Potential COVID-19 Treatments: Some In, Some Out

On 26 May, the UK government said the National Health Service would provide access to remdesivir to adult and adolescent COVID-19 patients meeting certain clinical criteria, to speed up their recovery. Treatment was authorised through the Medicines & Healthcare products Regulatory Agency (MHRA)’s Early Access to Medicines Scheme and will be prioritised for patients who are likely to benefit the most.

The antiviral drug, originally developed as an Ebola treatment, is currently undergoing clinical trials for COVID-19 around the world, and preliminary data show it can shorten the time to recovery by about four days, from 15 to 11 days.

This step is part of a collaboration between the UK and manufacturer Gilead Sciences. Similar arrangements have already been made with other countries, including the U.S. and Japan. In mid-May, Gilead licensed remdesivir to five generic drug makers with operations in India and Pakistan, which is reported to help to make the medicine available to 127 countries. The manufacturers will not pay royalties until either a second drug is approved, or the pandemic is declared ended.

In the laboratory, remdesivir has been found to inhibit the growth of several notable viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome coronavirus (MERS), SARS-CoV-1, and SARS-CoV-2. In early April, the European Medicines Agency approved remdesivir for compassionate use in COVID-19 patients.

Meanwhile, WHO’s clinical trial of another much-hyped potential COVID-19 treatment, hydroxycholoroquine and chloroquine, has been paused. This was announced by WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing on COVID-19 on 25 May.

Integrating Social Determinants of Health into the EHR

April 03, 2020 - It’s now considered common knowledge that providers need to address a patient’s social determinants of health. These factors such as an individual’s financial situation, ability to get healthy food options, and access to reliable transportation can be more important to an individual’s health outcomes than the actual clinical care he receives.

In fact, commonly cited statistics show that clinical care influences just 10 to 20 percent of a patient’s outcomes, while social determinants of health impact the remainder. If a patient cannot adhere to his hypertension care plan if the medication is too expensive for him to buy every month, then outcomes will suffer. Similarly, outcomes will not improve for an obese patient, if she cannot afford healthy food options or get to a grocery store miles away from home.

But providers are often unaware of this information and some have previously felt it was not their responsibility to address. Only as the evidence has grown have providers felt a push to incorporate these non-traditional risk factors into their clinical decision-making.

“Slowly but surely, the evidence base is showing the benefits of doing social needs screening and social needs interventions. Until recently, there wasn’t an empirically strong evidence base, even though intuitively it’s quite obvious that if you can address the patient’s food insecurity, it’s going to help their diabetes outcomes,” said Rachel Gold, PhD, MPH, senior investigator at Kaiser Permanente Center for Health Research and lead research scientist at OCHIN, Inc.

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AI Detects COVID-19

In Israel, using an AI-based system has been found to be an effective way to help find people most at risk of severe COVID-19 complications. Maccabi Healthcare Services, a leading health maintenance organisation (HMO) in the country, said the system enabled it to determine who among its 2.4mln members were in the high-risk group.

The AI company Medial EarlySign co-developed the technology, which was adapted from an existing system trained to detect people most at risk from flu. The system is backed by huge sets of medical data from Maccabi going back 27 years. These medical records include a person’s age, BMI, health conditions (eg, diabetes; heart disease), and history of hospital admissions.

By trawling through this comprehensive database, the AI tool has already identified around 40,000 of Maccabi members in the high-risk group. These members were then prioritised for testing.

In addition, the AI system helps with assessing the level of treatment these at-risk members might need should they get sick: 1) home-based care; 2) confinement in a quarantine hotel; or 3) admission to hospital.

Maccabi is currently in talks with major health providers in the United States who have shown interest in using the AI system to help flag their own high-risk patients. However, bringing such a tool to the U.S. and other countries may not be that easy. In the U.S., for instance, medical records are kept in “data silos” of hospitals and other healthcare organisations. “Our ability to develop algorithms to identify individuals as high risk is limited by the lack of data sets,” notes Darren Schulte, an MD and CEO of AI firm Apixio, who hopes that the current pandemic will bring about needed improvements in data sharing.