coronavirus

A literature-review-based summary of the frequency and duration of post-acute COVID-19 signs and symptoms. The results are biased toward patients with severe disease initially. James W. Mold, MD, MPH

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The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection
but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021,
found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC)
affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and
complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified
over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents.
Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed
to better understand and mitigate the long-term effects of PASC on individual and population health.
(J Am Coll Cardiol Basic Trans Science 2021;-:-–-) © 2021 The Authors. Published by Elsevier on behalf of the American
College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license

Author/s:

Jiang, D. H., Roy, D. J., Gu, B. J., Hassett, L. C., McCoy, R. G.

A retrospective cohort study of 12,306 pediatric COVID‑19 patients in the United States

Devin Evans — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Scientific Reports

Publication Date:

May 13, 2021

Issue:

Volume:

URL:

A retrospective cohort study of 12,306 pediatric COVID‑19 patients in the United States

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1038/s41598-021-89553-1

Keywords

2019 novel coronavirus

coronavirus

PMID (1):

33986390

MeSH

child

2-toluenesulfonamide

delivery of health care

Critical Care

COVID-19

A retrospective analysis of the symptoms and clinical course of over 12,000 children with COVID-19. James W. Mold, Md, MPH

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Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49-2.61]) and Hispanic children (RR 1.31 [95% CI 1.03-1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.

Author/s:

Parcha, V., Booker, K.S., Kalra, R., Kuranz, S., Berra, L., Arora, G., Arora, P.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine

Devin Evans — Wed, 27 Jan 2021 06:00:00 +0000

Date Added:

January 27, 2021

Journal/Publication:

The Journal of the American Medical Association

Publication Date:

January 21, 2021

URL:

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2021.0600

Keywords

Pfizer–BioNTech mRNA vaccine

Anaphylaxis

Allergic reactions

PMID (1):

33475702

MeSH

A review of cases of severe allergic reactions to the SARS-2 vaccines. The reported rate is around 11 cases per million doses. There have been no deaths reported so far. James W. Mold, MD, MPH.

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On December 11, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine, administered as 2 doses separated by 21 days.1 Shortly after, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for its use.2 Following implementation of vaccination, reports of anaphylaxis after the first dose of the Pfizer-BioNTech COVID-19 vaccine emerged.3 Anaphylaxis is a life-threatening allergic reaction that occurs rarely after vaccination, with onset typically within minutes to hours.4

Notifications and reports of suspected severe allergic reactions and anaphylaxis following vaccination were captured in the Vaccine Adverse Event Reporting System (VAERS), the national passive surveillance (spontaneous reporting) system for adverse events after immunization.5 Physicians at the US Centers for Disease Control and Prevention (CDC) evaluated these reports and applied Brighton Collaboration case definition criteria6 to classify case reports as anaphylaxis or not anaphylaxis. Nonallergic adverse events, mostly vasovagal or anxiety-related, were excluded from the analysis. Anaphylaxis and nonanaphylaxis allergic reaction cases with symptom onset occurring later than the day after vaccination were also excluded because of the difficulty in clearly attributing allergic reactions with delayed onset after vaccination. Because the Moderna COVID-19 vaccine was only available beginning December 21, 2020, this article focuses on the Pfizer-BioNTech COVID-19 vaccine.

During December 14 to 23, 2020, after administration of a reported 1 893 360 first doses of Pfizer-BioNTech COVID-19 vaccine (1 177 527 in women, 648 327 in men, and 67 506 with sex of recipient not reported),3 CDC identified 21 case reports submitted to VAERS that met Brighton Collaboration case definition criteria for anaphylaxis (Table), corresponding to an estimated rate of 11.1 cases per million doses administered. Four patients (19%) were hospitalized (including 3 in intensive care), and 17 (81%) were treated in an emergency department; 20 (95%) are known to have been discharged home or had recovered at the time of the report to VAERS. No deaths from anaphylaxis were reported.

Author/s:

Shimabukuro, T., Nair, N.

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

CDC

Publication Date:

December 18, 2020

Issue:

Volume:

Pages:

1922-1924

URL:

The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine — United States, December 2020

Type:

Public Health Announcements

Format:

Article

DOI (1):

10.15585/mmwr.mm6950e2

Keywords

immunizations

Pfizer–BioNTech mRNA vaccine

PMID (1):

33332292

MeSH

Summary and conclusions of the ACIP regarding the Pfizer COVID-19 vaccine based upon the RCT data available from Pfizer. James W. Mold, MD, MPH

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On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine (Pfizer, Inc; Philadelphia, Pennsylvania), a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 doses (30 μg, 0.3 mL each) administered intramuscularly, 3 weeks apart. On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation* for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19. To guide its deliberations regarding the vaccine, ACIP employed the Evidence to Recommendation (EtR) Framework,† using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.§ The recommendation for the Pfizer-BioNTech COVID-19 vaccine should be implemented in conjunction with ACIP's interim recommendation for allocating initial supplies of COVID-19 vaccines (2). The ACIP recommendation for the use of the Pfizer-BioNTech COVID-19 vaccine under EUA is interim and will be updated as additional information becomes available.

Author/s:

Oliver, Sara E., Gargano, Julia W., Marin, Mona, Wallace, Megan, Curran, Kathryn G., Chamberland, Mary, McClung, Nancy, Campos-Outcalt, Doug, Morgan, Rebecca L., Mbaeyi, Sarah, Romero, Jose R., Talbot, H.K., Lee, Grace M., Bell, Beth P., Dooling, Kathleen

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

Lancet Child Adolescent Health

Publication Date:

September 18, 2020

Issue:

Volume:

Pages:

133-141

URL:

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S2352-4642(20)30304-7

Keywords

PMID (1):

32956615

MeSH

pediatric multisystem inflammatory disease, COVID-19 related

COVID-19

child

Consensus recommendations for management of children with multi-system inflammatory syndrome following COVID-19. (The best we are likely to do because of difficulties conducting RCTs with children and small numbers of cases.) James W. Mold, MD, MPH

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Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.

Author/s:

Harwood, Rachel, Allin, Benjamin, Jones, Christine E., Whittaker, Elizabeth, Ramnarayan, Padmanabhan, Ramanan, Athimalaipet V., Kaleem, Musa, Tulloh, Robert, Peters, Mark J., Almond, Sarah, Davis, Peter J., Levin, Michael, Tometzki, Andrew, Faust, Saul N., Knight, Marian, Kenny, Simon

Discriminating Multisystem Inflammatory Syndrome in Children Requiring Treatment from Common Febrile Conditions in Outpatient Settings

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

The Journal of Pediatrics

Publication Date:

October 13, 2020

Volume:

229

Pages:

26-32

URL:

Discriminating Multisystem Inflammatory Syndrome in Children Requiring Treatment from Common Febrile Conditions in Outpatient Settings

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2020.10.013

Keywords

kawasaki disease

SARS-CoV-2

multisystem inflammatory syndrome in children

myocarditis

COVID-19

coronavirus

PMID (1):

33065115

MeSH

pediatric multisystem inflammatory disease, COVID-19 related

SARS-CoV-2

child

C-Reactive Protein

Guidance regarding how to distinguish post-COVID multi-system inflammatory syndrome from other febrile illnesses in children. James W. Mold, MD, MPH

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Objectives: To examine whether patients with multisystem inflammatory syndrome in children (MIS-C) demonstrated well-defined clinical features distinct from other febrile outpatients, given the difficulties of seeing acute care visits during the severe acute respiratory syndrome coronavirus 2 pandemic and the risks associated with both over- and underdiagnosis of MIS-C.

Study design: This case-controlled study compared patients diagnosed with and treated for MIS-C at a large urban children's hospital with patients evaluated for fever at outpatient acute care visits during the peak period of MIS-C. Symptomatology and available objective data were extracted. Comparisons were performed using t tests with corrections for multiple comparisons, and multivariable logistic regression to obtain ORs.

Results: We identified 44 patients with MIS-C between April 16 and June 10, 2020. During the same period, 181 pediatric patients were evaluated for febrile illnesses in participating outpatient clinics. Patients with MIS-C reported greater median maximum reported temperature height (40°C vs 38.9, P < .0001), and increased frequency of abdominal pain (OR 12.5, 95% CI [1.65-33.24]), neck pain (536.5, [2.23-129,029]), conjunctivitis (31.3, [4.6-212.8]), oral mucosal irritation (11.8, [1.4-99.4]), extremity swelling or rash (99.9, [5-1960]), and generalized rash (7.42, [1.6-33.2]). Patients with MIS-C demonstrated lower absolute lymphocyte (P < .0001) and platelet counts (P < .05) and greater C-reactive protein concentrations (P < .001).

Conclusions: Patients treated for MIS-C due to concern for potential cardiac injury show combinations of features distinct from other febrile patients seen in outpatient clinics during the same period.

Author/s:

Carlin, Rebecca F., Fischer, Avital M., Pitlowsky, Zachary, Abel, Dori, Sewell, Taylor B., Landau, Erika G., Caddle, Steve, Robbins-Milne, Laura, Boneparth, Alexis, Milner, Josh D., Cheung, Eva W., Zachariah, Philp, Stockwell, Mellissa S., Anderson, Brett R., Gorelik, Mark

Masks and Face Coverings for the Lay Public : A Narrative Update

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

Annals of Internal Medicine

Publication Date:

December 29, 2020

URL:

Masks and Face Coverings for the Lay Public : A Narrative Update

Type:

Meta-analyses, Reviews, and Guidelines, Patient Education Materials

Format:

Article

DOI (1):

10.7326/M20-6625

Keywords

PMID (1):

33370173

MeSH

Policy

Respiratory Physiological Phenomena

A narrative summary of our current understandings regarding mask wearing and prevention of the spread of COVID-19. James W. Mold, MD, MPH

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Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airborne indicates that infection control interventions must go beyond contact and droplet measures (such as handwashing and cleaning surfaces) and attend to masking and ventilation. Observational evidence suggests that masks work mainly by source control (preventing infected persons from transmitting the virus to others), but laboratory studies of mask filtration properties suggest that they could also provide some protection to wearers (protective effect). Even small reductions in individual transmission could lead to substantial reductions in population spread. To date, only 1 randomized controlled trial has examined a community mask recommendation. This trial did not identify a significant protective effect and was not designed to evaluate source control. Filtration properties and comfort vary widely across mask types. Masks may cause discomfort and communication difficulties. However, there is no evidence that masks result in significant physiologic decompensation or that risk compensation and fomite transmission are associated with mask wearing. The psychological effects of masks are culturally shaped; they may include threats to autonomy, social relatedness, and competence. Evidence suggests that the potential benefits of wearing masks likely outweigh the potential harms when SARS-CoV-2 is spreading in a community. However, mask mandates involve a tradeoff with personal freedom, so such policies should be pursued only if the threat is substantial and mitigation of spread cannot be achieved through other means.

Author/s:

Czypionka, Thomas, Greenhalgh, Trisha, Bassler, Dirk, Bryant, Manuel B.

REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

The New England Journal of Medicine

Publication Date:

December 17, 2020

URL:

REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMoa2035002

Keywords

PMID (1):

33332778

MeSH

A review of what is currently known about the monoclonal antibody cocktail for outpatient treatment of COVID-19. James W. Mold, MD, MPH

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Background: Recent data suggest that complications and death from coronavirus disease 2019 (Covid-19) may be related to high viral loads.

Methods: In this ongoing, double-blind, phase 1-3 trial involving nonhospitalized patients with Covid-19, we investigated two fully human, neutralizing monoclonal antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, used in a combined cocktail (REGN-COV2) to reduce the risk of the emergence of treatment-resistant mutant virus. Patients were randomly assigned (1:1:1) to receive placebo, 2.4 g of REGN-COV2, or 8.0 g of REGN-COV2 and were prospectively characterized at baseline for endogenous immune response against SARS-CoV-2 (serum antibody-positive or serum antibody-negative). Key end points included the time-weighted average change from baseline in viral load from day 1 through day 7 and the percentage of patients with at least one Covid-19-related medically attended visit through day 29. Safety was assessed in all patients.

Results: Data from 275 patients are reported. The least-squares mean difference (combined REGN-COV2 dose groups vs. placebo group) in the time-weighted average change in viral load from day 1 through day 7 was -0.56 log10 copies per milliliter (95% confidence interval [CI], -1.02 to -0.11) among patients who were serum antibody-negative at baseline and -0.41 log10 copies per milliliter (95% CI, -0.71 to -0.10) in the overall trial population. In the overall trial population, 6% of the patients in the placebo group and 3% of the patients in the combined REGN-COV2 dose groups reported at least one medically attended visit; among patients who were serum antibody-negative at baseline, the corresponding percentages were 15% and 6% (difference, -9 percentage points; 95% CI, -29 to 11). The percentages of patients with hypersensitivity reactions, infusion-related reactions, and other adverse events were similar in the combined REGN-COV2 dose groups and the placebo group.

Conclusions: In this interim analysis, the REGN-COV2 antibody cocktail reduced viral load, with a greater effect in patients whose immune response had not yet been initiated or who had a high viral load at baseline. Safety outcomes were similar in the combined REGN-COV2 dose groups and the placebo group.

Author/s:

Weinreich, David M., Sivapalasingam, Sumathi, Norton, THomas,, Ali, Shazia, Gao, Haitao, Bhore, Rafia, Musser, Bret J., Soo, Yuhwen, Rofail, Diana, Im, Joseph, Perry, Christina, Pan, Cynthia, Hosain, Romana, Mahmood, Adnan, Davis, John D., Turner, Kenneth C., Hooper, Andrea T., Hamilton, Jennifer D., Baum, Alina, Kyratsous, Christos A., Kim, Yunji, Cook, Amanda, Kampman, Wendy, Kohli, Anita, Sachdeva. Yessica, Graber, Ximena, Kowal, Bari, DiCioccio, Thomas, Stahl, Neil, Lipsich, Leah, Braunstein, Ned, Herman, Gary, Yancopoulos, George D.

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Devin Evans — Mon, 21 Dec 2020 06:00:00 +0000

Date Added:

December 21, 2020

Journal/Publication:

Journal of the American Medical Association Dermatology

Publication Date:

December 9, 2020

URL:

Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamadermatol.2020.4779

Keywords

COVID-19

coronavirus

children

Multisystem Inflammatory Syndrome

PMID (1):

33295957

MeSH

A summary of mucocutaneous manifestations of post-COVID MIS-C in children hospitalized in the U.S. James W. Mold, MD, MPH

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Importance: To date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms.

Objective: To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020.

Design, setting, and participants: A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C.

Main outcomes and measures: Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists.

Results: Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity.

Conclusions and relevance: In this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.

Author/s:

Young, Trevor K., Shaw, Katharina S., Shah, Jinal K., Noor, Asif, Alperin, Risa A., Ratner, Adam J., Orlow, Seth J., Betensky, Rebecca A., Shust, Gail F., Kahn, Philip J., Oza, Vikash S.

Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19

Devin Evans — Mon, 21 Dec 2020 06:00:00 +0000

Date Added:

December 21, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

December 8, 2020

URL:

Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M20-3337

Keywords

COVID-19

coronavirus

SARS coronavirus

Polymerase chain reaction

PCR

PMID (1):

33284684

MeSH

Reverse Transcriptase Polymerase Chain Reaction

COVID-19

Coronavirus

Critical Illness

The figures in this article show the course of PCR positivity and appearance of antibodies during the course of confirmed COVID-10 cases. The information should be helpful when deciding when to order those tests and how to interpret the results. James W. Mold, MD, MPH

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Background: The understanding of viral positivity and seroconversion during the course of coronavirus disease 2019 (COVID-19) is limited.

Objective: To describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity.

Design: Retrospective cohort study.

Setting: 3 designated specialty care centers for COVID-19 in Wuhan, China.

Participants: 3192 adult patients with COVID-19.

Measurements: Demographic, clinical, and laboratory data.

Results: Among 12 780 reverse transcriptase PCR tests for severe acute respiratory syndrome coronavirus 2 that were done, 24.0% had positive results. In 2142 patients with laboratory-confirmed COVID-19, the viral positivity rate peaked within the first 3 days. The median duration of viral positivity was 24.0 days (95% CI, 18.9 to 29.1 days) in critically ill patients and 18.0 days (CI, 16.8 to 19.1 days) in noncritically ill patients. Being critically ill was an independent risk factor for longer viral positivity (hazard ratio, 0.700 [CI, 0.595 to 0.824]; P < 0.001). In patients with laboratory-confirmed COVID-19, the IgM-positive rate was 19.3% in the first week, peaked in the fifth week (81.5%), and then decreased steadily to around 55% within 9 to 10 weeks. The IgG-positive rate was 44.6% in the first week, reached 93.3% in the fourth week, and then remained high. Similar antibody responses were seen in clinically diagnosed cases. Serum inflammatory markers remained higher in critically ill patients. Among noncritically ill patients, a higher proportion of those with persistent viral positivity had low IgM titers (<100 AU/mL) during the entire course compared with those with short viral positivity.

Limitation: Retrospective study and irregular viral and serology testing.

Conclusion: The rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within 4 to 5 weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity. Low IgM titers (<100 AU/mL) are an independent risk factor for persistent viral positivity.

Author/s:

Fu, Yu, Li, Yongsheng, Guo, Ensong, He, Liang, Liu, Jia, Yang, Bin, Li, Fuxia, Wang, Zizhuo, Li, Yuan, Xiao, Rourou, Liu, Chen, Huang, Yuhan, Wu, Xue, Lu, Funian, You, Lixin, Qin, Tianyu, Wang, Chaolong, Li, Kezhen, Wu, Peng, Ma, Ding, Sun, Chaoyang, Chen, Gang

Coronavirus Disease 2019 (COVID-19): People with Certain Medical Conditions

Devin Evans — Wed, 04 Nov 2020 06:00:00 +0000

Date Added:

November 4, 2020

Publisher:

CDC

Publication Date:

November 2, 2020

URL:

Coronavirus Disease 2019 (COVID-19): People with Certain Medical Conditions

Type:

Patient Education Materials

Format:

Article

Keywords

COVID-19

coronavirus

underlying medical conditions

MeSH

severe acute respiratory syndrome coronavirus 2

masks

A summary for patients of conditions that could put them at increased risk for severe COVID-19 infection and measures they can do to reduce their risk. James W. Mold, MD, MPH

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Revisions were made on November 2, 2020 to reflect recent data supporting increased risk of severe illness during pregnancy from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

We are learning more about COVID-19 every day. The below list of underlying medical conditions is not exhaustive and only includes conditions with sufficient evidence to draw conclusions; it is a living document that may be updated at any time, subject to potentially rapid change as the science evolves. This list is meant to inform clinicians to help them provide the best care possible for patients, and to inform individuals as to what their level of risk may be so they can make individual decisions about illness prevention. Notably, the list may not include every condition that might increase one’s risk for developing severe illness from COVID-19, such as those for which evidence may be limited or nonexistent (e.g., rare conditions). Individuals with any underlying condition (including those conditions that are NOT on the current list) should consult with their healthcare providers about personal risk factors and circumstances to determine whether extra precautions are warranted.

Author/s:

Centers for Disease Control and Prevention (CDC)

Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial)

Devin Evans — Wed, 28 Oct 2020 05:00:00 +0000

Date Added:

October 28, 2020

Journal/Publication:

British Medical Journal

Publication Date:

October 22, 2020

Issue:

371

URL:

Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial)

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1136/bmj.m3939

Keywords

PMID (1):

33093056

MeSH

Based upon this RCT, once a COVID-19 patient is hospitalized, treatment with convalescent plasma apparently has little effect on outcomes. James W. Mold, MD, MPH

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Abstract

Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronavirus disease 2019 (covid-19) in adults in India.

Design Open label, parallel arm, phase II, multicentre, randomised controlled trial.

Setting 39 public and private hospitals across India.

Participants 464 adults (≥18 years) admitted to hospital (screened 22 April to 14 July 2020) with confirmed moderate covid-19 (partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio between 200 mm Hg and 300 mm Hg or a respiratory rate of more than 24/min with oxygen saturation 93% or less on room air): 235 were assigned to convalescent plasma with best standard of care (intervention arm) and 229 to best standard of care only (control arm).

Interventions Participants in the intervention arm received two doses of 200 mL convalescent plasma, transfused 24 hours apart. The presence and levels of neutralising antibodies were not measured a priori; stored samples were assayed at the end of the study.

Main outcome measure Composite of progression to severe disease (PaO2/FiO2 <100 mm Hg) or all cause mortality at 28 days post-enrolment.

Results Progression to severe disease or all cause mortality at 28 days after enrolment occurred in 44 (19%) participants in the intervention arm and 41 (18%) in the control arm (risk difference 0.008 (95% confidence interval −0.062 to 0.078); risk ratio 1.04, 95% confidence interval 0.71 to 1.54).

Conclusion Convalescent plasma was not associated with a reduction in progression to severe covid-19 or all cause mortality. This trial has high generalisability and approximates convalescent plasma use in real life settings with limited laboratory capacity. A priori measurement of neutralising antibody titres in donors and participants might further clarify the role of convalescent plasma in the management of covid-19.

Trial registration Clinical Trial Registry of India CTRI/2020/04/024775.

Author/s:

Agarwal, Anup, Mukherjee, Aparna, Kumar, Gunjan, Chatterjee, Pranab, Bharnagar, Tarun, Malhotra, Pankaj

Dog Bites in Children Surge during COVID-19: A Case for Enhanced Prevention

Brian Desmarais — Mon, 29 Jun 2020 16:26:15 +0000

Date Added:

June 29, 2020

Journal/Publication:

Journal of Pediatrics

Publication Date:

June 25, 2020

URL:

Dog Bites in Children Surge during COVID-19: A Case for Enhanced Prevention

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2020.06.071

Keywords

At first, this study may not seem relevant, but take a look anyway. You recommend safe storage of poisons and keeping a supply of ipecac, right? Here’s another chance to practice prevention.

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Author/s:

Dixon, C.A., Mistry, R.D.