The biology of coronavirus COVID-19 - including research and treatments

New research project by the Swedish National Board of Health and Welfare and SBU (the Swedish Agency for Health Technology Assessment and Assessment of Social Services), focusing on covid-19 patients who suffer from long-term symptoms. They will probably create clinical guidelines based on their findings, down the line.
SVT Google Translate said:
Long-term disease in covid-19 will be investigated

Published yesterday 15:36

Patients with long-term symptoms, ie those who do not become seriously ill but also not really recover from covid-19, are in focus when a new scientific report has been ordered.
- We have to look at whether there may be another underlying disease, says Thomas Lindén at the National Board of Health and Welfare.

The vast majority of people who fall ill with covid-19 get mild symptoms and can recover after a few days with the help of self-care or simpler care interventions. Some are severely affected and need hospital care. And then there are also a number of people who get diffuse symptoms for a long time.

The National Board of Health and Welfare, together with the SBU, has been commissioned to compile the scientific knowledge base report on these.

- We do not know how many patients there are or if there are underlying health problems that cause this type of problem, says Thomas Lindén, head of department at the National Board of Health and Welfare, at the Public Health Agency's press conference on Thursday.

"Can not assume that it is due to covid-19"

Knowledge about the long-term effects of the disease, especially in these patients, is limited. And now the National Board of Health and Welfare and SBU will compile what the scientific basis looks like when it comes to guidelines on how to make a diagnosis and treat these patients.

- It is important to point out already now, both to patients and caregivers, is that one can not without examination assume that long-term symptoms, such as prolonged fever, are due to covid-19. In the event of such symptoms, an examination must assess whether there may be any other underlying disease, which requires treatment, in order to prevent potentially dangerous conditions from occurring, says Thomas Lindén.

An initial interim report will be submitted in August.
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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19) A Review


"Observations: SARS-CoV-2 is spread primarily via respiratory droplets during close face-to-face contact. Infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers.

The average time from exposure to symptom onset is 5 days, and 97.5% of people who develop symptoms do so within 11.5 days.

The most common symptoms are fever, dry cough, and shortness of breath. Radiographic and laboratory abnormalities, such as lymphopenia and elevated lactate dehydrogenase, are common, but nonspecific.

Diagnosis is made by detection of SARS-CoV-2 via reverse transcription polymerase chain reaction testing, although false-negative test results may occur in up to 20% to 67% of patients; however, this is dependent on the quality and timing of testing.

Manifestations of COVID-19 include asymptomatic carriers and fulminant disease characterized by sepsis and acute respiratory failure.

Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. More than 75% of patients hospitalized with COVID-19 require supplemental oxygen.

Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care (21.6% vs 24.6%; age-adjusted rate ratio, 0.83 [95% CI, 0.74-0.92]) and that remdesivir improves time to recovery (hospital discharge or no supplemental oxygen requirement) from 15 to 11 days.

In a randomized trial of 103 patients with COVID-19, convalescent plasma did not shorten time to recovery. Ongoing trials are testing antiviral therapies, immune modulators, and anticoagulants. The case-fatality rate for COVID-19 varies markedly by age, ranging from 0.3 deaths per 1000 cases among patients aged 5 to 17 years to 304.9 deaths per 1000 cases among patients aged 85 years or older in the US.

Among patients hospitalized in the intensive care unit, the case fatality is up to 40%. At least 120 SARS-CoV-2 vaccines are under development.

Until an effective vaccine is available, the primary methods to reduce spread are face masks, social distancing, and contact tracing. Monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies."
 
Wiersinger et al. in JAMA July 10 said:
Although studies have described rates of asymptomatic infection, ranging from 4% to 32%, it is unclear whether these reports represent truly asymptomatic infection by individuals who never develop symptoms, transmission by individuals with very mild symptoms, or transmission by individuals who are asymptomatic at the time of transmission but subsequently develop symptoms.37-39 A systematic review on this topic suggested that true asymptomatic infection is probably uncommon.38
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Immunity to Covid-19 could be lost in months, UK study suggests

Exclusive: King’s College London team found steep drops in patients’ antibody levels three months after infection

People who have recovered from Covid-19 may lose their immunity to the disease within months, according to research suggesting the virus could reinfect people year after year, like common colds.

In the first longitudinal study of its kind, scientists analysed the immune response of more than 90 patients and healthcare workers at Guy’s and St Thomas’ NHS foundation trust and found levels of antibodies that can destroy the virus peaked about three weeks after the onset of symptoms then swiftly declined.

Blood tests revealed that while 60% of people marshalled a “potent” antibody response at the height of their battle with the virus, only 17% retained the same potency three months later. Antibody levels fell as much as 23-fold over the period. In some cases, they became undetectable.

“People are producing a reasonable antibody response to the virus, but it’s waning over a short period of time and depending on how high your peak is, that determines how long the antibodies are staying around,” said Dr Katie Doores, lead author on the study at King’s College London.

The study has implications for the development of a vaccine, and for the pursuit of “herd immunity” in the community over time.

The immune system has multiple ways to fight the coronavirus but if antibodies are the main line of defence, the findings suggested people could become reinfected in seasonal waves and that vaccines may not protect them for long.
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https://www.theguardian.com/world/2...n-months-uk-study-suggests?CMP=share_btn_link

https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v1
 
Tracked down a BRAIN paper which discusses clinical observations of encephalomyelitis and other neurological symptoms from suspected COVID-19 as mentioned in this weeks TWIV.
https://www.virology.ws/

Of 43 patients ... inflammatory CNS syndromes (n = 12)
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The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings
https://academic.oup.com/brain/article/doi/10.1093/brain/awaa240/5868408

Abstract
Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms, which will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.

Jounalised here

https://medicalxpress.com/news/2020-07-delirium-rare-brain-inflammation-linked.html
https://www.ucl.ac.uk/news/2020/jul/delirium-rare-brain-inflammation-and-stroke-linked-covid-19
 
Merged thread

Contracting Covid 19 twice: It’s not better the 2nd time around

But these more recent reports sound more rigorous and detailed. I recently saw a
report from a respected physician (the Vox author notes this report too) in New Jersey who said he’d found two cases of reinfection. In one case there was an initial positive test, a clearing of the disease confirmed by a negative test, a positive antibodies test and then reinfection after a loss of antibodies. The additional serology evidence makes this case much harder to explain away.

https://talkingpointsmemo.com/edblog/can-you-get-reinfected
“Wait. I can catch Covid twice?” my 50-year-old patient asked in disbelief. It was the beginning of July, and he had just tested positive for SARS-CoV-2, the virus that causes Covid-19, for a second time — three months after a previous infection.
While there’s still much we don’t understand about immunity to this new illness, a small but growing number of cases like his suggest the answer is yes.
Covid-19 may also be much worse the second time around. During his first infection, my patient experienced a mild cough and sore throat. His second infection, in contrast, was marked by a high fever, shortness of breath, and hypoxia, resulting in multiple trips to the hospital.

https://www.vox.com/2020/7/12/21321653/getting-covid-19-twice-reinfection-antibody-herd-immunity
 
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During his first infection, my patient experienced a mild cough and sore throat. His second infection, in contrast, was marked by a high fever, shortness of breath, and hypoxia, resulting in multiple trips to the hospital.
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He was unable to get an antibody test after his first infection, so we do not know whether his immune system mounted an effective antibody response or not.
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Hmmm, maybe the first infection wasn’t actually Covid-19? False positives are quite common for the PCR tests.
 
But Daniel Griffin, MD. the expert from Columbia U in NYC who has treated over1000 covid patients, said in last week's virology podcast (see Twiv, via microbe tv) that he has witnessed an apparent second infection.

So, case isn't closed (no pun intended) on this question.
 
Reports from Daniel Griffin in New York of two COVID19 infections second time round in this & a previous episode of TWiV - also nastier second time. He considers the possibility that it is one of those viruses that get worse, not better each time. Two cases is an anecdote, but needs watching seriously. Listen about 10 mins in:
https://www.microbe.tv/twiv/
 
JaneL said:
Hmmm, maybe the first infection wasn’t actually Covid-19? False positives are quite common for the PCR tests.
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It could also be that the sheer variability in symptoms applies just the same based on the circumstances of contact and the immune response. So the first time could have been roughly the same if the circumstances of exposure were identical.

But caution should definitely prepare for the worst. Anyway I hope we soon hear the last of herd immunity because it's not going to happen by natural infection, even if we discounted the heavy burden of complications and post-viral illness, it's clearly not even a possibility.
 
Another option might be a virus going latent, spreading in the host without eliciting a response and reactivating with increased severity.

We wont know until someone gathers empirical data on reinfection and specifically checks for that possiblity.
 
Sean said:
Until otherwise proven, I am assuming surface transmission to be a thing. Those droplets have to settle somewhere.
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I thought there had been some contact tracing that did show contagion stemmed from high-touch surface areas in certain situations - elevator buttons in a shared building? some sort of payment screens? Maybe not 100% proven source, but highly likely?

Faulty memory, obviously, but I have a vague recollection of this being mentioned in some article.
 
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