Saturday, July 11, 2020



Dr K Aggarwal
President CMAAO
With inputs from Dr Monica Vasudev

971:  New WHO Guidance Calls for More Evidence on Airborne Transmission

1.    The WHO on Thursday released new guidelines on the transmission of the novel coronavirus that acknowledge some reports of airborne transmission of the virus that causes COVID-19, ut stopped short of confirming that the virus spreads through the air.
2.    WHO acknowledged that some outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission, such as during choir practice, in restaurants or in fitness classes. (
3.    WHO said the coronavirus that causes COVID-19 spreads through contact with contaminated surfaces or close contact with infected people who spread the virus through saliva, respiratory secretions or droplets released when an infected person coughs, sneezes, speaks or sings.
4.    People should avoid crowds and ensure good ventilation in buildings, in addition to social distancing, and encourage masks when physical distancing is not possible.
5.    Pandemic is driven by super-spreading events, and that the best explanation for many of those events is aerosol transmission
6.     People without symptoms - to wear masks.
7.    Only a very small number of diseases are believed to be spread via aerosols, or tiny floating particles. These include measles and tuberculosis - two highly contagious pathogens that can linger in the air for hours and require extreme precautions to prevent exposure.
8.     WHO is using an "outdated definition of droplets and aerosols" and is too focused on the size of the droplets and the distance they travel. WHO defines aerosols as being under 5 microns because only particles that small could float in the air long enough to be inhaled. However, Linsey Marr, an aerosol expert at Virginia Tech  said a much larger range of particle size has been shown to contribute to infection. Rather than size, the differences between droplets and aerosols should be based on how the infection occurs: If a person inhales the virus and becomes infected, it's an aerosol. If the infection occurs by contact, they are droplets. Although WHO has been focused on airborne transmission at long distances, Marr said breathing in aerosols "is of greater concern at close contact and when people are in the same room. [Reuters]

972: Predictors of survival in COVID-19 patients treated with tocilizumab

1.     Receipt of the IL-6 receptor antagonist tocilizumab within 12 days of symptom onset in patients with severe coronavirus disease 2019 (COVID-19) was an independent predictor for in-hospital survival at 28 days, according to a study published in the Journal of Autoimmunity.
2.      Patients were eligible for tocilizumab if they exhibited persistent fevers (38.0 °C for greater than 6 hours), had PaO2/FiOof < 200, and exhibited persistently rising inflammatory laboratory parameters (ferritin, D-dimer, and lactate dehydrogenase [LDH]) or an elevated inflammatory laboratory parameter defined as ferritin ≥1000 μg/L, D-dimer ≥ 5 mg/mL, or LDH ≥ 500 U/L. An IL-6 level ≥ five times the upper limits of normal (≤5 pg/ml) was assessed in addition to these parameters.
3.      Tocilizumab was administered as an 8 mg/kg IV dose using actual body weight with a maximum dose of 800 mg. Patients were eligible for a second dose if persistently febrile despite treatment. Due to medication shortages the tocilizumab dose was changed to a fixed 400 mg IV dose for all patients on March 30, 2020. All patients were followed for up to 28 days from the first dose.
4.      Results showed that the 28-day in-hospital mortality was 43.2%, leaving 46 patients in the survivors and 35 in the non-survivors group. According to the authors, the single independent predictor of 28-day in-hospital survival was receipt of tocilizumab within 12 days of symptom onset (adjusted OR: 0.296, 95% CI: 0.098–0.889). Meanwhile, a SOFA score ≥8 was independently associated with 28-day in-hospital mortality (adjusted OR: 2.842, 95% CI: 1.042–7.753).
5.      Patients in the survivor group were more likely to have a clinical response to tocilizumab by day 28 (80.4% vs 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Further, the hospital length of stay was longer in the survivor group compared to non-survivors (27.5 days [14–31] vs 14 days [9–20]; p < 0.001), while 14 (17.3%) patients remained hospitalized at the end of the study.

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