Tenofovir Disoproxil Fumarate Reduces the Severity of COVID-19 in Patients with Chronic Hepatitis B.

BACKGROUND AND AIMS: HIV-positive patients on tenofovir hydroxyl fumarate (TDF)/emtricitabine have a lower risk of COVID-19 and hospitalization than those given other treatments. Our aim was to analyze the severity of COVID-19 in patients with chronic hepatitis B (CHB) on TDF or entecavir (ETV). METHODS: Spanish hospital databases (n = 28) including information regarding adult CHB patients on TDF or ETV for the period February 1st to November 30th 2020 were searched for COVID-19, defined as a positive SARS-CoV-2 polymerase chain reaction, and for severe COVID-19. RESULTS: Of 4736 patients, 117 had COVID-19 (2.5%), 67 on TDF and 50 on ETV. Compared to patients on TDF, those on ETV showed (p < 0.05) greater rates of obesity, diabetes, ischemic cardiopathy, and hypertension. COVID-19 incidence was similar in both groups (2.3 vs. 2.6%). Compared to TDF, patients on ETV more often (p < 0.01) had severe COVID-19 (36 vs. 6%), required intensive care unit (ICU) (10% vs. 0) or ventilatory support (20 vs. 3%), were hospitalized for longer (10.8 ± 19 vs. 3.1 ± 7 days) or died (10 vs. 1.5%, p = 0.08). In an IPTW propensity score analysis adjusted for age, sex, obesity, comorbidities, and fibrosis stage, TDF was associated with a sixfold reduction in severe COVID-19 risk (adjusted-IPTW-OR 0.17, 95%CI 0.04-0.67, p = 0.01). CONCLUSION: Compared to ETV, TDF seems to play a protective role in CHB patients with SARS-CoV-2 whereby the risk of severe COVID-19 is lowered.

Lung Ultrasound Score to Predict Outcomes in COVID-19.

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) can develop severe bilateral pneumonia leading to respiratory failure. We aimed to study the potential role of lung ultrasound score (LUS) in subjects with COVID-19. METHODS: We conducted an observational, prospective pilot study, including consecutive subjects admitted to an intermediate care unit due to COVID-19 pneumonia. LUS is a 12-zone examination method for lung parenchyma assessment. LUS was performed with a portable convex transducer, scores from 0 to 36 points. Clinical and demographic data were collected at LUS evaluation. Survival analysis was performed using a composite outcome including ICU admission or death. Subjects were followed for 30 d from LUS assessment. RESULTS: Of 36 subjects included, 69.4% were male, and mean age was 60.19 ± 12.75 y. A cutoff LUS ≥ 24 points showed 100% sensitivity, 69.2% specificity, and an area under the receiver operating characteristic curve of 0.85 for predicting worse prognosis. The composite outcome was present in 10 subjects (55.6%) with LUS ≥ 24 points, but not in the group with lower LUS scores (P < .001). Subjects with LUS ≥ 24 points had a higher risk of ICU admission or death (hazard ratio 9.97 [95% CI 2.75-36.14], P < .001). Significant correlations were observed between LUS and [Formula: see text], serum D-dimer, C-reactive protein, lactate dehydrogenase, and lymphocyte count. CONCLUSIONS: LUS ≥ 24 points can help identify patients with COVID-19 who are likely to require ICU admission or to die during follow-up. LUS also correlates significantly with clinical and laboratory markers of COVID-19 severity.

Uso institucional de Twitter para combatir la infodemia causada por la crisis sanitaria de la Covid-19

La crisis sanitaria internacional provocada por la Covid-19, más grave que las provocadas por el SARS, el MERS, la Gripe A y el Ébola, supone un desafío sin precedentes para las instituciones de todo el mundo. El objetivo principal de este trabajo es analizar el comportamiento institucional a través de Twitter para determinar si es posible inferir un modelo eficaz de comunicación institucional de crisis online de aplicación en contextos más amplios. En este sentido, se establece un diseño metodológico cuantitativo, sustentado en el análisis de contenido sobre un corpus de 995 mensajes emitidos durante el primer estado de alarma por las cuentas oficiales de Twitter de las instituciones oficiales al cargo de la gestión de la crisis sanitaria de la Covid-19 en España: @sanidadgob (483 tweets), @mitmagob (154 tweets), @defensagob (263 tweets) e @interiorgob (95 tweets). Los resultados muestran un predominio de mensajes de empatía y seguridad (60,40%);una distribución estable de tweets por día, concentrándose el 88,74% de los mismos entre las 10:00 y las 20:59 horas;un uso comedido de recursos audiovisuales (32,26%) con un enfoque eminentemente informativo (96,18%);diferencias significativas según el estadístico chi-cuadrado con respecto al formato (χ2(12) = 606,066;p < 0,001) y el enfoque (χ2(3) = 36,084;p < 0,001) en función de la cuenta analizada, y una destacada tasa de engagement adscrita al Ministerio de Sanidad (68,96%). Estos resultados evidencian que Twitter permite aplicar un modelo de comunicación institucional online, de fácil transferencia al contexto internacional, que sugiere una estrategia de relaciones públicas sustentada en la transparencia informativa y el goteo informativo constante.Alternate abstract: The international health crisis caused by Covid-19, more serious than those caused by SARS, MERS, influenza A, and Ebola, poses an unprecedented challenge for all institutions around the world in combating the infodemic. The main objective of this work is to analyze institutional behavior through Twitter to determine whether it is possible to deduce an effective institutional online crisis communication model that is applicable in wider contexts. In this sense, a quantitative methodological design is established based on content analysis performed on a simple of 995 tweets from the official Twitter accounts of institutions in charge of managing the health crisis during the first state of alarm in Spain: @sanidadgob (483 tweets), @mitmagob (154 tweets), @defensagob (263 tweets), and @interiorgob (95 tweets). The results illustrate a predominance of empathetic and security-related messages (60.40%);a stable distribution of tweets per day, with 88.74% of them published between 10:00 and 20:59;a moderate use of audiovisual resources (32.26%) with a very informative approach (96.18%);a few significant differences according to the chi-squared statistic with respect to the format (χ2(12) = 606.066;p < 0.001) and approach (χ2(3) = 36.084;p < 0.001) depending on the accounts analyzed;and a substantial level of engagement with the Spanish Ministry of Health’s account (68.96%). These results demonstrate that Twitter allows the application of an online institutional communication model that is easily transferable to an international context, suggesting a public relations strategy based on information transparency and constant information flow.

Description of a Novel Fameshifting Site in the 5'UTR of SARS-CoV-2 as a Potential Drug Target (preprint)

SARS-CoV-2 is an enveloped positive-sense single-stranded RNA coronavirus that causes COVID-19 whose present outbreak has cost a high number of casualties throughout the world. The aim of this work was to scan the SARS-CoV-2 genome in search for new therapeutic targets. We found a sequence in the 5'UTR (NC 045512:74-130), consisting of a typical heptamer next to a structured region that may cause frameshifting. The potential biological value of this region is shown by its similarity with other coronaviruses related with SARS-CoV and its sequence conservation within isolates from SARS-CoV-2. We have predicted the secondary structure of the region by means of different bioinformatic tools. We have chosen a probable secondary structure to proceed with a 3D reconstruction of the structured segment. We carried out virtual docking on the 3D structure to look for a binding site and then for drug ligands from a database of lead compounds. Several molecules that would probably administered as oral drugs show promising binding affinity within the structured region and so it would be possible interfere the potential regulatory role of our sequence of interest.

Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients (preprint)

Background: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; p<0.001). Multivariable proportional hazards model showed that age ³65 years (HR 4.14; 95%CI 2.31-7.42; p<0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p=0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p<0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p<0.001). Conclusions: IMCU allow to safely and effectively manage severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

SARS-CoV-2 in human sewage in Santa Catalina, Brazil, November 2019 (preprint)

We analysed human sewage located in Florianopolis (Santa Catalina, Brazil) from late October until the Brazil lockdown on early March. We detected SARS-CoV-2 in two samples collected independently on 27th November 2019 (5.49{+/-}0.02 log genome copies/L). Subsequent samplings were positive until 4th March 2020 (coinciding with the first COVID-19 case reported in Santa Catalina), with a SARS-CoV-2 RNA increase of one log (6.68{+/-}0.02 log genome copies/L). Our results show that SARS-CoV-2 has been circulating in Brazil since late November 2019, much earlier than the first reported case in the Americas (21st January 2020, USA).

Tocilizumab is associated with reduction of the risk of ICU admission and mortality in patients with SARS-CoV-2 infection (preprint)

Background In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world, therefore, clinical strategies to avoid ICU admission are needed. Objective We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Methods A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P= 0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0*1, P=0.0001) of ICU admission or death. Conclusions Tocilizumab in the early stages of the inflammatory flare, could avoid an important number of ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports.