The proper use of corticosteroids for 2019-nCov pneumonia: Towards promising results?

Boglione, Lucio; Rostagno, Roberto; Poletti, Federica; Moglia, Roberta; Bianchi, Bianca; Esposito, Maria; Biffi, Stefano; Borrè, Silvio

doi:10.1016/j.jinf.2020.08.001

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…The improved treatment of COVID-19 patients with e.g. Remdesevir, dexamethasone, and prophylaxis and treatment of bleeding disorders [ 26 , 27 ], is probably the reason for the proportionally lower number of hospitalized patients who in the fall were treated in ICU s or died.…”

Section: Discussionmentioning

confidence: 99%

“…For example, both the reported H tot and ICU occupation time series have sharper peaks at the onset of the pandemic than the simulated peaks. Also to enable the simulated ICU data to follow the reported time series data in a reasonable manner we need to use an average ICU occupation time 1/ γ icu = 10 days, which is shorter than the reported average occupation time in the spring of 13 days, although it should also be noted that a more recent improved treatment of COVID-19 patients means that fewer have a severe course [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

2021

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Background Initially, the relative sizes of the asymptomatic and the symptomatic infected populations were not known for the COVID-19 pandemic and neither was the actual fatality rate. Therefore it was not clear either how the pandemic would impact the healthcare system. As a result it was initially predicted that the COVID-19 epidemic in Denmark would overwhelm the healthcare system and thus both the diagnosis and treatment of other hospital patients were compromised for an extended period. Aim To develop a mathematical model, which includes both asymptomatic and symptomatic infected persons, for early estimation of the epidemic’s course, its Infection Fatality Rate and the healthcare system load in Denmark, both retrospectively and prospectively. Methods The SEIRS (Susceptible—Exposed—Infected—Recovered—Susceptible) model including deaths outside hospitals and separate assessments of symptomatic and asymptomatic cases (based on seroprevalence) with different immunological memories. Optimal model parameters are in part identified by Monte Carlo based Least Square Error methods while micro-outbreaks are modeled by noise and explored in Monte Carlo simulations. Estimates for infected population sizes are obtained by using a quasi steady state method. Results The calculations and simulations made by the model were shown to fit with the observed development of the COVID-19 epidemic in Denmark. The antibody prevalence in the general population in May 2020 was 1.37%, which yields a relative frequency of symptomatic and asymptomatic cases of 1 to 5.2. Due to the large asymptomatic population, the Infection Mortality Rate was only 0.4%. However, with no non-pharmacological restrictions the COVID-19 death toll was calculated to have more than doubled the national average yearly deaths within a year. The transmission rate ℜ0 was 5.4 in the initial free epidemic period, 0.4 in the lock-down period and 0.8–1.0 in the successive re-opening periods through August 2020. The large asymptomatic population made the termination of the epidemic difficult and micro-outbreaks occurred when the country re-opened. The estimated infected population size July 15 to August 15 was 2,100 and 12,200 for October 1–20, 2020. Conclusions The results of the model show, that COVID-19 has a low Infection Fatality Rate because the majority of infected persons are either asymptomatic or with few symptoms. A minority of the infected persons, therefore, requires hospitalization. That means that for a given infection pressure of both symptomatic and asymptomatic infected there will be a lower pressure on the capacity of the health care system than previously predicted. Further the epidemic will be difficult to terminate since about 84% of the infected individuals are asymptomatic but still contagious. The model may be useful if a major infection wave occurs in the autumn-winter season as it could make robust estimates both for the scale of an ongoing expanding epidemic and for the expected load on the healthcare system. The simulation may also be useful to evaluate different testing strategies based on estimated infected population sizes. The model can be adjusted and scaled to other regions and countries, which is illustrated with Spain and USA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

2021

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“…Built upon the RCT dexamethasone report, the mortality rate was reduced by 1 in 3 COVID-19 patients receiving mechanical ventilation and by 1 in 5 COVID-19 patients receiving oxygen therapy without mechanical ventilation, but mortality rates were not reduced in those without oxygen therapy [18], [19]. Table 1 shows the use of dexamethasone in the preliminary report and some guidelines that have used dexamethasone as a therapy in the treatment of COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of the Use of Dexamethasone in Treatment of Coronavirus Infections: A Systematic Review

Munir

Sarifuddin

Basry

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: WHO declared the coronavirus disease (COVID)-19 outbreaks as a worldwide pandemic in March 2020. More than 1,500,000 confirmed cases have been diagnosed in more than 130 countries and regions, estimated to cause 93,000 deaths so far recorded on April 10, 2020. There is no vaccine or antiviral treatment for coronavirus. METHODS: The literature sources from the research were obtained by searching for national and international journals. The journal is indexed in Google Scholar, PubMed, Science Direct, e-books, and others. Five journals were obtained, including a literature review, systematic review, and randomized controlled trials (RCT) discussing the use of dexamethasone in COVID-19 therapy, Middle East respiratory syndrome, and severe acute respiratory syndrome. RESULTS: A study from Oxford University compared 2100 COVID-19 patients who received low and moderate potential dexamethasone at a dose of 6 mg/day for 10 days with 4300 COVID-19 patients who only received standard treatment for coronavirus infection. The results obtained in patients using ventilator mortality decreased from 40% to 28%, and patients using oxygen, the mortality rate decreased from 40% to 20%. The dexamethasone RCT study can reduce the death rate of 1 in 3 COVID-19 patients who received mechanical ventilation therapy and 1 in 5 patients who received oxygen therapy without mechanical ventilation but did not reduce patients’ mortality rate who did not receive therapy oxygen. CONCLUSION: The use of dexamethasone with oxygen therapy and mechanical ventilation can reduce mortality patients with COVID-19.

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“…The improved treatment of COVID-19 patients (with e.g. Remdesevir, dexamethasone, and prophylaxis and treatment of bleeding disorders, [5][12]) is probably the reason for the proportionally lower number of hospitalized patients who in the fall were treated in ICUs or died.…”

Section: Discussionmentioning

confidence: 99%

“…For example, both the reported H tot and ICU occupation time series have sharper peaks at the onset of the pandemic than the simulated peaks. Also to enable the simulated ICU data to follow the reported time series data in a reasonable manner we need to use an average ICU occupation time 1/ γ icu = 10 days, which is shorter than the reported average occupation time, although it should also be noted that a more recent improved treatment of COVID-19 patients means that fewer have a severe course [5] [12].…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

Rasmussen

Petersen

Høiby

2020

Preprint

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Background: There has long been uncertainty about the relative size of the "dark" numbers, the infected population sizes and the actual fatality rate in the COVID-19 pandemic and thus how the pandemic impacts the healthcare system. As a result it was initially predicted that the COVID-19 epidemic in Denmark would overwhelm the healthcare system and thus both the diagnosis and treatment of other hospital patients were compromised for an extended period. Aim: To develop a robust method for reliable estimation of the epidemic and the healthcare system load in Denmark, both retrospectively and prospectively. To do this a new pandemic simulation had to be developed that accounts for the size and the infection impact of the infectious incubating and asymptomatic infected individuals (dark numbers). Methods: Our epidemic simulation is based on a SEIRS (Susceptible - Exposed - Infected - Recovered - Susceptible) model, coupled to a simple healthcare model that also includes deaths outside hospital settings. The SEIRS model has separate assessments of asymptomatic and symptomatic cases with different immunological memories. The main data used for parameter estimation in the models are hospital and ICU occupations, death data, serological data of antibody prevalence from the onset through August 2020 together with hospital data and clinical data about the viral infection. Optimal model parameters are in part identified by Monte Carlo based Least Square Error methods while micro-outbreaks are modeled by noise and explored in Monte Carlo simulations. Estimates for the infected population sizes are obtained by using a quasi steady state method. Results: The age adjusted antibody prevalence in the general population in May 2020 was 1.37%, which yields a relative frequency of symptomatic and asymptomatic cases of 1 to 5.2. Due to the large asymptomatic population found, the actual mortality rate to date is 0.4%. However, with no behavioral and policy restrictions the COVID-19 death toll would have more than doubled the national average yearly deaths within a year. The transmission rate Ro was 5.4 in the initial free epidemic period, 0.4 in the lock-down period and 0.8 -1.0 in the successive re-opening periods through August 2020. The estimated infected population size July 15 to August 15 was 2,100 and 12,200 for October 1 - 20, 2020. The efficiency of the applied daily testing strategy for both periods are estimated to be 40\% of the PCR observable infected. Of more theoretical interest we demonstrate how the critical infection parameters for COVID-19 are tightly related in a so-called iso-symptomatic infection diagram. Conclusions: Our simulation may be useful if a major infection wave occurs in the winter season as it could make robust estimates both for the scale of an ongoing expanding epidemic and for the expected load on the healthcare system. Our simulation may also be useful to assess a future controlled epidemic, e.g. as a basis for evaluating different testing strategies based on estimated infected population sizes. Finally, we believe our simulation can be adjusted and scaled to other regions and countries, which we illustrate with Spain and the US.

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The proper use of corticosteroids for 2019-nCov pneumonia: Towards promising results?

Cited by 4 publications

References 8 publications

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

Effectiveness of the Use of Dexamethasone in Treatment of Coronavirus Infections: A Systematic Review

SARS-CoV-2 infection dynamics in Denmark, February through October 2020: Nature of the past epidemic and how it may develop in the future

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