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Clin Immunol ; 223: 108631, 2021 02.
Article in English | MEDLINE | ID: covidwho-919716


Although the starting event in COVID-19 is a viral infection some patients present with an over-exuberant inflammatory response, leading to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS). Since IL-6 plays a critical role in the inflammatory response, we assessed the efficacy and safety of tocilizumab (TCZ) in this single-centre, observational study in all Covid-19 in-patient with a proven SARS-CoV-2 rapidly progressing infection to prevent ALI and ARDS. 104 patients with COVID-19 treated with TCZ had a lower mortality rate (5·8%) compared with the regional mortality rate (11%), hospitalized patient's mortality (10%), and slightly lower than hospitalized patients treated with our standard of care alone (6%). We found that TCZ rapidly decreased acute phase reactants, ferritin and liver release of proteins. D-Dimer decreased slowly. We did not observe specific safety concerns. Early administration of IL6-R antagonists in COVID-19 patients with impending hyperinflammatory response, may be safe and effective treatment to prevent, ICU admission and further complications.

Acute Lung Injury/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Cytokine Release Syndrome/drug therapy , Inflammation/drug therapy , Respiratory Distress Syndrome/drug therapy , SARS-CoV-2/physiology , Acute Lung Injury/mortality , Aged , COVID-19/mortality , Cohort Studies , Cytokine Release Syndrome/mortality , Female , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Inflammation/mortality , Male , Middle Aged , Receptors, Interleukin-6/immunology , Respiratory Distress Syndrome/mortality , Survival Analysis
Fam Pract ; 38(2): 154-159, 2021 03 29.
Article in English | MEDLINE | ID: covidwho-756903


BACKGROUND: There is a scarcity of information about patients with mild or moderate symptoms during the coronavirus disease 2019 (COVID-19). This is especially true for those who attended and were followed up at primary care settings. OBJECTIVES: We aim to measure the seroprevalence of antibodies against SARS-CoV-2 infection in a community sample of possible cases and among probable cases followed in primary care. METHODS: We selected a random sample of 600 individuals stratified by age groups from a total population of 19 899 individuals from a community area in Barcelona. We also invited all the patients that had been followed by General Practitioners (GPs). For both populations, we used COVID-19 rapid lateral flow immunoassays, which qualitatively assess the presence of patient-generated Immunoglobulins G (IgG) and Immunoglobulin M (IgM). RESULTS: Three hundred and eleven asymptomatic individuals from the randomly selected sample participated in the study. The mean age was 43.7 years [standard deviation (SD) = 21.79] and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting in an overall prevalence of 5.47% (95% confidence interval = 3.44-8.58). Six hundred and thirty-four symptomatic patients were followed up by GPs. The mean age was 46.97 years (SD = 20.05) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive. Results of the multivariate logistic regression analysis showed that the odds ratio for a positive test was significantly increased in patients who had fever, ageusia and contact with a patient diagnosed with COVID-19. CONCLUSIONS: The seroprevalence of antibodies against SARS-CoV-2 among possible cases was lower than expected. Approximately, 40% of the symptomatic patients followed up by GPs during the peak months of the pandemic were positive.

COVID-19 Serological Testing , COVID-19/diagnosis , COVID-19/epidemiology , Primary Health Care , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Infant , Logistic Models , Male , Middle Aged , Prevalence , Prospective Studies , Seroepidemiologic Studies , Severity of Illness Index , Spain/epidemiology , Young Adult