Author: Frank Domino, MD in collaboration with Aylin Madore, MD

I stay up-to-date on the latest COVID-19 news and am regularly compiling a list of articles published that are relevant to your primary care practice. Read the insights below from recently published articles in less than two minutes.

Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020

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The CDC, in December, 2020, designated 10 critical recommendations to address the SARS-CoV-2 pandemic: face mask use, physical distancing, avoidance of nonessential indoor spaces (e.g., restaurants) and crowded outdoor spaces, increased testing, diagnosis, and isolation, contact tracing, postponing travel, improved ventilation and effective vaccination.

The CDC Has Updated Guidelines on Isolation and Quarantine

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• Quarantine:
  • For those patients exposed to COVID-19, they may come out of quarantine after 7 days post-exposure if they have no symptoms and have a negative PCR or antigen test result; the specimen for testing may be collected as early day 5. Without a test, people can end their quarantine at 10 days if they still have no symptoms. The agency says that 14 days is still optimal.
• Isolation:
  • If COVID positive but has no symptoms, they can be with others after 10 days have passed since the date you had your positive test.
  • If COVID-19 positive and has symptoms, patients may be with others after at least 10 days since symptoms first appeared and at least 24 hours with no fever without fever-reducing medication and other symptoms of COVID-19 are improving (loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation).
  • If severe illness from COVID-19 (hospitalized and needed oxygen), healthcare providers may recommend staying in isolation for longer than 10 days after your symptoms first appeared (possibly up to 20 days) and you may need to finish your period of isolation at home.

Coronavirus Disease 2019 (COVID-19) Treatment Guidelines

View ISDA Article
View NIH Article
View WHO Article

The World Health Organization (WHO), the National Institutes of Health (NIH), and the US Infectious Disease Society of America (IDSA) issued simultaneous guidelines on treatment of COVID-19 illness:

• All three recommend dexamethasone at a dose of 6 mg once daily (or an equivalent corticosteroid) for patients with moderate-to-severe COVID-19, and all advise AGAINST its use in those with mild disease.
• The WHO guideline recommends AGAINST the use of remdesivir in any situation.
• The IDSA and NIH recommend 5 days of remdesivir for patients on supplemental oxygen, but not for those on mechanical ventilation or extracorporeal membrane oxygenation.
• The NIH suggests use of remdesivir with dexamethasone for severe disease and those on noninvasive ventilation and those who were recently intubated.
• The IDSA and NIH guidelines do not recommend routine use of tocilizumab, bamlanivimab, or reconvalescent plasma.
• All three advised AGAINST the use of chloroquine, hydroxychloroquine, lopinavir/ritonavir, or azithromycin

There Remains No Definitive Clinical Trial Data on the Use of Vitamin D, Vitamin C, Zinc, or Aspirin for COVID-19

Some observational data and information is provided below:

• Vitamin C: as of November 20, 2020, the NIH states: “There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of vitamin C for the treatment of COVID-19 in non-critically ill patients.”
• Vitamin D: there is inconsistent data on the benefit of vitamin D treatment for patients with any stage of COVID-19 infection; the NIH has not updated its recommendation since July 19, 2020, where it stated: “There are insufficient data to recommend either for or against the use of vitamin D for the prevention or treatment of COVID-19.”
• Zinc: the NIH states: “There are insufficient data to recommend either for or against the use of zinc for the treatment of COVID-19. The COVID-19 Treatment Guidelines Panel (the Panel) recommends against using zinc supplementation above the recommended dietary allowance for the prevention of COVID-19, except in a clinical trial.”
• Aspirin: due to its inherent anti-inflammatory and anti-thrombotic effects, aspirin is theoretically a possible therapeutic option for COVID-19 patients, but confirmatory data is still being evaluated. View Article

For more insights, view our collection of COVID-19 resources and CME courses. We recognize it is critical that you have access to timely, reliable information, so we are working hard to release new content in collaboration with our team of infectious disease experts, medical specialists, and primary care clinicians like Dr. Frank Domino.