ABSTRACT
Background. In an effort to reduce strain on healthcare systems with patient hospitalizations and deaths due to COVID-19, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for 2 monoclonal antibodies for the treatment of COVID-19 in November 2020: bamlanivimab (BAM) and casirivmab-imdevimab (CAS-IMD). While clinical trial data demonstrated reductions in hospitalization rate, real-world data at the time of approval was vastly limited. Methods. A retrospective chart review of non-hospitalized patients who received either BAM or CAS-IMD from November 27th, 2020 to February 16th, 2021. Variables included timing of monoclonal antibody infusion, adverse events, and 30-day hospitalization rate. Descriptive statistics were calculated for all data. Results. 101 patients received either BAM (75.2%) or CAS-IMD (24.8%) at a median of 6 days (IQR 4-7) from reported symptom onset. The most commonly reported symptoms of COVID-19 at time of referral were cough (57.4%), fever (29.7%), and myalgia (27.7%). All patients (100%) had at least 1 documented EUA defined risk factor for severe COVID-19 (Table 1). Following transfusion, 7/101 (6.9%) and 3/101 (3.0%) experienced mild to moderate and severe adverse events, respectively (Table 2). At day 30, 5 patients (5.0%) were hospitalized with COVID-19 at a median of 7 days (IQR 3-8) post monoclonal antibody infusion. Conclusion. We observed a higher frequency of hospitalization compared to 1.6% for BAM in BLAZE-1 and 3% for CAS-IMD in REGN-COV-2. This observation may reflect our higher risk population as all patients presented with at least 1 risk factor for severe disease compared to 69.6% and 65.0% in BAM and CAS-IMD clinical trials, respectively. Additionally, patients presented with longer durations of symptoms prior to infusion in our study population compared to 3 days reported in BAM and 4 days reported in CAS-IMD trials. Since the conclusion of this study, the FDA revoked the EUA for BAM administered alone based on increased observations of resistant variants to BAM monotherapy. However, our observations highlight the need for further exploration in the prevention of hospitalization in high risk populations as well as the optimal timing of monoclonal antibody therapy.
ABSTRACT
Introduction and Aim: Prone positioning has been reported to facilitate oxygenation in patients suffering from COVID-19, and improvement has been observed in cardiorespiratory functions following practice of asanas and pranayamas. We investigated the effects of prone asanas and slow pranayama on recovery from COVID-19 illness. Methods: A study was conducted on six COVID-19 patients of varied age with different pre-existing comorbidities such as asthma, diabetes and hypertension, admitted to COVID-hospital. In addition to routine medical treatment, all the patients practiced the prone asanas and slow pranayamic breathing for a period of four weeks (2 weeks of hospital stay during the illness and two weeks of home quarantine following discharge from the hospital). The intensity of illness, days to recover, level of stress assessed by Perceived Stress Scale (PSS-10), degree of depression assessed by Patient Health Questionnaire (PHQ-9), myocardial work stress determined by rate-pressure product, and complications if any, were recorded. They were advised to continue the asana-pranayama practice for another four weeks during the entire recovery period. Results: All the patients recovered smoothly from COVID-19 illness, their hospital stay was eventless, and the psychological stress, levels of depression and myocardial work stress due to COVID illness were reduced significantly by four-weeks practice of asana-pranayama schedule. Multiple regression demonstrated the association of decreased depression to decreased level of stress following asana-pranayama practice. There were no post-recovery complications during the one-month follow-up in the recovery period. Conclusion: Practice of prone asanas and slow pranayama for four weeks facilitated the healing from COVID-19 illness, alleviated psycho-physical stress and depression, and prevented development of post-recovery complications in all the patients. The reduction in depression could be linked to the reduced stress level following asana-pranayama practice in COVID-19 patients.
ABSTRACT
Introduction and Aim: It has been observed that recovery from COVID-19 is delayed due to continuation of myalgia, fatigue, headache and some respiratory problems even after the discharge from the hospital. Reports indicate the improvement of sensory, cardiorespiratory and psychological functions following practice of Prone asanas and Pal’s pranayama. Therefore, we conducted a pilot study to assess if practice of asanas in prone posture and slow breathing exercise of Pal’s pranayama schedule can facilitate recovery from the COVID-19 illness and alleviate post-recovery complications in these patients. Materials and Methods: This is an interventional pilot study conducted in COVID positive patients. A structured module of prone asanas and Pal’s pranayama schedule was given to the COVID positive patients in addition to the routine medical treatments and their stress levels were assessed prior to and after the practice. Also, the acute effects of asana-pranayama schedule on the improvement of cardiorespiratory functions and occurrence of other complications in the recovery phase was recorded. Results: Following practice of asana-pranayama schedule, the patients recovered faster from myalgia, fatigue, headache and respiratory problems and they had a feeling of well-being. Further, the complications in the recovery phase of COVID-19 were prevented and the intensity of stress was reduced with the practice of asana-pranayama schedule. Conclusion: This pilot study has shed some light on the early recovery and the prevention of complications in the recovery phase of COVID-19.