The Food and Drug Administration (FDA) warned against the use of Hydroxychloroquine or chloroquine for Covid-19 outside of a hospital or a clinical trial setting due to the risk of QT interval prolongation, ventricular tachycardia and the increased risk of these complications when combined with some antibiotics such as azithromycin. Several studies have reported no benefit of Hydroxychloroquine or chloroquine, when used alone or with a macrolide in COVID-19 hospitalized patients. Despite these warnings, in several developing countries the official guidelines for treatment of Covid-19 patients at the primary care level recommend Hydroxychloroquine and azithromycin, among other treatments, as the first-choice for mild symptomatic Covid-19 patients, asymptomatic contacts or for prophylaxis. In our opinion there is a primum non nocere dilemma during this Covid-19 pandemic. In order to solve this bioethical problem, we strongly recommend that a randomized controlled trial in a primary care setting be carried out as a matter of urgency in these areas of the world.

The COVID-19 pandemic forces the whole rheumatic and musculoskeletal diseases community to reassemble established treatment and research standards. Digital crowdsourcing is a key tool in this pandemic to create and distil desperately needed clinical evidence and exchange of knowledge for patients and physicians alike. This viewpoint explains the concept of digital crowdsourcing and discusses examples and opportunities in rheumatology. First experiences of digital crowdsourcing in rheumatology show transparent, accessible, accelerated research results empowering patients and rheumatologists.

Aerosols represent a potential route of transmission of COVID-19. This study examined the effect of simulated sunlight, relative humidity, and suspension matrix on the stability of SARS-CoV-2 in aerosols. Both simulated sunlight and matrix significantly affected the decay rate of the virus. Relative humidity alone did not affect the decay rate; however, minor interactions between relative humidity and the other factors were observed. Decay rates in simulated saliva, under simulated sunlight levels representative of late winter/early fall and summer were 0.121±0.017 min-1 (90% loss: 19 minutes) and 0.379±0.072 min-1 (90% loss: 6 minutes), respectively. The mean decay rate without simulated sunlight across all relative humidity levels was 0.008±0.011 min-1 (90% loss: 125 minutes). These results suggest that the potential for aerosol transmission of SARS-CoV-2 may be dependent on environmental conditions, particularly sunlight. These data may be useful to inform mitigation strategies to minimize the potential for aerosol transmission.

Pulmonary capillary leak syndrome secondary to influenza SARS-CoV-2virus infection was not previously reported. We report 2 cases. The diagnosis of non-cardiogenic pulmonary edema due to pulmonary capillary leak syndrome SARS-CoV-2 virus infection was obtained by a medical committee of 6 physicians. The diagnosis of COVID-19 infection is confirmed by reverse transcription polymerase chain reaction (RT-PCR) test. Moreover, in this specific endemic situation, and according to the British Society of Thoracic Imaging expert reference group update, we took account of chest CT-Scan results in the early detection of COVID-19 pneumonia. Our 2 patients with a confirmed influenza SARS-CoV-2virus infection had respiratory distress with lung crackles on auscultation of one or both lungs and with alveolar pulmonary edema on the chest CT-Scan. The cardiogenic nature of pulmonary edema was ruled out in both cases by a transthoracic echocardiography showing normal systolic and diastolic functions. Our patients were treated by oxygen via face mask in one case and mechanical ventilation as supportive treatment in the other patient. Hydroxychloroquine (600mg/day), Azithromycine, steroids (dexamethasone 20mg/day), vitamin C (3g/day), Zinc, diuretics and Enoxaparine were equally used for the two patients. Evolution was marked by a good outcome in both of them. In summary, acute respiratory failure is a rare but major complication of COVID-19 virus infection. It is due to pulmonary capillary leak syndrome. Treatment is based on a good oxygenation, intravenous corticosteroids, diuretics, Azithromycine, vitamin C, and other symptomatic treatments. This article is protected by copyright. All rights reserved.

The primary objective is to determine the efficacy of a single dose of ivermectin, administered to low risk, non-severe COVID-19 patients in the first 48 hours after symptom onset to reduce the proportion of patients with detectable SARS-CoV-2 RNA by Polymerase Chain Reaction (PCR) test from nasopharyngeal swab at day 7 post-treatment. The secondary objectives are: 1.To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab at day 7 post treatment.2.To assess the efficacy of ivermectin to improve symptom progression in treated patients.3.To assess the proportion of seroconversions in treated patients at day 21.4.To assess the safety of ivermectin at the proposed dose.5.To determine the magnitude of immune response against SARS-CoV-2.6.To assess the early kinetics of immunity against SARS-CoV-2.