The Importance of the Timing of Tocilizumab Administration in Moderate to Severely Ill COVID-19: Single Centered Experience Case series

One of the main causes of death in COVID-19 is the dysregulation of the host's immune system which leads to cytokine storm, a potentially fatal systemic inflammatory syndrome. Interleukin 6 (IL-6) is a pro-inflammatory cytokine that is produced in response to infections and tissue injuries and is believed to play a pivotal role in the event of a cytokine storm, as signified by its increase in the process. Considering the role of IL-6 as a pro-inflammatory cytokine in the process of cytokine storm in COVID-19, perceiving IL-6 as a therapeutic target could prove to be promising. Tocilizumab is a monoclonal antibody that competitively inhibits the binding of IL-6 to its receptor (IL-6R). The use of IL-6R blocker is recommended for severe COVID-19 patients in the latest therapeutic guideline published by the World Health Organization (WHO), but the timing of the administration has not been specified. While previous studies about the use of tocilizumab in COVID-19 patients have shown various results, these studies do not emphasize on plasma IL-6 levels when deciding the time of tocilizumab administration. In this case series, we present three patients with moderate to severe COVID-19 infections that receive tocilizumab as an adjunct to the standard of care therapy. This case series introduces the novel idea that the timely use of tocilizumab as signified by plasma IL-6 levels in moderate to severe COVID-19 patients could potentially improve overall clinical condition and increase survival rate.

Tocilizumab as a Treatment for 'Cytokine Storm Syndrome' in COVID-19: A Case Report

Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.

The Collateral Impacts of Pandemic

A pandemic that covers the whole world occurs relatively in every 100 years. Thus, it can be said that no expert has ever experienced directly dealing with a global pandemic. In the absence of people who are truly experts who know the problems and impacts of a global pandemic, various studies need to be carried out extensively between fields and across regions in the world. Likewise, the results of the study need to be recorded permanently so that it can still be useful over a long period of time, preferably for more than a hundred years.Studies of the short-term and long-term impacts of the pandemic on things other than mortality are calling us to be worked upon. It is the time for us to be concerned with the risk assessment of benefits before a decision is taken and its openly scientific reporting. It is necessary to develop strategies to mitigate or avoid dire consequences of a policy. Until now, studies of health policy on the vulnerable group seem to be minimally done. It would be wise to encourage more studies to groups that are vulnerable to the impact of a policy.The collateral impacts of the pandemic do not only affect the health services on diseases other than Covid-19, but also includes the collateral impact of humanitarian threats in other fields. Management of a global pandemic needs to be carried out comprehensively, both in handling the disease, support for and access to other diseases, as well as collaboration and socioeconomic policies that maintain the pillars of humanity. Lessons must be taken by humans in order to defend their race in the future, including pandemics that occur repeatedly over a span that is longer than the age of three generations.