of this pandemic which includes a great deal of secondary problems: delays in diagnosis of life-threatening conditions, mental health/suicides, death from poverty, setbacks in the opioid crisis & overdose deaths, and enormous setbacks in global health projects.
Related blog posts:
- Do Deductibles Work to Improve Smart Spending on Health Care?
- NY Times: America can afford a world-class health system. Why don’t we have one?
- How the IRS Proved That Health Insurance Saved Lives
When I received an email in EARLY MARCH of this year regarding SECURE-IBD, I thought the researchers were insightful and proactive. Recently, the authors published their early findings: EJ Brenner, RC Ungaro et al. Gastroenterol 2020; 159: 481-491. Full Text PDF: Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry
“Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of patients with IBD with confirmed COVID-19.”
- 525 cases from 33 countries were reported (median age 43 years, 53% men)
- Risk factors for severe COVID-19 among patients with IBD included increasing age (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01–1.02), ≥2 comorbidities (aOR, 2.9; 95% CI, 1.1–7.8), systemic corticosteroids (aOR, 6.9; 95% CI, 2.3–20.5), and sulfasalazine or 5-aminosalicylate use (aOR, 3.1; 95% CI, 1.3–7.7).
- Tumor necrosis factor antagonist treatment was not associated with severe COVID-19 (aOR, 0.9; 95% CI, 0.4–2.2)
Other COVID-19 articles from same journal:
- WD Redd et al. Gastroenterol 2020; 159: 765-767. Full Text PDF: Prevalence and Characteristics of Gastrointestinal Symptoms in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in the United States: A Multicenter Cohort Study
- S Singh, A Khan. Gastroenterol 2020; 159: 768-771. Full Text: Clinical Characteristics and Outcomes of Coronavirus Disease 2019 Among Patients With Preexisting Liver Disease in the United States: A Multicenter Research Network Study
- N Forbes, ZL Smith et al. Gastroenterol 2020; 159: 772-774. Full Text PDF: Changes in Gastroenterology and Endoscopy Practices in Response to the Coronavirus Disease 2019 Pandemic: Results From a North American Survey
- G Cholankeril, A Podboy et al. Gastroenterol 2020; 159: 775-777. Full Text: High Prevalence of Concurrent Gastrointestinal Manifestations in Patients With Severe Acute Respiratory Syndrome Coronavirus 2: Early Experience From California
- J Garbe, S Eisenmann et al. Gastroenterol 2020; 159: 778-780. Full Text: German Endoscopy Unit Preparations for the Coronavirus Disease 2019 Pandemic: A Nationwide Survey
- I Rodriguez-Lago et al. Gastroenterol 2020; 159: 780-783. Full Text: Characteristics and Prognosis of Patients With Inflammatory Bowel Disease During the SARS-CoV-2 Pandemic in the Basque Country (Spain)
My take: There is a tremendous amount of information regarding SARS-CoV-2 & COVID-19 with regard to the GI tract and liver disease. For the most part, the data indicate that individuals need to continue to treat their underlying disease and that most therapies do not increase the risk of worsening infection; the biggest risk factors remain increasing age and common comorbidities (eg. obesity, hypertension, and diabetes). The published studies also provide insight and recommendations for preventing SARS-CoV-2 for health care providers.
Related blog posts:
- COVID-19 Projections (April 2020) & IBD Infusion Recommendations
- Pandemic Is NOT Taking a Summer Holiday
- COVID-19 Posts | gutsandgrowth
- 1st Cases of COVID-19 in Pediatric Inflammatory Bowel Disease –All Mild | gutsandgrowth
Findings In this cohort of 276 patients hospitalized with COVID-19 in Suizhou, China, the proportion of daily wearers of eyeglasses was lower than that of the local population (5.8% vs 31.5%).
Meaning These findings suggest that daily wearers of eyeglasses may be less likely to be infected with COVID-19.
From AAP News: AAP Report: 513,415 children diagnosed with COVID-19
- The latest report shows a rate of 680 COVID-19 cases per 100,000 children.
- Children make up 9.8% of the total cases and about 1.7% of all COVID-19 hospitalizations, up from 0.8% of hospitalizations in late May.
- Roughly 1.9% of children diagnosed with COVID-19 have been hospitalized, according to data from the 23 states and New York City that are publicly reporting hospitalization data.
- There also have been at least 103 pediatric deaths in 42 states and New York City, making up about 0.07% of all COVID-19 deaths. Roughly 0.02% of children who have contracted known cases of COVID-19 have died.
- There have been 792 confirmed cases of multisystem inflammatory syndrome in children in 42 states, New York City and Washington, D.C., and 16 death
Conclusion: In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
NY Times: E Emanuel et al. Where Is America’s Groundbreaking Covid-19 Research? The U.S. could learn a lot from Britain.
Excerpt: “ Yet with over six million coronavirus cases and 183,000 deaths, the United States has produced little pathbreaking clinical research on treatments to reduce cases, hospitalizations and deaths. Even one of the most important U.S. studies to date, which showed that the antiviral drug remdesivir could reduce the time Covid-19 patients spent in the hospital to 11 days from about 15, had too few subjects to demonstrate a statistically significant reduction in mortality…[British] researchers found no benefits from the use of hydroxychloroquine in hospitalized Covid-19 patients, nor from the lopinavir-ritonavir drug combination. On the other hand, dexamethasone, an inexpensive steroid, was found to reduce mortality by up to one-third in hospitalized patients with severe respiratory complications.”
“Unfortunately, unlike Britain, the United States has lacked a clear, unified message from government health care leaders, major insurance companies and hospital systems to put in place large, simple randomized trials that are considered the standard of care for Covid-19 treatment. We need to change that muddled approach now and reassert the nation’s clinical research excellence.”
NY Times: Roni Rabin. How a Bus Ride Turned Into a Coronavirus Superspreader Event
An excerpt: “A passenger on one of the buses had recently dined with friends from Hubei. She apparently did not know she carried the coronavirus. Within days, 23 fellow passengers on her bus were also found to be infected.
It did not matter how far a passenger sat from the infected individual on the bus, according to a study published in JAMA Internal Medicine on Tuesday. Even passengers in the very last row of the bus, seven rows behind the infected woman, caught the virus…
The new study “adds strong epidemiological evidence that the virus is transmitted through the air, because if it were not, we would only see cases close to the index patient — but we see it spread throughout the bus,” said Linsey Marr…
[THIS] took place on Jan. 19, when there were still no confirmed Covid-19 cases reported in Ningbo…The potential for airborne transmission in close confined spaces raises concern about the winter months, when people will be spending more time indoors, Dr. Marr said. Her advice: “Avoid crowded indoor spaces where people are not wearing masks and the ventilation is poor.”