Failure to act early and adhere to social distancing measures shown to have major effect on number o

Embargoed for release until 5:00 p.m. ET on Monday 26 October 2020
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. Failure to act early and adhere to social distancing measures shown to have major effect on number of COVID-19 cases

Abstract (free to the public):
https://www.acpjournals.org/doi/10.7326/M20-4096

Editorial (free to the public):
https://www.acpjournals.org/doi/10.7326/M20-6934

URL goes live when the embargo lifts

An agent-based computer model shows that delayed implementation of, low adherence to, and premature easing of social distancing measures generally resulted in increased cases of COVID-19 in urban areas of the United States. These findings highlight the importance of enacting region-specific guidelines for social distancing and show the value of using the COVID-specific model to guide policy. The findings are published in Annals of Internal Medicine.

Researchers from the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital developed an agent-based model to determine the effect of social distancing measures on patients of varying ages in three unique regions - Dane County, Wisconsin; the Milwaukee metropolitan (metro) area; and New York City (NYC). The model, the COVID-19 Agent-based simulation Model (COVAM), measured the effect of different times for implementing and easing social distancing measures at different levels of adherence. The model showed that that the timing of implementation of social distancing and adherence had a large effect on the number of cases that varied widely by region. For example, had social distancing measures were initiated in NYC one week earlier than the actual date, infections could have been reduced by 80 percent by May 31 whereas a 1 week delay in initiating the measures would have led to a 5-fold increase in the number of infections in the same time frame. The effect in NYC was large compared with Dane County and the Milwaukee metro area. In addition, the data showed that maintaining other personal behaviors that reduce the risk of transmission such as face mask use after easing social distancing measures had a major effect on the number of cases.

According to the researchers, the regional variations in cases, even within the same state, show the importance of considering implementation of reopening policies at the regional level. They also suggest that even when social distancing mandates are eased, communities should maintain behaviors that reduce transmission, such as continuing to wear masks.

Media contacts:

For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

The corresponding author, Oguzhan Alagoz, PhD, can be reached directly at alagoz@engr.wisc.edu.

The corresponding author of the accompanying editorial, Jeffrey Koplan, MD, MPH, can be reached directly at jkoplan@emory.edu.

2. Case suggests that nivolumab may be an effective treatment for refractory Burkitt lymphoma

Abstract:
https://www.acpjournals.org/doi/10.7326/L20-1090

URL goes live when the embargo lifts

Checkpoint inhibitor nivolumab may be an effective treatment for refractory Burkitt lymphoma, a rare and aggressive form of cancer. This is an important development for patients whose cancer cells remain resistant to usual treatment with high-dose chemotherapy. A case report is published in Annals of Internal Medicine.

Checkpoint inhibitors have been proven effective and are approved for treating Hodgkin lymphoma and primary mediastinal B-cell lymphoma. However, they have shown limited efficacy in common non-Hodgkin lymphoma subtypes and use in patients with Burkitt lymphoma has not been previously reported.

Researchers from the University of California, Los Angeles report the case of a patient with successful treatment of refractory Burkitt lymphoma using nivolumab. They started the patient on the prevailing standard-of-care chemotherapy to initial good results. However, a few days before cycle 2 of his chemotherapy, the patient's peripheral marker of cancer (LDH) started trending upward, likely indicating rapidly progressive disease. After repeating the course another time with the same results, the physicians discussed the options with the patient: more chemotherapy; the possibility of hospice; and the option of changing treatment to nivolumab. They made the shared decision to proceed with nivolumab, 480 mg every 4 weeks with additional standard medications. After initiation of nivolumab, the patient's LDH level decreased substantially to within the normal range, where it remained during the past 5 months. Six months after initial diagnosis, the patient had no symptoms, LDH remained undetectable, and his scans showed no evidence of disease after 4 months of nivolumab treatment. Based on their experience with this patient, the researchers encourage clinical trials to establish the role of checkpoint inhibitors for treating Burkitt lymphoma, especially in patients who are refractory to current chemotherapy regimens.

Media contacts:

For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.

To reach the corresponding author, B. Scott Colton, MD, please contact him directly at bscolton@mednet.ucla.edu.

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