Early Stage COVID-19 Research Articles

Exploring East Asia's Successful Early-Stage Covid-19 Response: An Empirical Investigation

AbstractThis study examines whether a degree of autocracy and high quality of bureaucracy—two mechanisms often discussed in the context of Covid-19 responses—provide a meaningful explanation for East Asia's relative success compared to the rest of the world at the beginning of the Covid pandemic. Our multiple regression analysis for 111 countries supports our expectation, as East Asia as a region is significantly and negatively associated with confirmed Covid-19 cases and deaths compared to the rest of the world, and its interaction with the quality of bureaucracy further contributes to the negative association. In sum, this research highlights the important role of East Asia's regional characteristics in pandemic responses.

The clinical characteristics analysis of serum markers for the cardiovascular system in early-stage COVID-19 patients.

This study aimed to investigate alterations in serum markers [creatine kinase-MB (CKMB), cardiac troponin T (cTnT), myoglobin (Myo), B-type natriuretic peptide (BNP), D-dimer (DD), procalcitonin (PCT) and interleukin-6 (IL6)] in early Omicron variant infection and analyzed their correlation with clinical parameters. Retrospective analysis of 1,138 mild/asymptomatic cases at Tianjin First Central Hospital, including age, gender, serum markers and nucleic acid test results. Statistical analysis used SPSS software, version 24.0. Elevated cTnT, BNP (125-400), and DD (0.55-1.10) levels were prevalent at 12.92%, 15.64%, and 14.50%, respectively. Females had significantly higher proportions with slightly elevated BNP (19.34%) and DD (19.69%) levels. Patients over 35 had a higher proportion of slight elevation in BNP (20.00%). Abnormal levels of serum markers were significantly associated with older age, increased PCT and IL6 levels, as well as delayed nucleic acid clearance. Additionally, levels of immunoglobulin G (IgG) were notably reduced in these cases. Patients with prolonged nucleic acid clearance (>14 days) had higher BNP and DD levels upon admission. Logistic regression identified PCT (OR = 237.95) as the most significant risk factor for abnormal serum markers for cardiovascular system injury. Early Omicron infection might do subclinical damage to the cardiovascular system. Elevated cTnT, BNP and DD levels were correlated with age, gender, inflammatory factors, and IgG. Notably, high PCT level emerged as the most robust predictor of abnormal serum biomarkers.

Influences of vaccination and public health strategies on COVID-19 dynamics in the United States: Evaluating policy impacts, behavioral responses, and variant proliferation

Background and Aim: The United States (US) government implemented interventions against COVID-19, but their effects on variant-related risks remain inconclusive. We aimed to assess the causal effects of vaccination rates, booster uptakes, face mask mandates, and public area mobility (societal behavioral factor) on early-stage COVID-19 case and death growth rates and identify the most effective public health response for controlling COVID-19 in the US. Materials and Methods: We performed retrospective analyses using four standard correlated random effects models, analyzing a robust panel dataset that encompasses 16,700 records across all fifty US states. Models 1 and 3 analyzed COVID-19 case rates and death growth rates, respectively, from January 2021 to November 2021. In contrast, using the data from August 2021 to November 2021, Models 2 and 4 assessed the effect of Delta variants and booster shots on COVID-19 case and death growth rates, respectively. Results: We found that face mask mandate (p < 0.01) and workplace mobility (p < 0.05) led to lower COVID-19 case growth rates. COVID-19 vaccination uptake rate reduced COVID-19 death growth rates (p < 0.01). Furthermore, contrary to Epsilon variant (p < 0.01), which contributed to reduced COVID-19 case growth rates, Delta variant led to significant increases in COVID-19 cases (p < 0.001). Conclusion: This study suggests that immediate public health interventions, like mask mandates, are crucial for crisis mitigation, while long-term solutions like vaccination effectively address pandemics. The findings of this study not only sheds light on the recent pandemic but also equips policy-makers and health professionals with tools and knowledge to tackle future public health emergencies more effectively. Keywords: COVID-19, face mask mandate, public mobility, vaccination, variants.

Circulating Inflammatory Factor Levels in the Early Phase of COVID-19 are Associated with the Progression of Respiratory Failure: A Single-Center Retrospective Study.

To evaluate the potential relationships between serum interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α levels and occurrence of respiratory failure in patients with early-stage COVID-19 disease. We analyzed clinical characteristics, laboratory parameters, and immunoinflammatory markers in 302 patients diagnosed with SARS-CoV-2 infection who required hospitalization at Changshu Hospital of Nantong University. IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α levels in the peripheral blood of patients hospitalized five days after disease onset were measured using multiplex bead-based flow fluorescent immunoassay (MBFFI). Patients with respiratory failure had higher serum IL-4 [0 (0, 0.54) pg/mL], IL-6 [40.76 (12.33, 90.28) pg/mL], IL-10 [6.65 (4.12, 11.34) pg/mL], and IL-17 [9.48 (4.31, 12.13) pg/mL] levels than patients without respiratory failure (P=0.042, P<0.0001, P=0.012, and P=0.036, respectively). Serum IL-2, IFN-γ, and TNF-α levels were not significantly different between the two groups. The occurrence of respiratory failure was positively correlated with sex (R=0.122, P=0.034), lactic acid (R=0.193, P=0.007), white blood cell count (R=0.121, P=0.038), erythrocyte distribution width (R=0.131, P=0.024), thyrocalcitonin (R=0.280, P<0.0001), and D-dimer levels (R=0.214, P<0.0001) but negatively correlated with oxygen partial pressure (R=-0.208, P=0.004), oxygen saturation (R=-0.220, P=0.002), lymphocyte count (R=-0.129, P=0.026), and calcium (R=-0.152, P=0.042). Among the immunoinflammatory biomarkers, the occurrence of respiratory failure was positively correlated with IL-4 (R=-0.117, P=0.042), IL-6 (R=0.206, P<0.0001), IL-10 (R=0.145, P=0.012), and IL-17 (R=0.121, P=0.036) levels. Serum levels of pro-inflammatory cytokines IL-6 and IL-17 and anti-inflammatory cytokines IL-4 and IL-10 were significantly elevated in patients with respiratory failure and weakly positively correlated with the occurrence of respiratory failure. Further studies are required to explore these key immune mechanisms to help clinicians better manage acute complications, long-term sequelae, and possible future COVID-19 variants and be flexible in managing future epidemics and similar public health threats.

SUPER Score Contributes to Warning and Management in Early-Stage COVID-19

BackgroundSome COVID-19 patients deteriorate to severe cases with relatively higher case-fatality rates, which increases the medical burden. This necessitates identification of patients at risk of severe disease. Early assessment plays a crucial role in identifying patients at risk of severe disease. This study is to assess the effectiveness of SUPER score as a predictor of severe COVID-19 cases. MethodsWe consecutively enrolled COVID-19 patients admitted to a comprehensive medical center in Wuhan, China, and recorded clinical characteristics and laboratory indexes. The SUPER score was calculated using parameters including oxygen saturation, urine volume, pulse, emotional state, and respiratory rate. In addition, the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity of the SUPER score for the diagnosis of severe COVID-19 were calculated and compared with the National Early Warning Score 2 (NEWS2). ResultsThe SUPER score at admission, with a threshold of 4, exhibited good predictive performance for early identification of severe COVID-19 cases, yielding an AUC of 0.985 (95% confidence interval [CI] 0.897–1.000), sensitivity of 1.00 (95% CI 0.715–1.000), and specificity of 0.92 (95% CI 0.775–0.982), similar to NEWS2 (AUC 0.984; 95% CI 0.895–1.000, sensitivity 0.91; 95% CI 0.587–0.998, specificity 0.97; 95% CI 0.858–0.999). Compared with patients with a SUPER score<4, patients in the high-risk group exhibited lower lymphocyte counts, interleukin-2, interleukin-4 and higher fibrinogen, C-reactive protein, aspartate aminotransferase, and lactate dehydrogenase levels. ConclusionsIn conclusion, the SUPER score demonstrated equivalent accuracy to the NEWS2 score in predicting severe COVID-19. Its application in prognostic assessment therefore offers an effective early warning system for critical management and facilitating efficient allocation of health resources.

Efficacy of Andrographis paniculata extract treatment in mild to moderate COVID-19 patients being treated with favipiravir: A double-blind, randomized, placebo-controlled study (APFaVi trial)

BackgroundWhile favipiravir had been the standard anti-SARS-CoV-3 drug for COVID-19 treatment in Thailand, the efficacy of favipiravir treatment is controversial. Andrographis paniculata extract (APE) inhibits viral entry, exhibits immunomodulatory effects, and proposes to have the potential for early-stage COVID-19 treatment. MethodsA randomized, double-blind, placebo-controlled trial was performed in Thailand during June - September 2021. Non-severe COVID-19 patients were randomized 1:1 to groups receiving 180 mg/day of APE plus favipiravir (APE-FPV group) or placebo plus favipiravir (placebo-FPV group). Efficacy in preventing disease progression to severe COVID-19 was assessed on day 4, using World Health Organization Clinical Progression Scale (WHOCPS) score and visual analog scale (VAS) for acute respiratory tract infection symptoms. ResultsOf 146 patients, there were 73 patients in each group. Non-deterioration of WHOCPS scores on day 4 was 98.63% versus 97.26% of patients in the APE-FPV and placebo-FPV groups (p = 1.000). No difference in supplemental oxygen, hospitalization, and death was shown in both groups. The oxygen supplemental was 4.11% in the placebo-FPV group. The interleukin (IL)-1β was significantly lower in the APE than in the placebo-FPV group throughout the study. We found no difference in virologic outcomes between groups and no substantial adverse events. ConclusionsAPE treatment did not demonstrate additional clinical and virological benefits in patients with mild to moderate COVID-19 being treated with favipiravir. Early reduction of IL-1β with APE may be advantageous in preventing cytokine storms in severe COVID-19 and requires further study.

Photodynamic therapy (pdt) in early stages of acute adult covid-19 patients: effects on viral load measured by qpcr

Background: The Covid-19 pandemic has negatively impacted Global Health and the world’s economy dramatically since early 2020. Although the development of vaccines has made fast progress, there are currently only a few effective medications and treatment options available for infected patients available. Objectives: The objective of this study was to evaluate the efficacy and safety of Photodynamic Therapy (PDT) with Riboflavin and a specially designed light treatment kit with blue and UVA light as a treatment tool for reducing viral load and clinical symptoms in patients with early stage Covid-19 infection. Methods: This interventional, non-randomized study involved 140 adult subjects. Participants were allocated to receive either PDT plus daily testing for 5 days or to receive conventional care plus testing. The viral load in the oral and nasal cavity and clinical symptoms were measured at the start of the study and after 24,48,72,96,120 and 168 hours. Results: The mean CT value in the treatment group was 29.63 at day 1 and 36.3 at day 5, for a difference of 6.68 threshold cycles and a confidence interval of [5.2;8.72]. Based on Welch’s t-test for two samples, this difference was significant (p&lt;0.01). The same test showed no difference in the means of the control group. Further analysis showed a significant difference between the treatment and control group in the clinical symptoms after 5 days as well, when controlled for the differences at the beginning. Conclusion: PDT decreases viral load and improves clinical symptoms in patients in early stages of Covid-19 significantly. It could be a promising tool for treatment of acutely infected patients in early stages to prevent progression of disease.

Disrupted chromatin architecture in olfactory sensory neurons: looking for the link from COVID-19 infection to anosmia

We tackle here genomic mechanisms of a rapid onset and recovery from anosmia—a potential diagnostic indicator for early-stage COVID-19 infection. Based on previous observations on how olfactory receptor (OR) gene expression is regulated via chromatin structure in mice, we hypothesized that the disruption of the OR gene expression and, respectively, deficiency of the OR function can be caused by chromatin reorganization taking place upon SARS-CoV-2 infection. We obtained chromatin ensemble reconstructions from COVID-19 patients and control samples using our original computational framework for the whole-genome 3D chromatin ensemble reconstruction. Specifically, we used megabase-scale structural units and effective interactions between them obtained in the Markov State modelling of the Hi-C contact network as an unput in the stochastic embedding procedure of the whole-genome 3D chromatin ensemble reconstruction. We have also developed here a new procedure for analyzing fine structural hierarchy with (sub)TAD-size units in local chromatin regions, which we apply here to parts of chromosomes containing OR genes and corresponding regulatory elements. We observed structural modifications in COVID-19 patients on different levels of chromatin organization, from the alteration of whole genome structure and chromosomal intermingling to reorganization of contacts between chromatin loops at the level of topologically associating domains. While complementary data on known regulatory elements point to potential pathology-associated changes within the overall picture of chromatin alterations, further investigation using additional epigenetic factors mapped on 3D reconstructions with improved resolution will be required for better understanding of anosmia caused by SARS-CoV-2 infection.

Japanese urban household carbon footprints during early-stage COVID-19 pandemic were consistent with those over the past decade

As urbanization accelerates worldwide, substantial energy and services are required to meet the demand from cities, making cities major contributors to adverse environmental consequences. To bridge the knowledge gap in the absence of fine-grained city-level climate protection measures due to data availability and accuracy, this study provides a detailed carbon emission inventory for analyzing the monthly fluctuations based on citizens’ daily consumption behaviors. Here, carbon emissions embodied in approximately 500 household consumption items were calculated in 47 prefectural-level cities in Japan from 2011 to June 2021. We analyzed the results considering the regional, seasonal, demand, and emission way-specific aspects, and compared the emission before and during the COVID-19 pandemic. Notably, the carbon footprints during the pandemic were consistent with the previous level despite downtrends in specific categories. This study provides an example of utilizing city-level emission data to improve household green consumption behavior as references for enriching city-level decarbonization paths.

Efficacy and Safety of Inhaled Ethanol in Early-Stage SARS-CoV-2 Infection in Older Adults: A Phase II Randomized Clinical Trial

Inhaled ethanol in the early stages of SARS-CoV-2 infection may reduce the viral load, decreasing progression and improving prognosis. The ALCOVID-19 trial was designed to study the efficacy and safety of inhaled ethanol in older adults at initial phases of infection. Randomized, triple-blind, placebo-controlled phase II clinical trial. Experimental group (n = 38) inhaled 65° ethanol through an oxygen flow, while in the control group (n = 37), water for injection was used. General endpoint was to evaluate disease progression according to the modified World Health Organization (WHO) Clinical Progression Scale. Specific effectiveness endpoints were body temperature, oxygen saturation, viral load assessed by cycle threshold (Ct) on real-time polymerase chain reaction (RT-PCR), analytical biomarkers and use of antibiotics or corticosteroids. Specific safety outcomes were the absence of ethanol in plasma, electrographic, analytical, or respiratory alterations. In the intention-to-treat population, no differences were found regarding disease progression. Mean Ct values increased over time in both groups, being numerically higher in the ethanol group, reaching a value above 33 only in the ethanol group on day 14, a value above which patients are considered non-infective. No differences were found in the other specific effectiveness endpoints. Inhaled ethanol was proven to be safe as no plasma ethanol was detected, and there were no electrocardiographic, analytical, or respiratory alterations. The efficacy of inhaled ethanol in terms of the progression of SARS-CoV-2 infection was not demonstrated in the present trial. However, it is positioned as a safe treatment for elderly patients with early-stage COVID-19.

Three-dimensional chromatin ensemble reconstruction via stochastic embedding reveals a missing link from COVID-19 infection to anosmia.

We propose a comprehensive method for reconstructing the whole-genome chromatin ensemble from the Hi-C data. The procedure starts from Markov state modeling (MSM), delineating the structural hierarchy of chromatin organization with partitioning and effective interactions archetypal for corresponding levels of hierarchy. The stochastic embedding procedure (SEP) provides the 3D ensemble reconstruction, using effective interactions obtained by the MSM as the input. As a result, we obtain the structural ensemble of a genome, allowing one to model the functional and the cell-type variability in the chromatin structure. Using SEP we investigate genomic mechanisms of a rapid onset and recovery from anosmia - a useful diagnostic indicator for early-stage COVID-19 infection. On the basis of published observations on how olfactory receptor (OR) gene expression is regulated via chromatin structure in mice, we hypothesized that the disruption of OR gene expression and, respectively, deficiency of OR function can be caused by chromatin reorganization taking place upon SARS-CoV-2 infection. We obtained chromatin ensemble reconstructions from COVID-19 patients and control samples using our original computational framework for whole-genome chromatin ensemble 3D reconstruction. We have also developed here an additional procedure for analyzing fine structural hierarchy in local, megabase scale, parts of chromosomes containing OR genes and corresponding regulatory elements. We observed structural modifications in COVID-19 patients on different levels of chromatin organization, from the alteration of whole genome structure and chromosomal intermingling to reorganization of contacts between chromatin loops at the level of topologically associating domains. While complementary data on known regulatory elements point to pathology-associated changes within the overall picture of chromatin alterations, further investigation using additional epigenetic factors mapped on 3D reconstructions with improved resolution will be required for better understanding of anosmia caused by SARS-CoV-2 infection.

Disparities in Physical Activity and Depressive Symptoms among Young Adults in the Early Stage of the COVID-19 Pandemic

Background of the study: The COVID-19 pandemic has deeply impacted people’s daily lives, while the influence on behaviors and mental health among college students at the early stage of this pandemic is rarely studied. Objective: This study examined the impact of the COVID-19 pandemic in the early stage on college students’ physical activity (PA), sedentary behavior, and depressive symptoms and its impact on sex and ethnic disparities in these outcomes. Methods: Using a cross-sectional design, 111 college students were recruited, and the data were collected before COVID-19 (n = 64) and in the early stage of the COVID-19 pandemic (n = 47), respectively. All participants completed a survey measuring depressive symptoms and wore an accelerometer to monitor PA behavior (light PA [LPA], moderate-to-vigorous PA [MVPA]), and sedentary behavior. Results: More MVPA engagement and lower levels of depressive symptoms were observed in the early-stage COVID-19 group compared to the before-COVID-19 group. The magnitude of the sex and ethnicity disparities in PA and depressive symptoms were reduced in the early-stage of the COVID-19 pandemic. Conclusion: Understanding college students’ behaviors and mental health in the midst of a global crisis can be useful to determine appropriate strategies to address health and wellness in the chance of the lockdown returning and to further promote this vulnerable population’s physical and mental wellness.

The possible therapeutic role of curcumin and quercetin in the early-stage of COVID-19-Results from a pragmatic randomized clinical trial.

Curcumin (CUR) and quercetin (QUE), two natural polyphenols, possess diverse biological activities including broad-spectrum antiviral, antioxidant, and immunomodulatory effects. Both CUR and QUE have shown inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in in vitro assays. In the present study we aimed to assess the possible treatment benefits of a combined curcumin and quercetin (CUR-QUE) oral supplement, alongside standard of care (SOC), in the early-stage COVID-19 infection. This was an exploratory, pragmatic, open-label, randomized controlled clinical trial, conducted at the Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, PK. The study compared the treatment effect of an oral CUR-QUE supplement plus SOC vs. SOC alone, in the early-stage/mild to moderately symptomatic COVID-19 outpatients. Patients were randomized in a 1:1 ratio to CUR-QUE (n = 25) and control (n = 25) treatment groups. The CUR-QUE supplementation consisted of a daily intake of 168 mg curcumin and 260 mg quercetin, as two soft capsules, to be taken twice a day at home for 14 days. After one-week of treatment, most of the patients in the CUR-QUE group showed an expedited clearance of the viral infection i.e., 18 (72.0%) vs. 6 (24.0%) patients in the control group tested negative for SARS-CoV-2 in the nasal-oropharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) analysis (p = 0.0002). In addition, COVID-19-associated acute symptoms were also speedily resolved in the CUR-QUE treated patients, i.e., 10 (40.0%) vs. 4 (16.0%) patients in the control group (p = 0.061). The CUR-QUE supplementation therapy was well-tolerated by all 25 patients and no treatment-emergent effects or serious adverse events were reported. The results revealed in this exploratory study suggest a possible therapeutic role of curcumin and quercetin in the early-stage of COVID-19. It is proposed that the two agents possibly acting in synergy, interfere the SARS-CoV-2 replication, and thus help a speedy recovery in the early-stage of COVID-19. Further research is highly encouraged. Clinicaltrials.gov, Identifier NCT04603690.

Effect of Andrographis paniculata Treatment for Nonimmune Patients with Early-Stage COVID-19 on the Prevention of Pneumonia: A Retrospective Cohort Study

Effect of Andrographis paniculata Treatment for Nonimmune Patients with Early-Stage COVID-19 on the Prevention of Pneumonia: A Retrospective Cohort Study

EVALUATION OF PATIENTS WITH COVID-19 IN THE EARLY HYPOXEMIC STAGE AND PATIENTS WITH VIRAL RESPIRATORY TRACT INFECTION IN TERMS OF PULMONARY HYPERTENSION.

Arterial hypoxemia occurs in many COVID-19 patients. Hypoxemia is one of the causes of pulmonary hypertension (PH). Main pulmonary artery dilatation and the main pulmonary artery diameter (mPAD) to ascending aorta diameter (AAD) ratio of ≥1 are significant findings regarding PH. In this study, COVID-19 patients and non-COVID-19 patients with viral respiratory tract infection were evaluated retrospectively in terms of PH. A total of 124 patients (71 male and 53 female), age range 18-85 years, were included in the study as case group and control group. Thoracic computed tomography (CT) images, blood and biochemical parameters, and demographic information were compared between the case group and control group. The normality of numerical variables was examined with Kolmogorov-Smirnov test and homogeneity of the variances with Levene's test. This is the first study researching the effect of early hypoxemic stage COVID-19 infection on development of PH. As a result, it was specified that COVID-19 infection had no effects on mPAD, whereas it had a positive effect on AAD and thus led to a decrease in the mPAD/AAD ratio. Through these values, which could be easily calculated from thoracic CT images, the changes caused by COVID-19 infection on vessel diameters were put forward.

Evaluation of coagulation parameters according to serum CRP levels in early stage COVID-19 patients

Evaluation of coagulation parameters according to serum CRP levels in early stage COVID-19 patients

Network-based community detection of early-stage COVID-19 pandemic based on the international geographical distance

Network-based community detection of early-stage COVID-19 pandemic based on the international geographical distance

Ayurvedic Management on Covid-19: A Case Report

Severe acute respiratory syndrome, also known as SARS-Cov-2 or Covid-19, first emerged in march 2020. It has many of the same symptoms as influenza, including a dry cough, headache, body ache, mild increase in body temperature, trouble in breathing, low oxygen levels, nausea, and vomiting. Clinical results of early-stage Covid-19 patients receiving Ayurvedic treatment. Ashwagandha ghan vati and Giloye ghan vati with herbal immune tea or Kahda of Tulsi leaves, ginger, Haldi, Giloye, and Mulaithi, among other ingredients, were used as the first line of treatment. This conventional approach lasted for seven days and included a liquid diet of fresh mosambi and fresh coconut water as well as complete bed rest. The improvement of the Covid -19 afflicted patient's greatest recovery was successfully discovered with the use of a 7-day protocol therapy. Deep breathing exercises, Bhastrika, and Anuloma-Viloma in particular, gave the lungs the vigour they needed to enhance the respiratory system.

A Clinically Validated, Broadly Active, Oral Viral Superinfection Therapy Could Mitigate Symptoms in Early-stage COVID-19 Patients.

More than 200 viruses infect humans, but treatments are available for less than ten of them. To narrow the gap between 'bugs and drugs,' a paradigm shift is required. The "one drug, one bug" approach can be expanded to a "one drug, multiple bugs" strategy such that the host's defense system is targeted rather than the virus. Viral superinfection therapy (SIT) activates interferon genes' natural, antiviral defense system of host cells following exposure to viral infection, e.g., superinfection with an attenuated infectious bursal disease virus (IBDV) with the release of its double-stranded RNA (dsRNA) cargo inside host cells. An attenuated IBDV therapeutic vaccine has successfully treated hepatitis A virus infection (HAV) in marmoset monkeys as well as acute hepatitis B and hepatitis C virus infections (HBV/HCV) in 42 patients. SIT has also been shown to be safe and effective in four patients with chronic HBV or HCV infection with hepatic decompensation. The proof-of-principle of SIT has also been demonstrated in a 43-year-old male patient with COVID-19. Three doses of orally administered IBDV (3x106 IU) alleviated most of his COVID-19 symptoms; even his sense of smell returned within a week. Two additional COVID-19 patients responded similarly to oral treatment with IBDV. Furthermore, a severe herpes zoster ophthalmicus outbreak with orbital edema responded to a combination of acyclovir and 7 doses of IBDV (7x106 IU) within a few days. IBDV is simple to manufacture and affordable, even in resource-limited settings. Acid-resistant IBDV can be orally administered in an outpatient setting, providing simple dosing and high medication adherence. Under an Emergency Use Authorization, the broad-spectrum IBDV drug candidate could be tested immediately in clinical trials and rapidly distributed to millions of early-stage patients with COVID-19. The German Paul Ehrlich Institute is currently supporting a phase I safety study for persons acutely infected with SARS‑CoV-2. An expert team of the US National Institutes of Health-sponsored ACTIV public-private partnership came to the conclusion that the IBDV drug candidate shows merit as a potential treatment for COVID19, and an FDA-approved clinical trial is in the pipelines in Los Angeles.

Use of convalescent plasma in pregnant women with early stage COVID-19 infection in a tertiary care hospital in Dubai, February to March 2021: a case series study

BackgroundThe use of COVID-19 convalescent plasma (CCP) for the treatment of SARS-CoV-2 infection in pregnancy is intriguing in view of its safety profile in pregnancy and historical precedence of the use of plasma for other viral illnesses. This study aimed to evaluate the use of CCP in pregnant women with early COVID-19 infection.MethodsThis is a retrospective case series study. We have included seven pregnant women admitted with early COVID-19 infection to a tertiary care hospital, Latifa Maternity Hospital in Dubai, United Arab Emirates between 12 February and 04 March 2021 and who consented to receive COVID-19 convalescent plasma as part of their treatment plan. Main outcomes measured were clinical and radiological features, laboratory tests, WHO clinical progression scale pre and post treatment, and maternal, fetal outcomes. COVID-19 clinical severity was classified according to the NIH guidelines for criteria of SARS-CoV-2. For the radiological features, a modified chest X-ray scoring system was used where each lung was divided into 6 zones (3 on each side upper, middle, and lower). Opacities were classified into reticular, ground glass, patchy and dense consolidations patterns.ResultsSeven pregnant women with early COVID-19 were enrolled in this study, their mean age was 28 years (SD 3.6). Four had comorbidities: 2 with diabetes, 1 with asthma, and 1 was obese. Five patients were admitted with a WHO clinical progression score of 4 (hospitalized; with no oxygen therapy) and 2 with a score of 5 (hospitalized; oxygen by mask/nasal prongs). Upon follow up on day 10, 6 patients had a WHO score of 1 or 2 (asymptomatic/mild symptoms) indicating clinical recovery. Adverse reactions were reported in 2 patients, one reported a mild skin rash, and another developed transfusion related circulatory overload. All patients were discharged alive.ConclusionCCP seems to be a promising modality of treating COVID-19 infected pregnant women. However, further studies are needed to ascertain the efficacy of CCP in preventing progressive disease in the management of COVID-19 infection in pregnant women.