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

Covid-19: Lack of PPE in care homes is risking spread of virus, leaders warn

BMJ
Volume 368, 2020, m1280-m1280

Iacobucci, Gareth.

Introduction

A lack of access to personal protective equipment (PPE) and staff testing in care homes poses a major risk of covid-19 being spread, sector leaders have warned. Care homes have been identified as one of the biggest potential risks for virus spreading, owing to the number of elderly residents with underlying health conditions. At a health select committee hearing hosted remotely on 26 March, Sarah Pickup, the deputy chief executive of the Local Government Association, said that more equipment and testing was needed to protect both residents and workers.1 “Access to PPE is insufficient in the care sector,” she said, warning that people entering care homes on discharge from hospital could bring an infection.

Keywords

Clinical aspects, diagnosis, treatment; Ethics, social science, economics

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

Practical Considerations In The Anaesthetic Management Of Patients During A COVID-19 Epidemic

The European respiratory journal

Ong, S.; Tan, T. Khee.

Abstract

We read with interest the excellent Association guidelines for the anaesthetic management of patients during a COVID-19 outbreak. We concur with these guidelines, which are not dissimilar to our hospital's protocols since Singapore reported its first case of COVID-19 on 23 January 2020. To date, there have been 226 confirmed cases in Singapore with no deaths reported. We are preparing for many more when community transmission becomes widespread and every patient presenting for surgery becomes a potential asymptomatic infected case. We would like to highlight additional anaesthetic considerations in this COVID-19 pandemic. Our discussion is limited to patients not known to be COVID infected.

Keywords

Clinical aspects, diagnosis, treatment

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

Perioperative Presentation of COVID-19 Disease in a Liver Transplant Recipient

Hepatology (Baltimore, Md.)

Qin, Juanjuan; Wang, Haitao; Qin, Xuan; Zhang, Peng; Zhu, Lihua; Cai, Jingjing; Yuan, Yufeng; Li, Hongliang.

Abstract

Coronavirus disease 2019 (COVID-19) is highly contagious. It may rapidly progress to acute respiratory distress syndrome (ARDS) and result in multiorgan dysfunction or death in some cases.((1,2)) Here, we report the case of a patient with hepatocellular carcinoma (HCC) who underwent liver transplantation and experienced COVID-19 infection during the perioperative period. This case may help clinicians by alerting them to potential COVID-19 infection in transplant recipients during the outbreak.

Keywords

Clinical aspects, diagnosis, treatment

How emergency departments prepare for virus disease outbreaks like COVID-19

European Journal of Emergency Medicine

Möckel, Martin; Bachmann, Ulrike; Behringer, Wilhelm; Pfäfflin, Frieder; Stegemann, Miriam Songa.

Introduction

Acute outbreaks of novel virus caused diseases like coronavirus disease 2019 (COVID-19) challenge the national and international healthcare systems and specifically the emergency departments (EDs) as patients, even if they have only mild symptoms, intuitively present in the ED once they fear to have a serious disease. Therefore, EDs need to prepare fast and effectively to address the challenge of walk-in patients who might transmit the virus SARSCoV-2 without displaying severe symptoms themselves, to protect personnel and vulnerable patient groups who are typically present in the ED at any time like patients with immunosuppression, chronic disease and older age. The outbreak of COVID-19 in Wuhan, China and the transmission to Europe is a typical example with some lessons learned for the ED. This early report reflects the situation from a German perspective including the capital city of Berlin.

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

Covid-19: diabetes clinicians set up social media account to help alleviate patients’ fears

BMJ
Volume 368, March 2020, m1262-m1262

Iacobucci, Gareth.

Abstract

A group of diabetes doctors and other clinicians has set up a social media account to help alleviate patients’ fears around covid-19 and provide them with “a secure base” of information. Around one in 13 people in the UK has diabetes, roughly 90% type 2 diabetes and 10% type 1. The UK government has advised that all people with diabetes—along with other at-risk groups—should be “particularly stringent” in following social distancing measures that ministers have set out for the whole country to follow

Keywords

Epidemiology

A War on Two Fronts: Cancer Care in the Time of COVID-19

Annals of Internal Medicine

Kutikov, Alexander; Weinberg, David S.; Edelman, Martin J.; Horwitz, Eric M.; Uzzo, Robert G.; Fisher, Richard I.

Introduction

The rapidly expanding coronavirus disease 2019 (COVID-19) (SARS–CoV-2) acute respiratory pandemic has assaulted all aspects of daily life. As of 25 March 2020, there were more than 450 000 cases worldwide. In the absence of a vaccine or a therapeutic agent, a “social distancing” strategy is the primary intervention to hamper the spread of infection. A major fear of most governments and individuals is the heavy impact on the health care delivery system. Cumbersome diagnostic testing, inadequate protective supplies for frontline providers and first responders, and limited hospital capacity—including intensive care—have all conspired to create an environment compared to warfare.

Keywords

Epidemiology; Ethics, social science, economics

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

Tracking COVID-19 Responsibly

The Lancet

Muhareb, Rania; Giacaman, Rita.

Introduction

As of March 25, 2020, WHO's online coronavirus disease 2019 (COVID-19) situation dashboard reveals that the pandemic spans 195 countries and territories with 375 498 cases. With this rapid expansion of the pandemic comes a growing need to ensure that accurate and credible information is accessible to public health authorities, researchers, and the wider public. This has prompted WHO, institutions, and individuals to develop online tools to track the spread of the pandemic. Although WHO's emergency preparedness is informed by established principles of international law,

1 the multiplicity of actors has the potential to create confusion and barriers to accessing reliable and consistent data. These actors’ categorisation of countries and territories, which could be subject to geopolitical considerations, remains unaccountable to affected populations.

Keywords

Epidemiology

The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19

JMIR public health and surveillance
Volume 6, Issue 1, e18503

Al Nsour, M.; Bashier, H.; Al Serouri, A.; Malik, E.; Khader, Y.; Saeed, K.; Ikram, A.; Abdalla, A. M.; Belalia, A.; Assarag, B.; Baig, M. A.; Almudarra, S.; Arqoub, K.; Osman, S.; Abu-Khader, I.; Shalabi, D.; Majeed, Y.

Abstract

The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR's Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies.

Keywords

COVID-19, Outbreak, Preparedness, Response, Public health 

Reacquainting Cardiology with Mechanical Ventilation in Response to the COVID-19 Pandemic

JACC: Case Reports

Gage, Ann; Higgins, Andrew; Lee, Ran; Panhwar, Muhammad Siyab; Kalra, Ankur

Introduction

Reports from countries struck by the coronavirus disease 2019 (COVID-19) pandemic have consistently highlighted physician shortages and the utilization of physicians not specifically trained in critical care to care for COVID-19 patients. Given the significant overlap between cardiology and critical care, cardiologists may be among the first physicians asked to step in to fill this shortage. If and when this occurs, a basic framework for recognition of acute respiratory failure, acute respiratory distress syndrome (ARDS), and initial ventilator management is imperative. The following is a brief review of ARDS and an overview of ventilator management designed to help ensure physician comfort and patient safety.

Keywords

Clinical aspects, diagnosis, treatment

Videolaryngoscopy Increases 'Mouth-To-Mouth' Distance Compared With Direct Laryngoscopy

The European respiratory journal

Hall, D.; Steel, A.; Heij, R.; Eley, A.; Young, P.

Abstract

The COVID-19 outbreak has resulted in the consideration of videolaryngoscopy (VL) for tracheal intubation of patients during an outbreak. Benefits of VL compared with a standard curved Macintosh (MAC) blade include postural advantages, improved view for the laryngoscopist and assistants, enhanced supervision and easier management of unanticipated difficult airways.

Keywords

Infection prevention and control

Race to find COVID-19 treatments accelerates

Science (New York, N.Y.)
Volume 367, 2020, Issue 6485, P 1412-1413

Kupferschmidt, K.; Cohen, J.

Abstract

With cases of the new coronavirus disease 2019 (COVID-19) climbing steeply everywhere from Madrid to Manhattan , overwhelming one hospital after another and pushing the global death toll past 17,000, the sprint to find treatments has dramatically accelerated. Drugs that stop the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, protect health care workers and others at high risk of infection, and reduce the time patients spend in hospital beds.

Keywords

Clinical aspects, diagnosis, treatment