Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

JAMA

Shen, Chenguang; Wang, Zhaoqin; Zhao, Fang; Yang, Yang; Li, Jinxiu; Yuan, Jing; Wang, Fuxiang; Li, Delin; Yang, Minghui; Xing, Li; Wei, Jinli; Xiao, Haixia; Yang, Yan; Qu, Jiuxin; Qing, Ling; Chen, Li; Xu, Zhixiang; Peng, Ling; Li, Yanjie; Zheng, Haixia; Chen, Feng; Huang, Kun; Jiang, Yujing; Liu, Dongjing; Zhang, Zheng; Liu, Yingxia; Liu, Lei

Introduction

Importance  Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

Objective  To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design, Setting, and Participants  Case series of 5 critically ill patients with laboratory-confirmed COVID-19 and acute respiratory distress syndrome (ARDS) who met the following criteria: severe pneumonia with rapid progression and continuously high viral load despite antiviral treatment; Pao2/Fio2 <300; and mechanical ventilation. All 5 were treated with convalescent plasma transfusion. The study was conducted at the infectious disease department, Shenzhen Third People's Hospital in Shenzhen, China, from January 20, 2020, to March 25, 2020; final date of follow-up was March 25, 2020. Clinical outcomes were compared before and after convalescent plasma transfusion.

Exposures  Patients received transfusion with convalescent plasma with a SARS-CoV-2–specific antibody (IgG) binding titer greater than 1:1000 (end point dilution titer, by enzyme-linked immunosorbent assay [ELISA]) and a neutralization titer greater than 40 (end point dilution titer) that had been obtained from 5 patients who recovered from COVID-19. Convalescent plasma was administered between 10 and 22 days after admission.

Main Outcomes and Measures  Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), Pao2/Fio2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion.

Results  All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and Pao2/Fio2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

Conclusions and Relevance  In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Convalescent Plasma to Treat COVID-19: Possibilities and Challenges

JAMA

Roback, John D.; Guarner, Jeannette

Introduction

In this issue of JAMA, Shen et al report findings from a preliminary study of 5 severely ill patients with coronavirus disease 2019 (COVID-19) who were treated in the Shenzhen Third People's Hospital, China, using plasma from recovered individuals.1 All patients had severe respiratory failure and were receiving mechanical ventilation; 1 needed extracorporeal membrane oxygenation (ECMO) and 2 had bacterial and/or fungal pneumonia. Four patients without coexisting diseases received convalescent plasma around hospital day 20, and a patient with hypertension and mitral valve insufficiency received the plasma transfusion at day 10. The donor plasma had demonstrable IgG and IgM anti–SARS-CoV-19 antibodies and neutralized the virus in vitro cultures. Although these patients continued to receive antiviral treatment primarily with lopinavir/ritonavir and interferon, the use of convalescent plasma may have contributed to their recovery because the clinical status of all patients had improvement approximately 1 week after transfusion, as evidenced by normalization of body temperature as well as improvements in Sequential Organ Failure Assessment scores and Pao2/Fio2 ratio. In addition, the patients’ neutralizing antibody titers increased and respiratory samples tested negative for SARS-CoV-2 between 1 and 12 days after transfusion.

Keywords

Clinical aspects, diagnosis, treatment

Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality

JAMA Cardiology

Bonow, Robert O.; Fonarow, Gregg C.; O'Gara, Patrick T.; Yancy, Clyde W.

Introduction

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and a public health crisis of global proportions. As a medical community, we are actively engaged in a real-time data gathering mode to facilitate active learning and an expedited study of best practices of care. Although we are becoming more aware of the natural history of COVID-19, we have had scant information as of yet that addresses any unique risks of COVID-19 for those with underlying cardiovascular disease. Such information is of paramount importance as we now must begin to consider the potential for direct and indirect adverse effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the heart and especially so in those with already established heart disease.

Keywords

Clinical aspects, diagnosis, treatment

Prevent loss of life by providing all NHS staff with WHO standard personal protective equipment

The European respiratory journal

Hero, Isabelle.

Introduction

As a retired consultant histopathologist with 40 years’ experience of working in the NHS, I am appalled that NHS staff are not being provided with adequate personal protective equipment (PPE). PPE that meets the standard set out by the World Health Organization is still today, 27 March 2020, not reaching many wards and clinics.1 2 All NHS staff need to be protected. All hospital departments, general practices, ambulances, and care homes need adequate PPE. We must prevent what happened in Italy.3-5 In the UK, six doctors and nurses are already fighting for their lives on ventilators, and one surgeon and a GP have already died from covid-19.6-10 And the battle has only just started. Please prevent the loss of numerous precious NHS staff through lack of PPE of WHO standard.

Keywords

Epidemiology

The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)

JAMA

Curtis, J. Randall; Kross, Erin K.; Stapleton, Renee D.

Introduction

The novel coronavirus disease 2019 (COVID-19) pandemic is challenging health care systems worldwide and raising important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. Even if capacity to provide care is sufficient, one priority should be addressing goals of care in the setting of acute life-threatening illness, especially for patients with chronic, life-limiting disease.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

COVID-19: “A Tale of Two Epidemics” March 20, 2020

Disaster Medicine and Public Health Preparedness

James, James J.

Introduction

We are all too aware of the first epidemic - over 120,000 cases reported from well over a 100 countries with some 4,500 deaths and another 6,000+ severe or critical cases. Large outbreaks have occurred, and local medical facilities overwhelmed with many hospitals literally turned into war zones with medical personnel surrounded by suffering and death and having little at their disposal to combat the microscopic foe. From the perspective of the individual healthcare worker, trained in the ethos of individual care, this is a real and harrowing experience; for those not yet infected such images, well publicized in traditional and social media, naturally lead to feelings of concern and vulnerability. With widespread concern and alarm governments activate measures in an attempt to contain the epidemic. Such measures include quarantines, isolation, and travel restrictions in an effort to prevent introduction of the causative agent and/or its spread.

Keywords

Epidemiology

Simulation As A Tool For Assessing And Evolving Your Current Personal Protective Equipment: Lessons Learned During The Coronavirus Disease (COVID-19) Pandemic

Canadian Journal of Anaesthesia

Lockhart, Shannon L.; Naidu, Justen J.; Badh, Charanjit S.; Duggan, Laura V.

To the Editor

We believe that protection of the well-being of healthcare providers while maintaining a workforce sufficient to respond to the coronavirus disease (COVID19) are fundamental to pandemic planning. In this letter, we describe how our hospital used low-fidelity airway simulation to assess and evolve the personal protective equipment (PPE) used for airway management of patients with COVID-19.

Keywords

Clinical aspects, diagnosis, treatment

Heart Failure Collaboratory Statement on Clinical Trials in the Landscape of COVID-19

JACC: Heart Failure

Abraham, William T.; Fiuzat, Mona; Psotka, Mitchell A.; O’Connor, Christopher M.

Introduction

Heart Failure Collaboratory Statement on Clinical Trials in the Landscape of COVID-19 The COVID-19 pandemic has disrupted health care delivery systems around the world, with a significant impact on clinical trials for current and future study participants, sponsors, investigators, coordinators, and regulators. Thoughtful consideration on how to manage clinical trials during the COVID-19 pandemic is of particular relevance to the heart failure (HF) ecosystem, as HF patients represent a vulnerable population at high risk for COVID-19 related morbidity and mortality. This ecosystem includes patients with HF, clinical trialists, investigators, research coordinators, regulatory authorities, payers, and both public and private sponsors of HF clinical trials.

Keywords

Clinical aspects, diagnosis, treatment

Medical Education And Care In Dermatology During The SARS-Cov2 Pandemia: Challenges And Chances

Journal of the European Academy of Dermatology and Venereology

Reinholz, M.; French, L. E.i

Abstract

The first novel coronavirus (SARS‐CoV‐2) cases occurred in Germany after contact with a Chinese business delegate between January 19 and 22, 2020 near the city of Munich, Bavaria. Since then numerous additional cases have been reported and the dissemination of the infection does not only pose a major health challenge for the entire population, medical care facilities and the economy, but also for the medical training of future doctors and outpatient care of patients with skin disease.

Keywords

Dermatology, viral infections, medical education, patient care, teaching, SARS-CoV2

virus

Does hand hygiene reduce SARS-CoV-2 transmission?

Graefe's Archive for Clinical and Experimental Ophthalmology

Yang, Chao.

Letter To The Editor

Tracy share their experience of stepping up infection control measures in ophthalmology to minimize COVID19 infection of both healthcare workers and patients, and emphasize universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE). However, whether hand hygiene is “particularly important” for SARS-CoV-2 infection control needs further study, as there is no convincing evidence that this prevention tool is effective in the SARS-CoV-2 epidemic…

Keywords

Infection prevention and control

What Dermatologists Could Do To Cope With The Novel Coronavirus (SARS-Cov-2): A Dermatologist's Perspective From China

Journal of the European Academy of Dermatology and Venereology: JEADV

Zhang, Hanlin; Tang, Keyun; Fang, Rouyu; Sun, Qiuning

Abstract

Coronavirus disease, first emerged in Wuhan, China, rapidly spread all over the country since December 2019. Up to now, the epidemic situation in China remains stable, while the global march of the virus is seemingly unstoppable, especially in South Korea, Iran, and Italy. Here, we reported what dermatologists could do to cope with novel coronavirus from a Chinese dermatologist's perspective.

Keywords

Clinical aspects, diagnosis, treatment

Influenza Immunization Among Chinese Seniors: Urgent Calling For Improving Vaccination Coverage, Education, And Research

AGING MEDICINE
Volume 3, Issue 1

Li, Xin; Leng, Sean X.

Background

It is with great pleasure that we provide this commentary with a focus on influenza vaccination for an expert consensus entitled “Recommendations for influenza and Streptococcus pneumoniae vaccination in elderly people in China” to be published in this issue of Aging Medicine. Influenza is a major global public health burden with pandemic threat. Seasonal influenza infection is responsible for 3‐5 million severe illness cases and 290 000‐650 000 respiratory deaths annually worldwide.  According to the Centers for Disease Control and Prevention (CDC), influenza affects 5%‐20% of the population each year in the United States. It is estimated that influenza causes 226 000 excess hospitalizations, 25 000‐69 000 deaths, and US $87 billion excess health‐care cost with over 600 000 life‐years lost annually. Among all infectious diseases, influenza is foremost in its age‐related increase in serious complications, leading to hospitalization, catastrophic disability, and death in older adults. Moreover, influenza frequently causes exacerbation of many chronic conditions that are common in older adults, including cardiovascular diseases, further indirectly impacting senior health and mortality. In fact, over 90% of influenza‐related mortality occurs in persons aged over 65 years. In the United States, influenza and its secondary pneumonia are the fourth leading cause of death in this population. Therefore, prevention and treatment of influenza in older adults have become a major public health priority.

Keywords

COVID-19, SARS-CoV-2, Treatment

Economic and Monetary Union at twenty: a stocktaking of a tumultuous second decade: introduction

Journal of European Integration
Volume 42, 2020, Issue 3, Pages 287-293

Howarth, David; Verdun, Amy

Abstract

This contribution discusses the two main asymmetries of European Economic and Monetary Union (EMU) as they developed over the past two decades since the launch of the Single Currency. From the outset, EMU involved asymmetric degrees of integration in the area of ‘economic’ union (less centralised governance) versus ‘monetary’ union (more supranational governance). With the outbreak of the Sovereign Debt Crisis in 2010, the regime-shaping relevance of a second asymmetry emerged: one roughly between the member states of the Euro Area ‘core’ and those in the ‘periphery’. Each of the two asymmetries have created a range of challenges — institutional, policy and political — that undermine the stability and sustainability of the EMU project.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Clinical And Immunologic Features In Severe And Moderate Coronavirus Disease 2019

The Journal of Clinical Investigation

Chen, Guang; Wu, Di; Guo, Wei; Cao, Yong; Huang, Da; Wang, Hongwu; Wang, Tao; Zhang, Xiaoyun; Chen, Huilong; Yu, Haijing; Zhang, Xiaoping; Zhang, Minxia; Wu, Shiji; Song, Jianxin; Chen, Tao; Han, Meifang; Li, Shusheng; Luo, Xiaoping; Zhao, Jianping; Ning, Qin

Abstract

BACKGROUND: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunological features of severe and moderate COVID-19.
METHODS: In this retrospective study, the clinical and immunological characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the guidelines released by the National Health Commission of China.
RESULTS: The median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough, and fatigue. Compared with moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α. Absolute numbers of T lymphocytes, CD4+ T cells, and CD8+ T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5, and 89.0 × 106 /L, respectively) than moderate cases (640.5, 381.5, and 254.0 × 106 /L, respectively). The expression of IFN-γ by CD4+ T cells tended to be lower in severe cases (14.1%) than in moderate cases (22.8%).
CONCLUSION: The SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4+ and CD8+ T cells, resulting in a decrease in numbers as well as IFN-γ production by CD4+ T cells. These potential immunological markers may be of importance because of their correlation with disease severity in COVID-19.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

A Survey Of 434 Clinical Trials About Coronavirus Disease 2019 In China

Journal of Medical Virology

Leng, Zikuan; Yin, Dongfei; Zhao, Zhe; Yan, Miaoheng; Yang, Yanlei; He, Xijing; Zhao, Robert Chunhua; Liu, Hongjian

To the Editor,

As of 15 March 2020, 81 059 cases were diagnosed totally in China, including 10 817 patients receiving treatments and 3226 severe cases. Currently, there are no effective antiviral medications or vaccines available. However, many clinical trials about coronavirus disease 2019 (COVID‐19) are undergoing to find effective treatment in China, which has not been reported.

Keywords

Clinical aspects, diagnosis, treatment

Surveillance To Improve Evidence For Community Control Decisions During The COVID-19 Pandemic – Opening The Animal Epidemic Toolbox For Public Health

One Health

Foddai, Alessandro; Lindberg, Ann; Lubroth, Juan; Ellis-Iversen, Johanne

Abstract

During the first few months of 2020, the COVID-19 pandemic reached Europe and spread around the world. Health systems all over the world are trying to control the outbreak in the shortest possible time. Exotic disease outbreaks are not uncommon in animal health and randomised surveillance is frequently used as support for decision-making. This editorial discusses the possibilities of practicing One Health, by using methods from animal health to enhance surveillance for COVID-19 to provide an evidence base fort decision-making in communities and countries.

Keywords

Coronavirus, COVID-19, Disease surveillance, Pandemic, Decision-making

Radiation Therapy in King County, Washington During The COVID-19 Pandemic: Balancing Patient Care, Transmission Mitigation and Resident Training

Advances in Radiation Oncology

Dinh, Tru-Khang T.; Halasz, Lia M.; Ford, Eric; Rengan, Ramesh.

Introduction

On December 31, 2019, a cluster of cases of severe respiratory syndrome was reported in patients with connection to a seafood market in Wuhan, Hubei Province, China1. Within one week, Chinese health authorities were able to link these cases to a novel, enveloped RNA coronavirus, SARS-CoV-2, now commonly known to cause COVID-192. By February 14, 2020, over 66,000 cases of COVID-19 were reported in China3. On January 19, a 35-year-old man returning from Wuhan to his home in Snohomish County, Washington, presented to urgent care with several days of cough and fever and ultimately tested positive for COVID-19, becoming the first case in the United States. The first COVID-related death occurred 4 weeks later, associated with a separate site, along-term care facility in Kirkland, WA, which rapidly became a cluster of 30 fatal cases as of March 16th. At the writing of this article, March 17th, there are 1,012 confirmed cases in the state of Washington, with 52 deaths, primarily in King County. Evergreen Health, the major medical center in Kirkland has recently declared that they have no remaining critical care capacity.

Keywords

Clinical aspects, diagnosis, treatment

Spiritual Lessons From the Coronavirus Pandemic

Journal of Religion and Health

Hart, Curtis W.

Editor,

This Editorial is being written from my study here in the Hudson Valley in Westchester County just north of New York City. Here I am, as I imagine many of you are, getting used to the “new normal” imposed by the pandemic of the coronavirus. It is a jarring process to get used to the restraint this puts upon us: no movies, no shopping trips, and no evenings out with friends. When we look at our current situation with the perspective now of about a week we realize that these inhibitions are at least for now not insurmountable.

Keywords

Clinical aspects, diagnosis, treatment

COVID-19 and Economy

Dermatologic Therapy

Gupta, Mrinal; Abdelmaksoud, Ayman; Jafferany, Mohammad; Lotti, Torello; Sadoughifar, Roxanna; Goldust, Mohamad

Dear Editor,

Novel coronavirus (COVID-19), which originated from Wuhan, China, has spread to more than 125 countries s of the world infecting more than 100 000 population.1Apart from being a global health concern, COVID-19 is having major consequences on the world economy, and experts have predicted that COVID-19 will lower global gross domestic product growth by one-half a percentage point for 2020 (from 2.9% to 2.4%). The whole world is now a single global community, where any major happening in one part is bound to have repercussions in rest of the world.

Keywords

Ethics, social science, economics

Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS-CoV-2/COVID-19

mBio
Volume 11, 2020, Issue 2

Patel, R.; Babady, E.; Theel, E. S.; Storch, G. A.; Pinsky, B. A.; St George, K.; Smith, T. C.; Bertuzzi, S.

GUEST EDITORIAL

As we enter the second quarter of the COVID-19 pandemic, with testing for severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) increasingly available (though still limited and/or slow in some areas), we are faced with new questions and challenges regarding this novel virus. When to test? Whom to test? What to test? How often to test? And, what to do with test results? Since SARS–CoV-2 is a new virus, there is little evidence to fall back on for test utilization and diagnostic stewardship.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology