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šŸ¦˜Cacatman's Personal Coronavirus COVID-19 Update Thread

Risk Factors - Obesity in the Top 3
Obesity is one of the three greatest risk factors for suffering the most serious consequences of Covid-19, including age. The study give us insight into why Covid-19 has a more serious consequence for the obese and overweight. Fat cells express the receptor for SARS-CoV-2, serving as a reservoir for virus infection. Those who are overweight and obese remain infected several days longer than their aged-matched leaner counterparts. Moreover, obesity creates an underlying inflammatory condition, one that very likely exacerbates the inflammation caused by SARS-C0V-2 infection, one of the leading causes of Covid-19 disease.

Obesity increases risk of being Sicker and Dying
Not only does obesity increase your risk of being sicker and dying from COVID-19; obesity increases your risk of getting infected in the first place.

You have a higher death rate risk at days 21 and 45 if you are obese

Higher rates of obesity in COVID-19 patients who are critically ill

Obesity is associated with 236 medical diagnoses including 13 types of cancer

In an analysis of data and studies from more than 160 countries, the researchers found that Covid-19 mortality rates increased along with countries' prevalence of obesity. They note that the link persisted even after adjusting for age and national wealth.

The report found that every country where less than 40% of the population was overweight had a low Covid-19 death rate of no more than 10 people per 100,000.
But in countries where more than 50% of the population was overweight, the Covid-19 death rate was much higher -- more than 100 per 100,000.

Worse COVID-19 severity, higher risk of ICU, increased mortality (3.78 times more likely to die in hospitalisation)

Obesity
Risk of death and severity is about 3-4 times higher. Due to chronic inflammation in the system which then potentiates COVID-19 cytokine storm.


In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than for nonobese patients.

At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity.

The findings from this study show an association between weight loss achieved with surgery and improved outcomes of COVID-19 infection, suggesting that obesity can be a modifiable risk factor for the severity of COVID-19 infection.
 
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Biochemical Markers that Predict Severe Disease Prior
Findings showed that 5 proteins (resistin, lipocalin-2, HGF, IL-8, and G-CSF) that are associated with neutrophils, were elevated in patients who eventually became severely ill. The biomarkers were seen before the patients ever experienced serious symptoms and those who never developed severe symptoms had lower levels of the neutrophils.
 
Pregnancy & Vaccination
Highly recommended because risk of hospitalisation, ICU admission, intubation and death is higher in pregnant women. Animal data in pregnancy using the two USA released vaccines didn't show an increased risk for pregnant women.

But phase 3 trials in pregnant women hasn't been studied yet. 10,000 pregnant women are being tracked, but nothing significant so far. Fauci - "Thus far no red flags"

Breast feeding mothers - No problems receiving a vaccine while breast feeding. Benefits of breast feeding far outweighs risk to child.

No vertical transmission from infected mother to child in utero. But also, they don't receive antibodies from mothers either.

Being <1 yo is a higher risk factor if they get covid-19.

No effect on fertility.

It was recommended that you follow through on second vaccine if you get pregnant after first vaccine.


There is ā€œabsolutely no evidenceā€ that covid-19 vaccines can affect the fertility of women or men.
 
60% Still Continue Shedding Virus at Day 28

In spit and mucus, virus is cleared within 5 weeks.
In stool, virus remains for longer.
Blips of viral shedding can occur sporadically after recovery
Probability of shedding is very low even with blips.

 
Brazilian Variant Can Reinfect Previously Infected People
They found that the effectiveness of their antibodies dropped sixfold against P.1 compared with other coronaviruses.

CoronaVac a Chinese-made vaccine that has been used in Brazil. They found that the vaccine-generated antibodies were less effective at stopping the P.1 variant than other types.They found that the effectiveness of their antibodies dropped sixfold against P.1 compared with other coronaviruses.

2.2 more transmissible and can evade immunity from previous COVID-19 infection by up to 61%
 
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Treatment - Tocilizumab Beneficial
Tocilizumab is a recombinant humanized anti-interleukin (IL)-6 receptor monoclonal antibody

The anti-inflammatory drug tocilizumab cut the death risk of people hospitalized with the disease, reduced their need for a mechanical ventilator, and shortened time spent in the hospital


Based on the collective evidence from the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) and Randomized Evaluation of COVID-19 Therapy (RECOVERY) trials, the COVID-19 Treatment Guidelines Panel (the Panel) has determined the following:
  • The Panel recommends the use of tocilizumaba (single intravenous dose of 8 mg/kg of actual body weight, up to 800 mg) in combination with dexamethasone (6 mg daily for up to 10 days)b in certain hospitalized patients who are exhibiting rapid respiratory decompensation due to COVID-19.c The patients included in this population are:
    • Recently hospitalized patientsd who have been admitted to the intensive care unit (ICU) within the prior 24 hours and who require invasive mechanical ventilation, noninvasive mechanical ventilation (NIV), or high-flow nasal canula (HFNC) oxygen (>0.4 FiO2/30 L/min of oxygen flow) (BIIa); or
    • Recently hospitalized patientsd (not in the ICU) with rapidly increasing oxygen needs who require NIV or HFNC and have significantly increased markers of inflammation (BIIa) (Note: The RECOVERY trial inclusion criterion for inflammation was C-reactive protein [CRP] ā‰„75 mg/L; see details below).
  • For hospitalized patients with hypoxemia who require conventional oxygen supplementation, the Panel recommends using one of the following options: remdesivir (BIIa), dexamethasone plus remdesivir (BIII), or dexamethasone alone (BI)(see Therapeutic Management of Adults With COVID-19).
    • There is insufficient evidence to specify which of these patients would benefit from the addition of tocilizumab. Some Panel members would also give tocilizumab to patients who are exhibiting rapidly increasing oxygen needs while on dexamethasone and have a CRP ā‰„75 mg/L but who do not yet require NIV or HFNC, as described above.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion
a Use of tocilizumab should be avoided in patients with any of the following: (1) significant immunosuppression, particularly in those with a history of recent use of other biologic immunomodulating drugs; (2) alanine transaminase >5 times the upper limit of normal; (3) high risk for gastrointestinal perforation; (4) an uncontrolled, serious bacterial, fungal, or non-SARS-CoV-2 viral infection; (5) absolute neutrophil count <500 cells/ĀµL; or (6) platelet count <50,000 cells/ĀµL.
b As an alternative to dexamethasone, corticosteroids at a dose equivalent to dexamethasone 6 mg are acceptable (see Corticosteroids).
c Respiratory decompensation should be due to progressive COVID-19 and not due to alternative causes, such as volume overload or asthma exacerbation.
d For example, within 3 days. Median days of hospitalization until randomization was 1.2 days (IQR 0.8ā€“2.8 days) in REMAP-CAP and 2 days (IQR 1ā€“5 days) in the RECOVERY trial.

Additional Considerations​

  • Tocilizumab should be given only in combination with dexamethasone (or another corticosteroid at an equivalent dose).
  • Some clinicians may assess a patientā€™s clinical response to dexamethasone first, before deciding whether tocilizumab is needed.
  • Although some patients in the REMAP-CAP and RECOVERY trials received a second dose of tocilizumab at the discretion of treating physicians, there are insufficient data to determine which patients, if any, would benefit from an additional dose of the drug.
  • Cases of severe and disseminated strongyloidiasis have been reported with the use of tocilizumab and corticosteroids in patients with COVID-19.3,4 Prophylactic treatment with ivermectin should be considered for persons who are from areas where strongyloidiasis is endemic.5
  • Tocilizumab use should be avoided in patients who are significantly immunocompromised. The basis for this precaution is that the REMAP-CAP and RECOVERY trials enrolled very few severely immunocompromised patients, and thus the safety of using tocilizumab plus a corticosteroid in such patients is unknown.
  • There are insufficient data to recommend either for or against tocilizumab for the treatment of hospitalized children with COVID-19 or multisystem inflammatory syndrome of children (MIS-C). In children, tocilizumab has been used to treat cytokine release syndrome associated with CAR-T cell therapy and systemic and polyarticular juvenile idiopathic arthritis.
  • Health systems are encouraged to ensure that an adequate supply of tocilizumab is available for patients who need the drug for FDA-approved indications.
 
Biomarkers in COVID-19
5 proteins (resistin, lipocalin-2, HGF, IL-8, and G-CSF) that are associated with a of a type of white blood cell called neutrophils, were elevated in patients who eventually became severely ill. The biomarkers were seen before the patients ever experienced serious symptoms and those who never developed severe symptoms had lower levels of the neutrophils.
 

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