Am J Physiol Lung Cell Mol Physiol. 2020 May 13. doi: 10.1152/ajplung.00144.2020. [Epub ahead of print]
Treatment of COVID-19 exacerbated asthma: should systemic corticosteroids be used?
Kumar K1, Hinks TS2, Singanayagam A1.
Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is a new rapidly spreading infectious disease. Current guidance from the World Health Organisation (WHO) highlights asthmatics as a high-risk group for severe illness from COVID-19. Viruses are common triggers of asthma exacerbations and the current SARS-CoV-2 pandemic raises several questions regarding the optimum management strategies. Here, we discuss the contentious issue of whether the mainstay therapies systemic corticosteroids should be used in the routine management of COVID-19-associated asthma exacerbations. Recent guidance from the WHO has advised against the use of corticosteroids if COVID-19 is suspected due to concerns that these agents may impair protective innate anti-viral immune responses. This may not be appropriate in the unique case of asthma exacerbation, a syndrome associated with augmented type 2 inflammation, a disease feature that is known to directly inhibit anti-viral immunity. Corticosteroids, through their suppressive effects on type 2 inflammation, are thus likely to restore impaired anti-viral immunity in asthma and, in contrast to non-asthmatic subjects, have beneficial clinical effects in the context of SARS-CoV-2 infection
https://doi.org/10.1152/ajplung.00144.2020
Leaked Chinese Virus Database Covers 230 Cities, 640,000 Updates
New information may offer insight into the honesty of China’s coronavirus numbers.
BY ISAAC STONE FISH, MARIA KROL SINCLAIR | MAY 12, 2020, 8:32 PM
snip
While not fully comprehensive, the data is incredibly rich: There are more than 640,000 updates of information, covering at least 230 cities—in other words, 640,000 rows purporting to show the number of cases in a specific location at the time the data was gathered. Each update includes the latitude, longitude, and “confirmed” number of cases at the location, for dates ranging from early February to late April.
https://foreignpolicy.com/2020/05/12/leaked-chinese-coronavirus-database-number-cases/
Two cases of coronavirus confirmed at primary school now closing for deep-clean
https://www.mirror.co.uk/news/uk-news/breaking-two-cases-coronavirus-confirmed-22035200
the problem with corticosteroids is, they can promote fungal growth, such as thrush in COPD users of inhaled corticosteroids.
COVID-19 and Fungal Superinfections: The Deadly, Perfect Storm
“In contrast to COVID-19, much is known about invasive aspergillosis. This infection is caused by microscopic Aspergillus spores, which are typically present in the air we breathe. Aspergillus spores do not cause infection in people who are otherwise healthy with functioning immune systems. However, people who, for example, are severely immunocompromised as a result of cancer treatment or immunosuppressive medications can become seriously ill after breathing in this dangerous fungal pathogen, with mortality rates ranging from 40 to 90 percent even after treatment with existing antifungal therapies.
Physicians on the frontlines managing severe COVID-19 infections are now sounding the alarm that their patients are also at significant risk for developing the deadly superinfection, invasive aspergillosis. Originally reported in China and France, anecdotal reports of this infection in patients with severe COVID-19 are now appearing on social media from physicians in New York, California, Washington, the Netherlands, and the United Kingdom. In one study from France, one third of ICU patients with COVID-19 also had invasive aspergillosis. “