Sars virus covid

Hem / Hälsa & Välmående / Sars virus covid

 [PMID:32876694]

Comment: Seven randomized trials included 1703 patients, of whom 647 died. The SAVE-MORE RCT showed sufficient efficacy (reduction by 11-point WHO clinical progression at d28, 0.36 (95% confidence interval 0.26–0.50 compared to placebo) and safety, but enrollment was dependent on elevations of soluble urokinase plasminogen activator receptor levels (uPAR ≥6 ng ml−1), a test not routinely available in the US.

It can be considered for use similar to tocilizumab for treating progressive COVID-19 pneumonia in hospitalized patients.

  • Omicron appears to be at least as transmissible as the Delta variant and is 50-70% more transmissible than earlier variants, including Alpha.
    • This CDC genomic variant surveillance tracks circulating Omicron sublineages in the U.S.; as of July 2025, most variants in the U.S.

      are LP.8.1, NB.1.8.1 and XFG.

      • Includes NOWCAST projection and modeling of what may happen in real-time since data lags by 2- 3+ weeks.
      • Projections as of 2025-2026 are subject to higher uncertainty due to fewer isolates being sequenced.
  • Severe infections remain more prevalent in the oldest age groups and for those with multiple risk factors, especially solid organ transplants and people with poor antibody responses to vaccines or infections.
  • Risk groups
    • Older age, especially > 65 yrs, and people with comorbidities appear more likely to develop an infection with severe symptoms and be at risk for death.

      2021;384(8):693-704.

      • Prolonged cultivatable virus was seen in some severely immunocompromised patients. Importance is higher for those in advanced age groups and those with multiple risk factors.
      • 2023-24 season, COVID-19 vaccines prevented ~68,000 hospitalizations and 5,300 in-hospital deaths.
    • Lessens the chance of developing long COVID.
  • Multiple vaccines worldwide, with those below used in the U.S.


    • Previous ACIP/CDC recommendation (before September 2025): Recommended for all ≥ 6 months. Adverse events were comparable.
      • If also infected with influenza, use neuraminidase inhibitors for severe infection (or baloxivir for outpatient use in high-risk patients).
        • Survived patients were mainly in Western European trial sites and received either tocilizumab or baricitinib, confounding results.
        • IDSA COVID guideline recommends its use; our JH guidelines do not.
  • Abatacept is a recombinant fusion protein that blocks T cell activation (cytotoxic T-lymphocyte-associated antigen 4 [CTLA-4])
    • Potential alternative if BAR or TOCI is unavailable for severe, rapidly progressive or critical COVID-19[9].
    • Unapproved for COVID-19
  • Infliximab
    • Potential alternative if BAR or TOCI is unavailable for severe, rapidly progressive or critical COVID-19[9].
    • Unapproved for COVID-19

    • Antibody-based therapies

    Antibody-based therapies

    Antibody-based therapies

    COVID convalescent plasma (CCP) serum-containing neutralizing antibodies against SARS-CoV-2, using high-titer plasma (defined as a ≥250 titer in the Broad Institute’s neutralizing antibody assay or an S/C cutoff of ≥12 in the Ortho VITROS IgG assay)

    • FDA indication is for treatment of COVID-19 in patients with immunocompromised-immunosuppressive disease/process or receiving immunosuppressive treatments at risk of severe disease progression in either the inpatient or outpatient setting
      • First FDA approval for convalescent plasma to treat an infectious disease, Dec 2024; FDA EUA authorizes use in those with immunosuppressive disease or receiving immunosuppressive medications.
    • One Blood, a non-profit service in Florida, Georgia, North Carolina, and South Carolina, produces the product.

      2020;324(13):1330-1341.

      • Omicron median is 3-4 days following exposure.
    • SARS-CoV-2 continues to evolve due to the inherent infidelity of RNA viruses that generate random mutations, population immunity and a high rate of daily infections.
    • Criteria for Identifying High-Risk Individuals: treatment for outpatients limited to those with medical conditions or other factors may place adults and pediatric patients (age 12-17 years and weighing at least 40 kg) at higher risk for progression to severe COVID-19:
        • See risk factors in the "Clinical" subheading.
    • Tiered recommendations (in descending order of preference; see individual modules for details) are provided for outpatient treatment of COVID-19 in patients with mild-to-moderate infection.

      JAMA Intern Med. 28-day all-cause mortality was lower among patients who received corticosteroids than those who received usual care or placebo (summary odds ratio, 0.66).

      • Clinician indication of risk factors is not required (though it is variable in some organizations), and self-attestation is acceptable for those under 65 years.
  • Offers protection against severe COVID, hospitalization and death.
  • The 2025-2026 COVID-19 vaccines.

    • Studies are ongoing to understand the condition. Consider this possible limitation of pulse oximetry for appropriate patient presentations.
  • Prone positioning appears helpful if hypoxemia worsens despite intubation and ventilation.
  • ICU patients have high rates of clots (DVT, PE and thrombotic events [CVA, MI]).
  • Anticoagulation is often used prophylactically in ICU patients to prevent thrombotic events.
  • Secondary infections, especially in severe/critically ill patients:
    • ICU patients
      • Evaluate and treat bacterial or fungal superinfection (especially Aspergillus)
        • Sputum culture, beta-D-glucan, and serum or BAL galactomannan are helpful in decision-making.
        • Often “nosocomial” pathogens (ESBL, P.

          The availability of high-titer convalescent plasma remains limited, but it is now FDA-approved for the treatment of immunosuppressed patients. Baricitinib is an alternative and is favored by many since it appears to have fewer adverse effects and potentially is more effective, although robust head-to-head trials are lacking.

          Vilobelimab

          The drug is a chimeric human/mouse immunoglobulin G4 (IgG4) antibody consisting of mouse anti-human complement factor 5a (C5a) monoclonal binding sites (the variable regions of the heavy and light chains) and human gamma four heavy chain and kappa light chain constant regions.

          sars virus covid

      • Investigators concluded that patients benefited before the need for mechanical ventilation, suggesting that this antiviral yields greater benefits the earlier it is initiated.
    • Another RCT from China did not show a benefit, but did note a mortality trend toward benefit.
    • The Solidarity trial (WHO trial, interim results) included RDV as one of four arms but did not show benefits in mortality, LOS, or reduced need for mechanical ventilation.

      • These practices are essential for older adults and people who are immunocompromised.
  • Hospital guidance per CDC recommendations includes:
    1. Isolation
    2. N95 or PAPR for HCWs
    3. Medical personnel encouraged to be up-to-date with COVID vaccination
  • Viral shedding as an infectious risk
    • The condition occurs following recovery but does not appear to play a role in transmission in relatively healthy people more than 10 days after the onset of infection (though some variants may be infectious longer, viral RNA may be detected long after for many weeks; hence, repeated routine testing for negative SARS-CoV-2 RT-PCR is not recommended).
    • It may not be so short for severely ill hospitalized patients or those with health problems.

      The primary endpoint was hospitalization or death within 29 days. Current source: One Blood

      • COVID-19-infected AND vaccinated patients (so-called high-titer vax convalescent plasma) have the highest neutralizing antibody titers.
      • Standard plasma contains antibodies against SARS-CoV-2 but has an unknown titer.
  • Molnupiravir
    • Lower effectiveness (30%) than the above therapies in avoiding hospitalization/death in unimmunized patients.
    • Need pregnancy screen in women of childbearing age, due to genotoxicity concerns.
    • No meaningful drug interactions are known.

    • Antivirals

    Antivirals

    Antivirals

    • Studies for EUA or FDA approval were primarily carried out in the early part of the pandemic in unimmunized individuals.