Κορονοϊός ( COVID-19 )

[Argirios Argiriou]

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[Argirios Argiriou]

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[Argirios Argiriou]

03/07/2020
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[Argirios Argiriou]

13-07-2020

ΕΡΕΥΝΑ-ΚΑΜΠΑΝΑΚΙ ΑΠΟ ΑΠΘ: ΑΝΗΣΥΧΗΤΙΚΗ ΑΥΞΗΣΗ ΚΟΡΩΝΟΪΟΥ ΣΤΑ ΛΥΜΑΤΑ ΤΗΣ ΘΕΣΣΑΛΟΝΙΚΗΣ

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[Argirios Argiriou]

What Have Lockdowns, Social Distancing, Masks, and Other Measures Achieved?

Anthony L. Komaroff, MD reviewing Hsiang S et al. Nature 2020 Jun 8

An estimated 530 million COVID-19 cases possibly were prevented or delayed globally.

July 14, 2020

What Have Lockdowns, Social Distancing, Masks, and Other Measures Achieved?
Anthony L. Komaroff, MD reviewing Hsiang S et al. Nature 2020 Jun 8

An estimated 530 million COVID-19 cases possibly were prevented or delayed globally.

The curves of COVID-19 cases and COVID-19–related hospitalizations and deaths in various countries show a steep upward slope, followed by a plateau and then a fall by July 2020 (except in the U.S., where nationwide numbers still are rising). Thus, lockdowns, social distancing, masks, and related interventions bent the initial curve. But unarguably, the cost of these measures to the economy has been substantial. So how much benefit has resulted from these costly and unpopular pandemic containment measures compared with the alternative: allowing the pandemic to run its course?

A multinational team of social scientists modeled data on the effects of large-scale anticontagion policies in six countries. The team estimates that these measures already have prevented 285 million cases in China, 38 million in South Korea, 49 million in Italy, 54 million in Iran, 45 million in France, and 60 million in the U.S. — a total of 530 million cases prevented or delayed, thus far. If COVID-19–related mortality is 0.5% (a conservative estimate), such measures have prevented 2.65 million deaths.

COMMENT
The investigators do not attempt the difficult task of estimating the money saved by averting COVID-19 cases in 530 million people — or comparing that estimate to the money spent in containment measures so far. However, in addition to the suffering and death averted, the money saved likely exceeds the money spent. Indeed, in retrospect, the world (particularly the U.S.) appears to have erred in not moving more aggressively.

At the time NEJM Journal Watch reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Anthony L. Komaroff, MD at time of publication
Consultant/Advisory Board   SerImmune Inc.; Ono Pharma
Grant / Research Support   NIH (1U54NS105542-01)
Editorial Boards   Harvard Medical School: Harvard Health Publications; Harvard Health Letter
CITATION(S):
Hsiang S et al. The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature 2020 Jun 8; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Argirios Argiriou]

Stephen G. Baum, MD reviewing Long Q-X et al. Nat Med 2020 Jun 18 The Severe Covid-19 GWAS Group N Engl J Med 2020 Jun 17

Asymptomatic confirmed cases shed virus longer and have a weaker, shorter-lived immune response than symptomatic ones, whereas the severest cases are most often seen in individuals with blood type A.

July 8, 2020

Studies on the Extremes of COVID-19
Stephen G. Baum, MD reviewing Long Q-X et al. Nat Med 2020 Jun 18 The Severe Covid-19 GWAS Group N Engl J Med 2020 Jun 17

Asymptomatic confirmed cases shed virus longer and have a weaker, shorter-lived immune response than symptomatic ones, whereas the severest cases are most often seen in individuals with blood type A.

During the 6 months that COVID-19 has wreaked pandemic havoc on the world's population, much remains to be known about this disease, yet much has already been learned. Now, two studies shed some light on pathophysiology at both extremes of the COVID-19 spectrum.

Investigators in China found that 37 asymptomatic confirmed COVID-19 cases (AC) had a median duration of virus shedding (of unknown infectiousness) that was 5 days longer than that of age- and sex-matched symptomatic persons with COVID-19. AC tested positive for virus-specific IgG and IgM in 81.1% and 62.2% of cases, respectively, compared with 83.8% and 78.4% of symptomatic cases. These differences were maintained during the early convalescent phase (8 weeks after hospital discharge), during which time titers decreased in both groups. Anti- and pro-inflammatory cytokine and chemokine levels were also significantly higher in the symptomatic patients.

Another study used genomewide association analysis to examine 8,582,968 single nucleotide polymorphisms in 1980 patients with COVID-19 in Italy and Spain, looking for genetic factors associated with severe disease, defined as need for supplemental oxygen or ventilator-assisted respiration. Two loci, 3p31.21 and 9q34.2, were associated with susceptibility to and severity of COVID-19; 9q34.2 coincided with the ABO blood group locus. Examination of this locus showed that blood type A had the highest correlation with severe disease, whereas blood group O was associated with reduced risk for severe disease. Homozygosity of the 3p31.21 risk allele was associated with younger age of COVID-19 acquisition.

COMMENT
While these two studies address entirely different aspects of COVID-19 infection, and the study of asymptomatic persons was too small to allow for generalization, they both provide useful prognostic value. The first seems to indicate that, compared with symptomatic patients, asymptomatic patients are potentially able to spread the infection for longer (if infectious) and may also be more susceptible to reinfection. The second illuminates a correlation between blood type and disease severity that may explain the variability of outcomes and might inform therapeutic approaches.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Stephen G. Baum, MD at time of publication
Consultant/Advisory Board   Clinical Infectious Diseases
Equity   Select Medical Holdings Corp. (no annual income is derived from this equity holding)
Editorial Boards   Medical Letter
CITATION(S):
Long Q-X et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med 2020 Jun 18; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

The Severe Covid-19 GWAS Group . Genomewide association study of severe Covid-19 with respiratory failure. N Engl J Med 2020 Jun 17; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Argirios Argiriou]

15/07/2020

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[Argirios Argiriou]

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[Argirios Argiriou]

21/07/2020

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[Argirios Argiriou]

Αν η θνησιμότητα είναι τελικά 0,6% τότε ο Ιωαννίδης έχει πέσει αρκετά πιο κοντά από τον π.χ. Μόσιαλο.

19-07-2020 Καθημερινή.

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[Argirios Argiriou]

Γράφει Νοσοκομειακός συνάδελφος στις 23/07/2020 σε Ιατρική Ομάδα του facebook στις 23/07/2020:

Γυναικα 30 ετων χωρις συνοδα νοσήματα προσήλθε στο ΤΕΠ νοσοκομείου λόγω "πυρετού από 10ημερου". Δεν διαπιστώθηκε εστία λοίμωξης. Ελήφθη και επιχρισμα για SARS-CoV-2 το οποίο ήταν αρνητικό. Παραπεμψαμε τη γυναίκα (αφου το τεστ ήταν αρνητικο) στον οικογενειακό της γιατρο για τα περαιτέρω. Δεν έχρηζε εισαγωγής διοτι ήταν αριστη κλινικα. Την επόμενη ημέρα μας τηλεφώνησε και μας είπε ότι απευθύνθηκε σε δυο ιδιώτες οι οποίοι όμως της είπαν ότι δεν βλέπουν εμπυρετα ακόμα και με αρνητικο τεστ! Μου έκανε εντύπωση και ήθελα να ρωτήσω αν το έχουν ακούσει και άλλοι συνάδελφοι αυτό ως πρακτική.

Και του απαντά πολύ σωστά συνάδελφος ιδιώτης Γενικός Ιατρός σε Ιατρική ομάδα του facebook στις 23/07/2020:

Ασθενείς με συμπτώματα συμβατά με covid πρέπει να διαχωριστούν από τους υπόλοιπους ασθενείς, ειδικά τους ηλικιωμένους με χρόνια νοσήματα. Οπότε τα solo ιδιωτικά ιατρεία βγάλτε τα από την εξίσωση. Μόνο με κατ' όικον επίσκεψη και έχοντας λάβει όλα τα ΜΑΠ μπορεί να συνδράμει ο ιδιώτης. Στην περίπτωση αυτή χρειάζονται τα αφιερωμένα covid KY. Αυτό προέβλεπε και ο σχεδιασμός του ΥΥ. Με την επιτυχή διαχείριση της πρώτης φάσης της πανδημίας με το lock down δεν τα χρειαστήκαμε ουσιαστικά. Από το φθινόπωρο με την έξαρση του κοινού κρυολογήματος και της γρίπης θα πρέπει να τα έχουμε σε πλήρη ανάπτυξη διαφορετικά θα υπάρχει πρόβλημα....

Και απαντώ στον πρώτο και εγώ στις 23/07/2020:

Όταν σου λέει ότι σε περίπτωση που βρεθεί στο ιδιωτικό σου Ιατρείο κρούσμα Κοροναϊού θα σου σφραγίσουν το Ιατρείο για 14 ημέρες και θα σε υποχρεώσουν να πληρώσεις από την τσέπη σου την απολύμανση, τι περιμένεις ότι θα κάνει ο ιδιώτης;

[Argirios Argiriou]

July 23, 2020

“I don’t think that this is a disease that we can eradicate – not with the methods that we have right now. It might be a disease that in the long term we can eradicate with a vaccine, but I’m not even sure about that. If you look at comparable diseases like the flu and other respiratory viruses we are not even close to eradicating them despite the fact that we have a vaccine. I personally believe that this is a disease we are going to have to learn to live with.”

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the evidence base for using masks in society is still very weak. Even if more and more countries are now enforcing them in different ways … we haven’t seen any new evidence coming up, which is a little bit surprising. The other reason is that everything tells us that keeping social distance is a much better way of controlling this disease than putting masks on people. We are worried (and we get at least tales from other countries) that people put on masks and then they believe they can go around in society being close to each other, even going around in society being sick. And that, in our view, would definitely produce higher spread than we have right now.”

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His belief is that, in the final account, the Infection Fatality Rate will be similar to the flu: “somewhere between 0.1% and 0.5% of people getting infected, maybe … And that is not radically different to what we see with the yearly flu.”

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On the controversial question of immunity, he suggests that a larger percentage of the population in Sweden is already immune than antibody studies suggest.

“There are a number of small studies already that show that of people who had been diagnosed with Covid-19 with PCR, not all of them develop antibodies. On the other hand we have quite a lot of evidence that falling ill with Covid-19 twice seems to be extremely rare… Obviously there is also quite a big part of the population that has other kinds of immunity and T Cell immunity is the one that is most likely.

“What we see right now is a rapid fall in the number of cases, and of course some kind of immunity has to be involved in that as nothing else has changed. That means that immunity affects the R value quite a lot in Sweden today.”

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[Argirios Argiriou]

COVID-19 Symptoms After Virologic Recovery

Wendy S. Armstrong, MD reviewing Carfì A et al. JAMA 2020 Jul 9

Of patients hospitalized with COVID-19, 87% had persistent symptoms more than 2 months after onset of disease, despite resolution of viral infection.

July 27, 2020

COVID-19 Symptoms After Virologic Recovery
Wendy S. Armstrong, MD reviewing Carfì A et al. JAMA 2020 Jul 9

Of patients hospitalized with COVID-19, 87% had persistent symptoms more than 2 months after onset of disease, despite resolution of viral infection.

Anecdotal reports of prolonged symptomatic recovery after COVID-19 are increasing in the popular press. Now, investigators in Italy report outcomes of 143 patients previously hospitalized for COVID-19, evaluated a mean of 60 days after symptom onset and 36 days after hospital discharge. This observational cohort had a mean age of 56.5 years, 37% were women, and the mean length of hospitalization was 13.5 days. During hospitalization,73% had evidence of interstitial pneumonia, 15% required noninvasive ventilation, and 5% received mechanical ventilation. For this study, participants were virus-free by polymerase chain reaction testing and met World Health Organization criteria for ending quarantine (isolation).

On physical examination and history taking, only 13% of participants reported being symptom-free; 55% had 3 or more symptoms and the remainder had 1 or 2 symptoms. The most common symptoms were fatigue in 53%, dyspnea in 43%, joint pain in 27%, and chest pain in 22%. Compared with their pre-COVID-19 quality of life, 44% reported that their quality of life was ≥10 points lower on a scale of 0 (worst health) to 100 (best health).

COMMENT
The U.S. President has described COVID-19 as “totally harmless” 99% of the time. I suspect this is the first of many reports to suggest that such characterizations are far from true and that survival and recovery are not synonymous. Longitudinal data are needed to fully understand how long symptoms persist and how many become permanent. Whether any effective therapies exist for COVID-19 sequelae is equally unclear. Long-term postacute interdisciplinary clinics are needed to follow-up on these phenomena further.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Wendy S. Armstrong, MD at time of publication
Consultant/Advisory Board   Centers for Disease Control and Prevention/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment
Leadership Positions in Professional Societies   HIV Medicine Association Representative to the Infectious Diseases Society of America (Board of Directors); HIV Medicine Association (Board of Directors); American Board of Internal Medicine Infectious Diseases Subspecialty Board (member)
CITATION(S):
Carfì A et al. Persistent symptoms in patients after acute COVID-19. JAMA 2020 Jul 9; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Argirios Argiriou]

Richard T. Ellison III, MD reviewing Ibarrondo FJ et al. N Engl J Med 2020 Jul 21

Individuals with mild COVID-19 infection have a rapid decline in SARS-CoV-2 antibody levels.

Richard T. Ellison III, MD reviewing Ibarrondo FJ et al. N Engl J Med 2020 Jul 21

Individuals with mild COVID-19 infection have a rapid decline in SARS-CoV-2 antibody levels.

One of the many still unanswered questions regarding COVID-19 is the duration of protective immunity following infection. A recent report from China indicated that individuals with asymptomatic COVID-19 had a less robust immune response to SARS-CoV-2 (NEJM JW Infect Dis Sep 2020 and Nat Med 2020 Jun 18; [e-pub]). California investigators now report further longitudinal data on antibody levels after mild COVID-19.

Thirty-four individuals with mild COVID-19 (30 that were polymerase-chain-reaction assay confirmed) had serial anti–SARS-CoV-2 receptor binding domain IgG levels determined at a mean of 37 and 86 days after symptom onset. The estimated mean IgG half-life was 36 days.

COMMENT
The finding of a relatively short anti–SARS-CoV-2 IgG half-life in these two reports has received substantial coverage in the lay press and does raise concerns regarding the duration of protective immunity that is present both after infection and with a COVID-19 vaccine. Still, the present report did not directly assess neutralizing antibodies, and neither this nor the report from China assessed either T-cell mediated immunity or the potential for an anamnestic response to this virus.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Richard T. Ellison III, MD at time of publication
Consult/Advisory Board   Acurx Pharmaceuticals, LLC; Philips Healthcare
Speaker’s Bureau   Philips Healthcare
Grant/Research Support   Philips Healthcare
CITATION(S):
Ibarrondo FJ et al. Rapid decay of anti–SARS-CoV-2 antibodies in persons with mild Covid-19. N Engl J Med 2020 Jul 21; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)


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[Αρχίατρος]

Επειδή έχω βαρεθεί να διαβάζω συνωμοσιολογικές μπαρούφες τελευταία για τον ιό, πάρτε μια ιστορική αναδρομή από μη-γιατρό:

Ανδρέας Σταλίδης

Ο λοιμός των Αθηνών.

Ένα χρόνο μετά την έναρξη του Πελοποννησιακού Πολέμου ξέσπασε μεγάλος λοιμός στην Αθήνα.

Το 430 π.Χ. πέθανε από τον λοιμό όλη η οικογένεια του Περικλή. Είδε τους δύο γιους τους να πεθαίνουν.

Την επόμενη χρονιά, το 429 π.Χ. πέθανε και ο ίδιος από το δεύτερο ξέσπασμα του ίδιου λοιμού.

Ο λοιμός μετά έκανε μία προσωρινή κάμψη και επανήλθε δριμύτερος το 427 π.Χ., μέχρι να εξαφανιστεί.

Από τον ίδιο λοιμό προσεβλήθη και ο Θουκυδίδης, αλλά κατάφερε και επιβίωσε!

Ευτυχώς να λέμε, διότι αρκετά χρόνια αργότερα μας έγραψε το εντυπωσιακό γραπτό μνημείο για τον Πελοποννησιακό Πόλεμο που ακόμα και σήμερα το διδάσκουν σε όλα τα πανεπιστήμια του κόσμου.

Υπάρχουν περιγραφές για τις επιπτώσεις στην υγεία των ανθρώπων από τον Ιπποκράτη, ο οποίος κι αυτός ζούσε εκείνη την εποχή. (Δεν θυμάμαι αν κόλλησε και ο ίδιος, πιθανώς όχι).

Κανείς δεν ξέρει σε τι ακριβώς οφείλεται εκείνος ο λοιμός. Ποιος ξέρει αν ήταν ιός ή κάτι άλλο, πώς προήλθε.

Όπως έχω ξαναπεί, δεν υπάρχει σελίδα της ανθρώπινης Ιστορίας που να μην έχει κάποιο τέτοιο συμβάν επιδημίας, λοιμού, πανώλης, πανδημίας ή κάτι άγνωστο που να χτύπησε και να θανάτωσε μαζικά τους ανθρώπους. Γιατί η εποχή μας να διαφέρει; Πόσο μοναδικοί ή μάγκες είμαστε;

Ποιος ξέρει τι ανοησίες θα έλεγαν οι Αθηναίοι εκείνης της εποχής μεταξύ τους. Ευτυχώς ή δυστυχώς, δεν καταγράφτηκαν πουθενά.

Τον κατασκεύασαν οι Πέρσες; (οι Κινέζοι της εποχής;), το έφτιαξε ο Βασίλειος Πύλης εξ Εσπερίας για να πουλήσει το εμβόλιο; είναι παραμύθι των Σπαρτιατών για να νικήσουν τον Πόλεμο; ή διάφορες άλλες μπούρδες. (ενεργοποιώ την φαντασία σας).

Κανείς δεν ξέρει, κανείς δεν έμαθε. Σήμερα τουλάχιστον έχουμε ένα όπλο που λέγεται επιστήμη και προσπαθούμε να καταλάβουμε τι συμβαίνει, να φτιάξουμε θεραπείες ή εμβόλιο ή και τα δύο για να προστατευθούμε.

Όπως λέει και ένας grandmaster του σκάκι (Ben Finegold) στα απολαυστικά βίντεό του που παρακολουθώ τον τελευταίο καιρό: "Truth hurts".