COVID-19 updates

Garg et al.[1] argue in a review article in January 2021 issue of that journal that severe coronavirus disease 2019 (COVID-19) is a distinct entity. In this evolving pandemic, the authors underscore a few important points about the manifestations of severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) and weigh up various treatment options. Table 1 of the article enumerates comorbidities associated with severe COVID-19. This table correctly includes several medical conditions which increase the risk of developing severe disease. In this respect, US Centers for Disease Control and Prevention runs a webpage where it provides live information – called living document – to share which we are amassing on a daily basis.[2] This list includes pregnant women in the high-risk group, among several others. The health-protection agency releases guidelines regarding pregnancy, breastfeeding, and caring for newborn.[3] Here, the American public agency points out that pregnant people are at increased risk for severe illness from COVID-19 and death, compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks). Elisabeth Mahase informs in British Medical Journal that pregnant women with SARS-CoV-2 are more likely to need intensive care on the basis of a study.[4] Hence, we propose that this point should be included in this list. On the basis of these findings, Rasmussen et al.[5] explore an option of delaying pregnancy during this public health crisis while examining public health recommendations for COVID-19 and beyond. Under the heading ‘Medical Treatment’, the authors discuss various treatment options available to such patients and point out their outcomes. Under Remdesivir, the authors state that it’s considered beneficial in the treatment of COVID-19. Here, we emphasize ACTT-1 trial conducted by Beigel et al.[6] and its Final Report. The report states that Remdesivir is beneficial in only that subgroup of moderately ill patients which require oxygen support. If the disease is not severe enough to have this requirement, curves of Kaplan–Meier estimates in Figure 2 don’t get separated, resulting in no overall benefit. Conversely, if the disease is so much severe that they need high-flow oxygen/non-invasive ventilation/mechanical ventilation or extra corporeal membrane oxygenation (ECMO), again there is no benefit of this repurposed antiviral drug. An accompanying editorial explains this intriguing behaviour of the drug. It clarifies that in the initial stage, viral replication is the predominant pathology and antiviral drugs act effectively in these patients, whereas later on due to cytokine storm, inflammatory system goes haywire and then anti-inflammatory drugs have value. Therefore, it’s important to assess the stage a patient is having in his disease process, which may determine choice of drugs at that specific point of time. Figure 3 of the trial explores time to recovery according to subgroup. An interesting finding there is that the drug works better for ‘other’ race – other than White, Black and Asian ones. That finding deserves further scrutiny and results should be analysed accordingly. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. We accessed all the webpages at the time of submission of this Letter.