The National University of Singapore serves the island nation as a tertiary hospital, clinical training center, and research center for medical and dental faculties. With 1,160 beds serving more than 670,000 outpatients and 49,000 inpatients, NUS is ranked first in Singapore & Asia Pacific and 11th in the world, according to the 2019 QA World University Rankings. This prestigious research organization initiated a large randomized Phase III open-label prophylaxis trial among migrant workers at high-risk of COVID-19; this study is known as the DORM Trial. Among the prophylaxis under investigation, hydroxychloroquine and Ivermectin are included. The study is led by Senior Consultant, Division of Neurology, Department of Medicine at NUS, Associate professor Seet Chee Seong Raymond.
The COVID-19 Devastation
A crushing disease when in escalation, COVID-19 causes a lower respiratory tract infection dominated by symptoms of fever, cough, and sore throat. The incubation period was estimated at between 5 to 7 days, but could last as long as 14 days. Most COVID-19 cases are mild; respiratory involvement has been reported in about 5% of the population, requiring supplementary oxygen and even ventilatory support to relieve hypoxia. Alveolar damage, fibrosis, and consolidation have been reported in radiologic and post-mortem studies. According to NUS, the COVID-19 death rate is approximately 1-2%, but this rate is higher among people with comorbidities as well as those in healthcare systems with lack of sufficient ventilatory support.
As the COVID-19 cases grow, an actual count of infected is not known. Disturbingly, patients are known to shed viruses despite mild or no symptoms, making it essential that a collective approach against COVID-19 incorporates active pharmacological treatment to prevent or mitigate virus parthenogenesis before possible disease evolution and, hence, causing respiratory distress. Most studies to date have focused on treatment of hospitalized patients while less have centered on the clinical benefits of pharmacological agents despite few compelling in vitro data publications.
The Singapore Social Lab
Migrant workers in Singapore working in closed dormitory environments experience relatively high COVID-19 transmission rates. With a growing concern that an excess of cases can overly burden the healthcare system, the availability of an effective prophylaxis treatment could reduce this burden.
This study team targets 5,000 participants in this five arm study, including (A) Hydroxychloroquine [400mg loading dose followed by 200mg daily 42 days], (B) Ivermectin [12 mg single dose], (C) Zinc [Zinc tablet 80 mg/Vitamin C 500 mg daily for 42 days], (D) Povidone-iodine [Povidone-iodine throat spray] and (E) an active comparator of Vitamin C [Vitamin C 500mg daily for 42 days].
The study started in May and runs through July 2020. The Primary end point includes an evaluation of the incidence of acute respiratory illness in treatment arms at the end of day 42. The actual research site is located at the Tuas South Dormitory, while the entire study is sponsored by NUS.
Raymond Chee Seong Seet, MBBS, MMED
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