In an add-on study of the WHO Solidarity trial, Norwegian investigators examined the effect of remdesivir and hydroxychloroquine on the degree of clinical respiratory failure, on SARS-CoV-2 viral load in the oropharynx, and on levels of inflammatory variables in plasma or serum.

Background The understanding of coronavirus disease 2019 (COVID-19) is rapidly evolving. Although it is primarily a respiratory illness, other manifestations, such as Guillain-Barré syndrome, immune thrombocytopenia, and immune-mediated thrombotic thrombocytopenic purpura, have been described. We present a case of a patient with hemophagocytic lymphohistiocytosis secondary to COVID-19 treated with tocilizumab with a marked biochemical improvement. Case presentation In this case report we present a Caucasian patient with COVID-19 who developed a marked elevation of inflammatory parameters with ferritin 36,023 μg/L, but also elevated C-reactive protein 334 mg/L and lactate dehydrogenase 1074 U/L, 1 week after admission to the intensive care unit. He met five of eight criteria for hemophagocytic lymphohistiocytosis, but he lacked the high fever and cytopenia seen in the majority of cases. He was treated with tocilizumab, a monoclonal antibody targeting the interleukin-6 receptor, and over the next days, a rapid decrease in ferritin and C-reactive protein levels was observed. However, his respiratory failure only improved gradually, and he was weaned off the respirator 11 days later. Conclusion COVID-19 may induce a hyperinflammatory clinical picture and in some cases develop into hemophagocytic lymphohistiocytosis. In our patient’s case, therapeutic interleukin-6 blockade abrogated signs of hyperinflammation but did not seem to improve pulmonary function. Measurement of ferritin and C-reactive protein, as well as quantification of interleukin-6 on indication, should be performed in patients with severe COVID-19. Specific treatment in such patients must also be contemplated, preferably in randomized controlled trials.

Summary Infection with coronavirus disease‐2019 (COVID‐19) may predispose for venous thromboembolism (VTE). There is wide variation in reported incidence rates of VTE in COVID‐19, ranging from 3% to 85%. Therefore, the true incidence of thrombotic complications in COVID‐19 is uncertain. Here we present data on the incidence of VTE in both hospitalised and non‐hospitalised patients from two ongoing prospective cohort studies. The incidence of VTE after diagnosis of COVID‐19 was 3·9% [95% confidence interval (CI): 2·1–7·2] during hospitalisation, 0·9% (95% CI: 0·2–3·1) in the three months after discharge and 0·2% (95% CI: 0·00–1·25) in non‐hospitalised patients, suggesting an incidence rate at the lower end of that in previous reports.

Despite numerous studies on SARS-CoV-2induced inflammation, we still lack markers for rapid disease progression with admission to intensive care unit (ICU) or respiratory failure (RF). Few studies have evaluated the prognostic value of routine diagnostic repertoire available at most hospitals. The NOR-Solidarity trial is an independent add-on study to the WHO Solidarity trial, evaluating hydroxychloroquine (HCQ) and remdesivir compared to standard of care in hospitalized COVID-19 patients [1]. We explored whether standard biomarkers in peripheral blood could give information on ICU admission and RF in hospitalized COVID-19 patients.Adult patients admitted to 23 Norwegian hospitals with PCR-confirmed SARS-2-CoV-2 infection were eligible for participation. In this substudy, the routine biochemistry was related to (i) the need for ICU admission or (ii) RF defined as pO 2 /FiO 2 (P/F ratio) < 26.6 kPa during the first 10 days of hospitalization. Routine peripheral blood samples were collected at inclusion and daily until discharge from the hospital, and outpatients were followed up 3 months after discharge. Markers included were C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), haemoglobin, fibrinogen, procalcitonin (PCT), D-dimer, platelet count, total white blood cell count, monocyte, neutrophil and lymphocyte count. Exclusion criteria, intervention, ethical statement, details on viral load and SARS-CoV-2 antibodies and statistical analysis are given in the Supporting Information file.

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