Clinical update on COVID-19 for the emergency and critical care clinician: Medical management

Long, Brit; Chavez, Summer; Carius, Brandon M; Liang, Stephen Y.; Brady, William J.; Koyfman, Alex; Gottlieb, Michael

doi:10.1016/j.ajem.2022.03.036

Cited by 13 publications

(11 citation statements)

References 128 publications

(265 reference statements)

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“…The severity of COVID-19 varies across a wide range, with age, co-morbidity and vaccination status the most significant influences 1 – 3 . Immunity against SARS-CoV-2 can provide protection against infection, or when breakthrough infections do occur, protection against illness 4 , 5 .…”

Section: Discussionmentioning

confidence: 99%

“…The actual number of infections is undoubtedly much higher than those confirmed, especially with the unprecedented transmission rates of Omicron and its subvariants invoking widespread changes to testing criteria. While most SARS-CoV-2 infections are self-limiting and produce mild coronavirus disease (COVID-19), the course of infection varies from completely asymptomatic, primarily in healthy young individuals, to life-threatening, primarily in older individuals with co-morbidity 1 – 3 . Where available, vaccination against COVID-19 has reduced rates of transmission and limited the severity of breakthrough infections 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

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Moderate to severe SARS-CoV-2 infection primes vaccine-induced immunity more effectively than asymptomatic or mild infection

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Ings

Harnum³

et al. 2022

npj Vaccines

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Hybrid immunity induced by vaccination following recovery from SARS-CoV-2 infection is more robust than immunity induced by either infection or vaccination alone. To investigate how infection severity influenced the strength and character of subsequent vaccine-induced humoral or cellular immune responses against SARS-CoV-2, we assessed humoral and cellular immune responses against SARS-CoV-2 following recovery from infection, vaccine dose 1 and vaccine dose 2 in 35 persons recovered from COVID-19. Persons with polymerase chain reaction or serologically confirmed SARS-CoV-2 infection were recruited into a study of immunity against SARS-CoV-2. Self-reported symptoms categorized them as experiencing asymptomatic, mild, moderate or severe infection based on duration, intensity and need for hospitalization. Whole blood was obtained before vaccination and after first and second doses. Humoral immunity was assessed by ELISA and cellular immunity by ELISpot and intracellular flow cytometry. Responses were compared between groups recovered from either asymptomatic/mild (n = 14) or moderate/severe (n = 21) infection. Most subjects experienced robust increases in humoral and cellular immunity against SARS-CoV-2 spike (S) protein following 1 vaccination. Quantitative responses to second vaccination were marginal when measured 2.5 months afterwards and moderate or severe infection maintained stronger responses. Polyfunctional CD8+ T cell responses were largely restricted to subjects recovered from moderate or severe infection. One vaccine dose triggered stronger immune responses than in a comparable group never infected with SARS-CoV-2, while the second dose produced only minor lasting increases in humoral or cellular responses. Infection history should be considered in planning COVID-19 vaccine administration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Moderate to severe SARS-CoV-2 infection primes vaccine-induced immunity more effectively than asymptomatic or mild infection

Holder

Ings

Harnum³

et al. 2022

npj Vaccines

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“…If they are currently receiving dexamethasone for treatment of COVID-19 but present with refractory septic shock, a steroid with mineralocorticoid effects (e.g., hydrocortisone) can be administered [ 7 , 18 , 19 ]. Additional discussion of the medical management for patients with COVID-19 has been addressed earlier in this series [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Coronavirus disease of 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic, with the first outbreak in late 2019 in Wuhan, Hubei Province, China [ 1 , 2 ]. This paper is the final submission of a series that provides focused updates of COVID-19 for emergency clinicians [ 3 , 4 ]. This review will focus specifically on acute resuscitation and airway management in the patient with severe COVID-19 not involving cardiac arrest.…”

Section: Introductionmentioning

confidence: 99%

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

Chavez

Brady

Gottlieb

et al. 2022

The American Journal of Emergency Medicine

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“…The well-established treatments for asymptomatic or mildly symptomatic patients include nirmatrelvir/ritonavir (Paxlovid), sotrovimab, remdesivir, and molnupiravir. [5] However, in mid-2021, none of these medications were available in Thailand except remdesivir, which was reserved for patients with moderate to severe symptoms. [6] Favipiravir is an oral, broad-spectrum, antiviral agent approved for treating influenza viruses in Japan and China.…”

Section: Introductionmentioning

confidence: 99%

Early antiviral and supervisory dexamethasone treatment improve clinical outcomes of nonsevere COVID-19 patients

et al. 2022

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This study aimed to evaluate the efficacy of early antiviral treatment in preventing clinical deterioration in asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus 2 infected (COVID-19) patients in home isolation and to share our experiences with the ambulatory management of nonsevere COVID-19 patients. This retrospective study included mild COVID-19 adult patients confirmed by real-time reverse transcription-polymerase chain reaction. They received care via an ambulatory management strategy between July 2021 and November 2021. Demographic data, clinical progression, and outcomes were collected. Both descriptive and inferential statistics were performed to illustrate the cohort’s characteristic and outcomes of the study. Univariable and multivariable logistic regression models were employed to investigate the associations between clinical factors and disease progression. A total of 1940 patients in the Siriraj home isolation system met the inclusion criteria. Their mean age was 42.1 ± 14.9 years, with 14.2% older than 60 years, 54.3% female, and 7.1% with a body weight ≥ 90 kg. Only 115 patients (5.9%) had deterioration of clinical symptoms. Two-thirds of these could be managed at home by dexamethasone treatment under physician supervision; however, 38 of the 115 patients (2.0% of the study cohort) needed hospitalization. Early favipiravir outpatient treatment (≤ 5 days from onset of symptoms) in nonsevere COVID-19 patients was significantly associated with a lower rate of symptom deterioration than late favipiravir treatment (50 [4.6%] vs 65 [7.5%] patients, respectively; P = .008; odds ratio 1.669; 95% confidence interval, 1.141–2.441). The unfavorable prognostic factors for symptom deterioration were advanced age, body weight ≥ 90 kg, unvaccinated status, higher reverse transcription-polymerase chain reaction cycle threshold, and late favipiravir treatment. The early delivery of essential treatment, including antiviral and supervisory dexamethasone, to ambulatory nonsevere COVID-19 patients yielded favorable outcomes during the COVID-19 pandemic in Thailand.

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Clinical update on COVID-19 for the emergency and critical care clinician: Medical management

Cited by 13 publications

References 128 publications

Moderate to severe SARS-CoV-2 infection primes vaccine-induced immunity more effectively than asymptomatic or mild infection

Moderate to severe SARS-CoV-2 infection primes vaccine-induced immunity more effectively than asymptomatic or mild infection

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

Early antiviral and supervisory dexamethasone treatment improve clinical outcomes of nonsevere COVID-19 patients

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