COVID-19 Roundup

Record Low COVID-19 Hospitalizations, Metformin Reduces SARS-Cov-2 Viral Load, Low Mortality Rates in Older Patients Taking Remdesivir, and More

Anthony Calabro, MA

CDC Reports Record Low Weekly COVID-19 Hospitalizations, Ends Requirements to Report Data1-3

The CDC reported a record low number of weekly hospitalizations due to COVID-19 at the end of April. A total of 5615 hospitalizations were reported—the fewest since the CDC began its tracking at the beginning of the pandemic. For context, at the peak of the Omicron variant in early 2022, there were more than 150,000 weekly hospitalizations.2

The reporting of record low hospitalizations comes as the CDC issued a notice that, effective May 1, it will no longer require hospitals to report COVID-19 hospital data.3 While hospitals are no longer required to submit their reporting, the CDC’s National Healthcare Safety Network still has the capability to obtain hospitalization data sent to them voluntarily, which is encouraged.

“The COVID-19-related data reporting is important in supporting surveillance of, and response to, COVID-19 and other respiratory illnesses. Given the value of these data for patient safety and public health, CDC strongly encourages ongoing, voluntary reporting of the data through National Healthcare Safety Network,” the CDC wrote on their website.3

Metformin Reduces SARS-CoV-2 Viral Load, Rebound4

In a randomized, placebo-controlled, double-blind trial of outpatients treated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), researchers found that metformin, a medication commonly used to treat patients with diabetes, significantly reduced SARS-CoV-2 viral load compared with those who received placebo.

Researchers obtained patient samples during the COVID-OUT trial. A total of 999 patients provided at least one nasal swab sample. The results of the study’s subanalysis showed that those who received metformin had less viral load than those who received placebo. Indeed, the mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin vs placebo.  Additionally, patients who received metformin were less likely to have a detectable viral load than placebo on both day 5 and day 10, and viral rebound was less frequent with metformin (3.28%) than placebo (5.95%).

“In this randomized, placebo-controlled trial of outpatient treatment of SARS-CoV-2, metformin significantly reduced SARS-CoV-2 viral load, which may explain the clinical benefits in this trial,” the researchers concluded. “Metformin is pleiotropic with other actions that are relevant to COVID-19 pathophysiology.”

Remdesivir reduces mortality in older patients hospitalized for COVID-19 during Omicron5

In a real-world, observational study, remdesivir was associated with reduced mortality among older patients (65 years of age and older) hospitalized for COVID-19 during the Omicron era (December 2021 to April 2023). This study was presented at the European Society of Clinical Microbiology and Infectious Diseases Global 2024 Congress in Barcelona, Spain.

The study used matching with replacement to compare inpatient mortality in patients 65 years of age or older who were administered remdesivir in the first 2 days of hospitalization (n = 45,038) with those not administered remdesivir during hospitalization (n = 20,425). The authors noted that since they used matching with replacement, one patient who did not receive remdesivir could be matched multiple times to different patients in the remdesivir group.

The researchers characterized the patients into different groups: those with no supplemental oxygen, those on low-flow oxygen, those on high-flow oxygen or invasive ventilation, and by age groups. The primary endpoints were 14-day in-hospital mortality and 28-day hospital mortality.

Overall, the study results showed that patients administered remdesivir had a lower 28-day mortality rate compared with those not given the antiviral medication across all age groups and across all baseline supplemental oxygen groups (13.3% vs 16.9%, respectively). This research was funded by Gilead.

How COVID-19 Vaccines Prevent Severe Illness6,7

A big-data analysis examining how COVID-19 vaccines mitigate severe illness found that those who received a COVID-19 vaccine had a reduction of disease severity indicators, meaning that inflammatory reactions to COVID-19 were less severe in this group compared with those who were not vaccinated.6

Researchers from the Oxford Vaccine Group conducted the study, which “characterizes the beneficial immune response conferred by ChAdOx1 nCoV-19 vaccine during breakthrough infection at the fine molecular level.”7

Among the key findings, researchers noted:6,7

  • a reduction in harmful responses associated with COVID-19 severity in recipients of the ChAdOx1 nCoV-19 vaccine compared with those who were unvaccinated
  • less COVID-19-induced blood cell count changes among vaccinated individuals compared with those who were not vaccinated, and
  • a link between decreased levels of microRNAs and elevated levels of inflammation.

“These results confirm the efficacy of vaccination and its pivotal role in reducing the harmful consequences associated with COVID-19,” Daniel O'Connor, BSc AFHEA MSc DPhil (OXON), Head of Bioinformatics at the Oxford Vaccine Group, said in a press release. “The results of our research highlight the ChAdOx1 nCoV-19 vaccine's ability to modulate harmful responses to the SARS-CoV-2 virus, and therefore to reduce the severity of illness. The implications of these findings are far-reaching, offering evidence that is fundamental to future vaccine development and pandemic mitigation strategies. It also provides valuable guidance for policymakers and public health experts.”

 

References:

  1. COVID data tracker. Centers for Disease Control and Prevention. May 10, 2024. Accessed May 16, 2024. https://covid.cdc.gov/covid-data-tracker.
  2. Benadjaoud Y. COVID-19 hospitalizations hit record low, the CDC says. ABC News. April 30, 2024. Accessed May 16, 2024. https://abcnews.go.com/Health/covid-19-hospitalizations-hit-record-low-cdc/story?id=109793784.
  3. COVID-19 Hospital Data Reporting. National Healthcare Safety Network. April 29, 2024. Accessed May 16, 2024. https://www.cdc.gov/nhsn/covid19/hospital-reporting.html.
  4. Bramante CT, Beckman KB, Mehta T, et al. Favorable antiviral effect of metformin on severe acute respiratory syndrome coronavirus 2 viral load in a randomized, placebo-controlled clinical trial of coronavirus disease 2019. Clin Infect Dis. Published online May 1, 2024. doi:10.1093/cid/ciae159
  5. Mozaffari E, Chandak A, Berry M. Remdesivir reduces mortality in elderly patients 65+ years hospitalisedfor COVID-19 during Omicron. Presented at the 34th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID);April 27-30, 2024; Barcelona, Spain. https://www.askgileadmedical.com/docs/conference/ECCMID%202024%20_%20Mozaffari_%20Oral%20Elderly%20CER@pdf.
  6. Ground-breaking study reveals how COVID-19 vaccines prevent severe disease. News release. University of Oxford; May 3, 2024. Accessed May 16, 2024. https://www.ox.ac.uk/news/2024-05-03-ground-breaking-study-reveals-how-covid-19-vaccines-prevent-severe-disease.
  7. Drury RE, Camara S, Chelysheva I, et al. Multi-omics analysis reveals COVID-19 vaccine induced attenuation of inflammatory responses during breakthrough disease. Nat Commun. 2024;15(1):3402. doi:10.1038/s41467-024-47463-6