Adult Coronavirus Disease 2019 Research Articles

Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: a systematic review and meta-analysis.

ObjectivesTo compare the chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) to other non-COVID viral pneumonia.MethodsMEDLINE, EMBASE, and Cochrane databases were searched through April 04, 2020, for published English language studies. Studies were eligible if they included immunocompetent patients with up to 14 days of viral pneumonia. Subjects had a respiratory tract sample test positive for COVID-19, adenovirus, influenza A, rhinovirus, parainfluenza, or respiratory syncytial virus. We only included observational studies and case series with more than ten patients. The pooled prevalence of each chest CT pattern or finding was calculated with 95% confidence intervals (95% CI).ResultsFrom 2263 studies identified, 33 were eligible for inclusion, with a total of 1911 patients (COVID-19, n = 934; non-COVID, n = 977). Frequent CT features for both COVID-19 and non-COVID viral pneumonia were a mixed pattern of ground-glass opacity (GGO) and consolidation (COVID-19, 0.37; 0.17–0.56; non-COVID, 0.46; 0.35–0.58) or predominantly GGO pattern (COVID-19, 0.42; 0.28–0.55; non-COVID 0.25; 0.17–0.32), bilateral distribution (COVID-19, 0.81; 0.77–0.85; non-COVID, 0.69; 0.54–0.84), and involvement of lower lobes (COVID-19, 0.88; 0.80–0.95; non-COVID, 0.61; 0.50–0.82). COVID-19 pneumonia presented a higher prevalence of peripheral distribution (COVID-19 0.77; 0.67–0.87; non-COVID 0.34; 0.18–0.49), and involvement of upper (COVID-19, 0.77; 0.65–0.88; non-COVID 0.18; 0.10–0.27) and middle lobes (COVID-19, 0.61; 0.47–0.76; non-COVID 0.24; 0.11–0.38).ConclusionExcept for a higher prevalence of peripheral distribution, involvement of upper and middle lobes, COVID-19, and non-COVID viral pneumonia had overlapping chest CT findings.Key Points • Most common CT findings of coronavirus disease 2019 (COVID-19) were a predominant pattern of ground-glass opacity (GGO), followed by a mixed pattern of GGO and consolidation, bilateral disease, peripheral distribution, and lower lobe involvement. • Most frequent CT findings of non-COVID viral pneumonia were a predominantly mixed pattern of GGO and consolidation, followed by a predominant pattern of GGO, bilateral disease, random or diffuse distribution, and lower lobe involvement. • COVID-19 pneumonia presented a higher prevalence of peripheral distribution, and involvement of upper and middle lobes compared with non-COVID viral pneumonia Electronic supplementary materialThe online version of this article (10.1007/s00330-020-07018-x) contains supplementary material, which is available to authorized users.

Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases.

Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups—non-critically ill, critically ill, and death groups—in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52–71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/s11427-020-1733-4 and is accessible for authorized users.

Olfactory and Gustatory Dysfunction as an Early Identifier of COVID-19 in Adults and Children: An International Multicenter Study.

ObjectiveTo evaluate the prevalence and characteristics of olfactory or gustatory dysfunction in coronavirus disease 2019 (COVID-19) patients.Study DesignMulticenter case series.SettingFive tertiary care hospitals (3 in China, 1 in France, 1 in Germany).Subjects and MethodsIn total, 394 polymerase chain reaction (PCR)–confirmed COVID-19-positive patients were screened, and those with olfactory or gustatory dysfunction were included. Data including demographics, COVID-19 severity, patient outcome, and the incidence and degree of olfactory and/or gustatory dysfunction were collected and analyzed. The Questionnaire of Olfactory Disorders (QOD) and visual analog scale (VAS) were used to quantify olfactory and gustatory dysfunction, respectively. All subjects at 1 hospital (Shanghai) without subjective olfactory complaints underwent objective testing.ResultsOf 394 screened subjects, 161 (41%) reported olfactory and/or gustatory dysfunction and were included. Incidence of olfactory and/or gustatory disorders in Chinese (n = 239), German (n = 39), and French (n = 116) cohorts was 32%, 69%, and 49%, respectively. The median age of included subjects was 39 years, 92 of 161 (57%) were male, and 10 of 161 (6%) were children. Of included subjects, 10% had only olfactory or gustatory symptoms, and 19% had olfactory and/or gustatory complaints prior to any other COVID-19 symptom. Of subjects with objective olfactory testing, 10 of 90 demonstrated abnormal chemosensory function despite reporting normal subjective olfaction. Forty-three percent (44/102) of subjects with follow-up showed symptomatic improvement in olfaction or gustation.ConclusionsOlfactory and/or gustatory disorders may represent early or isolated symptoms of severe acute respiratory syndrome coronavirus 2 infection. They may serve as a useful additional screening criterion, particularly for the identification of patients in the early stages of infection.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Clinical Characteristics and Outcomes of First 100 Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) Patients: A Single Center Experience

Since December 2019, the world has witnessed the Coronavirus disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2, which has been declared a pandemic by the World Health Organization in March 2020. We share our initial experience at a center in Dubai, UAE, with a diverse ethnic population and present the clinical characteristics of the first 100 laboratory-confirmed coronavirus disease patients. In this retrospective, single center study, we included all adult (≥12 years old) laboratory-confirmed COVID-19 patients who presented at Al Kuwait Hospital, Dubai, UAE between 21 February 2020 and 15 April 2020. We extracted data on the demograhics, clinical presentation, laboratory and imaging results, treatment, complications and outcomes from the electronic medical records. Results are expressed as counts and percentages for categorical variables, and mean (with range) for continuous variables. A total of one hundred patients were studied. Mean age was 44 years (range 13-82 years); 16% were aged more than 60 years. 69% were males. Most of the patients (41%) belonged to South Asia, while 33% belonged to the Middle East. 21% were diabetics, 20% were hypertensives, 10% were active smokers and 6% were known cases of asthma/chronic obstructive lung disease. Upon admission, fever (46%) and dry cough (41%) were the most common symptoms, while 24% were asymptomatic on admission. Mean duration of symptoms before hospital admission was 5.1 days (range 1-14 days). Upon admission, 8% had low platelets, 7% had lymphopenia, 61% had high C-reactive protein, 48% had high ferritin, 37% had high lactate dehydrogenase, and 31% had high D-dimers. 63% had normal chest radiography upon presentation. Computed tomography chest showed ground glass opacification in 80%, consolidation in 21% while 14% had ill defined patchy opacities. All lesions were located peripherally and 79% had bilateral involvement with predominantly lower lobe disease. 8% had critical illness. Chloroquine/hydroxychloroquine (93%) and the protease inhibitor lopinavir-ritonavir (86%) were the most commonly prescribed treatment. 8% needed non-invasive ventilation and 7% were intubated and ventilated invasively. 7% developed acute repiratory distress syndrome, 5% went into septic shock and needed vasopressor support, 2% developed acute cardiac injury, 17% had acute kidney injury, 11% had acute liver injury and 2% developed disseminated intravascular coagulation. Almost half of the patients (49%) were declared recovered after having two negative COVID-19 PCR tests while 5% died. We concluded that the Coronavirus disease 2019 (COVID-19) presents with different clinical characteristics in the UAE with an ethnic diverse background. Majority affected were young, males and diabetic. One-fourth were asymptomatic on admission, while fever and dry cough were the most common symptoms. High C-reactive protein and ferritin on admission was common. Most of the patients had normal chest radiograph on admission, while computed tomography chest showed the characteristic findings in over two-thirds. Almost half of our patients recovered while 5% died. This is an intial experience only and increased patient cohort will provide further information.

CT in coronavirus disease 2019 (COVID-19): a systematic review of chest CT findings in 4410 adult patients.

ObjectiveThe objective of this systematic review was to evaluate the key imaging manifestations of COVID-19 on chest CT in adult patients by providing a comprehensive review of the published literature.MethodsWe performed a systematic literature search from the PubMed, Google Scholar, Embase, and WHO databases for studies mentioning the chest CT imaging findings of adult COVID-19 patients.ResultsA total of 45 studies comprising 4410 patients were included. Ground glass opacities (GGO), in isolation (50.2%) or coexisting with consolidations (44.2%), were the most common lesions. Distribution of GGOs was most commonly bilateral, peripheral/subpleural, and posterior with predilection for lower lobes. Common ancillary findings included pulmonary vascular enlargement (64%), intralobular septal thickening (60%), adjacent pleural thickening (41.7%), air bronchograms (41.2%), subpleural lines, crazy paving, bronchus distortion, bronchiectasis, and interlobular septal thickening. CT in early follow-up period generally showed an increase in size, number, and density of GGOs, with progression into mixed areas of GGOs plus consolidations and crazy paving, peaking at 10–11 days, before gradually resolving or persisting as patchy fibrosis. While younger adults more commonly had GGOs, extensive/multilobar involvement with consolidations was prevalent in the older population and those with severe disease.ConclusionThis review describes the imaging features for diagnosis, stratification, and follow-up of COVID-19 patients. The most common CT manifestations are bilateral, peripheral/subpleural, posterior GGOs with or without consolidations with a lower lobe predominance. It is pertinent to be familiar with the various imaging findings to positively impact the management of these patients.Key Points • Ground glass opacities (GGOs), whether isolated or coexisting with consolidations, in bilateral and subpleural distribution, are the most prevalent chest CT findings in adult COVID-19 patients. • Follow-up CT shows a progression of GGOs into a mixed pattern, reaching a peak at 10–11 days, before gradually resolving or persisting as patchy fibrosis. • Younger people tend to have more GGOs. Older or sicker people tend to have more extensive involvement with consolidations. Electronic supplementary materialThe online version of this article (10.1007/s00330-020-06975-7) contains supplementary material, which is available to authorized users.

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Background:A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients.Methods:With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded.Results:Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT.Conclusion:Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.

Rapid Implementation of an Adult Coronavirus Disease 2019 Unit in a Children's Hospital

ObjectiveTo describe the rapid implementation of an adult coronavirus disease 2019 (COVID-19) unit using pediatric physician and nurse providers in a children's hospital and to examine the characteristics and outcomes of the first 100 adult patients admitted.Study designWe describe our approach to surge-in-place at a children's hospital to meet the local demands of the COVID-19 pandemic. Instead of redeploying pediatric providers to work with internist-led teams throughout a medical center, pediatric physicians and nurses organized and staffed a 40-bed adult COVID-19 treatment unit within a children's hospital. We adapted internal medicine protocols, developed screening criteria to select appropriate patients for admission, and reorganized staffing and equipment to accommodate adult patients with COVID-19. We used patient counts and descriptive statistics to report sociodemographic, system, and clinical outcomes.ResultsThe median patient age was 46 years; 69% were male. On admission, 78 (78%) required oxygen supplementation. During hospitalization, 13 (13%) eventually were intubated. Of the first 100 patients, 14 are still admitted to a medical unit, 6 are in the intensive care unit, 74 have been discharged, 4 died after transfer to the intensive care unit, and 2 died on the unit. The median length of stay for discharged or deceased patients was 4 days (IQR 2, 7).ConclusionsOur pediatric team screened, admitted, and cared for hospitalized adults by leveraging the familiarity of our system, adaptability of our staff, and high-quality infrastructure. This experience may be informative for other healthcare systems that will be redeploying pediatric providers and nurses to address a regional COVID-19 surge elsewhere.

Epidemiological and Clinical Characteristics of COVID-19 in Adolescents and Young Adults

Adolescents and young adults might play a key role in the worldwide spread of Coronavirus Disease 2019 (COVID-19) because they are more likely to be involved in overseas study, business, work, and travel. However, the epidemiological and clinical characteristics remain unknown. We collected demographic, epidemiological, and clinical data from 46 confirmed COVID-19 patients aged 10 to 35 years from the Chongqing Three Gorges Central Hospital. Several key epidemiological parameters, asymptomatic cases, transmission to family members, and clinical characteristics at admission and during treatment were summarized. Of 46 confirmed patients, 14 patients (30.4%) were aged between 10 and 24 years, and 24 (52.2%) patients were male. The estimated mean incubation period was 6.6days (95% confidence interval [CI] 4.4-9.6). The median serial interval was 1.9days (95% CI 0.4-6.2). Three of the asymptomatic cases showed transmission to their family members. Only one patient was identified as a severe case at admission. The common symptoms at admission were dry cough (34, 81.0%) and fever (29, 69.1%). Nearly 60% of the patients showed ground-glass opacity on chest computed tomography. Three patients developed acute kidney injury during treatment. Most of the patients (78.3%) recovered and were discharged by the end of the follow-up. This single-center study with a relatively small sample size showed that adolescent and young adult patients with COVID-19 had a long incubation period and a short serial interval. The transmission occurred from asymptomatic cases to family members. Fewer patients developed complications during treatment.

C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation.

BackgroundClinical findings indicated that a fraction of coronavirus disease 2019 (COVID-19) patients diagnosed as mild early may progress to severe cases. However, it is difficult to distinguish these patients in the early stage. The present study aimed to describe the clinical characteristics of these patients, analyze related factors, and explore predictive markers of the disease aggravation.MethodsClinical and laboratory data of nonsevere adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease aggravation and related factors. The receiver operating characteristic curve (ROC) was utilized to analyze the prognostic ability of C-reactive protein (CRP).ResultsAbout 7.7% (16/209) of nonsevere adult COVID-19 patients progressed to severe cases after admission. Compared with nonsevere patients, the aggravated patients had much higher levels of CRP (median [range], 43.8 [12.3–101.9] mg/L vs 12.1 [0.1–91.4] mg/L; P = .000). A regression analysis showed that CRP was significantly associated with aggravation of nonsevere COVID-19 patients, with an area under the curve of 0.844 (95% confidence interval, 0.761–0.926) and an optimal threshold value of 26.9 mg/L.ConclusionsCRP could be a valuable marker to anticipate the possibility of aggravation of nonsevere adult COVID-19 patients, with an optimal threshold value of 26.9 mg/L.

Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists.

Objective:In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add “surge capacity” has been the use of PICU beds and physicians to care for these critically ill adults.Design:Narrative review/perspective.Setting:Not applicable.Patients:Not applicable.Interventions:None.Measurements and Main Results:The virus’s high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common “adult” issues that may be encountered in the care of these patients and how they can best be managed in a PICU.Conclusions:This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.

Caring for older adults with multiple myeloma during the COVID-19 Pandemic: Perspective from the International Forum for Optimizing Care of Older Adults with Myeloma

The novel coronavirus (SARS-CoV-2, COVID-19) was first identified in the province of Wuhan, China in December 2019 [1], following the emergence of new cases of pneumonia of unknown etiology. Since then, the manifestations of COVID-19 infections have ranged from asymptomatic to severe respiratory infections, with increased morbidity in older adults including those with co-morbidities and cancer [2,3]. Presently, global mortality is reported at 4.7%, but this varies widely by location, from 0.7% in Germany to 10.8% in Italy [4]. As of April 13, 2020, the number of infections continues to rise well beyond the 1.9 million cases, and approximately 120,000 COVID-19-related deaths that have already occurred globally [5]. Multiple myeloma (MM) is a malignant plasma cell dyscrasia which predominantly affects older and often frail adults. Although tremendous gains have been made for older adults with MM, infections, including respiratory infections, significantly impact the rate of early mortality in these patients [6,7]. Furthermore, older adults with MM have age-associated vulnerabilities leading to heterogeneity in outcomes [8]. The complexity of caring for older patients have increased substantially during this pandemic, due to concern about their risk of severe morbidity of COVID19 infection. Optimal strategies for these patients will involve staging the malignancy/aging, while simultaneously considering the local prevalence of COVID-19 infection. Herein, we discuss strategies for the risk reduction of COVID-19 transmission, treatment stratification of anti-myeloma therapy and discussion regarding goals of care for older adults with MM during the COVID-19 pandemic.

Coronavirus, Its Neurologic Manifestations, and Complications

Context: We are going to face an epidemic of severe acute respiratory syndrome coronavirus (SARS-CoV-2) virus in our country. The main manifestation of this viral infection is respiratory and cardiovascular; however, up-to-date knowledge of its probable neurologic complications is highly needed. Evidence Acquisition: To provide up-to-date information on neurologic manifestation on coronaviruses, we concisely reviewed the neurologic manifestations and their complications. Using the keywords, coronavirus, corona, human coronaviruses (HCoVs), SARS, Middle East respiratory syndrome-related (MERS), coronavirus disease 2019 (COVID-19), manifestations, complications, and neurologic, all the relevant articles were retrieved from PubMed, reviewed, and critically analyzed. Results: Although the main clinical manifestation of human coronaviruses is respiratory involvement and the main cause of death is acute respiratory failure, extra respiratory manifestations such as neurologic findings have been reported. Fortunately, the neurologic manifestations in COVID-19 have not been reported yet. Conclusions: We need well-designed studies to monitor neurologic manifestations of COVID-19 in adults and children.

Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

BackgroundIn December 2019, the coronavirus disease 2019 (COVID-19) outbreak occurred in Wuhan. Data on the clinical characteristics and outcomes of patients with severe COVID-19 are limited.ObjectiveWe sought to evaluate the severity on admission, complications, treatment, and outcomes of patients with COVID-19.MethodsPatients with COVID-19 admitted to Tongji Hospital from January 26, 2020, to February 5, 2020, were retrospectively enrolled and followed-up until March 3, 2020. Potential risk factors for severe COVID-19 were analyzed by a multivariable binary logistic model. Cox proportional hazard regression model was used for survival analysis in severe patients.ResultsWe identified 269 (49.1%) of 548 patients as severe cases on admission. Older age, underlying hypertension, high cytokine levels (IL-2R, IL-6, IL-10, and TNF-α), and high lactate dehydrogenase level were significantly associated with severe COVID-19 on admission. The prevalence of asthma in patients with COVID-19 was 0.9%, markedly lower than that in the adult population of Wuhan. The estimated mortality was 1.1% in nonsevere patients and 32.5% in severe cases during the average 32 days of follow-up period. Survival analysis revealed that male sex, older age, leukocytosis, high lactate dehydrogenase level, cardiac injury, hyperglycemia, and high-dose corticosteroid use were associated with death in patients with severe COVID-19.ConclusionsPatients with older age, hypertension, and high lactate dehydrogenase level need careful observation and early intervention to prevent the potential development of severe COVID-19. Severe male patients with heart injury, hyperglycemia, and high-dose corticosteroid use may have a high risk of death.

Interleukin-6 Levels of Children with SARS-CoV-2 Infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic remains a global threat, with a total number of coronavirus disease 2019 (COVID-19) at 1,696,588 cases worldwide, and a mortality rate of 6.24%. Interestingly, paediatric patients have lower infection rates and a less severe clinical presentation, although the mechanism behind this phenomenon remains elusive. In this article, we aimed to assess the current evidence on the IL-6 levels of paediatric COVID-19 cases. Data from 7 studies was extracted, with a total sample size of n = 127 patients. Results show that paediatric COVID-19 cases had IL-6 levels within normal range (mean: 81%, range from 50 – 100%). This finding contrasts previous reports of high IL-6 in severe adult COVID-19 cases. It also reinforces previous notions that the cytokine storm, indicated by excessive circulating IL-6, is a possible mechanism of COVID-19 progression and that this aggressive inflammatory cascade is less likely to occur in children.

COVID-19 in newborns and in children: the state of the art

Novel COronaVIrus Disease 2019 (COVID-19) is an emerging disease of public health concern because it is caused by a newly identified pathogen, against which humans have no pre-existing immunity. Since its outbreak, a growing number of studies have examined COVID-19 in adults, but the data on its epidemiological and clinical characteristics in newborns and in children are few and patchy. Children appear to develop moderate-mild or silent forms of the disease; to our knowledge, only two cases of death (a 14-year-old and a 16-year-old teenagers) have been reported. Arguably, the number of pediatric cases may be underestimated, since presumably cases with mild or no symptoms are not brought to the doctor’s attention. We have selected the most interesting and significant papers (including some pre-publication or ahead-of-print papers). The key factors in the pathophysiology of COVID-19, available data on pregnancy, the neonatal period, and later are discussed. A review of pediatric cases is available and 3 practical algorithms help the reader in clinical choices. Finally, diagnostic criteria and treatment are presented.

COVID-19 in children: Pathogenesis and current status.

Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C). The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions. The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19-associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C. COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2-associated MIS-C similar to KD.

Comparison of the Computed Tomography Findings in COVID-19 and Other Viral Pneumonia in Immunocompetent Adults: A Systematic Review and Meta-Analysis

Background: As the coronavirus disease 2019 (COVID-19) present at chest computed tomography (CT) as other viral pneumonia, our purpose was to evaluate imaging features that could distinguish them. Methods: In this meta-analysis, MEDLINE, EMBASE, and Cochrane databases were searched through March 31, 2020. Studies were eligible if they had included immunocompetent adults with up to 14 days of viral pneumonia and described their chest CT findings. Subjects should have in a respiratory tract sample positive identification of COVID-19, adenovirus, influenza A, rhinovirus, parainfluenza, or respiratory syncytial virus. We included controlled or observational studies, and case series with more than ten patients. Studies were excluded if presence of immunocompromised and/or non-adults subjects; letters to the editor, reviews, or case series with less than ten patients; not in English. We calculated the pooled prevalences of the included variables and their corresponding 95% confidence intervals (95%CI). Findings: From 2263 studies identified, 33 were eligible for inclusion, with a total of 1930 patients (COVID, n=934; 48.4%; non-COVID, n=996; 51.6%). Frequent CT features for all viral pneumonia were a mixed pattern of ground-glass opacity (GGO) and consolidation (COVID-19, 0.37;0.17-0.56; non-COVID, 0.50;0.39-0.62). bilateral distribution (COVID, 0.81;0.77-0.85; non-COVID, 0.70;0.55-0.85), and presence in lower lobes (COVID, 0.88; 0.80-0.95; non-COVID, 0.66;0.50-0.82). COVID-19 pneumonia presented a higher prevalence GGO predominance (0.42;0.28-0.55; non-COVID 0.21;0.14-0.27), peripheral distribution (0.77;0.67-0.87), and involvement of upper (0.77;0.65-0.88) and middle lobes (0.61;0.47-0.76). Interpretation: Although COVID-19 might present a higher prevalence of GGO predominance, involvement of upper and middle lobes, and peripheral distribution, most CT findings overlap with other viral pneumonia. Thus, chest CT should not be encouraged as a first-line test for COVID-19 diagnosis in the general population. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.

Clinical Efficacy of Intravenous Immunoglobulin Therapy in Critical Patients with COVID-19: A Multicenter Retrospective Cohort Study

Background: Coronavirus disease 2019 (COVID-19) has become pandemic, causing more than 1.5 million infections and over ten-thousands of deaths in a short period of time worldwide. However, little is known about its pathological mechanism, and reports on clinical study on specific treatment are few. The purpose of this study is to determine the clinical efficacy of intravenous immunoglobulin (IVIG) therapy in COVID-19 patients. Methods: This multicenter retrospective cohort study enrolled 325 adult critical COVID-19 patients, including severe type and critical type, according to the clinical classification defined by National Health Commission of China, in 8 government designated treatment centers in China from Dec 23, 2019 to Mar 31, 2020. Demographic, clinical, treatment, and laboratory data as well as prognosis were extracted from electronic medical records, and IVIG was exposure factor. Primary outcomes were the 28-day and 60-day mortality, and secondary outcomes were the total length of in-hospital and the total duration of the disease. Meanwhile, the parameters of inflammation responses and organ functions were measured. The risk factors were determined by COX proportional hazards model. The subgroup analysis was carried out according to clinical classification of COVID-19, IVIG dosage, and timing. Findings: In the enrolled 325 patients, 222 (68%) were severe type and 103 (32%) were critical type; 42 (13%) died in 28-day within hospitalization, and 54 (17%) died within 60-day; The death in 60-day includes 6 (3%) severe type patients and 48 (47%) critical type patients. 174 cases were used IVIG, and 151 cases were not. Compared with the baseline characteristics between two groups, the results showed that the patients in IVIG group presented higher Acute Physiology and Chronic Health Evaluation (APACHII) score and Sequential Organ Failure Assessment (SOFA) score, higher plasma levels of IL-6 and lactate, and lower lymphocyte count and oxygenation index (all P 15 g/d) exhibited significant reduction of 60-day mortality in the critical type patients. Interpretation: Early administration of IVIG with high dose improves the prognosis of critical type patients with COVID-19. This study provides important information on clinical application of the IVIG in treatment of SARS-CoV-2 infection, including patient selection and administration timing and dosage. Funding Statement: This work was supported by grants from the PLA Logistics Research Project of China [18CXZ030, CWH17L020, 17CXZ008], Sanming Project of Medicine in Shenzhen (SZSM20162011) and Clinical Research Project of Shenzhen municipal health commission (SZLY2017007). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study was approved by the Research Ethics Commission of General Hospital of Southern Theater Command of PLA and the requirement for informed consent was waived by the Ethics Commission.

Hydroxychloroquine as prophylaxis or treatment for COVID-19: What does the evidence say?

Hydroxychloroquine (HCQ), an antimalarial has been proposed as possible treatment for coronavirus disease-2019 (COVID-19). India has approved the use of HCQ for prophylaxis of asymptomatic health workers treating suspected or confirmed COVID-19 cases, and asymptomatic household contacts of confirmed patients. The U.S. Food and Drug Administration has issued Emergency Use Authorization for the use of HCQ to treat COVID-19 in adolescents and adults. In this review, we go over the available evidence for and against HCQ's use as prophylaxis or treatment for COVID-19, especially in the Indian context.