October 6, 2020 - a podcast by COVID19LST

In today's episode we discuss:

—Understanding the Pathology: Discordance between Serum Neutralizing Antibody (NAbs) Titers and the Recovery from COVID-19 was seen in a cross-sectional study of adult serum samples after recovery from COVID-19 (n=49) conducted at Bezmialem Vakif University Hospital in Turkey. 20.36% of participants had low titers of NAbs, while NAbs increased with the severity of disease (r=0.73, p=0.016, 95%CI 0.18-0.93) and patient age (r=0.29, p=0.04,95%CI 0.01-0.53). Authors suggest COVID-19 recovery may not be dependent on antibody titers alone and the SARS-CoV-2 immune response likely depends on patient age, disease severity, and several other complex factors.

—Management: Treatment of COVID-19 atypical pneumonia by early Tocilizumab administration in "non-critically-ill" patients on hemodialysis was explored in three case reports of hemodialysis (HD) patients with atypical COVID-19 pneumonia and progressively worsening alteration of inflammatory markers, most notably increased interleukin-6 (IL-6). All three patients showed significant symptom improvement and progressive resolution of disease after administration of tocilizumab (an anti-IL-6 monoclonal antibody). These findings show potential for tocilizumab as a treatment option for atypical COVID-19 pneumonia, specifically for patients on HD.    

—R&D: Diagnosis & Treatments: Androgen Receptor Genetic Variant Predicts COVID-19 Disease Severity according to a Prospective Longitudinal Study of Hospitalized COVID-19 Male Patients. The study followed 65 hospitalized male COVID-19 patients over 60 days and found that patients with high glutamine (CAG) repeats in the androgen response (AR) gene had longer hospitalizations (mean: 45.7 days) and a high rate of ICU admissions (70.6%) compared to patients with low CAG repeats (mean 25 days, 45.2%). These findings suggest AR CAG length is associated with severe COVID-19 disease in males, which supports current evidence of the importance of androgens in SARS-CoV-2 infection. The authors recommend AR CAG length as a potential biomarker for risk of ICU admission and suggest further study into the use of anti-androgens in treating COVID-19.    

· Mass screening of asymptomatic persons (n=1,924) for SARS-CoV-2 using saliva conducted in Japan by researchers affiliated with Hokkaido University Hospital and Hokkaido Graduate School of Medicine found self-collected saliva and nasopharyngeal swabs had equivalent utility with similar specificity and sensitivity as specimens for nucleic acid amplification. Authors suggest the self-collected saliva method may be superior to nasopharyngeal swabs for mass testing in asymptomatic populations as it eliminates close contact between the test subject and provider, allows for parallel sample collection, and minimizes discomfort.

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