Effectiveness of tocilizumab in non-intubated cases with COVID-19: a systematic review and meta-analysis.

PURPOSE: Tocilizumab, a monoclonal IL-6 receptor blocker, is an effective agent for severe-to-critical cases of COVID-19; however, its target patients for the optimum use need to be detailed. We performed a systematic review and meta-analysis to define its effect among severely ill but non-intubated cases with COVID-19. METHODS: We searched PubMed, Scopus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Medrxiv, and Biorxiv until February 13, 2022, for non-intubated cases, and included randomized-controlled trials (RCT) based on bias assessment. The primary outcomes were the requirement of invasive mechanical ventilation and mortality. Random effect and fixed-effect models were used. The heterogeneity was measured using the χ2 and I2 statistics, with χ2 p ≤ 0.05 and I2 ≥ 50% indicating the presence of significant heterogeneity. We registered the study to the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42021232575. RESULTS: Among 261 articles, 11 RCTs were included. The pooled analysis of the 11 RCTs demonstrated that the rate of mortality was significantly lower in the tocilizumab group than in the control group (20.0% and 24.2%, OR: 0.84, 95% CI 0.73-0.96, and heterogeneity I2 = 0%. p = 0.82.). The mechanical ventilation rate was lower in the tocilizumab group than the control group (27% vs 35.2%, OR: 0.76, 95% CI 0.67-0.86, and heterogeneity I2 = 6%. p = 0.39). CONCLUSION: Among non-intubated severe COVID-19 cases, tocilizumab reduces the risk of invasive mechanical ventilation and mortality compared to standard-of-care treatment.

Duration of infectious shedding of SARS-CoV-2 Omicron variant and its relation with symptoms.

OBJECTIVES: SARS-CoV-2 infections with Omicron variants have a high capability of human-to-human transmission. Nevertheless, the duration of isolation for mild cases was shortened to 5 to 7 days. We aimed to detect the duration of viral shedding among healthcare workers (HCWs) with Omicron by using viral culture. METHODS: We prospectively included newly diagnosed nonsevere, symptomatic SARS-CoV-2 positive HCWs. Nasopharyngeal swab samples were obtained consecutively on days 5, 7,10, and 14 of onset of symptoms. The samples were examined by nucleic acid amplification test and viral culture. RESULTS: In total, 55 non-severe patients with SARS-CoV-2 Omicron variant were included. The mean age of the population was 34 years (range, 23 to 54) and 78% (43/55) were female. The PCR positivity rate on days 5, 7, 10, and 14 was 96.4% (53/55), 87.3% (48/55), 74.545% (41/55), and 41.8% (23/55) consecutively, whereas the viral culture positivity rates were 83% (44/53), 52% (26/50), 13.5% (7/52), and 8% (4/50). Among the patients who became symptom-free, the viral culture positivity rates were 100% (4/4), 58% (7/12), 11% (3/27), and 5% (2/41). DISCUSSION: We showed that among the SARS-CoV-2 Omicron variant infected patients, viral shedding continues for ≥10 days in 13.5% of all cases and 11% in symptom-free cases. The decision for cessation of isolation according to the presence of symptoms could be reconsidered until further studies disapprove of our results. Meanwhile, the infected HCWs who give care to high-risk patients for severe COVID-19 might extend their isolations ≤10 days after the onset of symptoms, regardless of their symptoms.

COVID-19 Severity among Healthcare Workers: Overweight Male Physicians at Risk.

We performed a prospective longitudinal cohort study in two healthcare settings. In total, 909 HCWs out of 3982 (23.35%) were diagnosed with COVID-19 before the vaccination era. Eighty-five per cent of COVID-19 positive HCWs (n = 774) were asymptomatic or mild, and 15% were moderate or severe. The mean age of the infected HCWs in the moderate or severe group was higher than the mild or asymptomatic group (35.4 vs. 31.3 years, p < 0.001). Thirty-two per cent of HCWs were male and the rate of male gender was more frequent in the moderate/severe group (p = 0.009). The rate of those who have cardiovascular diseases (p = 0.003) and diabetes mellitus (p = 0.044) were significantly higher among the HCWs with moderate or severe COVID-19. In multivariate analysis, male gender (OR:1.65, CI:1.11-2.46, p = 0.013), BMI > 30 (OR: 1.9, CI: 1.09-3.51, p = 0.024), and being physician (OR: 2.56, CI:1.45-4.52, p = 0.001) were found to be associated with moderate or severe COVID-19.

ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the health care setting.

SCOPE: This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. METHODS: A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach. RECOMMENDATIONS: Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.

Effectiveness of favipiravir in COVID-19: a live systematic review.

We performed a systematic review and meta-analysis for the effectiveness of Favipiravir on the fatality and the requirement of mechanical ventilation for the treatment of moderate to severe COVID-19 patients. We searched available literature and reported it by using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Until June 1, 2021, we searched PubMed, bioRxiv, medRxiv, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar by using the keywords "Favipiravir" and terms synonymous with COVID-19. Studies for Favipiravir treatment compared to standard of care among moderate and severe COVID-19 patients were included. Risk of bias assessment was performed using Revised Cochrane risk of bias tool for randomized trials (RoB 2) and ROBINS-I assessment tool for non-randomized studies. We defined the outcome measures as fatality and requirement for mechanical ventilation. A total of 2702 studies were identified and 12 clinical trials with 1636 patients were analyzed. Nine out of 12 studies were randomized controlled trials. Among the randomized studies, one study has low risk of bias, six studies have moderate risk of bias, and 2 studies have high risk of bias. Observational studies were identified as having moderate risk of bias and non-randomized study was found to have serious risk of bias. Our meta-analysis did not reveal any significant difference between the intervention and the comparator on fatality rate (OR 1.11, 95% CI 0.64-1.94) and mechanical ventilation requirement (OR 0.50, 95% CI 0.13-1.95). There is no significant difference in fatality rate and mechanical ventilation requirement between Favipiravir treatment and the standard of care in moderate and severe COVID-19 patients.

The seroprevalence of SARS-CoV-2 antibodies among health care workers before the era of vaccination: a systematic review and meta-analysis.

BACKGROUND: The prevalence of SARS-CoV-2 infection among health care workers (HCWs) provides information about the spread of COVID-19 within health care facilities, and the risk groups. OBJECTIVES: We aimed to describe the rate of SARS-CoV-2 seroprevalence and its determinants among HCWs. DATA SOURCES: We used Web of Science, PubMed, Scopus, MEDLINE, EBSCOhost and Cochrane Library. STUDY ELIGIBILITY CRITERIA: We included the reports of SARS-CoV-2 seroprevalence with a sample size of minimum 1000 HCWs. METHODS: The study was registered at the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021230456). We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The keywords were "COVID-19", "SARS-CoV-2", "Coronavirus", "seroprevalence", "health care workers" and "risk factors". RESULTS: In total 4329 reports were retrieved, duplications were removed; after filtering according to the title and abstract, 25 studies were selected. Risk of bias was assessed in 25 studies; it was low in 13 studies, medium in four studies, and high in eight studies. In meta-analysis using the random effect model, the weighted average of seroprevalence was calculated as 8% (95% CI 6-10%). The pooled seroprevalence rates of the selected variables that have a rate above the average were male HCWs with 9% (95% CI 7-11%); HCWs from ethnic minorities with 13% (95% CI 9-17%); high exposure 9% (95% CI 6-13%); exposure to the virus outside the health care setting 22% (95% CI 14-32%). CONCLUSIONS: Our analysis indicates a SARS-CoV-2 seroprevalence rate of 8% among studies that included >1000 HCWs for the year 2020, before vaccinations started. The most common risk factors associated with higher seroprevalence rate were ethnicity, male gender and having a higher number of household contacts. Working as a frontline HCW was inconsistent in its association with higher seroprevalence.

Why we should be more careful using hydroxychloroquine in influenza season during COVID-19 pandemic?

The aim of this study was to describe the QTc prolongation and related adverse cardiac events during the administration of hydroxychloroquine (HCQ) and its combinations for the treatment of coronavirus disease 2019 (COVID-19). Hospitalized patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who received HCQ and had initial and follow-up electrocardiograms performed between March 10 and May 30, 2020 were included. Critical QTc prolongation was detected in 12% of the patients. On multivariate analysis, diabetes mellitus (odds ratio 5.8, 95% confidence interval 1.11-30.32, p = 0.037) and the use of oseltamivir (odds ratio 5.3, 95% confidence interval 1.02-28, p = 0.047) were found to be associated with critical QTc prolongation.

Influenza vaccination among infection control teams: A EUCIC survey prior to COVID-19 pandemic.

We aimed to describe the influenza vaccination rate and its determinants among infection control team (ICT) across different countries. Online multilingual survey consisting of 23 items, between 17 May -15 July of 2019 targeting the opinions and practices of ICTs regarding the 2018-2019 influenza season was employed. Participants were reached via European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Union Certificate for Infection Control (EUCIC) newsletters,social media, and national societies. In total, 899 participants from 56 countries responded to the survey. The overall vaccination rate was 76%, being the highest in Finland, Portugal, Norway, and Israel (100%), whereas the lowest in Italy (68%) and Turkey (39%). Influenza vaccination rate was 86% among IC physicians and 52% among IC nurses. The most significant factors affecting participants' decision were personal influenza vaccine experience (49%) and attitude of the scientific authorities (48%). In multivariate analysis, vaccination of the ICT head (OR: 16.04, 95%CI: 8.4-30.8, p < 0.001) and having free vaccine (OR: 7.56, 95%CI: 2.1-27.4, p = 0.02) were found to be the strongest predictors for influenza vaccination, whereas working in Turkey (OR: 0.41, 95%CI: 0.22-0.77, p = 0.006) and being an IC nurse (OR:0.43, 95%CI: 0.24-0.80, p = 0.007) were significantly associated with not having been vaccinated. In conclusion, COVID-19 pandemic increased the importance of protection against respiratory viruses including influenza. Vaccination strategies should have a special emphasis on IC nurses, who have a relatively lower vaccination rate, should enhance the vaccination of the ICT leaders, and put effort to provide free availability of the influenza vaccine.

Appropriate use of tocilizumab in COVID-19 infection.

OBJECTIVE: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. METHODS: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. RESULTS: Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. CONCLUSION: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.