Epidemiology
· A case-control study by a multidisciplinary team of Italian researchers examined autoimmune and inflammatory markers in 40 hospitalized COVID-19 patients compared to 40 healthy control patients and found that in addition to having elevated inflammatory markers such as IL-6, LDH and ferritin, blood samples of these COVID-19 patients also showed the presence of IgG autoantibodies such as ANA, ANCA, and ASCA IgG. Authors argue that patients with COVID-19 may be more susceptible to developing a new autoimmune response which can correlate to more severe disease and worse prognosis.
Understanding the Pathology
· A physician from the University of Oxford, UK explains the biology of the infectious cycle of SARS-CoV-2 and the immunopathology behind the clinical symptoms of the virus: cells that express the ACE2 receptor and TMPRSS2 serine protease are more susceptible to SARS-CoV-2 infection, disease progression is related to both an abnormal immune response and viral spread, and the lymphopenia and cytokine storms seen in COVID-19 are due to down-regulation of major histocompatibility complex 1 restricted antigen presentation and increased secretion of pro-inflammatory cytokines.
Management
· Investigators from Regeneron Pharmaceuticals report results from their ongoing, randomized, double-blind, phase 1–3 trial of their neutralizing antibody cocktail (REGN-COV2) in non-hospitalized patients with COVID-19 between June 16 and August 13, 2020. They found the least-squares mean difference in SARS-CoV-2 viral load at seven days between the REGN-COV2 dose group (n=182) and the placebo group (n=93) was −0.41 log10 copies/mL (95% CI: −0.71 to −0.10), with a more significant reduction in subjects who had not mounted an antibody response at the time of randomization. No significant adverse effects were reported. The authors concluded the REGN-COV2 antibody cocktail reduced viral load without significant adverse effects but, because there was no formal hypothesis testing, recommend further analysis of this ongoing trial to confirm these results.
Adjusting Practice During COVID-19
· A team of American cardiologists and emergency medicine physicians used a US registry (CARES) of out-of-hospital cardiac arrest (OHCA) to compare outcomes between March 16 and April 30, 2020 to the same period in 2019 and found lower rates of sustained return of spontaneous circulation (ROSC) during the COVID-19 pandemic compared to 2019 (23.0% vs 29.8%; p<0.001), with higher incidence of OHCA in communities with high (adjusted mean difference [AMD], 38.6 [95% CI, 37.1-40.1] per million residents) and very high (AMD, 28.7 [95% CI, 26.7-30.6] per million residents) COVID-19 mortality. Survival to discharge after OHCA was also lower during the pandemic than in 2019 (6.6% vs 9.8%, p=0.048). Authors suggest the lower rates of sustained ROSC indicates a need to better understand potential underlying causes, such as the impact of infection prevention protocols implemented early in the pandemic, and care-seeking behaviors in the community.
R&D: Diagnosis & Treatments
· A systematic review and meta-analysis of 26 articles conducted by gastrointestinal specialists in Spain found liver injury and elevated liver function tests (LFTs) upon admission were significantly associated with higher risk of severe COVID-19. They identified markers including elevations of AST, ALT and bilirubin, which were associated with worse outcomes (specificities of 78%, 77%, and 94% respectively), suggesting the usefulness of incorporating these laboratory markers into existing tools for COVID-19 monitoring and prognosis determination.
Mental Health & Resilience Needs
· A multidisciplinary team of researchers associated with the Centers for Disease Control and Prevention (CDC) discuss evidence of increased emergency room visits and hospitalizations for child abuse/neglect during the COVID-19 pandemic when compared to 2019. Authors attribute this trend to increases in stress, substance use, mental health issues, and financial hardships as a result of the pandemic and advocate for increased awareness of child abuse/neglect and outline specific prevention strategies recommended by the CDC.
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