CMAAO CORONA FACTS and MYTH Covid Updates

Dr K Aggarwal, President CMAAO with input from Dr Monica Vasudev

India,

healthysoch

New Delhi, November 08, 2020:

A study of the lungs of people died from COVID-19 has found persistent and extensive lung damage in most cases.
COVID-19 is not simply a disease caused by the death of virus-infected cells, but is likely the consequence of these abnormal cells persisting for long periods inside the lungs
The research team analysed samples of tissue from the lungs, heart, liver and kidneys of 41 patients who died of COVID-19 at Italy’s University Hospital of Trieste between February and April 2020.
They found vast destruction of the architecture of the lungs”, with healthy tissue “almost completely substituted by scar tissue”.
90% of the 41 patients had several characteristics unique to COVID-19 compared to other forms of pneumonia. One was that patients had extensive blood clotting of the lung arteries and veins. Another was that some lung cells were abnormally large and had many nuclei – a result of the fusion of different cells into single large cells in a process known as syncytia. The research, published in the Lancet journal EBioMedicine, also found the virus itself was still present in many types of cells. The presence of these infected cells can cause the major structural changes observed in lungs, which can persist for several weeks or months.

COVID-19 does not independently increase the risk of pulmonary embolism

Some patients with COVID-19 clearly do have a pro-thrombotic state, with potential for developing blood clots in many parts of their bodies
The overall group of patients with COVID-19 are not at substantially higher risk than patients who come to the hospital for other diseases,” Dr. Mark M. Hammer of Harvard Medical School note in JACC: Cardiovascular Imaging.
The study included patients who had been tested for SARS-CoV-2 by RT-PCR between March 1 and May 1 and had undergone computed tomography pulmonary angiography (CTPA) within seven days prior to and 14 days after the test.
The only significant difference in PE incidence was seen in patients who had a CTPA within a day of their COVID-19 test, 14.1% of whom were positive for PE, versus 7.7% of COVID 19-negative patients (P=0.04). This could have been because the patients with COVID-19 hadn’t yet received prophylactic anticoagulation.
The phenomenon of high rates of blood clotting is probably not unique to COVID-19. Reports from the prior pandemic of H1N1 influenza also mentioned high rates of blood clotting. It is likely that these viruses can cause, in some patients, a very strong inflammatory response that leads to blood clotting.

Mouthwashes with antiviral ingredients could help decrease COVID-19 transmission by reducing viral loads in the mouths of infected patients when they cough, sneeze or speak, according to a paper in the Journal of Dental Research.

Rinses containing cetylpyridinium chloride or povidone-iodine can reduce the oral coronavirus load; other promising compounds include hydrogen peroxide, chlorhexidine, cyclodextrin, Citrox, and certain essential oils.

Everyone should be using these mouthwashes because people can be infected and not realize it.

The study suggests using three doses of antiviral mouthwash the day before a meeting, and one dose the morning of the event. COVID-19 patients should be using mouthwash regularly for seven to 10 days.

Levels of CRP during the first 48 hours of hospital admission predict respiratory decline in patients with COVID-19

DG Alert: Among hospitalised patients with COVID-19, increasing levels of CRP during the first 48 hours of hospitalisation is a better predictor of respiratory decline than initial CRP levels or ROX indices, according to a study published in Cell Reports Medicine.

A review of data from the first 100 patients admitted to the Brigham and Women’s Hospital, Boston, Massachusetts, for COVID-19 infection found that among patients who were stable and did not require intubation at admission, elevated CRP values in the first 48 to 72 hours of hospital admission accurately distinguished patients who would develop progressive respiratory failure from patients who would remain stable throughout their hospital course.

CRP level at admission correlated with physiological measures of disease severity, including sequential organ failure assessment (SOFA) score, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), and interleukin-6 (IL-6).

All patients in the study presented to the hospital approximately 1 week after symptom onset. Only 1 patient required high-flow nasal cannula, but 45 were intubated and on mechanical ventilation at some point during their hospitalisation. Treatment strategies for patients included administration of hydroxychloroquine, remdesivir versus placebo as part of a clinical trial, or tocilizumab. The overall mortality rate was 24%.

In all patients, CRP levels peaked early within approximately 10 days of symptom onset; however, change in CRP <72 hours of admission was significantly different between patients with mild versus progressive COVID-19 (P = .009), whereas it was similar between patients with progressive and severe disease (P = .81).

Compared with patients with mild COVID-19, those with progressive disease had a more rapid increase in CRP levels drawn at 24 to 48 hours (182.0 ± 101 vs 97.6 ± 72 mg/L; P = 0.006) and 48 to 72 hours (190.1 ± 99 vs 90.2 ± 64 mg/L; P< .001) after admission.

The odds ratio of requiring advanced respiratory support was 16.9 (P = 0.01) when CRP values of greater than 300 mg/L was achieved within 72 hours of admission.

Our study suggests that examination of dynamic trends, rather that absolute value at admission, can lead to strong associations with prognosis despite only using a single laboratory value.

Trending CRP, a highly accessible tool for frontline clinicians compared to complicated scoring systems, has predictive value for respiratory failure among initially non-critically ill patients on the general medical floor.

IL-6 was markedly elevated in patients who required ICU level care at any point during their hospitalisation compared with non-ICU patients, and that IL-6 levels did show a striking correlation to CRP. IL-6 results took over 48 hours to return. In many institutions, CRP levels result within several hours and can capture rapidly evolving clinical courses that cytokine assays, which take more than 1 to 2 days, cannot.

Aspirin — a cheap, over-the-counter drug — may help COVID patients survive by helping to prevent those blood clots.

A British Professor Peter Horby of Oxford University, told a committee in Parliament that aspirin is the latest drug added to the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, which is looking at multiple treatments.

A study overseen by the University of Maryland School of Medicine showed that COVID patients had fewer complications when they took aspirin.

Researchers examined 412 patients who had coronavirus, according to the study published in Anesthesia and Analgesia . The study said 98 of those patients received aspirin a week before hospital admission, or within 24 hours of admission. The others didn’t.

The patients given aspirin were 43% less likely to be admitted to ICU, 44% less likely to be placed on ventilator, 47% less likely to die in the hospital.

Sources:

The Pharmaceutical Journal. “Aspirin added to RECOVERY COVID-19 trial, MPs told”
https://www.pharmaceutical-journal.com/news-and-analysis/news/aspirin-added-to-recovery-covid-19-trial-mps-told/20208522.article?firstPass=false

Anesthesia and Analgesia. “Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19”
https://journals.lww.com/anesthesia-analgesia/Abstract/9000/Aspirin_Use_is_Associated_with_Decreased.95423.aspx

University of Maryland School of Medicine. “New Landmark Study at UM School of Medicine Finds Aspirin Use Reduces Risk of Death in Hospitalized COVID-19 Patients”
https://www.medschool.umaryland.edu/news/2020/New-Landmark-Study-at-UM-School-of-Medicine-Finds-Aspirin-Use-Reduces-Risk-of-Death-in-Hospitalized-COVID-19-Patients.html#:~:text=Hospitalized%20COVID%2D19%20patients%20who,School%20of%20Medicine%20(UMSOM)

Cite this: Researchers Say Aspirin May Help COVID Patients – Medscape – Nov 06, 2020.