COVID-19 research briefs: Physical distancing measures are effective for reducing spread; colchicine may reduce symptoms

Daily POEMs

Published: 2020-08-29 © 2020 John Wiley & Sons, Inc.

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Clinical question
Can physical distancing reduce the transmission of COVID-19? Is colchicine a potential treatment option?

Bottom line
Physical distancing measures are effective in reducing COVID-19 transmission. Colchicine yielded small clinical improvements in a preliminary randomized trial. (LOE = 2c)

Reference
Islam N, Sharp SJ, Chowell G, et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ 2020;370:m2743. http://dx.doi.org/10.1136/bmj.m2743

Study design: Not applicable

Funding source: Unknown/not stated

Setting: Not applicable

Synopsis
Research Brief #51: Most information about the effectiveness of physical distancing (school closures, workplace closures, restrictions on mass gatherings, public transportation closures, and lock-down orders) on reducing COVID-19 transmission comes from modeling studies. This study uses empirical data regarding the effects of physical distancing on COVID-19 transmission in an interrupted time series analysis and a random effects meta-analysis of data from interventions in 149 countries, the most comprehensive data to date. Investigators calculated the incidence rate ratios (IRRs) of COVID-19 cases before physical distancing interventions and after (as measured 30 days after the intervention or on May 30, 2020, whichever came first). The implementation of any physical distancing intervention reduced COVID-19 cases by an average of 13% (IRR 0.87; 95% CI 0.85 - 0.89). Most countries implemented 4 or 5 of these interventions; the results were essentially the same whether 4 or 5 interventions were in place. The findings did not change in a detailed sensitivity analysis. Islam N, Sharp SJ, Chowell G, et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ 2020;370:m2743. Research Brief #52: In this preliminary clinical trial in Greece, 105 hospitalized patients with COVID-19 were randomized to receive colchicine or standard medical therapy for up to 3 weeks. The authors evaluated cardiac and inflammatory marker levels and clinical outcomes. The primary clinical outcome was time from baseline to clinical deterioration, defined as a 2-point deterioration on a 7-point scale, where 1 = ambulatory, normal activities and 7 = death. There were no significant differences in the levels of high-sensitivity troponin or time to maximum C-reactive protein. Mean event-free survival time was 18.6 days in the control group vs 20.7 in the colchicine group (log rank P = .03). Seven patients (14%) in the control group and 1 patient (1.8%) in the colchicine group had a 2-point deterioration in the primary clinical outcome (odds ratio 0.11; 0.01 - 0.96; P = .02). The sample size was too small to test for differences in mortality. A larger trial is needed to see if colchicine leads to a meaningful clinical benefit for patients with COVID-19. Deftereos SG, Giannopoulos G, Dimitrios A, et al, for the GRECCO-19 investigators. Effect of colchicine vs standard care on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019: The GRECCO-19 randomized clinical trial. JAMA Network Open 2020;3(6):e2013136. doi:10.1001/jamanetworkopen.2020.13136.

John Hickner, MD, MS
Professor Emeritus
Dept of Family Medicine
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.