Clinical Testing and Evaluations
In a cohort of 145 patients with mild to moderate COVID-19 illness, replication of SARS-CoV-2 in older children led to similar levels of viral RNA as adults, but significantly greater amounts are detected in children younger than 5 years. While the study only looked at nucleic acid levels rather than infectious virus, it draws concerns that young children could potentially be important drivers of SARS-CoV-2 spread in the population.
In a study of 85 COVID+ patients, SARS-CoV-2 RNA in serum (which generally has lower levels that the corresponding viral loads of throat swabs) was detected at highest levels between 11-15 days after symptom onset. The extent of lab derangement was higher and end organ damage was more common in those with higher SAR-CoV-2 RNA serum levels compared to those with lower levels. Mortality rates were also higher among patients with RNAemia.
Treatment
In a comparative analysis of phase 3 data from a remdesivir trial and a retrospective cohort of patients with severe COVID-19 found that remdesivir was associated with significantly greater clinical recovery by day 14 and 62% reduced odds of death versus standard-of-care treatment in patients with severe COVID-19
Observational study of 255 patients w/ COVID-19 found when IL-6 receptor inhibitors (tocilizumab or sarilumab) was administered prior to >45%FiO2 requirements, there was an associated with improved COVID-19 outcomes, such as decreased intubation and reduced mortality.
A retrospective study looking at hospitalized patients with COVID-19 who were admitted to the ICU compared to those not admitted to the ICU, and the clinical data regarding use of tocilizumab (an IL-6 inhibitor) was compared. The ICU group had higher rates of preexisting co-morbidities (hypertension, diabetes, coronary disease, etc) and higher IL‐6 than non- ICU group (all P<0.05). Age, peak IL‐6, and peak d‐dimer were significant predictors of in‐hospital mortality (1.05 [1.01‐1.09], P=0.012, 1.001 [1.000‐1.002], P=0.002, 1.10 [1.03‐1.18], P=0.008). Tocilizumab did not affect in‐hospital mortality after adjustment for confounders including IL‐6 (OR [95% CI]: 1.00 [0.27‐3.72, P=0.998]).
