COVID-19 research briefs: anosmia common in SARS-CoV-2 infection, and a negative trial of hydroxychloroquine

Daily POEMs

Published: 2020-05-09 © 2020 John Wiley & Sons, Inc.

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Clinical question
What is the incidence of anosmia in patients with COVID-19? Can hydroxychloroquine with or without azithromycin improve outcomes in patients hospitalized with the virus?

Bottom line
Although the loss of the sense of smell is a feature of sinus infections, the rate of anosmia appears to be higher in patients with COVID-19 than would ordinarily be the case with other viral respiratory infections. Retrospective data suggest no benefit of hydroxychloroquine with or without azithromycin in patients in US Veterans Health Administration medical centers. (LOE = 4)

Reference
Aspinato G, Fabbris C, Polesol J, et al. Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6771. Magagnoli J, Narendran S, Pereira F, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv. Posted April 23, 2020. https://doi.org/10.1101/2020.04.16.20065920

Study design: Other

Setting: Other

Synopsis
Research Brief #14: An alteration in taste and smell has been informally reported in patients with COVID-19. The virus attaches selectively to angiotensin-converting enzyme 2 receptors, which are numerous in the nasal epithelium. This Italian study identified adults who had a positive test result for SARS-CoV-2 during a 4-day period at the regional hospital in Treviso. Of the total 374 patients, 283 had contact information and 202 completed a telephone survey. Two-thirds of the patients (n = 130) reported any alteration in taste or smell, which was described as 'moderate,' 'severe,' or 'as bad as it can be' by 102 patients (78%). In 101 of 130 patients, the onset of the anosmia was concomitant with or followed the onset of other symptoms. Although there is no comparison with patients who have noncoronavirus respiratory infections, the rate of anosmia appears to be higher in patients with COVID-19 than would ordinarily be the case with other viral respiratory infections. Research Brief #15: This is the first published evaluation of hydroxychloroquine (HCQ) with or without azithromycin (AZ) in US patients. The authors identified patients who were hospitalized with COVID-19 in all US Veterans Health Administration medical centers. They identified 97 patients who had been given HCQ, 113 who had been given HCQ plus AZ, and 158 who had not received HCQ. They used propensity score matching to identify patients who looked similar other than the treatment received. In the unadjusted analysis, the risk of death was 27.8% in the HCQ group, 22.1% in the HCQ plus AZ group, and 11.4% in the no HCQ group. After propensity score matching, the adjusted hazard ratio for death was 2.61 (95% CI 1.10 - 6.17) for HCQ compared with no HCQ. However, the risk of death was not significantly increased for patients given the combination HCQ and AZ compared with those receiving no HCQ (adjusted hazard ratio 1.14; 0.56 - 2.32). There was no significant difference between groups with regard to the need for mechanical ventilation in the adjusted analysis.

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA

Copyright © 2020 John Wiley & Sons, Inc.