Clinical utility of repurposing a short course of hepatitis C drugs for COVID19. A randomized controlled study

BACKGROUNDPreliminary data suggests a potential therapeutic benefit for the hepatitis C drugs, sofosbuvir (SOF) and daclatasvir (DCV) for the treatment of COVID-19. We aim to evaluate efficacy of a short course of dual sofosbuvir/daclatasvir in patients with COVID-19. METHODSEighty-nine consecutive eligible patients were randomly assigned to two treatment groups. The experimental group was treated with the standard of care (SOC) therapy in addition to one 400 mg tablet sofosbuvir and one 60 mg daclatasvir daily for 10 days; while the control group was treated with the SOC therapy alone. Baseline clinical data was measured and followed up for 21 days. Data was compared between the two treatment groups. RESULTSThe proportion of cumulative clinical recovery in the experimental group at day 21 was numerically greater than the control group (40/44 (91%; 95%CI: 78.8-96.4%) versus 35/45 (77.8%; CI 63.7-87.5%)). The Hazard Ratio (HR) for time to clinical recovery adjusted for baseline severity, using a Cox-regression model was statistically significant: HR: 1.59 (95%CI: 1.001-2.5). Concordantly, the experimental group also showed trends for greater improvement in the mean 8-points ordinal scale score, the severity of lung lesions score and the case fatality rate (4.5% versus 11.1%). No serious or severe adverse events were reported in both groups. CONCLUSIONThis study supports potential benefit and safety of sofosbuvir combined with daclatasvir when given early in the treatment of COVID-19. We hope to encourage further large sized, multinational studies to confirm the results. HIGHLIGHTSO_LIPreliminary data suggests a potential therapeutic benefit for the hepatitis C drugs, sofosbuvir (SOF) and daclatasvir (DCV) for the treatment of COVID-19. C_LIO_LIEighty-nine COVID-19 patients were randomly assigned to either treatment with SOC plus a short course of combined SOF/DCV therapy or SOC therapy alone. C_LIO_LIThe Hazard Ratio (HR) for time to clinical recovery adjusted for baseline severity showed statistical significance: HR: 1.59 (95%CI: 1.001-2.5). Concordantly, all other efficacy endpoints showed numerical trends for greater improvement in the experimental group including the case fatality rate (4.5% versus 11.1%). No serious or severe adverse events were reported in both groups. C_LIO_LISOF/DCV therapy might be beneficial when given early in the treatment of COVID-19. C_LI

SARS-CoV-2 Genetic diversity and lineage dynamics of in Egypt

COVID-19 was first diagnosed in Egypt on 14 February 2020. By the end of November 2021, over 333,840 cases and 18,832 deaths had been reported. As part of national genomic surveillance, 1,027 SARS-CoV-2 near whole-genomes had been generated and published by the end of May 2021. Here we describe the genomic epidemiology of SARS-CoV-2 in Egypt over this period using a subset of 976 high-quality Egyptian genomes analysed together with a representative set of global sequences within a phylogenetic framework. We show that a single lineage, C.36, introduced early in the pandemic was responsible for most cases in Egypt. Furthermore, we show that to remain dominant in the face of mounting immunity from previous infection and vaccination, this lineage evolved into various sub-lineages acquiring several mutations known to confer adaptive advantage and pathogenic properties. These results highlight the value of continuous genomic surveillance in regions where VOCs are not predominant and enforcement of public health measures to prevent expansion of existing lineages.

Clinical efficacy of Early Administration of Convalescent Plasma among COVID-19 Cases in Egypt

ImportanceEarly and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection ObjectivesThe primary objective of the study was to assess the degree of clinical improvement in severe and critically ill COVID-19 patients, treated early with early CPT. DesignsAn interventional, single-arm, non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. SettingsThis was a multi-centre study conducted in 3 hospitals in Egypt. Participantsa total of 94 COVID-19 laboratory-confirmed patients using qRT-PCR were enrolled in the study. InterventionAll patients were administered with two plasma units (each unit is 200cc). The volume of donated plasma was 800cc. Main Outcome and MeasuresPrimary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within seven days ResultsA total of 94 patients were enrolled who received CPT either within seven days or after seven days of hospitalization. 82 were severely ill, 12 were critically ill. The average age remained 58 years ({+/-}SD 15.1 years). Male were 69% and 49% patients got cured while 51% died with CFR 51%. 75% deaths were above 45years of age. The symptoms were dyspnoea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained Diabetes Mellitus (21%) and Asthma (14%). Among 40-60 years Hypertension (56%), Diabetes Mellitus (39%) and among >60 years age group Hypertension (57%) and Chronic Heart Disease (24%) were reported. CPT within seven days remained significant as compared with the CPT after seven days with the number of days to cure (p=0.007) and ICU stay (P=0.008) among severely ill cured cases. Conclusion and RelevanceAmong patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within seven days with 65% cure rate. Trial RegistrationClinical Intervention identifier: MOHP_COVID-19_Ver1.1

Demographic and clinical features associated with in-hospital mortality in Egyptian COVID-19 patients: A retrospective cohort study

IntroductionSince the worldwide emergence of the COVID-19, several protocols were used by different healthcare organisations. We evaluated in this study the demographic and clinical characteristics of COVID-19 disease in Egyptian population with special consideration for its mortality predictors. Methodology8162 participants (mean age 48.7{+/-}17.3 years,54.5% males) with RT-PCR positive COVID-19 were included. The electronic medical records were reviewed for demographic, clinical, laboratory, and radiologic features. The primary outcome was the in-hospital mortality rate. ResultsThe in-hospital mortality was 11.2%. There was a statistically significant strong association of in-hospital mortality with age >60 years old (OR:4.7; 95% CI 4.1-5.4;p<0.001), diabetes mellitus (OR:4.6; 95% CI 3.99-5.32;p<0.001), hypertension (OR:3.9; 95% CI 3.4-4.5;p<0.001), coronary artery disease (OR:2.7; 95% CI 2.2-3.2;p<0.001), chronic obstructive pulmonary disease (OR:2.1; 95% CI 1.7-2.5;p<0.001), chronic kidney disease (OR:4.8; 95% CI 3.9-5.9;p<0.001), malignancy (OR:3.7; 95% CI 2.3-5.75;p<0.001), neutrophil-lymphocyte ratio >3.1 (OR:6.4; 95% CI 4.4-9.5;P< 0.001), and ground glass opacities (GGOs) in CT chest (OR:3.5; 95% CI 2.84-4.4;P<0.001), respectively. There was a statistically significant moderate association of in-hospital mortality with male gender (OR:1.6; 95% CI 1.38-1.83;p<0.001) and smoking (OR:1.6; 95% CI 1.3-1.9;p<0.001). GGOs was reported as the most common CT finding (occurred in 73.1% of the study participants). ConclusionsThis multicenter, retrospective study ascertained the higher in-hospital mortality rate in Egyptian COVID-19 patients with different comorbidities.

Determinants of the incidence and mortality rates of COVID-19 during the first six months of the pandemic; A cross-country study

COVID-19 pandemic raises an extraordinary challenge to the healthcare systems globally. The governments are taking key measures to constrain the corresponding health, social, and economic impacts, however, these measures vary depending on the nature of the crisis and country-specific circumstances. ObjectivesConsidering different incidence and mortality rates across different countries, we aimed at explaining variance of these variables by performing accurate and precise multivariate analysis with aid of suitable predictors, accordingly, the model would proactively guide the governmental responses to the crisis. MethodsUsing linear and exponential time series analysis, this research aimed at studying the incidence and mortality rates of COVID-19 in 18 countries during the first six months of the pandemic, and further utilize multivariate techniques to explain the variance in monthly exponential growth rates of cases and deaths with aid of a set of different predictors: the recorded Google mobility trends towards six categories of places, daily average temperature, daily humidity, and key socioeconomic attributes of each country. ResultsThe analysis showed that changes in mobility trends were the most significant predictors of the incidence and mortality rates, temperature and humidity were also significant but to a much lesser extent, on the other hand, the socioeconomic attributes did not contribute significantly to explaining different incidence and mortality rates across countries. ConclusionChanges in mobility trends across countries dramatically affected the incidence and mortality rates across different countries, thus, it might be used as a proxy measure of contact frequency.

Psychiatric morbidities and Coping strategies in patients with different Coronavirus disease-2019 severities and chronic medical diseases: A multicenter cross-sectional study

COVID-19 patients, especially those with chronic medical illnesses (CMI), may use different coping strategies, to reduce their psychological distress while facing the COVID-19 infection. The aim was to compare anxiety, depression and coping styles between patients infected with COVID-19 disease with and without CMI during the peak of COVID-19 disease in Egypt. This is a cross sectional study, that included an online survey consisting of Arabic versions of General Health Questionnaire-12, Taylor Manifest Anxiety Scale (TMAS), Beck Depression Inventory (BDI) and Brief-COPE scale. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. One hundred ninety-nine patients responded to the survey, where 46.73% of them had CMI. Religion, emotional support, use of informational support and acceptance were the most used coping strategies by participants. Avoidant coping strategies were frequently used by divorced patients, home quarantined individuals, patients who developed COVID-19 related anxiety/depression and patients who didnt receive hydroxyl-chloroquine. Approach strategies were frequently used by patients with mild COVID-19. Understanding the used coping strategies has implications for how individuals might be helped to manage their illness during the current presentation and intervene with development of serious long-term mental health conditions.