Background Convalescent plasma therapy for COVID‐19 relies on transfer of anti‐viral antibody from donors to recipients via plasma transfusion. The relationship between clinical characteristics and antibody response to COVID‐19 is not well defined. We investigated predictors of convalescent antibody production and quantified recipient antibody response in a convalescent plasma therapy clinical trial. Methods Multivariable analysis of clinical and serological parameters in 103 confirmed COVID‐19 convalescent plasma donors 28 days or more following symptom resolution was performed. Mixed‐effects regression models with piecewise linear trends were used to characterize serial antibody responses in 10 convalescent plasma recipients with severe COVID‐19. Results Donor antibody titres ranged from 0 to 1 : 3892 (anti‐receptor binding domain (RBD)) and 0 to 1 : 3289 (anti‐spike). Higher anti‐RBD and anti‐spike titres were associated with increased age, hospitalization for COVID‐19, fever and absence of myalgia (all P < 0.05). Fatigue was significantly associated with anti‐RBD ( P = 0.03). In pairwise comparison amongst ABO blood types, AB donors had higher anti‐RBD and anti‐spike than O donors ( P < 0.05). No toxicity was associated with plasma transfusion. Non‐ECMO recipient anti‐RBD antibody titre increased on average 31% per day during the first three days post‐transfusion ( P = 0.01) and anti‐spike antibody titre by 40.3% ( P = 0.02). Conclusion Advanced age, fever, absence of myalgia, fatigue, blood type and hospitalization were associated with higher convalescent antibody titre to COVID‐19. Despite variability in donor titre, 80% of convalescent plasma recipients showed significant increase in antibody levels post‐transfusion. A more complete understanding of the dose‐response effect of plasma transfusion amongst COVID‐19‐infected patients is needed.
To the Editor-Understanding the prevalence of coinfections with coronavirus disease 2019 (COVID-19) is crucial to delineating its true clinical impact. Numerous studies have evaluated coinfections in adults with COVID-19, 1-3 but data on pediatric COVID-19 coinfections are limited. Here, we evaluate the burden of coinfections in pediatric COVID-19 patients at 2 large Chicagoland medical centers. Methods We retrospectively reviewed electronic health records of all pediatric patients tested for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from March 9, 2020, through April 30, 2020, in 2 Chicagoland medical centers. At the University of Chicago Medicine, SARS-CoV-2 was diagnosed using one of the following real-time reverse transcriptase polymerase chain reaction (RT-PCR) assays on respiratory specimens: Cobas SARS-CoV-2 RT-PCR assay (Roche Basel, Switzerland) or Xpert Xpress SARS-CoV-2 test (Cepheid, Sunnyvale, CA). Respiratory coinfections were primarily identified using a multiplex RT-PCR respiratory viral panel (RVP) with the following targets: adenovirus, coronavirus 229E/HKU1/NL63/OC43, human metapneumovirus, influenza-A/-B, parainfluenzas 1-4, respiratory syncytial virus, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis, and rhinovirus/enterovirus (FilmArray Respiratory Panel, BioFire Diagnostics, Salt Lake City, UT). Coinfections were also identified using the influenza/respiratory syncytial virus (RSV) RT-PCR assay (Cepheid Xpert Xpress Flu/RSV) known as the influenza/RSV panel (IRP). At NorthShore University HealthSystem, SARS-CoV-2 was identified similarly using RT-PCR: Xpert Xpress or BD Max (Becton Dickinson, Franklin Lakes, NJ). Coinfections were detected using a multiplex RT-PCR panel that contained only the viral targets of the RVP (GenMark Dx, GenMark Diagnostics, Carlsbad, CA), as well as an IRP (Roche Cobas Liat Influenza A/B and RSV). We included all RVPs and IRPs that were obtained within 7 days of a SARS-CoV-2 test.
A system for undertaking antimicrobial stewardship with a mechanism for prospective audit was put in place. The system may be adopted by other public sector hospitals of the developing country.
Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.
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