Coronavirus disease 2019 (COVID-19): a clinical update

Zhou, Min; Zhang, Xinxin; Qu, Jieming

doi:10.1007/s11684-020-0767-8

Cited by 417 publications

(463 citation statements)

References 60 publications

(83 reference statements)

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“…Parts of the lung can have alveolar exudate organization and pulmonary interstitial fibrosis. 7 The presence of microthrombi fits with the observation that abnormal coagulation parameters, including increased plasma d-dimers, are associated with poor prognosis. 8 Anecdotal evidence suggests that peripheral pulmonary thrombosis or embolism might be common in patients with severe COVID-19 (https://renal.org/wp-content/uploads/ 2020/04/COVID-19_synthesis-of-clinical-experience-in-UK-intensive-care_04.04.2020_FINAL.pdf).…”

Section: Introductionsupporting

confidence: 73%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

178

163

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The ongoing novel coronavirus disease pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning.The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive endexpiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

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Section: Introductionsupporting

confidence: 73%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

178

163

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“…Excessive immune responses can trigger cytokine storms and cause damage to multiple target organs. Recent guidelines also point that a progressive rise in IL-6 may be a clinical warning indicator for the deterioration of COVID-19 13 . Tocilizumab, a monoclonal antibody against interleukin-6, emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms recently 14 .…”

Section: Discussionmentioning

confidence: 99%

Improved survival outcome in SARs-CoV-2 (COVID-19) Acute Respiratory Distress Syndrome patients with Tocilizumab administration

Wadud

Ahmed

Shergil

et al. 2020

Preprint

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Background: The novel human coronavirus, severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), was declared a global pandemic by the World Health Organization on March 11, 2020. Hence, there is an urgency to find effective treatment. Of those patients afflicted in the United States, many have required treatment with ventilator secondary to acute respiratory distress syndrome (ARDS). Data are needed regarding the benefit of treatment and prevention of the cytokine storms in COVID-19 patients with Tocilizumab. Methods: Clinical outcomes data for patients admitted to Orange Regional Medical Center with confirmed COVID-19 from Mar 15, 2020 to Apr 20, 2020 were identified through electronic health record chart review. We conducted a retrospective case-control study in confirmed COVID 19 positive patients with ARDS requiring mechanical ventilation and compared outcome in terms of mortality and length of stay amongst those who received Tocilizumab as treatment modality opposed to those that did not. Results: A total of 94 patients with COVID-19 ARDS were analyzed. 44 were in the study group and 50 in the control group. We tried to match both group as close as possible in terms of age, sex, BMI and HS score- calculated using inflammatory markers- ferritin, triglycerides, AST and fibrinogen. The median age was 55.5 years in the study group and 66 in the control group, difference was not statistically significant. Average HS score was 114 in the Tocilizumab group and 92 in the control group, difference was statistically significant with P<0.0001. Also, the patients in the study group had elevated levels of IL-6, triglycerides, AST, ferritin which were statistically significant with p < 0.0001 when compared to the control group. Length of stay was longer, average 17.9 days in the Tocilizumab. Survival rate was much lower at 48 % in the control group and 61.36 % in patients who received Tocilizumab with significant P value of < 0.00001. The number needed to treat (NNT) was 7.48, if we treat 8 patients with Tocilizumab, 1 will not die. Conclusions: Cytokine Release Syndrome (CRS) occurs in a large number of patients with severe COVID-19, which is also an important cause of death. IL- 6 is the key molecule of CRS, so IL-6R antagonist Tocilizumab may be of value in improving outcomes. In our study Tocilizumab group seemed to have improved survival outcome. Results have to be interpreted with caution since this is a retrospective study and mortality is affected by multiple, confounding factors. We await the results of ongoing randomized controlled trials to definitely answer the question of whether Tocilizumab improves survival in COVID-19 ARDS patients.

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“…Recent data from infections in special contexts such as cruise liners (9) and in close contacts of COVID-19 patients (10) have demonstrated that SARS-CoV-2-specific RT-PCR may be positive in the early phase of the disease, and that viral shedding in the asymptomatic phase and in the early prodromal phase can be considerable. (11,12) At present screening of asymptomatic individuals by RT-PCR has been constrained by limited testing capacity, and the need to focus on public health efforts and resources on symptomatic persons.…”

Section: Clinical and Immunodiagnostic Trajectory Of Covid-19 And Sammentioning

confidence: 99%

Diagnosis of COVID-19: Considerations, Controversies and Challenges in South Africa

Dheda¹,

Davids²,

Chang³

et al. 2020

WJCM

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Coronavirus disease 2019 (COVID-19): a clinical update

Cited by 417 publications

References 60 publications

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Improved survival outcome in SARs-CoV-2 (COVID-19) Acute Respiratory Distress Syndrome patients with Tocilizumab administration

Diagnosis of COVID-19: Considerations, Controversies and Challenges in South Africa

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