COVI D-19 Upda te E pi (tiny bit), c linic al manife statio ns, - PowerPoint PPT Presentation

COVI D-19 Upda te E pi (tiny bit), c linic al manife statio ns, diagno stic s, tre atme nt, & pre ve ntio n Bria n Sc hwa rtz, MD Pro fe sso r o f Me dic ine UCSF , Divisio n o f I nfe c tio n Dise a se s

Outline • E pi upda te • Vira l pa tho g e ne sis • Clinic a l dise a se • Dia g no stic s • T he ra pe utic s • Pre ve ntio n

Outline • E pi update • Vira l pa tho g e ne sis • Clinic a l dise a se • Dia g no stic s • T he ra pe utic s • Pre ve ntio n

De aths pide mio lo g y Case s https:/ / c o ro na virus.jhu.e du/ us-ma p E Unite d State s ldwide Wor

Outline • E pi upda te • Vir al pathoge ne sis • Clinic a l dise a se • Dia g no stic s • T he ra pe utic s • Pre ve ntio n

SARS-Co V-2  COVI D-19 ? Wide spr e ad thr ombosis and mic r oangiopathy SAR S-CoV-2 binds Patie nt with se ve r e ACE -2 r e c e ptor COVID-19 Inflammator y ge ne e xpr e ssion in patie nts who die d of COVID-19 vs. Influe nza A Ac ke rma nn M. NE JM. 2020

Outline • E pi upda te • Vira l pa tho g e ne sis • Clinic al dise ase • Dia g no stic s • T he ra pe utic s • Pre ve ntio n

Clinic a l Ma nife sta tio ns o f COVI D-19 ICU ologic al: de lirium, stro ke s? ? Ne ur 4% E ye s: Co njunc tivitis Asymptomatic Se ve r e 17% E NT : L o ss o f sme ll/ ta ste 12% ungs: Pne umo nia -> ARDS L CV: Myo c a rditis, c a rdio myo pa thy GI : Dia rrhe a , N/ V, tra nsa minitis Mild - mode r ate 67% Constitutional: F e ve r -> c yto kine sto rm He me : T hro mb o sis Skin: Ac ra l e rythe ma ? ? Asymptomatic gr oups: P r e-symptomatic : sympto ms la te r Multisyste m Inflammator y Asymptomatic : ne ve r sympto ms Syndr ome in Childr e n

Outline • E pi upda te • Vira l pa tho g e ne sis • Clinic a l dise a se • Diagnostic s • T he ra pe utic s • Pre ve ntio n

Dia g no stic s R T -PCR : Se r ology (IgM/ IgG): • Prima ry me tho d fo r Dx o f COVI D-19 • L a te Dx o f COVI D-19 • Na so pha ryng e a l swa b • I g M do e s no t o ffe r muc h • Se nsitivity ~80% • Se nsitivity va rie s b y te st • E pide mio lo g ic a l surve y Antige n: • Do na te c o nva le sc e nt pla sma • Ve ry ra pid (15 mins) • Re duc e se nsitivity vs. RT -PCR • Va c c ine re spo nse

Vira l dyna mic s

Outline • E pi upda te • Vira l pa tho g e ne sis • Clinic a l dise a se • Dia g no stic s • T he r ape utic s • Pre ve ntio n

T re a tme nts b e ing studie d fo r COVI D-19 T ho rlund K e t a l. L a nc e t

Re mde sivir • I nhib its vira l RNA po lyme ra se • Administe re d intra ve no usly • I n vivo (mo nke y) COVI D-19 mo de l sug g e ste d b e ne fit • Studie s via NI AI D a nd Gile a d

Pre limina ry da ta fro m Re mde sivir RCT • RCT , b linde d pla c e b o c o ntro l • 1063 ho spita lize d pa tie nts • Sho rte ne d time to re c o ve ry • 11 vs. 15 da ys (p<0.001) • T re nd to de c re a se d mo rta lity • 7.1% vs. 11.9% • Mo st b e ne fit - hypo xic / no t intub a te d --------------------------------------------------------------------------- • I n no n-ve ntila te d pa tie nts 5d = 10d Be ig e l JH. NE JM 2020; Go ldma n JD. NE JM. 2020

Hydro xyc hlo ro q uine Pr e ve ntion T r e atme nt • Asympto ma tic a dults e xpo se d to • Ho spita lize d pa tie nts COVI D+ COVI D+ • RCT , HCQ vs. usua l c a re • RCT , HCQ vs. pla c e b o x 5 da ys • 1º e ndpo int 28-da y mo rta lity • 1º e ndpo int: COVI D Dx o r COVI D • 1542 HCQ vs. 3132 usua l c a re Sx in 14d • HCQ 25.7% (1542) vs. usua l c a re • 821 e nro lle d 23.5% (3132); p=0.10 • HCQ 11.8% (49) vs. pla c e b o 14.5% • No b e ne fit o f HCQ o n mo rta lity o r (58), p=0.35 ho spita l sta y • No b e ne fit HCQ to pre ve nt COVI D Bo ulwa re DR. NE JM. 2020 https:/ / www.re c o ve rytria l.ne t/

Co nva le sc e nt Pla sma R CT : Plasma infusion vs. standar d of c ar e • What is c onvale sc e nt plasma? • 1º e ndpoint : Clinic a l impro ve me nt a t 28d Se rum fro m pa tie nts with re so lve d • 55 se ve re dise a se (hypo xia w/ o intub a tio n) COVI D (a nti-COVI D I g G) • 91% (plasma) vs. 68%; HR 2.15, p=0.03 • Is it be ing use d c ommonly? • 59 with life -thre a te ning dise a se (intub a te d) Ye s, >20K do se s g ive n in US • No diffe re nc e • Is it safe ? Ye s • imitations : Unde rpo we re d, he te ro g e no us L • Is it e ffe c tive ? 1 RCT …? b a c kg ro und tre a tme nt • Conc lusion : Co nva le sc e nt pla sma ma y impro ve o utc o me s in no n-I CU COVI D pa tie nts. https:/ / www.usc o vidpla sma .o rg / ;

Outline • E pi upda te • Vira l pa tho g e ne sis • Clinic a l dise a se • Dia g no stic s • T he ra pe utic s • Pr e ve ntion

Pre ve ntio n