Weekly Review: Clinical testing and treatment

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Weekly Review: Clinical testing and treatment

Weekly Review: Clinical testing and treatment

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]).

|2020-07-31T12:58:55-04:00July 30th, 2020|COVID-19 Literature|0 Comments

About the Author: Megan McHenry

Megan McHenry
Megan S. McHenry, MD, MS, FAAP is a pediatrician and an Assistant Professor of Pediatrics in the Ryan White Center for Pediatric Infectious Disease and Global Health at Indiana University School of Medicine. Dr. McHenry's research focuses on early childhood development in children living in resource-limited settings. This work is frequently aligned with community-engaged research and dissemination and implementation science frameworks. She primarily conducts research in collaboration with the Academic Model for Providing Access to Healthcare (AMPATH) Research Network in Kenya. Dr. McHenry currently has a career development award through the National Institutes of Health to develop a neurodevelopmental screening program for children born to HIV-infected mothers in Kenya. Dr. McHenry is also the Director of Pediatric Global Health Education and a co-Director of the Morris Green Physician-Scientist Development Program at Indiana University School of Medicine. In additional to global health lectures, she also educates residents and students on early childhood development, basic biostatistical techniques, research methodologies, and research ethics. She mentors multiple pediatric fellows, residents, and medical students interested in early childhood development within global contexts.

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