Dödligt virus från Kina orsakar panik (SARS-CoV-2, COVID-19)

Arizona is preparing to implement SCORECARDS to determine eligibility for receiving care in a COVID world with limited supplies.

The elderly & people with pre-existing conditions immediately fall into a lower category of priority due to life expectancy.

https://azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/sdmac/covid-19-addendum.pdf

This randomized clinical trial on the use of convalescent plasma versus standard of care (n-86) on #COVID19 patients at hospital admission was halted as the patients had high titer neutralizing antibodies comparable to convalescent plasma donors

https://medrxiv.org/content/10.1101/2020.07.01.20139857v1

The short take of this study is :

COVID19 patients seem to have high titer of neutralizing antibodies at admission

=> use of convalescent plasma seems to be not as promising as it was thought and the effect looks rather marginal

1/ COVID19 patients seem to have high titer of neutralizing antibodies
2/ critical to check neutralizing antibodies titer before considering the use of convalescent antibodies which is not a quick process
=> use of convalescent plasma not as promising as it was thought

Abstract

Background After recovery from COVID-19, most patients have anti-SARS-CoV-2 neutralizing antibodies. Their convalescent plasma could be an inexpensive and widely available treatment for COVID-19. Methods The Convalescent-plasma-for-COVID (ConCOVID) study was a randomized trial comparing convalescent plasma with standard of care therapy in patients hospitalized for COVID-19 in the Netherlands. Patients were randomized 1:1 and received 300ml of plasma with anti-SARS-CoV-2 neutralizing antibody titers of at least 1:80. The primary endpoint was day-60 mortality and key secondary endpoints were hospital stay and WHO 8-point disease severity scale improvement on day 15. Results The trial was halted prematurely after 86 patients were enrolled. Although symptomatic for only 10 days (IQR 6-15) at the time of inclusion, 53 of 66 patients tested had anti-SARS-CoV-2 antibodies at baseline. A SARS-CoV-2 plaque reduction neutralization test showed neutralizing antibodies in 44 of the 56 (79%) patients tested with median titers comparable to the 115 donors (1:160 vs 1:160, p=0.40). These observations caused concerns about the potential benefit of convalescent plasma in the study population and after discussion with the data safety monitoring board, the study was discontinued. No difference in mortality (p=0.95), hospital stay (p=0.68) or day-15 disease severity (p=0.58) was observed between plasma treated patients and patients on standard of care. Conclusion Most COVID-19 patients already have high neutralizing antibody titers at hospital admission. Screening for antibodies and prioritizing convalescent plasma to risk groups with recent symptom onset will be key to identify patients that may benefit from convalescent plasma. Clinicaltrials.gov: NCT04342182