21 Sept 2020
COVID-19 illness, antibodies and testing
The serological response to SARS-2 virus is individual. In general, the antibody levels increase fast after the infection. Most persons with COVID-19 illness showed an antibody response between day 10 and day 21 after infection. The seropositivity was cumulatively 50% within two weeks and 100% on the 39th-day.The decrease is also individual, and in addition related to symptoms. 40% out of those individuals who became asymptomatic became also negative for IgG in the early convalescent phase, but only approx. 13% out of the symptomatic became seronegative.The serological tests can be offered for patients in addition to direct detection methods if they have been symptomatic for more than nine days. They benefit from the serological tests since the sensitivity of direct virus detection decreases and the serological tests’ sensitivity increases over time.
- Immune responses and immunity to SARS-CoV-2 https://www.ecdc.europa.eu/en/covid-19/latest-evidence/immune-responses
- Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clinical Infectious Diseases. 2020. DOI: 10.1093/cid/ciaa344
- Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections https://doi.org/10.1038/s41591-020-0965-6
- Interim Guidelines for COVID-19 Antibody Testing in Clinical and Public Health Settings https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests-guidelines.html
17 Sept 2020
Flu season approaches! CRP and other respiratory tests are useful in transient COVID-19-testing sites
It’s good to remember that respiratory symptoms are not always of SARS-CoV2. CRP is a good indicator of severity of respiratory infections (also in COVID-19), and it can reveal more than what is clinically observed1,2. Remote consultations and lab referrals are preferred more and more because of the pandemic3-5. Thus, measuring CRP brings much needed support for correct diagnosis especially now. One of the biggest healthcare providers in Finland, Mehiläinen, has already equipped their drive-in COVID testing site with e.g., CRP and throat sampling according to a Finnish newspaper, Aamulehti6.
CRP brings added value to both negative and positive SARS-CoV2 test results: With negative result, CRP can be effectively used to rule out serious bacterial infection and assess the severity and need of antibiotics for the respiratory infection1,7,8. With positive SARS-CoV2 result, CRP tells about the severity and risk of developing severe COVID-19 infection, and measured sequentially, CRP can be used to follow the course of infection1,2,9,11. QuikRead go CRP products provide reliable first CRP result if follow-up is needed, e.g., in case of hospitalization of COVID-19 patients.
Addition to CRP, specific detection of Strep A helps to make necessary treatment decisions at the point of care. Symptoms in COVID-19 vary and can resemble other respiratory infections11. Sore throat is a common symptom and only sometimes caused by bacterium (most typically Strep A) warranting antibiotic treatment.
Flexible QuikRead go system is ideal for evaluating respiratory infections (CRP and Strep A) also in transient locations: The samples are stable in the test, portable instrument can be operated by battery, Wi-Fi connection is possible, and the results are ready within minutes. QuikRead go can help guide patient’s next steps immediately!
- Pepys MB, Hirscheld GM. C-reactive protein: a critical update. J Clin Invest 2003; 111(12): 1
- Ghayda RA et al. Correlations of Clinical and Laboratory Characteristics of COVID-19: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020 Jul. doi: 10.3390/ijerph17145026
- World Heatlh Organization: Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed: Interim guidance 29.6.2020
- GP. Should remote consultations be the default after COVID-19? Luke Haynes, 3.8.2020 https://www.gponline.com/remote-consultations-default-covid-19/article/1690834, accessed 10.9.2020
- https://www.england.nhs.uk/2020/05/millions-of-patients-benefiting-from-remote-consultations-as-family-doctors-respond-to-covid-19/, accessed 10.9.2020
- Aamulehti. Mehiläisen Kaupin koronatestauspiste siirtyi keskeiselle paikalle Tampereen ytimeen – Ensimmäisenä aamuna noin tunnin jonotusaika. Katja Pajula. 11.8.2020, updated 12.8.2020. Article in Finnish. https://www.aamulehti.fi/a/fb122c76-bb44-4f6f-b191-e5ec0dba8914, Accessed 15.8.2020
- Little P, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013; 382(9899): 1175-1182.
- Aabenhus R et al. Biomarkers as point-of-care tests to guide antibiotics in patients with acute respiratory infections in primary care. Cohcrane Database of Systematic Reviews 2014; 11: CD010130.
- Wang G, et al. C-Reactive Protein Level May Predict the Risk of COVID-19 Aggravation. Open Forum Infectious Diseases 2020 May. https://doi.org/10.1093/ofid/ofaa153
- Yuan J, et al. The correlation between viral clearance and biochemical outcomes of 94 COVID‑19 infected discharged patients. Inflammation Research 2020. https://doi.org/10.1007/s00011-020-01342-0
- Struyf T, Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev 2020 Jul 7. doi: 10.1002/14651858.CD013665.
11 Sept 2020
Antimicrobial resistance could be the next pandemic after COVID-19
The current COVID-19 pandemic appears to have accelerated the threat of antimicrobial resistance, as many patients in the hospitals displaying COVID-19 symptoms are treated with antibiotics to reduce their chances of contracting secondary bacterial infections. This is making resistant bacteria more common. It has been estimated that up to 95% of COVID-19 inpatients are being prescribed antibiotics as part of their treatment.1
As with most colds and flus, coronavirus is a viral infection, which means treating it with antibiotics is useless and this shows need for faster testing for coronavirus and other infections, which could reduce overuse of antibiotics. United Nations’ Ad hoc Interagency Coordinating Group on Antimicrobial Resistance has warned that if action is not taken, drug-resistant diseases could cause 10 million deaths each year by 2050.
7 Sept 2020
CRP used to rapidly evaluate SARS-CoV-2 infection status of patients presenting at the ED with respiratory symptoms
“A corona score“ including CRP was developed for rapid and efficient triage of COVID -19 status in emergency department patients in the Netherlands.
Overcrowding of ED’s and need for isolation during pandemic necessitates rapid triage of patients. A cohort of 967 patients was used to develop and validate a corona score in this multicenter study. CRP together with four other routine laboratory parameters (lactate dehydrogenase, ferritin, absolute neutrophil and lymphocyte counts), X-ray, age and sex were included in the score. Concentrations between 39 and 69 mg/l produce the highest points for CRP – range reported also elsewhere to reflect severe COVID-19 infection.
The score resulted in 96 % of sensitivity and 95 % of specificity and could effectively predict SARS-CoV-2 RT-PCR results. Sensitivity of the score even exceeded that of initial RT-PCR result. The score has already been implemented in the ED of several hospitals in the Netherlands.
Full study here.
4 Sept 2020
Antibody tests are useful in COVID-19
Antibody tests have an important role in COVID-19 diagnostics although they are not the first tool for a patient presenting with recent start of the illness. Patients who come to the physician after having symptoms present for more than nine days, benefit from serological tests since the sensitivity of direct virus detection is decreasing due to the decreasing number of viruses. Instead, the sensitivity of serological tests increases over time. The serological tests can be offered for these patients in addition to direct detection methods.
Lengthy symptoms are common in adults who have had COVID-19 illness. Antibody tests are a useful means for the physician to determine if a patient with symptoms has had an earlier non-diagnosed COVID-19 illness.
20 Aug 2020
Combining antibody and molecular testing for COVID-19 is recommended for a complete screening of population in the current pandemic scenario
The 2019-nCoV IgG / IgM Rapid Test Cassette by Acro Biotech Inc. was used in a recent study by Alessandro Pancrazzi et al. They evaluated a dual laboratory approach for COVID-19 consisting of patient care reports for viral RNA detection on swabs and rapid serological tests in 516 patients (192 symptomatic or paucisymptomatic and 324 asymptomatic). This study aimed to evaluate the multiple approach, based on molecular analysis of swabs and serological screening for Ig G and M, in order to decrease improper diagnosis and viral spread in the general territory and the hospital structures.
In their findings, the serological test could be important to confirm negative and to clarify indeterminate molecular results, so health systems will have to consider the role of serology in their evaluation algorithms. Serological investigation is a simple method for the laboratory; these tests, based on the chromatographic technique, are fast (about 15 min to execute) and do not require additional instrumentation.
Their data confirm that serological and molecular approaches should not be considered as two alternative systems for the monitoring of virus spreading, rather they seem to be two necessary applications. The molecular test identifies the most part of infected patients and the simultaneous serological investigation helps to clarify diagnostic response of the indeterminate molecular cases. Used together the molecular and serological analyses help the virologist to determine disease status and to support clinical decisions.
Read the full study: https://www.sciencedirect.com/science/article/pii/S0009912020307918?via%3Dihub
19 May 2020
Serological response in COVID-19: A new study published in Nature
More evidence is being gathered about serological response to SARS-CoV2 virus revealing more about how antibodies can complement PCR in SARS-CoV2 diagnostics. In a new study published in Nature, serological response was studied.
In summary, most patients with COVID-19 infection generated serological response within few weeks from the onset of symptoms. 100 % of patients had detectable IgG antibodies against SARS-CoV2 within 19 days after symptom onset, and more than 50 % had detectable IgG already within the first 5-7 days. Following the serological courses in subset of patients revealed that the highest antibody titers were reached in about 6 days for both immunoglobulin types. Seroconversion of IgG and IgM occurred simultaneously or sequentially with either type preceding.
It was also shown that serology can complement PCR testing for asymptomatic and suspected persons with negative PCR results. Serology could identify 4 out of 52 suspected COVID-19 patients with several negative PCR results that were concluded as COVID-19 positives with high probability. In addition, serological assessment could correctly identify infected close-contacts of COVID-19 patients that were PCR positive, and additional persons that were PCR negative (4,3%). 10 % of these seropositive persons were asymptomatic.
17 April 2020
Antimicrobial resistance (AMR) has a role in COVID-19
Antimicrobial resistance (AMR) is an important threat to global health1. AMR should not be overlooked despite understandable focus on the ongoing COVID-19 pandemic. An increasing body of opinion indicates that AMR may have a role in COVID-192-4.
Firstly, a significant number of the deceased COVID-19 patients have had secondary bacterial infections like is common for other several viral infections5-9. In severe viral respiratory infections, the immune system is weakened, and respiratory system exposed to other pathogens. In such cases, if a hospitalized patient is infected with resistant bacteria, consequences can be fatal. There are indications of increase in resistant bacterial infections such as MRSA in hospitals during the outbreaks of novel emerging pathogens such as previous SARS epidemics10,11. It bears further investigation if the resistant bacteria have influenced the COVID-19 situation for example in Italy, where hospitals have been shown to have significant AMR-related problems12.
Secondly, prophylactic antibiotics are often used to prevent secondary bacterial infections of the hospitalized patients as is the case also in COVID-197,8,13-15. This can significantly increase the use of antibiotics during the pandemic and silently cause the emergence of resistant bacteria, as was recently commented by Prof. Anu Kantele from University of Helsinki4.
The actual role of antimicrobial resistance in COVID-19 may be revealed in the future. However, AMR as such is an important threat to global health although it develops more silently compared to COVID-19. The fight against AMR calls for collective global actions on various levels, as has now been rapidly done in COVID-19.1, 2, 16, 17.
- WHO. Global action plan on Antimicrobial Resistance 2015. Available at WHO: Global action plan on antimicrobial resistance 2015.
- Kirchhelle et al. Opinion: Antibiotic Resistance Could Lead to More COVID-19 Deaths. Scientific American 2020. April 1. https://blogs.scientificamerican.com/observations/antibiotic-resistance-could-lead-to-more-covid-19-deaths/?amp, accessed 15.4.2020
- Aftenposten. Derfor tar koronaviruset så mange liv i Italia | Erik Martiniussen. Article in Norwegian. https://www.aftenposten.no/article/ap-awEP27.html , accessed 15.4.2020
- Helsingin Sanomat. Antibioottien runsas käyttö saattaa selittää Italian koronaviruskuolemien määrää. 5.4.2020. Article in Finnish. https://www.hs.fi/tiede/art-2000006464588.html, accessed 15.4.2020
- Wang L et al. Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020. Mar 30. doi: 10.1016/j.jinf.2020.03.019.
- Li et al. Clinical characteristics of 25 death cases with COVID-19: a retrospectivereview of medical records in a single medical center, Wuhan, China. Int J Infect Dis 2020. doi: https://doi.org/10.1016/j.ijid... et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054–62.
- Huang et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
- Centers for Disease Control and Prevention (CDC). Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1) - United States, May-August 2009. MMWR Morb Mortal Wkly Rep. 2009; 58(38):1071-4.
- Yap et al. Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome. Clin Infect Dis. 2004; 39(4):511-6.
- Chai et al. Paradoxical Increase in Methicillin-Resistant Staphylococcus aureus Acquisition Rates Despite Barrier Precautions and Increased Hand Washing Compliance during an Outbreak of Severe Acute Repiratory Syndrome. Clin Infect Dis. 2005; 40(4): 632–633.
- European Centre for Disease Prevention and Control. ECDC country visit to Italy to discuss antimicrobial resistance issues. Stockholm: ECDC; 2017.
- Cao et al. Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Apr 2. doi: 10.1093/cid/ciaa243.
- Lupia et al. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. J Glob Antimicrob Resist. 2020 Mar 7; 21:22-27. doi: 10.1016/j.jgar.2020.02.021.
- Wang et al. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Mar 16. doi: 10.1093/cid/ciaa272.
- WHO. Strategic preparedness and response plan for the new coronavirus14.4.2020. https://www.who.int/publications-detail/covid-19-strategy-update-13-april-2020, Accessed 15.4.2020
- PEW. The Invaluable Role of Antibiotics—in a Pandemic and Beyond, 15.4.2020. https://www.pewtrusts.org/en/research-and-analysis/articles/2020/04/15/the-invaluable-role-of-antibiotics-in-a-pandemic-and-beyond?amp=1&__twitter_impression=true, Accessed 17.4.2020
14 April 2020
CRP and pulmonary findings correlate in COVID-19
A significant increase of C-reactive protein (CRP) has been reported with concentrations on average 30-50 mg/L1,2,3 from patients with COVID-19. It seems that the patients with severe disease symptoms have significantly higher CRP levels. For example a study reported, patients with mild symptoms had on average CRP level of 19 mg/L and patients with more severe symptoms CRP level of 39 mg/L1.
The pulmonary findings from CT scans of COVID-19 patients are similar to H1N1 influenza4. In both viral pneumonias CRP level correlates with the severity of pathological findings significantly. The severity of lung CT findings in COVID-19 is also associated with the disease progression5,6. Lung lesions are also more commonly seen in patients aged > 45 years compared to patients < 18 years7. Furthermore, patients with low oxygen saturation (SpO2 < 90%) had significantly higher CRP median (82 mg/L) compared to patients with oxygen saturation SpO2 > 90% (median 11 mg/L)8, suggesting that patients with more severe lung damage have higher CRP values. In conclusion, CRP correlates well with the severity of the symptoms of patients with COVID-19 and therefore it is suitable in assessing patient´s condition together with other clinical findings.
- Gao et al. 2020 Diagnostic Utility of Clinical Laboratory Data Determinations for Patients with the Severe COVID-19. J Med Virol. 2020 Mar 17. doi: 10.1002/jmv.25770.
- Chen et al. 2020. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13. https://doi.org/10.1016/S0140-6736(20)30211-7
- Mo et al. 2020. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020 Mar 16. doi: 10.1093/cid/ciaa270.
- Feng et al. The relationship between pulmonary HRCT findings and peripheral blood immunological parameters in adults with H1N1 influenza. Radiology of Infectious Diseases 2016; 3:60-65.
- Song F, Shi N, Shan F, et al. Emerging coronavirus 2019-nCoV pneumonia. Radiology 2020 Feb 6 [Epub ahead of print]
- Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020 Feb 13.
- Chen et al. High-resolution computed tomography manifestations of COVID-19 infections in patients of different ages. European Journal of Radiology. 24.3.2020. DOI:https://doi.org/10.1016/j.ejra... et al. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Mar 16. doi: 10.1093/cid/ciaa272.
30 March 2020
Antimicrobial resistance can play a role in death rates of COVID-19 patients.
Interesting observations about relevance of antimicrobial resistance in COVID-19 by journalist Erik Martiniussen were published in the Norwegian magazine Aftenposten. Resistant bacteria could play a role in some of the deaths of COVID-19 patients: secondary infections, partly bacterial, have been associated with a significant number of deaths, and the rate of COVID-19 deaths appear to be higher in countries such as Italy, that have high incidences of resistant bacteria. Original Aftenposten article in Norwegian: https://lnkd.in/ddbhGd5
9 March 2020
Are you familiar with how useful tool CRP is in assessing COVID-19 infection?
C-reactive protein (CRP) is used as one of the key markers at the forefront to evaluate the severity of infection and to direct patients further on the treatment path during the novel coronavirus (COVID-19) epidemic. In contrary to the mild viral respiratory infections where CRP does not normally elevate, COVID-19 seems to increase CRP levels significantly to appr. 40-50 mg/l. Prescreening with a rapid method like QuikRead go CRP is especially valuable when the capacity of specific COVID-19 testing and hospital beds are limited due to the high numbers of infected patients seeking medical help. Therefore General Office of the Chinese National Health Commission is recommending the use of CRP tests together with other clinical parameters for initial evaluation and follow-up of coronavirus infection.
20 February 2020
News from the front lines in China: fighting the coronavirus epidemic with mobile diagnostics
Aidian’s QuikRead go Instrument and CRP tests are in use on the front line of the fight against the coronavirus epidemic in Wuhan, China. QuikRead go Instrument is particularly well-suited for mobile use due to its compact size and fully automatic usage. Today we would like to share with you the experience of Jiang Haoqin, a Chinese healthcare professional from the Department of Laboratory Medicine, Huashan Hospital, Fudan University in Shanghai who is currently working in a mobile laboratory unit in early diagnostics of the coronavirus in Wuhan. She and her team are working long and busy days setting up diagnostic measures for newly infected patients. There are many practical issues to take care of before a mobile laboratory unit is up and running, such as sources of power and the disposal of the blood samples. The teams comprising of healthcare professionals, engineers, armed guards, and many more are protecting themselves from catching the virus by using protective clothing at all times. After more than 12 hours of working relentlessly, the team is successful, and the laboratory unit is ready to receive its first patients for CRP testing. Aidian continues to support the Chinese medical professionals and others around the world at their work against the coronavirus epidemic.
12 February 2020
CRP is an important marker in the prediagnostics and treatment follow up of the new coronavirus (2019-nCoV).
C-reactive protein (CRP) is one of the key markers needed to diagnose and follow up the treatment of the novel coronavirus (2019-nCoV). In practice, every single patient that comes to the fever clinics/hospitals with fever and other suspected symptoms will be first checked with CRP and whole blood cell count. These routine tests help to identify a common cold from this more severe new virus infection. Further chest imaging and nucleic acid test are used to confirm the coronavirus infection. During the treatment, C-reactive protein (CRP) is also monitored together with other biochemical markers throughout the whole treatment and recovery process.
Aidian is one of the biggest suppliers of C-reactive protein (CRP) point of care products in China, the QuikRead CRP and QuikRead go CRP products manufactured in Espoo, Finland, have been registered and marketed in China since early 2000s and are regarded as the leading industry standard in terms of both performance and quality. Aidian is supporting in the fight against the spread of the novel Coronavirus (2019-nCoV) and we and our partners in China are working hard together to supply the needed extra amount of QuikRead go instruments and CRP reagents to Hubei Province and other virus affected areas.
Aidian will continue to act with the highest standards of ethics and integrity in the fight against this newly discovered virus that has affected the lives of millions of people both in China and worldwide.
5 February 2020
CRP is part of the COVID-19 management triage in Chinese fever clinics
Coronavirus infection, which was officially named as COVID-19 by World Health Organization has caused a substantial influx of patients at the health care facilities in China. Based on the experience gained in the SARS epidemic in 2003, China has established fever clinics to triage a large number of patients entering the healthcare sites. CRP testing and complete blood count are used at the forefront for evaluation of infection and to direct patients further on the treatment path in the algorithm recently published by Lancet Respiratory Medicine1.
Although CRP does not normally elevate significantly in mild viral respiratory infections, levels have shown to increase in severe cases, such as in avian influenza H1N1 and H7N9, and during SARS epidemics in 2003. A similar significant increase of CRP has also been reported in COVID-19 patients2. One possible explanation for this phenomenon is the overproduction of inflammatory cytokines that take part in the defense against the pathogen, but also cause more severe symptoms and damage in lung alveoli and stimulate CRP production3-5. Therefore, CRP testing may be useful in the initial evaluation of coronavirus patients.
- Zhang et al. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med 2020; https://doi.org/10.1016/S2213-2600(20)30071-0
- Chen et al. 2020. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395:P507-513.
- Vasileva & Badawi. C-reactive protein as a biomarker of severe H1N1 influenza. Inflamm Res 2019; 68:39-46.
- Wu et al. A new perspective on C-reactive protein in H7N9 infections. Int J Infect Dis 2016; 44:31-36.
- Huang et al. An interferon‐γ‐related cytokine storm in SARS patients. J Med Virol 2005; 75:185-194.
31 January 2020
CRP testing aids coronavirus management in China
Although there are very limited available research data, currently spreading novel coronavirus (2019-nCoV) seems to increase C-reactive protein (CRP) levels significantly, due to viral alveolar damage that was also seen in the SARS epidemic in 2002. General Office of the Chinese National Health Commission has released a guideline to guide the diagnosis and treatment of 2019-nCoV recommending the use of CRP tests together with other clinical parameters for evaluation and follow-up of coronavirus infection.
Aidian participates in the fight against the coronavirus outbreak by providing cost-efficient CRP test solutions for the management of infection in China. QuikRead go CRP point-of-care tests provide fast and reliable test results that can be immediately used for making decisions about the patient’s management.