Tocilizumab has been reported to attenuate the “cytokine storm” in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI–7.19%–21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 ( P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI–99.17% to–17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s11684-020-0824-3 and is accessible for authorized users.

Background Suffering from COVID-19 is a strong psychological stressor to the patients. Even after recovery, patients are prone to a variety of mental health problems. Recently, some studies focus on the psychological situation of patients when they got COVID-19. However, no study focused on the psychological status of recovered COVID-19-infected patients in China. Our study aims to investigate sleep and mood status, and detect the influencing factors of the psychological status of the COVID-19 patients after recovery. Methods One hundred and twenty-five COVID-19 patients were enrolled from February to April 2020. The social demographic information of all participants was collected by a self-designed questionnaire. Insomnia and depression symptoms were evaluated through the Insomnia Severity Index (ISI) and the Center for Epidemiology Scale for Depression (CES-D). Results The rates of insomnia and depression were 26.45% and 9.92% in the COVID-19 patients after recovery. There were significant differences in physical, mental impairment, and the need for psychological assistance between the COVID-19 recovered patients with depression and the patients without depression. In addition, age and health status may be the influencing factors for insomnia, and care about the views of others may be the influencing factor of depression (P<0.05). Conclusions Based on the results, we found that COVID-19 recovered patients had a low rate of depression and a high rate of insomnia. We need to pay more attention to their sleep condition than mood status.

This single-center, retrospective study aimed to explore the immune characteristics of COVID-19 and biomarkers to predict the severity of this disease. Patients infected with SARS-CoV-2 (n = 215) treated at the First Affiliated Hospital of Nanchang University from January 24 to March 12, 2020, were included in the study and classified into severe and non-severe groups. Peripheral immunocyte count and cytokine statuses were compared. The correlation between immune status, cytokine levels, and disease severity was analyzed. Leukocyte numbers were normal in both groups; however, they were relatively high (7.19 × 10 9 / L) in patients of the severe group. Leukocyte distributions differed between the two groups; the severe group had a higher percentage of neutrophils and lower percentage of lymphocytes compared with the non-severe group, and absolute lymphocyte numbers were below normal in both groups, and particularly deficient in patients in the severe group. Lymphocyte counts have negative correlation with duration of hospital period whereas neutrophil count has no significant correlation with it. Of tested cytokines, IL-6 levels were significantly higher in the severe group (P = 0.0418). Low level of lymphocyte predicts severity of COVID-19. IL-6 levels were significantly higher in the severe group, especially in some extremely severe patients. But we did not detect the significant correlation between severity of COVID-19 with IL-6 level which may be due to limited case numbers. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of COVID-19.

The aim of this study was to investigate coronavirus disease 2019 (COVID-19) epidemic characteristics in Africa and provide some references to prevent pandemic. Methods: We collect information of the laboratory-confirmed case of COVID-19 that has been reported since April 28, 2020 in Africa, describe the epidemic characteristics in different regions of Africa, and predict the spread trend. Results: (1) There are 35,309 COVID-19 cases and 1,522 deaths in 54 African countries. Both case amount and death toll in Northern Africa are higher than those in other African regions, whereas the case fatality rate (CFR) in Africa is lower than that of the world. (2) Among the 54 countries in Africa, 39 of them (72.22%) report confirmed cases between 1 and 499. (3) In total, 596,146 tests have been conducted in 35 countries, and 28,271 patients have been confirmed, with a positive rate of 4.74%. However, there are only 335 tests (interquartile range: 145.5-874) for every 1 million people in Africa. (4) The number of infection cases will increase to around 150,000 at the end of May according to our model. Conclusion: In Africa, COVID-19 spreads faster while with a relatively lower CFR, and it may be related to higher young people ratio. In addition, test intensity of COVID-19 is obviously insufficient in Africa.