The Indian Practitioner

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

COVID-19: Current Perspectives


Affiliations
1 Consultant Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
     

   Subscribe/Renew Journal


COVID-19 has caused disruption, damage and death at an unprecedented scale. Knowledge about this disease is constantly evolving. The mode of transmission is believed to be primarily through droplet spread during face to face contact. In addition to the classical symptoms of fever, fatigue and breathlessness, loss of sense of smell and taste, skin manifestations and anorexia/ nausea/ diarrhea are emerging as new symptoms. The virus is now known to cause complications of almost all organ systems including blood vessels, heart, lung, kidney, brain and liver. The pediatric multi system inflammatory syndrome (PIMS) is a well-defined entity. Diagnosis is still by RT PCR in respiratory secretions. Obesity, genetic susceptibility have emerged as additional risk factors for severe disease. Evidence supports use of oxygen, anticoagulation, steroids and remdesivir in treatment of severe COVID-19. Steroids should not be given to non-hypoxic patients. Hydroxychloroquine, lopinavir ritonavir and azithromycin are no longer recommended for treatment. The jury is still out for tocilizumab and convalescent plasma. Patients can now be de-isolated 10-20 days after onset of symptoms for mild and severe disease respectively and demonstration of negative swabs is no longer essential. Vaccine development is underway.

Keywords

COVID-19, SARS-CoV-2, Remdesivir, Glucocorticoids, Tocilizumab, Convalescent plasma, Hydroxychloroquine.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Johns Hopkins University of Medicine. Coronavirus research centre. Available at www. https://coronavirus.jhu.edu/. Accessed on August 8, 2020.

  • Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 [COVID-19]: A Review. JAMA. doi:10.1001/jama.2020.12839.

  • Agyeman AA, Chin KL, Landersdorfer CB, Liew D, OforiAsenso R. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2020;95[8]:1621-1631.

  • Gottlieb M, Long B. Dermatologic manifestations and complications of COVID-19. Am J Emerg Med. 2020; 38[9]:17151721.

  • Zarifian A, Zamiri Bidary M, Arekhi S, et al. Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: A systematic review and meta-analysis. J Med Virol. 2020;10.1002/jmv.26314.

  • Gavriatopoulou M, Korompoki E, Fotiou D, et al. Organspecific manifestations of COVID-19 infection. Clin Exp Med. 2020;1-14. doi:10.1007/s10238-020-00648-x.

  • Gupta A, Madhavan MV, Sehgal K, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020; 26[7]:1017-1032.

  • Sethuraman N, Jeremiah SS, Ryo A. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA. 2020;10.1001/jama.2020.8259.

  • Huang P, Liu T, Huang L, et al. Use of Chest CT in Combination with Negative RT-PCR Assay for the 2019 Novel Coronavirus but High Clinical Suspicion. Radiology. 2020; 200330.

  • Indian Council of Medical Research. Newer Additional Strategies for COVID-19 Testing Dated: 23/06/2020. Available at https://www.icmr.gov.in/pdf/covid/strategy/New_additional_ Advisory_23062020_3.pdf. Accessed on August 8,2020.

  • Potere N, Valeriani E, Candeloro M, et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Crit Care. 2020;24[1]:389.

  • Xu L, Mao Y, Chen G. Risk factors for 2019 novel coronavirus disease [COVID-19] patients progressing to critical illness: a systematic review and meta-analysis. Aging [Albany NY]. 2020;12[12]:12410-12421.

  • Yousefzadegan S, Rezaei N. Case Report: Death due to COVID-19 in Three Brothers. Am J Trop Med Hyg. 2020; 102[6]:1203-1204.

  • Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020;/j/cclm.ahead-of-print/cclm-2020-0198/cclm-2020-0198.xml.

  • Lee Dickens BS, Lim JT, Low JW, et al. Simple ‘Rule-of-6’ predicts severe COVID-19 disease. Clin Infect Dis. 2020; ciaa938. doi:10.1093/cid/ciaa938.

  • Ministry of Health and Family Welfare, Govt of India. Clinical management protocol version 4. Dated 27/6/2020. Available at https://www.mohfw.gov.in/pdf/ ClinicalManagementProtocolfor COVID19dated27062020.pdf. Accessed on August 8,2020.

  • World Health Organization. Clinical Management of COVID 19. Dated 27/5/2020. Available at https://www.who.int/publications/i/item/clinical-management-of-covid-19. Accessed on August 2,2020.

  • Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Engl J Med. 2020;10.1056/ NEJMoa2019014.

  • Cai, M. Yang, D. Liu et al., Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study, Engineering, https://doi.org/10.1016/j.eng.2020.03.007.

  • Chen C, Zhang Y, Huang J et al. Favipiravir versus Arbidol for COVID-19: A Randomized Clinical Trial. Available at https://www.medrxiv.org/content/medrxiv/early/2020/04/15/2020.03.17.20037432.full.pdf. Accessed on August 8,2020.

  • Glenmark announces top-line results from Phase 3 clinical trial of favipiravir for COVID-19 treatment. Available at https://www.expresspharma.in/covid19-updates/glenmarkannouncestop-line-results-from-phase-3-clinical-trial-offavipiravirfor-covid-19-treatment/. Accessed on August 4, 2020.

  • RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med. 2020;10.1056/ NEJMoa2021436.

  • Remdesivir shows clinical improvement in Phase III Covid-19 trial. Available at https://www.clinicaltrialsarena.com/news/gilead-remdesivir-phaseiii-trial-data/. Accessed on August 4,2020.

  • Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 [COVID-19]. Crit Care Med. 2020;48[6]:e440-e469. .

  • Raoof S, Nava S, Carpati C, Hill NS. “How I Do It: High Flow, Non-invasive ventilation and Awake [non-intubation] Proning in Covid-19 Patients with Respiratory Failure. Chest. 2020; S0012-3692[20]31910-3.

  • Fadel R, Morrison AR, Vahia A, et al. Early Short Course Corticosteroids in Hospitalized Patients with COVID-19. Clin Infect Dis. 2020; ciaa 601. doi:10.1093/cid/ciaa601.

  • Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. N Engl J Med. 2020;10.1056/NEJMoa2007764.

  • Somers EC, Eschenauer GA, Troost JP, et al. Tocilizumab for treatment of mechanically ventilated patients with COVID-19. Clin Infect Dis. 2020; ciaa954. doi:10.1093/cid/ ciaa954.

  • Patel K, Gooley TA, Bailey N, et al. Use of the IL-6R Antagonist Tocilizumab in Hospitalized COVID-19 Patients. J Intern Med. 2020;10.1111/joim.13163. doi:10.1111/joim.13163

  • Roche’s Actemra fails to meet Phase III goals in Covid-19 patients. Available at https://www.clinicaltrialsarena.com/news/roche-actemra-covid-data/. Accessed on August 8,2020.

  • Ye M, Fu D, Ren Y, et al. Treatment with convalescent plasma for COVID-19 patients in Wuhan, China. J Med Virol. 2020;10.1002/jmv.25882. doi:10.1002/jmv.25882.

  • Li L, Zhang W, Hu Y, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial JAMA. 2020; 324[5]:1-11.

  • Gharbharan A, Jordans C, GeurtsvanKessel C et al. Convalescent Plasma for COVID-19. A randomized clinical trial. Available at https://www.medrxiv.org/content/10.1101/2020.07.01.20139857v1. Accessed on August 5,2020.

  • Horby P, Mafham M, Linsell L. Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19: Preliminary results from a multi-centre, randomized, controlled trial.Available at https://www.medrxiv.org/content/10.1101/2020.07.15.201 51852v1. Accessed on August1, 2020.

  • Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020; 382[19]:1787-1799.

  • American Society of Hematology. COVID-19 and VTE/anticoagulation: frequently asked questions. 2020. Available at: https://www.hematology.org/covid-19/covid-19-and-vteanticoagulation. Accessed May 8, 2020.

  • Rokadiya S, Gil E, Stubbs C, Bell D, Herbert R. COVID-19: Outcomes of patients with confirmed COVID-19 re-admitted to hospital. J Infect. 2020; 81[3]:e18-e19.

  • Centers for Disease Control. Duration of Isolation and Precautions for Adults with COVID-19. Available at https:// www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation. html. Accessed on August3, 2020.

  • Rao SN, Manissero D, Steele VR, Pareja J. A Narrative Systematic Review of the Clinical Utility of Cycle Threshold Values in the Context of COVID-. Infect Dis Ther. 2020; 1-14.

  • Chawla D, Chirla D, Dalwai S, et al. Perinatal-Neonatal Management of COVID-19 Infection - Guidelines of the Federation of Obstetric and Gynecological Societies of India [FOGSI], National Neonatology Forum of India [NNF], and Indian Academy of Pediatrics [IAP]. Indian Pediatr. 2020; S097475591600154.

  • Api O, Sen C, Debska M, et al. Clinical management of coronavirus disease 2019 [COVID-19] in pregnancy: recommendations of WAPM-World Association of Perinatal Medicine. J Perinat Med. 2020;/j/jpme.ahead-of-print/jpm-2020-0265/jpm-2020-0265.xml.

  • Dhochak N, Singhal T, Kabra SK, Lodha R. Pathophysiology of COVID-19: Why Children Fare Better than Adults?. Indian J Pediatr. 2020; 87[7]:537-546.

  • Whittaker E, Bamford A, Kenny J, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020;e2010369.

  • Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020; 581[7809]:465-469.

  • Deng W, Bao L, Liu J, et al. Primary exposure to SARS-CoV-2 protects against reinfection in rhesus macaques. Science. 2020; eabc5343. doi:10.1126/science.abc5343

  • Lu J, Peng J, Xiong Q, Liu Z, Lin H, Tan X, et al. Clinical, immunological and virological characterization of COVID-19b patients that test re-positive for SARS-CoV-2 by RT-PCR. [Preprint] Medrxiv. 2020. Available at: https://www.medrxiv.org/content/10.1101/2020.06.15.20131748v1

  • Phelan AL. COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges. Lancet. 2020; 395[10237]:1595‐1598.

  • Boulware DR, Pullen MF, Bangdiwala AS, et al. A Randomized Trial of Hydroxychloroquine as Post exposure Prophylaxis for Covid-19. N Engl J Med. 2020; 383[6]:517-525.

  • Indian Council of Medical Research. Revised advisory on the use of Hydroxychloroquine [HCQ] as prophylaxis for SARSCoV2 infection. Dated 22/5/2020. Available at https://www.icmr.gov.in/pdf/covid/techdoc/V5_Revised_advisory_on_ the_use_of_HCQ_SARS_CoV2_infection.pdf. Accessed on August 1,2020.

  • COVID-19 vaccine tracker. Available at https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccinetracker. Accessed on August 8,2020.


Abstract Views: 275

PDF Views: 0




  • COVID-19: Current Perspectives

Abstract Views: 275  |  PDF Views: 0

Authors

Tanu Singhal
Consultant Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India

Abstract


COVID-19 has caused disruption, damage and death at an unprecedented scale. Knowledge about this disease is constantly evolving. The mode of transmission is believed to be primarily through droplet spread during face to face contact. In addition to the classical symptoms of fever, fatigue and breathlessness, loss of sense of smell and taste, skin manifestations and anorexia/ nausea/ diarrhea are emerging as new symptoms. The virus is now known to cause complications of almost all organ systems including blood vessels, heart, lung, kidney, brain and liver. The pediatric multi system inflammatory syndrome (PIMS) is a well-defined entity. Diagnosis is still by RT PCR in respiratory secretions. Obesity, genetic susceptibility have emerged as additional risk factors for severe disease. Evidence supports use of oxygen, anticoagulation, steroids and remdesivir in treatment of severe COVID-19. Steroids should not be given to non-hypoxic patients. Hydroxychloroquine, lopinavir ritonavir and azithromycin are no longer recommended for treatment. The jury is still out for tocilizumab and convalescent plasma. Patients can now be de-isolated 10-20 days after onset of symptoms for mild and severe disease respectively and demonstration of negative swabs is no longer essential. Vaccine development is underway.

Keywords


COVID-19, SARS-CoV-2, Remdesivir, Glucocorticoids, Tocilizumab, Convalescent plasma, Hydroxychloroquine.

References