Last Sunday, there was a 50% overnight increase in people testing positive for the SARS-CoV-2 virus, with nearly 3,000 cases representing the highest daily total since mid-May. Concerns are obviously being felt at a time when, along with school pupils, most of us are returning to some semblance of work outside the home. I have argued before about the benefit of testing across the board. But with Matt Hancock, on a recent radio phone in, unable to assuage the distress of a caller from Nottingham who had been told to go to Dundee for a test, local lockdowns and spikes are likely for some time yet.
AMD and Covid
The higher morbidity and mortality from Covid-19 with increasing age is well known. That most eye disease is similarly associated with age has not been lost on ECPs. The need for balancing extra vigilance in avoiding infection while ensuring that adequate eye disease treatment is maintained has again been argued, most eloquently, in a new paper in Ophthalmology journal.1
Conditions known to express heightened activity in the complement inflammatory pathway, such as obesity and diabetes, are also shown to have a greater mortality risk from Covid-19. In recent years, research into AMD (figure 1) has confirmed that the disease is linked with overactive complement. This has prompted a team at Columbia University to look at AMD (as well as common coagulation disorders like thrombosis and haemorrhage) and its impact upon viral disease severity.2 They have found that, from a sample of 11,000 people with Covid-19, ‘over 25% of those with AMD died, compared to the average mortality rate of 8.5%... and roughly 20% required intubation. The greater mortality and intubation rates could not be explained by differences in the age or sex of the patients.’ So, evidence suggests the presence of AMD may make the impact of Covid-19 worse.
Testing
Testing helps focus resources upon areas of increasing infection. Negative results are also important and, for example, may reassure clinicians of the effectiveness of their continued interactions with susceptible patients. If universal testing is not on the agenda, a recent paper has highlighted how health professionals who suspect they may have been exposed might be usefully tested regularly.3 Suspicion of having the virus among this group correlates well with seropositivity.
Having a strong gagging reflex whenever I have been tested, I noted with interest a call from the US for increasing the availability of tests for patients to undertake themselves.4 When compared with the gag-making nasopharyngeal samples collected by health care workers, the less uncomfortable and quicker tongue, nasal, or mid-turbinate sampling when undertaken by patients themselves showed impressively similar sensitivity (89.9%, 94% and 96.2% respectively). As the authors state: ‘Collection by the patient reduces high exposure of the health care worker to the virus and preserves limited PPE.’
Vaccines and Plasma
After the travesty of the FDA seeming to support a pre-Republican Congress announcement of dubious integrity, much focus has been upon the use of convalescent plasma for therapy or prevention of Covid-19. For a more reasoned view on this, I recommend a glance at a new paper in the European Journal of Immunology,5 which notes that ‘the benefits of convalescent plasma treatment can only be clearly established through carefully designed randomised clinical trials. The experience from investigations of convalescent plasma products for severe influenza offers a cautionary tale. Despite promising pilot studies, large multicentre randomised controlled trials failed to show a benefit of convalescent plasma or hyperimmune intravenous globulin for the treatment of severe influenza A virus infection. These studies provide important lessons that should inform the planning of adequately powered randomised controlled trials to evaluate the promise of convalescent plasma therapy in Covid-19 patients.’
And with much macho and nationalistic posturing seeming to drive vaccine research, it is good to see support for the WHO Solidarity Vaccines Trial. Pooling resources and results while ignoring land borders will offer the best hope for the future, as is succinctly argued in a recent Lancet article.6
Masks and Dry Eye
We all know how masks cause specs to steam up. Good old Lyndon Jones and the team at CORE remind us to consider mask associated dry eye (MADE) and offer useful pointers to manage this increasingly common concern. The website https://core.uwaterloo.ca/covid-19 is well worth a visit.
References
- https://doi.org/10.1016/j.oret.2020.05.015
- https://doi.org/10.1038/s41591-020-1021-2
- JAMA August 6, 2020. doi:10.1001/jama.2020.14765
- DOI: 10.1056/NEJMc2016321
- https://doi.org/10.1002/eji.202048723
- https://doi.org/10.1016/S0140-6736(20)31821-3