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.