December 1, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Epidemiology: Is there SARS-CoV-2 persistence and non-protective immunity in infected haematological patients? Greek infectious disease physicians present a case of 35-year-old with a history of acute lymphoblastic leukemia 14 days status-post chemotherapy with R-hyper-CVAD who presented on April 8, 2020 with pneumonia after positive RT-PCR for SARS-CoV-2 on March 26. The patient eventually recovered after a seven-week hospitalization and developed antibodies suggestive of immunologic memory but was later readmitted on July 22 with severe COVID-19 pneumonia despite serologic testing with continued adequate IgG. Authors suggest defective innate and adaptive immunity in immunocompromised patients may facilitate SARS-CoV-2 infection (i.e. antibodies may be non-neutralizing following chemotherapy) and allow persistence or viral reactivation.

—Understanding the Pathology: There may be postmortem findings of diaphragm pathology related to critically ill patients with COVID-19. Critical care physicians conducted a case-control study using autopsies of 26 deceased critically ill COVID-19 patients from 3 medical centers in the Netherlands to analyze the extent of diaphragm involvement. Findings show increased ACE-2 expression and SARS-CoV-2 viral infiltration in the diaphragm of patients who died of severe COVID-19 compared to control specimens from 8 deceased ICU patients without COVID-19, suggesting that diaphragm fibrosis could be a source of respiratory distress in COVID-19 patients.

—Management: Early short-course corticosteroids have beneficial outcomes in hospitalized patients with COVID-19. A quasi-experimental study, conducted by the Henry Ford COVID-19 Management Task Force at multiple hospitals in Michigan, evaluated the effect of early corticosteroid therapy in 132 hospitalized patients with severe to moderate COVID-19 versus 81 COVID-19 patients on standard care treatment. They found that early corticosteroid group (median time to initiation 2 days, IQR 1-3, range 0-8) had less transfers to the ICU (34.9% vs 54.3%, p=0.005), decreased ARDS occurrences (26.6% vs 38.3%, p=0.04), and spent less days in the hospital (5 vs 8 days, p less than 0.001) compared with the standard of care group. These findings suggest that early methylprednisolone therapy in patients with moderate/severe COVID-19 may help curb the inflammatory response elicited by SARS-CoV-2 and thus lead to better outcomes.

—R&D: Diagnosis & Treatments: What is the role of immunoglobulin G and IgM antibodies against SARS-CoV-2? Investigators from the National Clinical Research Center for Infectious Diseases in Shenzhen, China analyzed 347 serum samples from 41 RT-PCR confirmed COVID-19 patients (15 with mild-moderate symptoms, 16 with severe, and 10 with critical) admitted to The Third People’s Hospital of Shenzhen.Results revealed 39% of COVID-19 patients had seroconversion of IgG antibodies against SARS-CoV-2 nucleocapsid (N) protein and spike (S) glycoprotein in an average of 11 days after onset of symptoms, and 51.2% with seroconversion to IgM antibodies in an average of 14 days. Further, critical patients were found to have a delayed, but more robust IgG and IgM response. This understanding of antibody kinetics against SARS-CoV-2 may assist in clinical diagnosis, specifically in utilizing immunoassays as a testing tool during the pandemic.

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