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New Delhi, April 17, 2020 :
Can BCG flatten the curve :
A report titled “Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19″ analyzes daily reports of COVID-19 cases and related deaths in over 50 countries.
Researchers stat that countries with a current policy mandating BCG vaccination have significantly slower growth of both cases and deaths, as compared to other countries.
Investigators analyzed daily reports of confirmed cases and deaths over a 30-day period, modeling differences between growth curves in countries that have mandated BCG policies at least until very recently (such as Brazil, Ireland, France and India) and countries that do not (such as the U.S., Italy and Lebanon).
The report can be found here: https://kitayama.psych.lsa.umich.edu/wp/wp-content/uploads/2020/04/Bergetal_All.pdf
As per USA, was WHO slow in its action
OBSERVATIONS –
WHO denied human-to-human spread of COVID-19 till 23rd January. On January 14, 2020, the WHO tweeted that “preliminary investigations conducted by Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus.” The preliminary investigations included China jailing any doctor that provided any information about COVID-19 not first cleared through state-run media. Additionally, the WHO ignored Taiwanese warnings of human-to-human transmission in December 2019, because Taiwan is not currently recognized by the WHO as an independent nation.
It delayed naming COVID-19 a Public Health Emergency of International Concern (PHEIC) and pandemic because China had the spread under control. By the time COVID-19 was declared a PHEIC on January 30, 2020, it had infected almost 10,000 and killed almost 1,000 people in 19 different countries.
Despite declaring COVID-19 a PHEIC and availability of extensive evidence of transmission through travel, the WHO insisted that other countries should not restrict travel or trade to China. The WHO has not issued updated travel restrictions since February 29 and has still not recommended restricting international travel. [The Economic Times]
What is the prognosis of in-hospital cardiac arrest :
In-hospital cardiac arrest has poor outcomes in COVID-19: only 2.9% survived to 30 days and less than 1% survived with good neurological outcome at that point in a series from Wuhan, China. (Resuscitation)
Five months on, what do scientists now know about the coronavirus
It is a spiky ball of genetic material coated in fatty chemicals called lipids; measures 80 billionths of a meter in diameter which has brought the whole world to a standstill.
Cath lab activations for STEMI down 38% during COVID-19 pandemic
Yes: The number of STEMI activations in the US cardiac catheterization laboratories has decreased during the COVID-19 pandemic, suggests research published in the Journal of the American College of Cardiology.
Anecdotal reports have pointed to a fall in primary percutaneous coronary intervention (PCI) volumes in the US and around the world during the early phase of the pandemic. Current guidelines recommend primary PCI for patients with ST-elevation myocardial infarction even during the pandemic.
Researchers assessed STEMI activations from nine high-volume cardiac catheterization laboratories in the US between January 2019 and March 2020.
March 1, 2020, was considered as the start of the “after COVID-19” period. The “before COVID-19” period referred to the 14 months before the pandemic, or from January 2019 to February 2020.
Researchers noted that there was a 38% decrease in STEMI activations from before the pandemic to after it started to affect life in the US. Before the pandemic, the sites reported more than 180 STEMI activations per month, with a mean of 23.6 activations per month per center. This declined to 138 activations per month, with a mean of 15.3 activations per month per center, for the period beginning March 1, 2020.
What can be the reasons for fewer heart attacks
Fewer heart attacks due to less stressful life
Avoidance of medical care due to social distancing
Concerns of contracting COVID-19 in the hospital
STEMI misdiagnosis
Increased use of pharmacological reperfusion due to COVID-19
Can blood transfusion be effective
Dr Keerthika Sundaram: COVID-19 patients not responding to a ventilator and who have a hypoxemic hypoxia-like picture – We should give blood transfusion, packed cells, cord blood cells.
Journal of Infection published study showed that arbidol monotherapy is superior to lopinavir/ritonavir in the treatment of COVID-19
Zhen Zhu, MD, Third People’s Hospital of Changzhou, Changzhou, China, and associates analyzed data from 34 patients with laboratory-confirmed COVID-19 who were given lopinavir/ritonavir 400 mg/100 mg and 16 patients with COVID-19 who received arbidol monotherapy (0.2 g tid). The cycle threshold values of open reading frame 1ab and nucleocapsid genes by RT-PCR assay were monitored during antiviral therapy.
None of the patients developed severe pneumonia or acute respiratory distress syndrome. On day 14 after admission, there was no viral load in the arbidol group compared with 15 (44.1%) patients in the lopinavir/ritonavir group showing viral load. Furthermore, patients in the arbidol group had a shorter duration of positive RNA test compared with those in the lopinavir/ritonavir group.
The authors concluded that arbidol monotherapy is more effective than lopinavir/ritonavir in treating COVID-19.
What is NL ratio [neutrophil-to-lymphocyte ratio]
A study published in the Journal of Infection, provides evidence that NLR is an independent risk factor for in-hospital mortality in patients with COVID-19, particularly in males.
Yuwei Liu, MD, Zhongnan Hospital of Wuhan University, Wuhan, China, and colleagues retrospectively assessed 245 patients with COVID-19 admitted from January 1, 2020, to February 29, 2020.
In-hospital mortality was 13.47%. According to multivariate analysis, there was 8% higher risk of in-hospital mortality for each unit increase in NLR (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.01-1.14; P = 0.0147). When compared with patients in the lowest tertile, the NLR of patients in the highest tertile was associated with a 15.04-fold higher risk of death (OR = 16.04; 95% CI, 1.14-224.95; P = 0.0395) after adjustment for potential confounders. The fully adjusted OR for mortality was 1.10 in males for each unit increase of NLR (OR = 1.10; 95% CI, 1.02-1.19; P = 0.016).
Assessment of NLR may therefore help in the identification of high-risk individuals with COVID-19.
Can late treatment in COVID-19 be helpful
A case report published in Pharmacotherapy describes the successful treatment of a patient with COVID-19 with remdesivir antiviral therapy 13 days after symptom onset.
What are the findings if Nature article
In an article published in Nature, investigators have reported temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from another sample of 77 infector–infectee transmission pairs.
The highest viral load was noted in throat swabs at the time of symptom onset. It was thus inferred that infectiousness peaked on or before symptom onset.
It was estimated that 44% of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should therefore be adjusted to account for probable substantial presymptomatic transmission. [Nature]
And now a saliva test
US FDA has given emergency approval for an approach that uses saliva as the primary test biomaterial for the diagnosis of COVID-19. The Rutgers Clinical Genomics Laboratory TaqPath SARS-CoV-2 Assay is intended for the qualitative detection of nucleic acid from SARS-CoV-2 in oropharyngeal (throat) swab, nasopharyngeal swab, anterior nasal swab, mid-turbinate nasal swab from individuals suspected of COVID-19.
To expand on this assay, Rutgers University-based RUCDR Infinite Biologics developed a saliva collection method in collaboration with Spectrum Solutions and Accurate Diagnostic Labs.
Diabetes and cytokine storm
COVID-19 infection in patients with type 2 diabetes is linked to a greater increase in inflammatory and coagulation markers, compared with COVID-19 patients without diabetes, suggest preliminary findings from a retrospective analysis of COVID-19 patients in Wuhan, China.
Despite being preliminary, the results could help explain why patients with diabetes and COVID-19 are at greater risk for more severe disease and death.
The results also indicate that more severe disease in patients with diabetes may occur due to a cytokine storm. In this condition, the patient’s immune system overreacts to the virus and inflicts collateral damage on its own organs, stated Herbert I. Rettinger, MD, a clinical endocrinologist in Orange County, Calif., and member of the editorial advisory board for Clinical Endocrinology News. Rettinger said in an interview, “Understanding the mechanism might help us understand the best way to treat,” COVID-19 in patients with diabetes.
Author : Dr KK Aggarwal, President CMAAO, HCFI and Past National President IMA
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