May 23, 2024

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COVID: 2020 Prevaccination Period Datasets

Estimates of SARS-CoV-2 Hospitalization and Fatality Rates in the Prevaccination Period, United States
These results are based on 2,479,423 cases from 21 jurisdictions with hospitalization information reported to the CDC from May 1, 2020, to December 1, 2020, to create a hospitalization dataset. The authors also analyzed 4,708,444 cases from 22 jurisdictions for a death dataset during the same time frame. The case-hospitalization dataset covers 25.5% of the US population, and the case-fatality dataset covers 43.7% of the U.S. population. Before the mid-December 2020 introduction of COVID-19 vaccines, the pandemic caused approximately 480,000 hospitalizations, and 350,000 deaths in the United States. The overall case-hospitalization rate among patients was 5.7%, and the rate by sex was 6.2% for male and 5.2% for female. Hospitalization rates were lowest for children ages 5 to 14 (0.6%), and highest in case-patients 75 years and older (25.9%). During the pre-vaccine period 18% of hospitalized patients and 44% of those admitted to an intensive care unit (ICU) for COVID-19 died.

COVID: Early Viral Phase

Characterization of Treatment Resistance and Viral Kinetics in the Setting of Single-Active Versus Dual-Active Monoclonal Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2
The authors compare the benefits of one active mAb versus two active mAb. An interesting study design as they are looking at people that got two mAbs and comparing those in whom both were active to people that had variants only sensitive to one of the two. Compared with single-active mAb therapy, dual-active mAbs led to similar clinical outcomes but significantly faster viral load decline and a lower risk of emergent resistance.

COVID: The Late Phase/PASC/Long COVID

Cardiopulmonary Exercise Testing in Children with Long COVID: A Case-controlled Study
These are results from a prospective, single-center, case-control observational study conducted at the Policlinico Agostino Gemelli in the period between May 2021 and September 2023 in which pediatric patients (age <18 years) were enrolled and underwent cardiopulmonary exercise testing (CPET) in presence of persistent symptoms compatible with the definition of LC according to the World Health Organization definition, requiring symptoms that last at least two months and cannot be explained by an alternative diagnosis, and symptoms have a negative impact on daily life. CPET was conducted with an electromagnetic brake cycle ergometer. The CPETs were all performed by an ERGOSTIK TM Geratherm (@Medgraphics) cardiorespiratory device equipped with “Blue Cherry software,” regularly calibrated for gases (O2 and CO2) and volumes before each test, with breath-by-breath data acquisition, using a suitable face mask size, with continuous 12-lead ECG monitoring, finger pulse oximetry, and manual blood pressure detection at baseline and every two minutes during cycling. They study 90 patients in the pediatric age group; the age of the patients was between 12 and 15 years (average age 13 years old). They found that children with LC have a reduced VO2 peak (Oxygen uptake at peak of exercise), abnormal cardiovascular efficiency (VO2/HR% pred), pathological VE/VCO slope (indicative of the possible presence of ventilatory inefficiency/pulmonary vascular commitment if higher than 30), and abnormally reduced slope of VO2 work. They note that many children, in fact, were not able to conclude the test and suggest that these events during LC are more probably due to poorly characterized functional events, like autonomic dysfunction or other unknown factors, rather than macroscopic heart damage. They reference studies in adults that suggest autonomic dysfunction as an underlying abnormality.
Assessment of the Impact of RNase in Patients With Severe Fatigue Related to Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): A Randomized Phase 2 Trial of RSLV-132
This article explores the idea that persistent genetic material left behind after SARS-CoV-2 infection may be triggering ongoing symptoms of Long COVID. They are looking at RSLV-132 which is a drug composed of a catalytically active human RNase1 fused to human IgG1 Fc. It is designed to remain in circulation and digest extracellular RNA. They hypothesized that removal of SARS-CoV-2 viral RNA might improve inflammation, neuroinflammation, and fatigue associated with post-acute sequelae of SARS-CoV-2 infection (PASC). Here the authors share the results of a phase 2, double-blind, placebo-controlled randomized clinical trial in participants with a 24-week history of PASC and severe fatigue. The primary endpoint of the trial assessed the impact of 6 intravenous doses of RSLV-132 on the mean change from baseline at day 71 in the Patient-Reported Outcomes Measurement Information System Fatigue Short Form 7a (PROMIS Fatigue SF 7a). Mixed results so while fatigue was not statistically significantly improved at Day 71, earlier timepoints revealed statistically significant improvement in fatigue and physician global assessment. The data suggest eliminating latent viral RNA by increasing serum RNase activity may improve fatigue in PASC patients. Women may respond better to this approach than men.
Potential Diaphragm Muscle Weakness-related Dyspnea Persists Two Years after COVID-19 and Could Be Improved by Inspiratory Muscle Training: Results of an Observational and an Interventional Trial
Here we see that compared with sham control, IMT improved diaphragm and inspiratory muscle function, inspiratory muscle fatigability, diaphragm voluntary activation index, and dyspnea.