COVID-19 Updates – Phase 3 Trials, Screening, Diabetes and Hypertension, Low Vitamin D, Unexpected Effects: Heart Damage and Hair Loss

Research continues to increase our knowledge of the novel coronavirus (SARS-CoV-2) and the COVID-19 pandemic it causes. Let us review the latest published developments.

Phase-3 vaccine clinical trials (large-scale human experiments) have begun

Moderna and the United States National Institutes of Health announced that they have begun phase 3 testing of their jointly developed COVID-19 vaccine candidate in clinical trials. Approximately 30 thousand adult volunteers will participate in the study, designed to assess the experimental vaccine's safety and whether two doses can prevent COVID-19.

The United States National Institute of Allergy and Infectious Diseases stated that the mRNA-1273 vaccine had been shown safe and immunogenic in early-stage clinical trials, supporting the phase 3 trial. The study is designed to determine whether the vaccine prevents COVID-19 and how long its protection lasts.

The first screening test

The United States Food and Drug Administration (FDA) announced that LabCorp's COVID-19 RT-PCR diagnostic test could be used for two additional situations: people whose COVID-19 symptoms are absent or people with no reason to suspect an infection. Thus, broader diagnostic testing without waiting for symptoms could enable early diagnosis of asymptomatic COVID-19 patients and help prevent the outbreak's spread. An FDA press release also described the new testing authorization as a step in the right direction to help schools and workplaces reopen.

Diabetes and hypertension

Analysis of data from hospitalized COVID-19 patients worldwide found that people with chronic conditions such as diabetes and hypertension had ICU admission and mortality rates that increased. Data on 15,794 hospitalized patients compiled from 65 reports published between December and April showed diabetes in 12% and hypertension in 17% of patients.

In an interview, study participant Dr. Fady Hannah-Shmouni said that despite certain limitations, they showed higher COVID-19 incidence among people with hypertension and diabetes. The results show that ICU admission rates among patients with diabetes, compared with those without diabetes, were 96% higher, and deaths increased 2.78-fold. Among people with hypertension, ICU need compared with those without hypertension increased 2.95-fold, while mortality was 2.39-fold higher.

The new findings indicate a relationship between the virus, diabetes, hypertension and other risk factors. Establishing the relationship between COVID-19, diabetes and hypertension means people with these chronic conditions should be informed about their COVID-19 risks and have adequate access to medicines and supplies needed to control blood pressure and high blood sugar.

Does low vitamin D increase risk?

A study indicates that low plasma vitamin D is an independent risk factor for COVID-19 infection and hospitalization. The study included 14 thousand patients tested for COVID-19 and for levels of 25(OH)D, the measure used to determine vitamin D status.

The study found that people testing positive for COVID-19 had around a 50% chance of having normal or low vitamin D levels. These findings indicate that to clarify vitamin D's relationship with COVID-19 risk, its ability to inform prognosis and hospitalization risk, and whether it helps prevent infection, a larger-scale randomized study is needed.

Heart damage observed after COVID-19

Evidence that the heart can be damaged in hospitalized COVID-19 patients, particularly those with cardiovascular disease or risk factors, was clearly seen in the pandemic's early days.

Although clinicians observed adverse effects of COVID-19 on the heart, they could not fully determine why the damage occurs. The key question is whether SARS-CoV-2 directly attacks the heart. On 27 July, 2 new reports showed the virus affecting heart muscle (myocardium) without causing heart muscle inflammation (myocarditis). Persistent myocardial injury and inflammation were also observed in some recovered COVID-19 patients, potentially leading to heart failure later in life.

Another study similarly reported ventricular dysfunction, increased ventricular mass and myocardial inflammation in patients who recovered from COVID-19. A further study examined 39 patients' hearts after death and found SARS-CoV-2 and viral replication in the heart muscle. Although initial studies demonstrate that COVID-19 damages the heart, more research is needed to understand long-term effects.

Does COVID-19 cause hair loss?

An unexpected long-term effect was observed in some patients recovering from COVID-19: hair loss. Telogen effluvium hair loss was reported weeks or even months after acute infection. Although temporary, this hair loss results from physical or emotional stress, high fever, illness or weight loss. These factors are also reported for COVID-19. Stress accounts for approximately 50% of hair loss causes, but why some COVID-19 patients experience hair loss has not been fully explained.

Conclusion

New studies are increasing our knowledge of the COVID-19 pandemic. During this period, we can protect ourselves and our loved ones by maintaining hand hygiene and social distance and wearing masks when needed, including indoors at home.

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