Efficacy and safety of tocilizumab in COVID-19 patients.

In this retrospective study we assessed the efficacy and safety of tocilizumab in patients with critical or severe coronavirus disease 2019 (COVID-19). We enrolled 181 patients admitted to Huoshenshan Hospital (Wuhan, China) with confirmed COVID-19 between January 2020 and February 2020. Ninety-two patients were treated with tocilizumab, and 89 patients were treated conventionally. We analyzed the clinical manifestations, changes in CT scan images, and laboratory tests before and after tocilizumab treatment, and compared these results with the conventionally treated group. A significant reduction in the level of C-reactive protein was observed 1 week after tocilizumab administration. In some cases this meant the end of the IL-6-related cytokine storm. In addition, tocilizumab relieved fever, cough, and shortness of breath with no reported adverse drug reactions. These findings suggest tocilizumab improves clinical outcomes and is effective for treatment of patients with critical or severe COVID-19. However, future clinical trials are needed to better understand the impact of tocilizumab interference with IL-6 and provide a therapeutic strategy for treatment of COVID-19.

Coronavirus disease 2019 associated with aggressive neurological and mental abnormalities confirmed based on cerebrospinal fluid antibodies: A case report.

INTRODUCTION: Coronavirus disease (COVID-19) is spreading worldwide. The reported possible neurological symptoms are varied and range from subtle neurologic deficits to unconsciousness. Knowledge regarding the detection, diagnosis, treatment, and follow-up of COVID-19-associated neurological damage is still limited. We report a case of serious neurological damage and mental abnormalities in a patient who was finally confirmed to have COVID-19 based on IgM and IgG antibodies in the cerebrospinal fluid (CSF). PATIENT CONCERNS: A 68-year-old man had slight flu-like symptoms and transient loss of consciousness in early February. Exaggerated unconsciousness and deteriorating mental abnormalities occurred over the next month without severe respiratory symptoms. Craniocerebral computed tomography showed normal results, but antibodies against severe acute respiratory syndrome coronavirus 2 were 100 times higher in the CSF than in the serum; tests for viral ribonucleic acid showed negative results with both a nasopharyngeal swab and CSF sample. DIAGNOSIS: COVID-19 pneumonia was diagnosed based on symptoms and positive results for IgM and IgG in the CSF. INTERVENTIONS: Antiviral, fluid, and nutritional support were administered for 30 days before admission without obvious improvement. A further 18 days of routine antiviral therapy, immunoglobulin therapy (10 g per day for 5 days), and antipsychotic drug treatment were administered. OUTCOMES: The patient's neurological and mental abnormalities were greatly ameliorated. He was discharged with mild irritability, slight shaking of the hands, and walking fatigue. These symptoms have persisted up to our last follow-up (May 4, 2020). CONCLUSION: We believe this is the first case involving neural system injury in a patient who confirmed COVID-19 based on CSF antibody test results. Negative ribonucleic acid test results, strong positivity for antibodies, and high protein levels in the CSF suggest the possibility of autoimmune encephalitis secondary to COVID-19. This case highlights additional novel symptoms of COVID-19, and these data are important for the assessment and follow-up of COVID-19 patients.

Trends in Transmissibility of 2019 Novel Coronavirus-infected Pneumonia in Wuhan and 29 Provinces in China (preprint)

Background The 2019 coronavirus disease (COVID-19) represents a sig- nificant p ublic h ealth t hreat g lobally. H ere w e d escribe e fforts to compare epidemic growth, size and peaking time for countries in Asia, Europe, North America, South America and Australia in the early epidemic phase. Methods Using the time series of cases reported from January 20, 2020 to February 13, 2020 and transportation data from December 1, 2019 to January 23, 2020 we have built a novel time-varying growth model to predict the epidemic trend in China. We extended our method, using cases reported from January 26, 2020 - or the date of the earliest case reported, to April 9, 2020 to predict future epidemic trend and size in 41 countries. We estimated the impact of control measures on the epidemic trend. Results Our time-varying growth model yielded high concordance in the predicted epidemic size and trend with the observed figures in C hina. Among the other 41 countries, the peak time has been observed in 28 countries before or around April 9, 2020; the peak date and epidemic size were highly consistent with our estimates. We predicted the remaining countries would peak in April or May 2020, except India in July and Pakistan in August. The epidemic trajectory would reach the plateau in May or June for the majority of countries in the current wave. Countries that could emerge to be new epidemic centers are India, Pakistan, Brazil, Mexico, and Russia with a prediction of 105 cases for these countries. The effective reproduction number Rt displayed a downward trend with time across countries, revealing the impact of the intervention remeasures i.e. social distancing. Rt remained the highest in the UK (median 2.62) and the US (median 2.19) in the fourth week after the epidemic onset. Conclusions New epidemic centers are expected to continue to emerge across the whole world. Greater challenges such as those in the healthcare system would be faced by developing countries in hotspots. A domestic approach to curb the pandemic must align with joint international efforts to effectively control the spread of COVID-19. Our model promotes a reliable transmissibility characterization and epidemic forecasting using the incidence of cases in the early epidemic phase.