COVID

COVID-19 Update: Viral Persistence in Sputum & Feces / ACE Inhibitors & ARBs / Malaria Drug Emergency Authorization

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

SARS-CoV-2, the virus that causes novel coronavirus disease (COVID-19), can persist in sputum and feces weeks after pharyngeal samples convert from positive to negative, according to findings in the Annals of Internal Medicine.

In particular, for 22 patients in Beijing with confirmed COVID-19, sputum samples remained positive up to 39 days after pharyngeal swabs became negative, and feces samples were positive up to 13 days afterward. The researchers write, "These findings raise concern about whether patients with negative pharyngeal swabs are truly virus-free." However, they emphasize that "it is not known whether the positive RT-qPCR results ... observed here indicate that a patient continues to pose a risk for infection to others."

Separately, in a special report in the New England Journal of Medicine, researchers discuss the controversy surrounding use of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in patients with COVID-19. They note that data in humans are insufficient to support or refute claims that these drugs may be harmful in such patients — and suggest that they instead may be beneficial. The researchers conclude that the drugs should be continued in patients with or at risk for COVID-19, adding: "Although additional data may further inform the treatment of high-risk patients ... clinicians need to be cognizant of the unintended consequences of prematurely discontinuing proven therapies in response to hypothetical concerns."

In other COVID-19 news, the FDA has granted emergency use authorization for chloroquine phosphate and hydroxychloroquine sulfate to treat patients "when clinical trials are not available, or participation is not feasible." And the American Medical Association has issued a guide for retired physicians who may be considering returning to work during the pandemic. It covers licensing considerations and professional liability, among other areas.