The Time to Offer Treatments for COVID-19

Introduction: COVID-19 has several overlapping phases. Treatment has focused on the late stage of the disease in hospital. Yet, the continuation of the pandemic is by propagation of the disease in outpatients. The current public health strategy relies solely on vaccines to prevent disease. Areas Covered: We searched the major national registries, pubmed.org, and the preprint servers for all ongoing, completed and published trial results with subject numbers of 100 or more on, and used a targeted search to find announcements of unpublished trial results. As of 2/15/2021, we found 111 publications reporting findings in human studies on 14 classes of agents, and on 9 vaccines. There were 62 randomized controlled studies, the rest retrospective observational analyses. Only 21 publications dealt with outpatient care, the rest all in hospitalized patients. Remdesivir and convalescent plasma have emergency use authorization for hospitalized patients in the U.S.A. There is also support for glucocorticoid treatment of the COVID-19 respiratory distress syndrome. Monoclonal antibodies are authorized for outpatients, but the supply is inadequate to treat all at time of diagnosis. Favipiravir, ivermectin, and interferons are approved in certain countries Expert Opinion: Worldwide vaccination is now underway. Vaccines and antibodies are highly antigen specific and new variants are appearing. There is a need for treatment of outpatients who contract the disease, in addition to mass immunization. We call on public health authorities to authorize treatments with known low risk and potential benefit for use in parallel with mass immunization

Infodemiology: Computational Methodologies for quantifying and visualizing key characteristics of the COVID-19 infodemic

Objectives. Infodemics of false information on social media is a growing societal problem, aggravated by the occurrence of the COVID-19 pandemic. The development of infodemics has characteristic resemblances to epidemics of infectious diseases. This paper presents several methodologies which aim to measure the extent and development of infodemics through the lens of epidemiology. Methods. Time varying R was used as a measure for the infectiousness of the infodemic, topic modeling was used to create topic clouds and topic similarity heat maps, while network analysis was used to create directed and undirected graphs to identify super-spreader and multiple carrier communities on social media. Results. Forty-two (42) latent topics were discovered. Reproductive trends for a specific topic were observed to have significantly higher peaks (Rt 4-5) than general misinformation (Rt 1-3). From a sample of social media misinformation posts, a total of 385 groups and 804 connections were found within the network, with the largest group having 1,643 shares and 1,063,579 interactions over a 12 month period. Conclusions. These approaches enable the measurement of the infectiousness of an infodemic, comparative analysis of infodemic topics, and identification of likely super-spreaders and multiple carriers on social media. The results of these analyses can form the basis for taking action to stem an ongoing spread of misinformation on social media and mitigate against future infodemics. The methods are not confined to health misinformation and may be applied to other infodemics, such as conspiracy theories, political disinformation, and climate change denial

The Importance of Understanding the Stages of COVID-19 in Treatment and Trials

COVID-19, caused by SARS-CoV-2, continues to be a major health problem since its first description in Wuhan, China, in December 2019. Multiple drugs have been tried to date in the treatment of COVID-19. Critical to treatment of COVID-19 and advancing therapeutics is an appreciation of the multiple stages of this disease and the importance of timing for investigation and use of various agents. We considered articles related to COVID-19 indexed on PubMed published January 1, 2020-November 15, 2020, and considered papers on the medRxiv preprint server. We identified relevant stages of COVID-19 including three periods: pre-exposure, incubation, and detectable viral replication; and five phases: the viral symptom phase, the early inflammatory phase, the secondary infection phase, the multisystem inflammatory phase, and the tail phase. This common terminology should serve as a framework to guide when COVID-19 therapeutics being studied or currently in use is likely to provide benefit rather than harm