Guidance on using rapid tests, managing COPD, and screening for cardiac problems in COVID-19

The FDA recently warned clinicians about the risk of false positives with rapid antigen tests for SARS-CoV-2. To reduce that risk, the package instructions must be followed carefully, such as ensuring the test cartridge/card is not stored open prior to use and reading the results at the appropriate time. Reading the test before or after the specified time could result in a false positive or false negative, the FDA noted in its Nov. 3 letter to clinicians. Clinicians should remember that the positive predictive value of a test varies with disease prevalence; as disease prevalence decreases, the percentage of test results that are false positives increases.

Guidance on the diagnosis and management of chronic obstructive pulmonary disease (COPD) during the pandemic was offered by the GOLD Science Committee in a report published Nov. 4 by the American Journal of Respiratory and Critical Care Medicine. It advised that spirometry should still be used when essential to diagnose COPD or assess lung function status. Clinicians should follow the usual indications for use of inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides in stable COPD patients and systemic steroids and antibiotics in those having exacerbations. The report generally recommends that patients with COPD who develop COVID-19 be treated with the same therapies used for other patients, but they should be monitored more frequently with particular attention to the need for oxygen therapy.

Evidence and guidance on cardiac aftereffects of COVID-19 in competitive athletes were offered by JACC: Cardiovascular Imaging on Oct. 30. A study using echocardiograms and cardiac MRI in 54 student-athletes who had tested positive for SARS-CoV-2 found that 39.5% showed pericardial late enhancements with associated pericardial effusion but that none showed specific imaging features to suggest ongoing myocarditis. An accompanying expert consensus statement provided guidance on screening athletes for cardiac involvement after COVID-19 infection. The authors reviewed the existing evidence on the subject and made recommendations on screening patients based on the presence and nature of their symptoms.

The granting of an emergency use authorization (EUA) does not oblige clinicians or health care facilities to offer the authorized treatment if they do not believe it has been proven effective, advised an Ideas and Opinions article published by Annals of Internal Medicine on Nov. 3. The article addressed the ethics of restricting access to therapies to patients in clinical trials after an EUA. The authors note that the obligation to provide a treatment depends “not on a product's legal availability, but rather on the weight of the evidence supporting it” and that some recent EUAs, for example, that for convalescent plasma, have been based on very limited evidence. “The decision to offer unproven EUA products exclusively through clinical trials is therefore ethically permissible—and may be critical to enabling evidence-based treatment decisions,” the authors said.

The latest episode of Annals On Call, posted on Nov. 5, discusses ACP's recent recommendations on the use of remdesivir in patients with COVID-19. ACP was also a sponsor of recent live online educational session held by the Society of Critical Care Medicine. “COVID-19: What's Next?” presented the latest information and clinical knowledge on the virus as it continues to spread. A recording of the educational sessions and presentations, including plenary lectures by Anthony S. Fauci, MD, MACP, and Adm. Brett P. Giroir, MD, is available online. A related self-directed course is CME-eligible.