Outpatient Management of COVID-19 Disease: A Holistic Patient-Centered Proposal Based on the Greek Experience

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, as of June 25, 2021. The Hellenic Thoracic Society (HTS) during the second wave of COVID-19 pandemic released a guidance document for the management of patients with COVID-19 in the community and in hospital setting. In this review, with guidance the HTS document, we are discussing the outpatient management of COVID-19 patients, including the preventive measures, the patients’ isolation and quarantine criteria of close contacts, the severity and risk stratification, including the decisions for advanced hospitalization, and the disease management at home in patients with mild disease and after hospital discharge for those with more severe disease.

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A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

Clinical Pediatrics ◽

10.1177/00099228211006688 ◽

2021 ◽

Vol 60 (4-5) ◽

pp. 247-251

Author(s):

Ameer Hassoun ◽

Nessy Dahan ◽

Christopher Kelly

Keyword(s):

New York ◽

Case Reports ◽

Severe Disease ◽

Case Series ◽

Pediatric Emergency ◽

Rt Pcr ◽

Vulnerable Group ◽

Mild Disease ◽

Young Infants ◽

Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

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Adolescents Hospitalized with SARS-CoV-2: Analysis of Clinical Profile and Risk Factors for Severe Disease over a two-year period

10.1101/2022.01.06.22268674 ◽

2022 ◽

Author(s):

Tamoghna Ghosh ◽

Tejas M Suri ◽

Kana Ram Jat ◽

Aditya Kumar Gupta ◽

Sushma Bhatnagar ◽

...

Keyword(s):

Risk Factors ◽

Severe Disease ◽

Tertiary Hospital ◽

Clinical Profile ◽

North India ◽

Mild Disease ◽

Reactive Protein ◽

Northern India ◽

Severity Grading ◽

Second Wave

Introduction: There is a lack of studies in adolescents with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in adolescents hospitalized with COVID-19. Methods: A retrospective analysis of a prospectively admitted cohort of COVID-19 patients was performed at a tertiary hospital in north India. Adolescents aged 12 to 18 years who were hospitalized during the first wave (March 2020 to December 2020) and the second wave (March 2021 to June 2021) of the pandemic were included. Data on the demographic details, clinical presentation, laboratory parameters, disease severity at admission, treatments received, and in-hospital outcomes were retrieved and logistic regression was used to identify the risk factors for occurrence of moderate or severe disease. Results: The study included 197 adolescents with median (IQR) age 15 (13-17) years, of whom 117 (59.4%) were male. Among these, 170 (86.3%) were admitted during the 1st wave. Underlying comorbidities were present in 9 (4.6%) patients. At the time of hospital admission, 60 (30.9%) patients were asymptomatic. In the severity grading, 148 (84.6%) had mild, 16 (9.1%) had moderate, and 11 (6.3%) had severe disease. Fever (14.9%) and cough (14.9%) were the most commonly encountered symptoms. The median (IQR) duration of hospital stay was 10 (8-13) days and 6 (3.1%) patients died in hospital. The odds of moderate to severe disease were 3.8 for second wave, 1.9 for fever and 1.1 for raised C reactive protein (CRP). Conclusion: In our single-center study from northern India, adolescents admitted with COVID-19 had predominantly asymptomatic or mild disease. Admission during the second wave of COVID-19 pandemic, presence of fever and raised CRP were risk factors for moderate or severe disease.

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Prognostic value of sTREM-1 in COVID-19 patients: a biomarker for disease severity and mortality

10.1101/2020.09.22.20199703 ◽

2020 ◽

Author(s):

Pedro V da Silva Neto ◽

Jonatan C S de Carvalho ◽

Vinicius E Pimentel ◽

Malena M Perez ◽

Ingryd Carmona-Garcia ◽

...

Keyword(s):

Disease Severity ◽

Clinical Characteristics ◽

Early Recognition ◽

Severe Disease ◽

Critical Role ◽

Critical Groups ◽

Receiver Operating Curve ◽

Mild Disease ◽

Clinical Scores ◽

Novel Coronavirus

Background: The uncontrolled inflammatory response plays a critical role in the novel coronavirus disease (COVID-19) and triggering receptor expressed on myeloid cells-1 (TREM-1) is thought to be intricate to inflammatory signal amplification. This study aims to investigate the association between soluble TREM-1 (sTREM-1) and COVID-19 as a prognostic biomarker to predict the disease severity, lethality and clinical management.Methods: We enrolled 91 patients with COVID-19 in domiciliary care (44 patients) or in hospital care (47 patients), who were classified after admission into mild, moderate, severe and critical groups according to their clinical scores. As non-COVID-19 control, 30 healthy volunteers were included. Data on demographic, comorbidities and baseline clinical characteristics were obtained from their medical and nurse records. Peripheral blood samples were collected at admission and after hospitalization outcome to assess cytokine profile and sTREM-1 level by specific immunoassays Results: Within COVID-19 patients, the highest severity was associated with the most significant elevated plasma levels sTREM-1. Using receiver operating curve analysis (ROC), sTREM-1 was found to be predictive of disease severity (AUC= 0.988) and the best cut-off value for predicting in-hospital severity was ≥ 116.5 pg/mL with the sensitivity for 93.3% and specificity for 95.8%. We also described the clinical characteristics of these patients and explored the correlation with markers of the disease aggravation. The levels of sTREM-1 were positively correlated with IL-6, IL-10, blood neutrophils counts, and critical disease scoring (r= 0.68, p<0.0001). On the other hand, sTREM-1 level was significantly negative correlated with lymphocytes counting, and mild disease (r= -0.42, p<0.0001). Higher levels of sTREM-1 were related to poor outcome and death, patients who received dexamethasone tended to have lower sTREM-1 levels. Conclusion: Our results indicated that sTREM-1 in COVID-19 is associated with severe disease development and a prognostic marker for mortality. The use of severity biomarkers such as sTREM-1 together with patients clinical scores could improve the early recognition and monitoring of COVID-19 cases with higher risk of disease worsening. Key words: COVID-19; sTREM-1; Inflammation; Biomarker; Severity; Mortality.

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The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012

Eurosurveillance ◽

10.2807/ese.17.40.20292-en ◽

2012 ◽

Vol 17 (40) ◽

Cited By ~ 1

Author(s):

R G Pebody ◽

M A Chand ◽

H L Thomas ◽

H K Green ◽

N L Boddington ◽

...

Keyword(s):

Severe Disease ◽

Fatal Case ◽

Respiratory Illness ◽

The Novel ◽

Public Health Response ◽

The United Kingdom ◽

Health Response ◽

Novel Coronavirus ◽

Severe Respiratory Illness ◽

Close Contacts

On 22 September 2012, a novel coronavirus, very closely related to that from a fatal case in Saudi Arabia three months previously, was detected in a previously well adult transferred to intensive care in London from Qatar with severe respiratory illness. Strict respiratory isolation was instituted. Ten days after last exposure, none of 64 close contacts had developed severe disease, with 13 of 64 reporting mild respiratory symptoms. The novel coronavirus was not detected in 10 of 10 symptomatic contacts tested.

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Emerging respiratory virus: COVID-19-Basic concepts and its impact on immunisation of vaccine preventable diseases

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.4378 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1830-1835

Author(s):

Ruchika Lulla (Sadhwani) ◽

Priyanka Jaiswal ◽

Narayan R. Sadhwani ◽

Nilesh N. Sadhwani

Keyword(s):

Health Care ◽

Severe Disease ◽

Gastrointestinal Symptoms ◽

General Information ◽

Vaccine Preventable Diseases ◽

Mild Disease ◽

Do No Harm ◽

Health Care Burden ◽

Novel Coronavirus ◽

No Harm Principle

In Dec 2019, pneumonia cluster in China caused by a previously unknown virus, now called Novel Coronavirus 2019, occurred, causing respiratory as well as gastrointestinal symptoms. The respiratory symptoms usually include common cold; pneumonia causing generally mild disease. There are, however, several examples of severe disease-causing coronaviruses that include severe acute respiratory syndrome (SARS)-Cov first identified in China in 2003; and Middle East Respiratory Syndrome (MERS) Cov, first identified in Saudi Arabia in 2012. In 2019 the n-COV was first detected in China. At present, there are many cases in China and along with it, this has spread to other countries as well. The article aims at giving general information about the novel coronavirus and its impact on vaccine preventable diseases. Currently, there is a big outbreak in India and other countries as well. By ensuring early immunisation, protecting people and groups of persons, reducing the susceptibility of a vaccine preventable disease (VPD) outbreak not only saves lives but also requires less resources and helps to reduce the health care burden. Immunizations are important resources for health care that protect people vulnerable to VPD. Countries may therefore contribute to the maintenance of immunisation programmes by using methods that adopt the do-no-harm principle and limit the transmission of COVID-19 when conducting immunisation activities.

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Antibody responses to SARS-CoV2 are distinct in children with MIS-C compared to adults with COVID-19

10.1101/2020.07.12.20151068 ◽

2020 ◽

Cited By ~ 10

Author(s):

Stuart P Weisberg ◽

Thomas Connors ◽

Yun Zhu ◽

Matthew Baldwin ◽

Wen-Hsuan Lin ◽

...

Keyword(s):

Distress Syndrome ◽

Severe Disease ◽

Clinical Manifestations ◽

Serological Response ◽

The Novel ◽

N Protein ◽

Mild Disease ◽

Patient Groups ◽

Novel Coronavirus ◽

Inflammatory Syndrome

Clinical manifestations of COVID-19 caused by the novel coronavirus SARS-CoV-2 are associated with age. While children are largely spared from severe respiratory disease, they can present with a SARS-CoV-2-associated multisystem inflammatory syndrome (MIS-C) similar to Kawasaki's disease. Here, we show distinct antibody (Ab) responses in children with MIS-C compared to adults with severe COVID-19 causing acute respiratory distress syndrome (ARDS), and those who recovered from mild disease. There was a reduced breadth and specificity of anti-SARS-CoV-2-specific antibodies in MIS-C patients compared to the COVID patient groups; MIS-C predominantly generated IgG Abs specific for the Spike (S) protein but not for the nucleocapsid (N) protein, while both COVID-19 cohorts had anti-S IgG, IgM and IgA Abs, as well as anti-N IgG Abs. Moreover, MIS-C patients had reduced neutralizing activity compared to COVID-19 cohorts, indicating a reduced protective serological response. These results suggest a distinct infection course and immune response in children and adults who develop severe disease, with implications for optimizing treatments based on symptom and age.

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Different Innate and Adaptive Immune Responses to SARS-CoV-2 Infection of Asymptomatic, Mild, and Severe Cases

Frontiers in Immunology ◽

10.3389/fimmu.2020.610300 ◽

2020 ◽

Vol 11 ◽

Author(s):

Rita Carsetti ◽

Salvatore Zaffina ◽

Eva Piano Mortari ◽

Sara Terreri ◽

Francesco Corrente ◽

...

Keyword(s):

Immune Response ◽

Immune Responses ◽

Nk Cells ◽

Wide Spectrum ◽

Severe Disease ◽

Adaptive Immune Response ◽

Organ Damage ◽

Mild Disease ◽

Adaptive Immune ◽

Novel Coronavirus

SARS-CoV-2 is a novel coronavirus, not encountered before by humans. The wide spectrum of clinical expression of SARS-CoV-2 illness suggests that individual immune responses to SARS-CoV-2 play a crucial role in determining the clinical course after first infection. Immunological studies have focused on patients with moderate to severe disease, demonstrating excessive inflammation in tissues and organ damage. In order to understand the basis of the protective immune response in COVID-19, we performed a longitudinal follow-up, flow-cytometric and serological analysis of innate and adaptive immunity in 64 adults with a spectrum of clinical presentations: 28 healthy SARS-CoV-2-negative contacts of COVID-19 cases; 20 asymptomatic SARS-CoV-2-infected cases; eight patients with Mild COVID-19 disease and eight cases of Severe COVID-19 disease. Our data show that high frequency of NK cells and early and transient increase of specific IgA, IgM and, to a lower extent, IgG are associated with asymptomatic SARS-CoV-2 infection. By contrast, monocyte expansion and high and persistent levels of IgA and IgG, produced relatively late in the course of the infection, characterize severe disease. Modest increase of monocytes and different kinetics of antibodies are detected in mild COVID-19. The importance of innate NK cells and the short-lived antibody response of asymptomatic individuals and patients with mild disease suggest that only severe COVID-19 may result in protective memory established by the adaptive immune response.

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SARS-COV2 virus and Coronavirus disease (COVID-19)

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3401 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 977-982

Author(s):

Mohamed J. Saadh ◽

Bashar Haj Rashid M ◽

Roa’a Matar ◽

Sajeda Riyad Aldibs ◽

Hala Sbaih ◽

...

Keyword(s):

Close Contact ◽

Antiviral Agents ◽

Health Concern ◽

The Novel ◽

Global Public Health ◽

Fatal Disease ◽

Mild Disease ◽

Life Threatening ◽

Novel Coronavirus

SARS-COV2 virus causes Coronavirus disease (COVID-19) and represents the causative agent of a potentially fatal disease that is of great global public health concern. The novel coronavirus (2019) was discovered in 2019 in Wuhan, the market of the wet animal, China with viral pneumonia cases and is life-threatening. Today, WHO announces COVID-19 outbreak as a pandemic. COVID-19 is likely to be zoonotic. It is transmitted from bats as intermediary animals to human. Also, the virus is transmitted from human to human who is in close contact with others. The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is nearly supportive; the role of antiviral agents is yet to be established. The SARS-COV2 virus spreads faster than its two ancestors, the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. In this article, we aimed to summarize the transmission, symptoms, pathogenesis, diagnosis, treatment, and vaccine to control the spread of this fatal disease.

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The Current Outbreak of COVID-19 with reference to India

Coronaviruses ◽

10.2174/2666796701999201026203911 ◽

2020 ◽

Vol 01 ◽

Author(s):

Harshita Gupta

Keyword(s):

Medical Research ◽

Preventive Measures ◽

Antiviral Drug ◽

Treatment Strategies ◽

Highly Pathogenic ◽

Indian Council ◽

Current Outbreak ◽

Novel Coronavirus ◽

Bat Coronavirus ◽

Viral Outbreak

Abstract:: This review summarizes the outbreak of viruses causing the fatal disease which is highly pathogenic and human to human transmittable and it first emerges in Wuhan, China and now this epidemic situation becomes worldwide. A novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus(SARS-CoV)-2 belongs to β-coronavirus genera which were originated in bats due to highly identical genome with bat coronavirus. This review highlights the Indian Council of Medical Research, India study which determined the detection of pathogenic coronavirus in two species of Indian bats. Indian Council of Medical Research, India has successfully isolated the COVID-19 virus strain which was the first step towards diagnosis and the development of vaccines in the country. The outbreaks of coronavirus received worldwide attention for overcoming the challenges faced during this current pandemic as there is no clinically approved antiviral drug or vaccine available, however, preventive measures and different treatments were taken to cope with this viral outbreak. In response to this global outbreak, this review tries to explain the Virology, Epidemiology, pathogenesis, and discusses the Diagnosis, treatment strategies of COVID-19. This review emphasizes the current update of knowledge about COVID-19.

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SAT0541 THE SEVERITY OF FMF MAY BE ASSOCIATED WITH CO-MORBIDITIES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.801 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1227.3-1228

Author(s):

M. E. Tezcan ◽

N. Şen ◽

M. Yilmaz ◽

Ö. Volkan ◽

E. Tükel ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Scoring System ◽

Disease Duration ◽

Severe Disease ◽

Smoking History ◽

Disease Group ◽

Severity Scoring ◽

Mild Disease ◽

Co Morbidity ◽

Mediterranean Fever

Background:Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.Objectives:One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.Methods:We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.Results:Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.Table.Features of mild and severe FMF groupsMild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5<0.001Co-morbidity (%)25 (18.5)9 (39.1)0.02Conclusion:In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.References:[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.Acknowledgments:NoneDisclosure of Interests:None declared

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