News briefs

Hydroxychloroquine hopes dashed

A meta‐analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID‐19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality. The authors found 29 articles that met their criteria, all but one of which involving hospitalised patients, and evaluated the effects of hydroxychloroquine with or without azithromycin. After excluding studies with a critical risk of bias, the meta‐analysis included 11 932 patients in the hydroxychloroquine group, 8081 in the hydroxychloroquine with azithromycin group, and 12 930 in the control group (who received neither drug). The results showed that hydroxychloroquine was not associated with mortality, either in all trials combined or in separate analyses of randomised controlled trials or observational studies. The relative risk of death for use of hydroxychloroquine was 17% lower than controls for all studies combined, but 9% higher in randomised controlled trials. In both cases, these results were not statistically significant. However, the combination of hydroxychloroquine and azithromycin in patients with COVID‐19 was associated with a statistically significant 27% increase in mortality compared with controls. The authors wrote: “These results confirm the preliminary findings of several observational studies which have shown that the combination of hydroxychloroquine and azithromycin might increase the risk of acute, life‐threatening cardiovascular events.”

Clinical Microbiology and Infection; https://www.sciencedirect.com/science/article/pii/S1198743X2030505X

Children have less severe COVID‐19 and death is exceptionally rare

A study published by The BMJ has found that children and young people have less severe COVID‐19 than adults and that death is exceptionally rare, only occurring in children with serious underlying conditions. However, the findings also show that children of Black ethnicity were disproportionately severely affected by COVID‐19 infection. Children and young people make up only 1–2% of cases of COVID‐19 worldwide, and the majority of reported infections in children are mild or asymptomatic, with few recorded deaths. As such, there has been less information on ethnicity, comorbidities and outcomes for children with COVID‐19 than for adults. To address this knowledge gap, UK researchers in the ISARIC4C consortium analysed data from 651 children and young people (aged less than 19 years) with COVID‐19 admitted to 138 hospitals in England, Wales and Scotland between 17 January and 3 July 2020. Patients in the study had a median age of 4.6 years and were predominantly male (56%) and of white ethnicity (57%), with most (58%) children having no known comorbidities. The main outcome measures were admission to critical care (a high dependency unit or intensive care unit), death in hospital, or meeting the WHO definition for multisystem inflammatory syndrome (MIS‐C), a rare condition thought to be linked to COVID‐19. Patients were tracked for a minimum of 2 weeks, during which time 18% (116) children were admitted to critical care. Those aged younger than 1 month, aged 10–14 years, and of Black ethnicity were more likely to be admitted to critical care. Six children (1%) died in hospital, all of whom had profound comorbidity. This is a “strikingly low” fatality rate compared with 27% across all ages (0–106 years) over the same time period, noted the authors. Eleven percent of children met the WHO definition for MIS‐C. These children were older (average age, 10.7 years) and more likely to be of non‐white ethnicity. These children were also more likely to be admitted to critical care, show symptoms such as fatigue, headache, muscle pain and sore throat, and have a low blood platelet count, but there were no deaths in this group. This is an observational study, so cannot establish cause, and the researchers point to some limitations that may have affected their results.

The BMJ; https://www.bmj.com/content/370/bmj.m3249