Updated: May 16, 2020
The research cited below is to inform lay folks about on-going research in a very relevant topic. This is not intended to provide any medical advice except you might have more information to prepare you for any meetings with doctors. For example, for those readers who might have an underlying cardio-vascular condition, you might ask if the emergency room you might be admitted to has the thromboelastography capability.
(3) Key considerations if you contract coronvirus COVID-19 and you have underlying heart and other vascular conditions.
(4) Identifies potential clotting problems associated with COVID-19 and testing that might be used to determine treatments.
(5) Modeling that shows the benefits of implementing various virus containment strategies.
(6) Studies that confirm (preliminary) that infection by the coronavirus will stimulate production of anti-bodies that will fight future exposures (does not say for how long), but there are very positive implications for development of an effective vaccine.
(3) Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
ER doctors highlight under appreciated risks, potential drug interactions
Date:May 15, 2020Source:University of Virginia Health SystemSummary:A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.Share:
FULL STORY COVID-19 can cause serious cardiovascular complications including heart failure, heart attacks and blood clots that can lead to strokes, emergency medicine doctors report in a new scientific paper. They also caution that COVID-19 treatments can interact with medicines used to manage patients' existing cardiovascular conditions.
The new paper from UVA Health's William Brady, MD, and colleagues aims to serve as a guide for emergency-medicine doctors treating patients who may have or are known to have COVID-19. The authors note that much attention has been paid to the pulmonary (breathing) complications of COVID-19, but less has been said about the cardiovascular complications that can lead to death or lasting impairment.
"In writing this article, we hope to increase emergency physicians' knowledge and awareness of this new pathogen and its impact on the cardiovascular system," said Brady, of UVA's Department of Emergency Medicine. "As we encounter more and more patients with COVID-19-related illness, we are increasing our understanding of its impact on the body in general and the cardiovascular system in particular. The rate of learning on this area is amazingly rapid. Information continues to change weekly, if not daily."
COVID-19 and Heart Failure Heart failure is a particular concern in patients with COVID-19. One study, the article authors note, found that almost a quarter of COVID-19 patients -- 24% -- were suffering acute heart failure when they were first diagnosed with the coronavirus. (This doesn't mean that 24% of all COVID-19 patients will suffer heart failure. The authors state that it remains unclear if the heart failure was the result of COVID-19 specifically or if the virus was worsening undiagnosed heart failure.)
Of the patients with heart failure, nearly half were not known to have high blood pressure or cardiovascular disease.
Strokes and Other Concerns The paper also notes that COVID-19, and other diseases that cause severe inflammation throughout the body, increase the risk that fatty plaque built up in the blood vessels will rupture, leading to heart attacks and stroke. Influenza and certain other viruses have been associated with increased risk of plaque ruptures within the first week after the disease was diagnosed, the authors state in their review of the available COVID-19 medical literature. Finally, the authors describe potential drug interactions in COVID-19 patients. For example, the highly publicized malaria drug hydroxychloroquine can interact with medications designed to regulate heart rhythm, in addition to causing heart damage and worsening cardiomyopathy. Remdesivir, an antiviral that is the only COVID-19 treatment authorized by the FDA, can cause low blood pressure and abnormal heart rhythm. It's important for doctors to bear these interactions in mind when treating patients with COVID-19, the authors note. "As we gain more experience with this new pathogen, we realize that its adverse impact extends beyond the respiratory system," Brady said. "We will continue to learn more about COVID-19 and the most optimal means of managing its many presentations."
Findings Published The article has been published online by the American Journal of Emergency Medicine. In addition to Brady, it was written by Brit Long, MD, of Brooke Army Medical Center; Alex Koyfman, MD, of the University of Texas Southwestern Medical Center; and Michael Gottlieb, MD, of Rush University Medical Center. Story Source: Materials provided by University of Virginia Health System. Note: Content may be edited for style and length. Journal Reference:
Brit Long, William J. Brady, Alex Koyfman, Michael Gottlieb. Cardiovascular complications in COVID-19. The American Journal of Emergency Medicine, 2020; DOI: 10.1016/j.ajem.2020.04.048
(4) Blood clotting abnormalities reveal COVID-19 patients at risk for thrombotic events
Date: May 15, 2020
Source: American College of Surgeons
Summary:A new article highlights early research on blood clotting evaluation work that may help identify and treat dangerous complications of the infection.Share:
FULL STORY When researchers from the University of Colorado Anschutz Medical Campus, Aurora, used a combination of two specific blood-clotting tests, they found critically ill patients infected with Coronavirus Disease 2019 (COVID-19) who were at high risk for developing renal failure, venous blood clots, and other complications associated with blood clots, such as stroke. Their study, which was one of the first to build on growing evidence that COVID-19-infected patients are highly predisposed to developing blood clots, linked blood clotting measurements with actual patient outcomes. The research team is now participating in a randomized clinical trial of a drug that breaks down blood clots in COVID-19-infected patients.
"This is an early step on the road to discovering treatments to prevent some of the complications that come with this disease," said Franklin Wright, MD, FACS, lead author of the research article and an assistant professor of surgery at the University of Colorado School of Medicine.
Their research is published as an "article in press" on the Journal of the American College of Surgeons website ahead of print.
Patients who are critically ill regardless of cause can develop a condition known as disseminated intravascular coagulation (DIC). The blood of these patients initially forms many clots in small blood vessels. The body's natural clotting factors can form too much clot or eventually not be able to effectively form any clot leading to issues of both excessive clotting and excessive bleeding. However, in patients with COVID-19 the clotting appears to be particularly severe and -- as evidenced by case studies in China and elsewhere -- clots in COVID-19 patients do not appear to dissipate, explained Dr. Wright.
Trauma acute care surgeons and intensive care physicians who treat trauma, transplant, and cardiothoracic surgery patients at UC Health University of Colorado Hospital saw the potential of using a specialized coagulation test to examine clotting issues in COVID-19 patients. Thromboelastography (TEG) is a whole blood assay that provides a broad picture of how an individual patient's blood forms clots, including how long clotting takes, how strong clots are, and how soon clots break down. TEG is highly specialized and used primarily by surgeons and anesthesiologists to evaluate the efficiency of blood clotting; it is not widely used in other clinical settings. "The COVID pandemic is opening doors for multidisciplinary collaboration so trauma acute care surgeons and intensivists can bring the tools they use in their day-to-day lives and apply them in the critical care setting to new problems," Dr. Wright said.
The researchers evaluated outcomes for all patients who had a TEG assay as part of their treatment for COVID-19 infection as well as other conventional coagulation assays, including ones that measure D-dimer levels. D-dimer is a protein fragment that is produced when a blood clot dissolves. D-dimer levels are elevated when large numbers of clots are breaking down.
A total of 44 patients treated for COVID-19 infection between March 22 and April 20 were included in the analysis. Those whose bodies were not breaking down clots most often required hemodialysis and had a higher rate of clots in the veins. These patients were identified by TEG assays showing no clot breakdown after 30 minutes and a D-dimer level greater than 2600 ng/mL. Eighty percent of patients with both affirmative test findings were placed on dialysis compared with 14 percent who tested for neither finding. Patients with affirmative test findings also had a 50 percent rate of venous blood clots compared with 0 percent for those patients with neither finding.
"These study results suggest there may be a benefit to early TEG testing in institutions that have the technology to identify COVID-19 patients who may need more aggressive anticoagulation therapy to prevent complications from clot formation," Dr. Wright said. A clinical trial of one form of treatment is already underway. The Denver Health and Hospital Authority is leading a multi-center study that includes UC Health University of Colorado Hospital, National Jewish Health-St Joseph Hospital, Beth Israel Deaconess Medical Center, and Long Island Jewish Hospital in conjunction with Genentech, Inc., enrolling patients with COVID-19 infection in a randomized clinical trial of tissue plasminogen activator (tPA). This drug is a natural anticoagulant that was approved by the U.S. Food and Drug Administration in 1996 for the treatment of diseases associated with clotting disorders, such as heart attack, stroke, and pulmonary embolism. The trial will assess the efficacy and safety of intravenous tPA in improving respiratory function and management of patients with aggressive blood clotting.
"This study suggests that testing whole blood clotting measurements may allow physicians to identify and treat patients with COVID-19 more effectively to prevent complications and encourage further research into therapies to prevent blood clots in these patients," Dr. Wright said.
Dr. Wright's associates in this study include: Thomas O. Vogler, PhD; Ernest E. Moore, MD, FACS; Hunter B. Moore, MD, PhD; Max V. Wohlauer, MD; Shane Urban, BSN, RN; Trevor L. Nydam, MD, FACS; Peter K. Moore, MD; and Robert C. McIntyre Jr., MD, FACS. Story Source: Materials provided by American College of Surgeons. Note: Content may be edited for style and length. Journal Reference:
Franklin L. Wright, Thomas O. Vogler, Ernest E. Moore, Hunter B. Moore, Max V. Wohlauer, Shane Urban, Trevor L. Nydam, Peter K. Moore, Robert C. McIntyre. Fibrinolysis Shutdown Correlates to Thromboembolic Events in Severe COVID-19 Infection. Journal of the American College of Surgeons, 2020; DOI: 10.1016/j.jamcollsurg.2020.05.007
American College of Surgeons. "Blood clotting abnormalities reveal COVID-19 patients at risk for thrombotic events." ScienceDaily. ScienceDaily, 15 May 2020. <www.sciencedaily.com/releases/2020/05/200515131909.htm>.
(5) Quantifying the impact of interventions in COVID-19 pandemic
Date: May 15, 2020
Source: Max Planck Institute for Dynamics and Self-Organization
Summary: Since the beginning of March, public life in Germany has been severely restricted due to the coronavirus pandemic. Following the encouraging decline in the number of new cases of COVID-19, the debate on the effectiveness of interventions taken to date and on further relaxation of the restrictions is meanwhile gaining momentum.Share:
FULL STORY Since the beginning of March, public life in Germany has been severely restricted due to the coronavirus pandemic. Following the encouraging decline in the number of new cases of COVID-19, the debate on the effectiveness of interventions taken to date and on further relaxation of the restrictions is meanwhile gaining momentum.
Researchers from the Max Planck Institute for Dynamics and Self-Organization (MPIDS) and the University of Göttingen have now succeeded in analyzing the German COVID-19 case numbers with respect to past containment measures and deriving scenarios for the coming weeks. Their computer models could also provide insights into the effectiveness of interventions in other countries. Their results have been published today online in the journal Science.
Simulations since mid-March Many people are currently concerned about how well the measures to contain the pandemic have worked in recent weeks and how things will continue in the coming weeks. Scientists at the MPIDS have been investigating these questions. The team has been simulating the course of the coronavirus epidemic in Germany together with scientists from the Göttingen Campus since mid-March. In their model calculations, the researchers relate the gradually increasing restrictions of public life in March to the development of COVID-19 case numbers. In particular, they examined the effect of the three packages of interventions in March: the cancellation of major public events around March 8, the closure of educational institutions and many shops on March 16, and the extensive contact ban on March 22. To this end, the researchers combined data on the temporal course of the COVID-19 new infections with an epidemiological dynamics model that allows the analysis of the course of the pandemic to date and the investigation of scenarios for the future. According to the computer models, the packages of measures initially slowed down the spread of COVID-19 and finally broke the dreaded exponential growth.
"Our analysis clearly shows the effect of the various interventions, which together ultimately brought about a strong trend reversal," says Viola Priesemann, research group leader at the Max Planck Institute. Michael Wilczek, research group leader and co-author of the study, adds: "Our model calculations thus show us the overall effect of the change in people's behavior that goes hand in hand with the interventions."
A computer model also for other countries and regions In their work, the Göttingen researchers did not only have Germany in mind. "From the very beginning, we designed our computer model so that it could be transferred to other countries and regions. Our analysis tools are freely available on GitHub (https://github.com/Priesemann-Group/covid19_inference_forecast) and are already being used and developed further by researchers around the world," says Jonas Dehning, lead author of the study. The Göttingen research team is currently working on applying the model to European countries. It is particularly important to work out the different points in time at which the measures were taken in different countries, which could allow to draw conclusions about the effectiveness of the individual measures.
Concerns about the second wave The Göttingen researchers' analysis of Germany on the basis of case numbers up to April 21 indicated an overall positive development of case numbers for the coming weeks. However, their analysis also reveals a central challenge in assessing the epidemic dynamics: changes in the spread of the coronavirus are only reflected in the COVID-19 case numbers with considerable delays. "We have only recently seen the first effects of the relaxation of restrictions of April 20 in the case numbers. And until we can evaluate the relaxations of May 11, we also have to wait two to three weeks," says Michael Wilczek. The researchers are therefore continuing to monitor the situation very closely. Every day they evaluate the new case numbers to assess whether a second wave is to be expected.
Using three different model scenarios, the Göttingen team also shows how the number of new cases might develop further. If the relaxations of May 11 doubles the infection rate, a second wave can be expected. Instead, if the infection rate balances the recovery rate, the new infections stay approximately constant. However, it is also possible that the number of new infections will continue to decrease, says Viola Priesemann: "If everyone continues to be very careful and contact tracing by the health authorities is effective, and at the same time all new outbreaks of infection are detected and contained early, then the number of cases can continue to decrease. How exactly the numbers will develop in the future, therefore, depends decisively on our behavior, the observance of distance recommendations and hygiene measures," says the Göttingen physicist. Story Source: Materials provided by Max Planck Institute for Dynamics and Self-Organization. Note: Content may be edited for style and length. Journal Reference:
Jonas Dehning, Johannes Zierenberg, F. Paul Spitzner, Michael Wibral, Joao Pinheiro Neto, Michael Wilczek, Viola Priesemann. Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions. Science, 2020; eabb9789 DOI: 10.1126/science.abb9789
(6) Detailed analysis of immune response to SARS-CoV-2 bodes well for COVID-19 vaccine
Date: May 15, 2020
Source: La Jolla Institute for Immunology
Summary: A new study documents a robust antiviral immune response to SARS-CoV-2 in a group of 20 adults who had recovered from COVID-19. The findings show that the body's immune system is able to recognize SARS-CoV-2 in many ways, dispelling fears that the virus may elude ongoing efforts to create an effective vaccine.Share:
FULL STORY Scientists around the world are racing to develop a vaccine to protect against COVID-19 infection, and epidemiologists are trying to predict how the coronavirus pandemic will unfold until such a vaccine is available. Yet, both efforts are surrounded by unresolved uncertainty whether the immune system can mount a substantial and lasting response to SARS-CoV-2 and whether exposure to circulating common cold coronaviruses provides any kind of protective immunity. A collaboration between the labs of Alessandro Sette, Dr. Biol. Sci. and Shane Crotty, Ph.D., at La Jolla Institute for Immunology is starting to fill in the massive knowledge gap with good news for vaccine developers and is providing the first cellular immunology data to help guide social distancing recommendations. Published in today's online edition of Cell, the study documents a robust antiviral immune response to SARS-CoV-2 in a group of 20 adults who had recovered from COVID-19. The findings show that the body's immune system is able to recognize SARS-CoV-2 in many ways, dispelling fears that the virus may elude ongoing efforts to create an effective vaccine. "If we had seen only marginal immune responses, we would have been concerned," says Sette, a professor in the Center for Infectious Disease and Vaccine Research, and adds, "but what we see is a very robust T cell response against the spike protein, which is the target of most ongoing COVID-19 efforts, as well as other viral proteins. These findings are really good news for vaccine development." "All efforts to predict the best vaccine candidates and fine-tune pandemic control measures hinge on understanding the immune response to the virus," says Crotty, also a professor in the Center for Infectious Disease and Vaccine Research. "People were really worried that COVID-19 doesn't induce immunity, and reports about people getting re-infected reinforced these concerns, but knowing now that the average person makes a solid immune response should largely put those concerns to rest." In an earlier study, Sette and his team had used bioinformatics tools to predict which fragments of SARS-CoV-2 are capable of activating human T cells. The scientists then, in this newest research, tested whether T cells isolated from adults who had recovered from COVID-19 without major problems, recognized the predicted protein fragments, or so-called peptides, from the virus itself. The scientists pooled the peptides into two big groups: The first so-called mega-pool included peptides covering all proteins in the viral genome apart from SARS-CoV-2's "spike" protein. The second mega-pool specifically focused on the spike protein that dots the surface of the virus, since almost all of the vaccines under development right now target this coronavirus spike protein. "We specifically chose to study people who had a normal disease course and didn't require hospitalization to provide a solid benchmark for what a normal immune response looks like, since the virus can do some very unusual things in some people," says Sette. The researchers found that all COVID-19 patients had a solid CD4, or "helper," T cell response, which helps antibody production. Almost all patients had produced virus-specific CD8, or "killer," T cells, which eliminate virus-infected cells. "Our data show that the virus induces what you would expect from a typical, successful antiviral response," says Crotty. And, although these results don't preclude that the immune response to SARS-CoV-2 may be detrimental, they provide an important baseline against which individuals' immune responses can be compared; or, as Sette likes to put it, "if you can get a picture of something, you can discuss whether you like it or not but if there's no picture there's nothing to discuss." "We have a solid starting foundation to now ask whether there's a difference in the type of immune response in people who have severe outcomes and require hospitalization versus people who can recover at home or are even asymptomatic," adds Sette. "But not only that, we now have an important tool to determine whether the immune response in people who have received an experimental vaccine resembles what you would expect to see in a protective immune response to COVID-19, as opposed to an insufficient or detrimental response." The teams also looked at the T cell response in blood samples that had been collected between 2015 and 2018, before SARS-CoV-2 started circulating. Many of these individuals had significant T cell reactivity against SARS-CoV-2, although they had never been exposed to SARS-CoV-2. But everybody has almost certainly seen at least three of the four common cold coronaviruses, which could explain the observed crossreactivity. It is still unclear, though, whether the observed crossreactivity provides at least some level of preexisting immunity to SARS-CoV-2 and therefore could explain why some people or geographical locations are hit harder by COVID-19. ¬¬"Given the severity of the ongoing COVID-19 pandemic, any degree of cross-reactive coronavirus immunity could have a very substantial impact on the overall course of the pandemic and is a key detail to consider for epidemiologists as they try to scope out how severely COVID-19 will affect communities in the coming months," says Crotty. The work was funded by the NIH NIAID (AI142742, AI135078, AI007036, AI00738475N9301900065, and U19 AI118626), the Bill and Melinda Gates Foundation, the Johnathan and Mary Tu Foundation and internal LJI institutional funds. Story Source: Materials provided by La Jolla Institute for Immunology. Note: Content may be edited for style and length. Journal Reference:
Alba Grifoni, Daniela Weiskopf, Sydney I. Ramirez, Jose Mateus, Jennifer M. Dan, Carolyn Rydyznski Moderbacher, Stephen A. Rawlings, Aaron Sutherland, Lakshmanane Premkumar, Ramesh S. Jadi, Daniel Marrama, Aravinda M. de Silva, April Frazier, Aaron Carlin, Jason A. Greenbaum, Bjoern Peters, Florian Krammer, Davey M. Smith, Shane Crotty, Alessandro Sette. Targets of T cell responses to SARS-CoV-2 coronavirus in humans with COVID-19 disease and unexposed individuals. Cell, May 14, 2020; DOI: 10.1016/j.cell.2020.05.015
(1) Fighting the COVID-19 pandemic and major diseases at the same time
A balancing act for biomedical scientists
Date:May 14, 2020Source:Helmholtz Zentrum München - German Research Center for Environmental HealthSummary:Researchers, politicians and funding bodies find themselves in front of a unique situation: The mounting pressure to accelerate and intensify efforts to tackle the COVID-19 pandemic while handling the growing threat from all other diseases endangering our society. This balancing and how well the scientific community will respond to it will define health across the globe for years to come, argue scientists in a new commentary.Share:
FULL STORY Researchers, politicians and funding bodies find themselves in front of a unique situation and enormous challenge: The mounting pressure to accelerate and intensify efforts to tackle the COVID-19 pandemic while handling the growing threat from all other diseases endangering our society. This balancing and how well the scientific community will respond to it will define health across the globe for years to come, argue scientists at Helmholtz Zentrum München and Deutsches Krebsforschungszentrum (DKFZ) in the latest issue of the leading journal Cell. In their commentary, the researchers discuss how to strike a good balance between maintaining and redefining research priorities. The world is currently facing a global pandemic without precedence. Looking at how leading research organizations and scientists across all disciplines are actively redeploying efforts to help identify and implement solution is encouraging and exciting to observe, the authors of the commentary say. "This does not mean, however, that we may lose sight of the challenges we are already facing and which are responsible for threatening the lives and quality of lives of billions of people. Delaying or putting at risk decades of intensive basic, translational and clinical research would be a risky course of action which may end up having the opposite effect," warns Prof. Matthias Tschöp, CEO at Helmholtz Zentrum München. "It is the duty of the research community to face the total of all current and future threats in a responsible and sustainable manner. We need to adjust the way we work together and take our learnings from the corona pandemic."
The threat of major diseases is growing The commentary refers in particular to chronic diseases, such as diabetes and cancer, which remain leading causes of death and disability. For example, type 2 diabetes affects more than 400 million people worldwide today, and the closely correlated cardiovascular diseases remain the main cause of death in Western societies. Similarly, the number of newly-diagnosed cancer patients will increase annually from 18 million today to approximately 30 million in the year 2040.
Opportunities must be taken According to the authors, the COVID-19 crisis has already changed the research community. Some of these changes and adaptations can be used to improve how we deal with other health challenges. International research teams are working together rather than in competition -- across organization, disciplines and borders. Regulatory bodies have accelerated their processing and the sharing of critical data has been faster than ever. "Based on what we have learned during the current COVID-19 crisis, smart, lasting, balanced and joint investments in improving our health as one global society are warranted. Ideally, all areas of biomedical research should benefit from this shift and be careful not to take a step back on our journey to prevent and eradicate many of the largest health threats worldwide," says Prof. Eleftheria Zeggini, Director of the Institute for Translational Genomics at Helmholtz Zentrum München.
make a difference: sponsored opportunity Story Source: Materials provided by Helmholtz Zentrum München - German Research Center for Environmental Health. Note: Content may be edited for style and length. Journal Reference:
Eleftheria Zeggini, Michael Baumann, Magdalena Götz, Stephan Herzig, Martin Hrabe de Angelis, Matthias H. Tschöp. Biomedical Research Goes Viral: Dangers and Opportunities. Cell, 2020; DOI: 10.1016/j.cell.2020.05.014
Cite This Page:
Helmholtz Zentrum München - German Research Center for Environmental Health. "Fighting the COVID-19 pandemic and major diseases at the same time: A balancing act for biomedical scientists." ScienceDaily. ScienceDaily, 14 May 2020. <www.sciencedaily.com/releases/2020/05/200514143524.htm>.
(2) Study tracks COVID-19 spread in pediatric dialysis unit
May 14, 2020
Source: Indiana University School of Medicine
Summary:As COVID-19 continues its sweep around the globe, dialysis units have continued to be hotspots for the virus' spread. Researchers hope to combat that threat, through a novel study that used antibody testing on patients, doctors, nurses and staff within the unit to track symptomatic and asymptomatic spread in a confined space.
(3) Arthritis drug may improve respiratory function in some patients with severe COVID-19
Date: May 14, 2020
Source: Cell Press
Summary: A small study in Greece found that the clinically approved anti-inflammatory drug anakinra, used to treat rheumatoid arthritis, improved respiratory function in patients with severe coronavirus disease 2019 (COVID-19).Share:
FULL STORY A small study in Greece found that the clinically approved anti-inflammatory drug anakinra, used to treat rheumatoid arthritis, improved respiratory function in patients with severe coronavirus disease 2019 (COVID-19). The eight patients also had a condition called secondary hemophagocytic lymphohistiocytosis (sHLH), which is characterized by overactivation of the immune system and organ failure. One patient, who did not require mechanical ventilation, improved rapidly after starting treatment with the drug and was discharged from the hospital 9 days later. But the therapy did not prevent three out of seven patients on ventilators from dying, and it's not yet clear whether it improves mortality rates. The report appears May 14 in the journal Cell Host & Microbe.
"These data argue that the administration of anakinra may be a viable treatment in severe COVID-19 with sHLH, supporting larger clinical studies to validate this concept," says senior author Evangelos J. Giamarellos-Bourboulis, a professor of internal medicine at the Medical School of the National and Kapodistrian University of Athens.
The death rate in patients with severe COVID-19 admitted to intensive care units (ICUs) is estimated to be between 50% and 65%. Severe complications of COVID-19 are thought to be driven by inflammatory responses, particularly through signaling molecules called interleukin 1? (IL-1?) and interleukin 6 (IL-6). The overproduction of IL-1? by immune cells called macrophages can cause sHLH, also known as macrophage activation syndrome, which is characterized by low counts of blood cells, excessive blood clotting, kidney injury, and liver dysfunction. Anakinra inhibits IL-1? signaling and has been shown to reduce the mortality of patients with signs of sHLH by 30%.
In the new study, the researchers tested whether anakinra could effectively treat severely ill COVID-19 patients with pneumonia and sHLH. Seven of the eight patients were males who had respiratory failure, were on ventilators in ICUs in Greece, and had serious underlying conditions such as heart disease and high blood pressure. They were treated with anakinra intravenously 200 mg every 8 hours for 7 days. They also received treatment with the antimalarial drug hydroxychloroquine and broad-spectrum antibiotics. The researchers monitored their outcomes over the course of 4 weeks.
Anakinra treatment improved the majority of laboratory findings and decreased signs of sHLH in the ICU patients. All of them showed improved respiratory function, as indicated by a 15% to 117% increase in the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2), which compares the oxygen level in the blood to the oxygen concentration that is breathed. Moreover, six patients needed a lower dose of drugs that increase blood pressure. Although three of the ICU patients died, previous studies have shown that sHLH can lead to death rates as high as 67%.
The non-ICU patient was a 71-year-old woman who was hospitalized in the Netherlands for COVID-19 2 weeks after the third cycle of chemotherapy. This patient was also on hydroxychloroquine for rheumatoid arthritis. She received anakinra treatment 300 mg once daily intravenously for 4 days, followed by 100 mg once daily for an additional 5 days. She improved within the first day of anakinra treatment, showing a reduced need for oxygen and a decrease in signs of sHLH, and was discharged 9 days after starting treatment. According to the authors, these results suggest that anakinra may prevent the progression of respiratory failure and the need for mechanical ventilation in COVID-19 patients with sHLH. "We believe that anakinra has the potential to improve outcomes in patients with severe COVID-19," says first author George Dimopoulos of the National and Kapodistrian University of Athens. "Larger clinical trials are warranted to validate these results and demonstrate the usefulness of anti-IL-1 therapy when COVID-19 is complicated by sHLH."
The study was funded in part by the Horizon 2020 grant ImmunoSep and the Hellenic Institute for the Study of Sepsis. A complete list of funding and declarations of interest can be found in the manuscript. (3) Can COVID-19 spread through fecal matter?
Studies indicate genetic material of virus showing up in stool
Date: May 14, 2020
Source: Rice University
Summary:Early studies show evidence of COVID-19 genetic material in fecal matter, but more work is needed to determine if the virus can be spread through stool, according to a new review paper.
(4) In victory over polio, hope for the battle against COVID-19
Date: May 13, 2020
Source:University of Virginia Health System
Summary: Medicine's great triumph over polio holds out hope we can do the same for COVID-19, two researchers say.
For much of the 20th century, summer was considered "polio season," and people were accustomed to seeing swimming pools and movie theaters closed to stave off the latest epidemic. Shaking hands was off limits, and even touching money was perilous. The ever-present threat of death or permanent paralysis from polio was part of life, as were regular social-distancing efforts to limit the terrible disease's spread.
For many younger people in America, the idea of living under threat from a serious infectious disease has been hard to imagine, at least until COVID-19. But now the story of the victory over polio is even more resonant. In a new editorial in the journal Science, UVA Health's William A. Petri, MD, PhD, and graduate student Alexandra N. Donlan highlight medicine's great triumph over polio, at least in the West, and hold out hope we can do the same for COVID-19.
"Nearly four decades ago the United States was faced with a similar challenge, the race to develop a vaccine against an infectious disease," said Petri, an infectious disease expert who is developing a COVID vaccine. "Jonas Salk's demonstration of the ability of vaccination to prevent paralysis due to polio in 1955 led to a nationwide celebration and Salk's invitation to the White House."
Preventing Polio The editorial authors call the prevention of polio epidemics a "signature success of science in the 20th century." But it was no easy task, they note, and the worldwide eradication of polio remains elusive.
Salk first developed an injectable vaccine in the mid-1950s. It was then tested in 2 million children in what Petri and Donlan call a "herculean" effort. "Today," they write, "the faith in, and support of, scientific research by the American public is, arguably, founded on the polio vaccine."
The Oral Vaccine An oral vaccine soon followed, developed by Albert Sabin, and the two vaccines have served as the armament for vanquishing polio around the world. There is a drawback to the oral vaccine, however: Because it is manufactured using live, but weakened, virus, recipients excrete live virus in their stool. This can lead to disease transmission in communities with low vaccination rates, especially in areas with limited sanitation infrastructure. There are also, rarely, cases of the weakened virus taking sufficient hold in a vaccine recipient to allow person-to-person transmission. This has resulted in polio outbreaks in recent years in Africa and parts of Asia. To overcome this, with the support of the Bill & Melinda Gates Foundation there is fast-tracking of clinical trials of a new version of the oral vaccine, much as scientists are fast-tracking potential vaccines for COVID-19.
While more work remains to be done to eradicate polio around the world, the disease's conquest in the West speaks to the tremendous power of vaccine research. Polio, in America, stands alongside measles, mumps, tetanus, smallpox and more as serious diseases that are no longer a serious threat. Hopefully, in the not-too-distant future, COVID-19 will join that list.
"As the world faces COVID-19," the scientists conclude, "it is heartening to see the same application of science to public health for [COVID] as the one used for the last 70 years of polio-virus research."