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January 18 | Daily COVID-19 LST Report

Epidemiology

· Seroprevalence of SARS-CoV-2 antibodies in over 6000 healthcare workers show increased occupational risk. Physicians and laboratory scientists from Spain conducted a cross-sectional study of 6,038 healthcare workers (HCW) across 4 regions in Spain to assess the seroprevalence of IgG anti-SARS-CoV-2 antibodies. They found 11% of HCW (n=662) had IgG against SARS-CoV-2, with those with high (OR: 2.06; 95%CI: 1.63-2.62) and moderate (OR: 1.77; 95%CI: 1.32-2.37) risk exposures more likely to have antibodies. Because this rate of seropositivity is slightly higher than in the general Spanish population, authors suggest their data confirm the occupational risk of SARS-CoV-2 infection among HCW with working in a clinical environment.

· The inhaled steroid Ciclesonide blocks SARS-CoV-2 RNA replication by targeting the viral replication-transcription complex in cultured cells. An in vitro study from the National Institute of Infectious Diseases in Japan evaluates the suppression of coronavirus replication, notably MERS-CoV and SARS-CoV-2, by the inhaled corticosteroid ciclesonide in human bronchial epithelial Calu-3 cells and VeroE6/TMPRSS2 cells. Results show that Ciclesonide reduced SARS-CoV-2 replication in both VeroE6 and Calu-3 cells, and it also suppressed replication (> 90%) in Ciclesonide escape mutants. In light of these results, the authors urge further study evaluating Ciclesonide's mechanism of action and potential clinical utility.

Adjusting Practice During COVID-19

· There was an effect of the COVID-19 pandemic process on STEMI patients’ timeline? An interdisciplinary group of cardiology researchers from hospitals in Samsun and Sivas, Turkey, performed a combined observational analysis as well as chart review to assess the effects that the COVID-19 pandemic has had on the management of ST elevation myocardial infarction (STEMI) patients. They concluded that there was a delayed time to first medical contact (61 minutes in non-pandemic times versus 190 minutes during the pandemic), as well as a delayed time for patients to leave their house after their onset of symptoms (30 minutes in non-pandemic times versus 165 minutes during the pandemic). While this implies that there may need to be widespread analysis of medical responses to patients experiencing STEMI, the authors do comment on the fact that the COVID-19 burden in areas studied was relatively small when compared to hotspots around the world. Further investigation is required in areas that can represent a patient population more severely burdened by COVID-19, however these results suggest an opportunity for quality improvement changes to more efficiently manage patients with STEMI during the pandemic and improve outcomes. · What were the early postoperative outcomes among patients with delayed surgeries after preoperative positive test for SARS-CoV-2? A case-control study conducted by surgeons at the AC Camargo Cancer Center in Sao Paulo, Brazil compared the rate of post-operative complications in 49 patients who had surgery after recovering from asymptomatic SARS-CoV-2 to 98 controls who had surgery but never had COVID-19. Only 14.3% of the control patients and 16.3% of the COVID-recovered patients developed complications within 30 days (OR: 1.17; 95% CI: 0.45–3.0; p=0.74), with 6 controls and 4 COVID-recovered patients developing grade III or higher complications by Clavien‐Dindo classification. Authors suggest there is no increased risk of post-operative complications among patients whose elective surgery was delayed due to asymptomatic SARS-CoV-2 positivity. R&D: Diagnosis & Treatments

· Fluvoxamine when compared to placebo can decrease clinical deterioration in outpatients with symptomatic COVID-19. A double-blind randomized clinical trial, conducted by physicians from Washington University in St. Louis, analyzed the efficacy of fluvoxamine (100 mg 3 times daily for 15 days) against a placebo to decrease clinical deterioration of COVID-19 in non-hospitalized patients with confirmed SARS-CoV-2 infection within 7 days and oxygen saturation 92% or greater. Clinical deterioration (defined as development of both 1) shortness of breath or hospitalization for shortness of breath or pneumonia and 2) oxygen saturation less than 92% on room air or need for supplemental oxygen to achieve oxygen saturation of 92% or greater) occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group without a significant increase in adverse events. This clinical trial supports the hypothesis that fluvoxamine administration for COVID-19 in an outpatient setting can decrease events of clinical deterioration, though an increased sample size and length of follow up is needed. · Repurposed Tocilizumab in patients with severe COVID-19 has shown benefits but need to be further studied. A respective study of 195 hospitalized patients in Wuhan, China found that 65 patients treated with tocilizumab sustained better outcomes compared to 130 matched patients who did not receive the IL-6 inhibitor. The tocilizumab group experienced lower in-hospital death rates, fewer ICU stay days, lower acute respiratory distress syndrome incidence rates, and lower infection related markers (IL-10, CRP).Additionally, T-cell counts were higher in the tocilizumab group, suggesting greater immune system recovery in this group. The authors suggest that, while tocilizumab was able to ameliorate the cytokine release storm associated with mortality in COVID-19, the possibility of negative effects like transaminitis should be further studied and characterized.



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