“The virus disappears – but the inflammation continues”

Why some Covid 19 patients become seriously ill and end up in intensive care is still unclear. In an interview, an expert explains what an essential role the immune system could play.

The immunologist Professor Dr. Andreas Radbruch already has the t-online podcast “Soundtrack Knowledge” talked about the effects of the coronavirus on the body. In an interview, he explains why the immune system can make Covid 19 disease worse and what he thinks of the current research on the bradykinin hypothesis.

t-online: Professor Radbruch, new research shows that hormones could be responsible for many serious Covid-19 cases. The so-called bradykinin hypothesis states that the coronavirus disrupts the body’s own functions such as regulating blood pressure and leads to an overreaction of the immune system. As an immunologist, how do you rate this theory?

Prof. Radbruch: I am somewhat surprised at the response to this study in the public media. In itself, this is relatively trivial. Because the immune reaction in Covid-19 patients can lead to inflammation and this is accompanied by vasodilating hormones. In this case a so-called peptide hormone with the beautiful name “Bradykinin”. This is not very different from histamine. A Dutch research group put forward this hypothesis in April and brought bradykinin into play. The new US study simply evaluated the research of others and wrote it down on paper.

(Source: Gero Breloer)
Prof. Dr. Andreas Radbruch is Scientific Director of the German Rheumatism Research Center and President of the European Federation of Immunological Societies.

According to the study authors, the body keeps making bradykinin, which cannot be broken down. A “bradykinin storm” is said to be responsible for many deaths in Covid 19 patients. Do you find that plausible?

I don’t think you can call that a storm. I see this more as a reflection of the ongoing illness that can drag on for weeks and months. Unfortunately, some of the patients are in the intensive care unit for a very long time. For me this shows that there is a serious inflammation going on there. Whether the coronavirus constantly causes cells to produce bradykinin is complete speculation.

It is also very difficult to detect the bradykinin. That did not happen in the study. If they had at least measured that the bradykinin itself is extremely highly concentrated on site, then you would have proof.

A “cytokine storm” was also mentioned in previous studies …

This refers to inflammatory cytokines that are suddenly released in large quantities. There was literature that claimed that Covid-19 patients suffered sepsis as a result, i.e. blood poisoning. The effect is comparable to an anaphylactic shock: If you are allergic, it can happen that a bee sting is enough to kill you.

But I think that it is not appropriate to call it a storm here either. Because the patients are not in a stormy, but a chronic inflammatory situation. A storm would pass again. Then one comes Sepsis it is also very dangerous. At the beginning it is extremely intense and then you recover from it – or not. Controlling sepsis is still a huge medical problem today.

Is it true that there are gender differences and that men are more prone to overreacting the immune system?

Yes, it seems that the reactions in women are milder. Men react more violently. The reasons for this are still unclear.

This is also the case with autoimmune diseases, some of which are mainly men, others more women. With women, the whole thing is more balanced. To this day it is not known exactly why, for example, predominantly women Lupus and not at least as many men.

You yourself examined the immune response of Covid 19 patients in a research team in the intensive care unit at the Charité in Berlin. What are your findings?

In our manuscript we describe that that Coronavirus triggers a chronic immune response. In the seriously ill patients we look at in the intensive care unit at the Charité, the virus disappears after a certain time – but the immune reaction and thus the inflammation continue. The body tries to slow down the immune response, but it fails. Why this is the case with some Covid 19 patients and not with others is still a great mystery. It can be assumed that it has to do with how the infected person’s immune system deals with the virus. Whether it will find a way to clear up the coronavirus efficiently and quickly or not.

Charité - Universitätsmedizin Berlin: Seriously ill Covid 19 patients are treated here.  (Source: Getty Images / Panama7)Charité – Universitätsmedizin Berlin: Seriously ill Covid 19 patients are treated here. (Source: Panama7 / Getty Images)

We also suspect that an autoimmune reaction is triggered. There are many diseases, such as chronic intestinal inflammation, where the immune system reacts against its own components, but it shouldn’t react against them. The cytokine we looked at is called TGF-β. Patients develop more and more of it over time; the cells in the lungs, for example, are full of it. The cytokine was supposed to suppress the immune response, but it doesn’t. Patients are then treated with medication to manage symptoms. But the cytokine also has the unfriendly side that it can lead to scarring in the lung tissue. This is a side effect that has been used in severe cases of Covid-19 has been described.

This can lead to long-term damage …

Exactly, the mucous membranes can scar. The tissue is then sometimes no longer functional.

Does it play a role in the severity of the disease, how strong the immune system is before the infection?

Patients who suffer from a suppressed immune system, for example rheumatism, are not recommended to reverse immunosuppression. You should keep taking your medication. So it seems to be different whether you inhibit chronic inflammation or have an acute immune reaction against a pathogen. So far there is no evidence that these patients with suppressed immune systems react worse to the virus.

Rather, it seems to be the case that most people infected with corona already have some kind of pre-conditioning because the body has already gone through something similar with related pathogens. The immune system then has memory cells. So if someone has been infected with other cold viruses, it can get on very quickly and efficiently SARS-CoV-2 responds. On the other hand, the patients who don’t do this are in a bad way. That seems to be much more important as to whether someone has to go to intensive care or not. The dose of the pathogen, its vitality and its ability to penetrate into the depths of the lungs also determine the course.

Thank you for the interview, Prof. Radbruch!

Important NOTE: Under no circumstances does the information replace professional advice or treatment by trained and recognized doctors. The content of t-online.de cannot and must not be used to make independent diagnoses or to start treatments.

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Targeted control possible: vaccination makes you more immune than disease


From Solveig Bach

Surviving an illness or getting vaccinated – both provide immunity. How long this will last and how strong it is can hardly be calculated. Vaccines can be more targeted. To do this, you have to know what immune response the human body would rely on.

On the way to immunity against the coronavirus, vaccination and a possible illness have so far been viewed as largely equivalent. The vaccination is only considered better because you do not have to take the risk of a serious disease course. However, a vaccination may also ensure a significantly better immune response in the body and thus more reliable protection.

The molecular biologist Maitreyi Shivkumar justifies this in an article for “The Conversation” with the complexity of the immune system. Shivkumar teaches at the Leicester School of Pharmacy at De Montfort University. It indicates that an infection initially triggers an innate, unspecific immune response. The white blood cells set off an inflammation that can be enough to clear the virus.

In the case of longer infections, however, the adaptive immune system is activated after a few days, in which T cells recognize and kill infected cells, while B cells produce antibodies that “neutralize” the virus. Some of these T and B cells persist long after infection. They are crucial for long-term immunity. If the Sars-Cov-2 infection is only mild, the adaptive immune system may not be activated at all. From Shivkumar’s point of view, this could explain secondary infections with Sars-CoV-2. She referred to a patient in Hong Kong and one in the United States. The Hong Kong patient showed no symptoms with the second infection, while the patient from Reno, in the US state of Nevada, became seriously ill the second time.

Design artificial infection

According to the microbiologist, a vaccine supplies antigens that stimulate the adaptive immune system, but also generates memory cells that can be quickly activated in the event of a real infection. However, since the antigens in the vaccine come from weakened or non-infectious material in the virus, there is little risk of serious infection.

For example, there is evidence that the vaccine against the human papillomavirus (HPV) triggers a stronger immune response than infection by the virus itself. One reason for this is that the vaccine contains higher concentrations of a viral envelope protein than the natural infection. This triggers strong neutralizing antibodies, which makes the vaccine very effective in preventing infection.

The advantage of vaccines to achieve immunity is even more complex. The composition can be used to control how effective the serum is in generating an immune response. Appropriate vaccination responses can be promoted in the right places via dose and route of administration.

For example, the oral polio vaccine was developed to stimulate the immune response in the intestines, where the poliovirus multiplies. In the case of Sars-Cov-2, it might make sense to give the vaccine through the nose in order to achieve an immunity in the lining of the nose and lungs that would make it impossible for the virus to penetrate further into the body. Shivkumar points out that Sars immunities against previous viruses were still detectable after almost 20 years. These memory T cells could also help people achieve lasting immunity in the fight against the coronavirus.

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Can my child go to daycare or school with a cold?

Are cold children allowed to daycare or school in Corona times? In many federal states there are now clear instructions for this. But some educators have their own rules. And the uncertainty about certain symptoms remains.

“The child has a cold!” – For many parents for months this automatically meant having to look after their offspring at home. Daycare centers and schools sent girls and boys back home even if they had only mild cold symptoms for fear of a corona infection or did not even accept them. In the meantime, mothers and fathers can breathe a sigh of relief nationwide: in most federal states, children with a cold nose are allowed to go to school and daycare. There are now clear recommendations, as a survey by the German Press Agency shows. In Saxony-Anhalt these are called “Schnupfenpapier”.

This will provide a lot of relief for parents, because colds are common in children: “In the first winter of kindergarten children get ten to 15 infections, in the second it is still five to ten,” explains Jakob Maske, Berlin pediatrician and spokesman of the professional association of paediatricians.

Infection protection or educational mandate

Bremen’s Senator for Health Claudia Bernhard (Linke) emphasized during the summer holidays that there must be a balance between infection protection and the educational and social mandate. Mild cold symptoms are not a sufficient reason to have to stay at home.

Often the guidelines are now clear, for example in Berlin. There, parents use a scheme to find out how to proceed: Children who have a cold or cough but no fever are allowed to continue attending daycare or school. If the temperature rises to 38.5 degrees with these symptoms, the child must stay at home for at least 24 hours. If you have further and / or worsened symptoms, a visit to a doctor is recommended. A corona test may then be initiated there, according to the education administration.

“Certificates or negative smears are not necessary”

In his practice, Jakob Maske experiences, however, that not all educators and teachers adhere to this scheme: “Even now our waiting rooms are quite full. Daycare and school children are presented with mostly only cold symptoms.” Despite the very good requirements of the Senate Administration, certificates or negative smears are often required – neither of which is necessary, according to the doctor. “The indication for a test is always provided by the doctor and not by a teacher.”

As in Berlin, there are also clear recommendations in other federal states. While in the capital, for example, persistent cough is an exclusion criterion, in Hamburg or Baden-Württemberg one speaks of dry cough, provided it is not caused by a chronic illness. And while the rules for daycare centers and schools apply in Berlin, other countries differentiate here.

In Saxony-Anhalt, for example, parents of daycare children have to make a written declaration that they will only send their child to daycare without typical Covid 19 symptoms. In the past there have been many complaints because daycare centers sent children home with a runny nose, said Minister of Social Affairs Petra Grimm-Benne (SPD) of the dpa. This has not existed since the new regulation. The Ministry of Education has published a “sniff paper” with recommendations for primary school children.

In North Rhine-Westphalia, on the other hand, children with a cold must first be observed at home for 24 hours. If their condition improves and no additional symptoms occur, they are allowed to go to school. In Bavaria, children with mild symptoms such as a runny nose and occasional cough are allowed to go to school if they have not developed a fever within 24 hours – an exception is made for primary school students.

The most common corona symptoms in children

According to the Robert Koch Institute, count with children SARS-CoV-2Infection, fever and cough – as in adults too – are the most common symptoms of a corona infection. However, a recent study in Great Britain confirms that other symptoms can often be more pronounced in children. Around half of them have no fever, no cough and no loss of smell or taste, report researchers in the journal “BMJ”.

Gastrointestinal problems such as diarrhea, loss of appetite or vomiting are quite common. Rash and headache are also mentioned as possible symptoms. With such rather unspecific signs, parents should be advised to leave the children at home until the symptoms have subsided, explained Tim Spector of King’s College London. In half of the cases considered for the study, however, the children had no symptoms at all.

Before the introduction of the new recommendations, there had been quite a proliferation nationwide: Some facilities required pediatricians to give a certificate that an infection with the coronavirus could be excluded. Others even wanted to see a PCR test result. Pediatricians sounded the alarm and warned of overcrowded practices. Parents feared for their jobs because they no longer saw themselves in a position to look after their children at home any longer after the corona-related school and daycare closings. The federal states reacted and published their recommendations for action.

From the point of view of doctors, autumn could still be difficult. “Now the children meet again in schools and daycare centers. It is unavoidable that germs are exchanged and the children get sick,” said the chairwoman of the Brandenburg General Practitioner Association, Karin Harre. The association is therefore considering whether children from the age of six should also go to the family doctor in order to relieve the pediatrician practice.

Important NOTE: Under no circumstances does the information replace professional advice or treatment by trained and recognized doctors. The contents of t-online.de cannot and must not be used to make independent diagnoses or to start treatments.

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Infection number at record high: France threatens to slip away from the virus situation

Parties and vacations in France mean that the number of new corona infections is higher than ever before. The authorities fear another overload of the hospitals. The already strict measures could therefore be tightened again.

In France, the number of people infected with corona continues to rise and has reached a record level. 9843 new cases of Covid-19 were recorded within 24 hours on Thursday, according to the Ministry of Health. This is the highest number in France since the pandemic began. With around 67 million inhabitants, France is one of the countries in Europe most affected by Corona.

The government now wants to discuss further measures to contain the pandemic. The Scientific Advisory Board urged the government to act. Many doctors fear that the intensive care units could be overloaded in autumn – as in March. Large gatherings are currently banned. In some cities, masks are mandatory in public places and even on the streets.

The previous maximum was reported at the beginning of September with around 9,000 newly recorded cases within a day – the numbers have been at a similarly high level since then. In spring, the maximum was around 7500 recorded cases. However, as in many countries, the number of tests has increased immensely.

As in other European countries, more and more young adults in France are currently being infected with Sars-CoV-2, according to information from the authorities, mainly at celebrations and vacation trips. For weeks now, the greater Île-de-France with the capital Paris and the Côte d’Azur region on the Mediterranean have been considered risk areas. Most recently, the French authorities had to classify other regions as areas with increased virus circulation.

From the German point of view, large parts of the country have been a risk area since the middle of the week. The Foreign Office issued an official travel warning for three other regions. Staying there entails a quarantine obligation when you return to Germany. In addition, a compulsory coronavirus test is due upon entry.

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Immune system downregulated: pregnancy changes Covid-19 symptoms

Pregnant in the middle of the corona pandemic, that worries many women. What if they get infected? Experts have now summarized the results of many studies on this. Accordingly, the Covid-19 disease expresses itself differently in expectant mothers.

Other symptoms and an increased risk of premature birth: Experts have examined the possible consequences of a corona infection in pregnant women. Premature birth is therefore more likely for them, although the rate of spontaneous premature births – that is, when labor begins by itself – is hardly higher. In the case of infected pregnant women, pregnancy is more often initiated and / or the baby is brought in earlier by caesarean section, explain the researchers in the specialist magazine “BMJ”.

There are various reasons for this. Virologist Susanne Modrow, who, among other things, researches viral infections in pregnancies, explained that this is a situation that can occur not only with infection with Sars-CoV-2, but also with other infections. “Acute infections often carry a risk of premature birth in the late phase of pregnancy.”

The researchers working with Shakila Thangaratinam from the WHO Collaborating Center for Global Women’s Health at the University of Birmingham have compiled the results of a total of 77 studies. Their analysis also shows that symptoms such as fever and muscle pain are less common in infected pregnant women than in non-pregnant women with an infection. This could also be due to the fact that pregnant women are usually tested for the coronavirus when they are admitted to the clinic – regardless of whether they show symptoms or not. Non-pregnant women, on the other hand, were often only tested because they showed symptoms.

Christian Albring, President of the Professional Association of Gynecologists, explained that the typical Covid-19 symptoms such as fever and muscle pain were mainly due to the activation of the immune system because it dealt with the pathogens. “The immune system of pregnant women is downregulated so that the baby is not recognized as a foreign body and a rejection reaction is initiated.” That could be a reason for the partially missing or different symptoms in infected pregnant women.

No Remdesivir approval

In addition, according to the study, pregnant women needed intensive medical care more often than non-pregnant infected people. “The fact that pregnant women are now particularly at risk compared to non-pregnant women – there are still too few conclusive data for that,” said virologist Modrow. It is clear – as also described in the study – that complications can arise in previously ill mothers, such as those with overweight, high blood pressure or diabetes. There are clear differences in the treatment of seriously ill Covid 19 patients. Antiviral treatment with the drug Remdesivir is not approved for pregnant women, said Modrow. In contrast, the drug is administered to adolescents and adults with pneumonia who require ventilation. Therefore, infection should be avoided, especially during pregnancy.

According to Modrow, transmission of the pathogen to the unborn child in the womb is “extremely rare”. If it does happen unexpectedly, this is not necessarily a concern. “So far there is no evidence that congenital damage with a lifelong problem occurs due to a coronavirus infection.” Another good news from the study: The number of stillbirths or deaths in newborns was no higher in infected pregnant women.

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Coronavirus: Children show different symptoms than adults!

Updated: 07.09.2020 – 16:52

Symptoms differ
Coronavirus: Children react differently to Covid-19

Photo: iStock.com/FamVeld

When a child becomes infected with the Sars-CoV-2 coronavirus, they do not always show symptoms – and if they do, they can differ from those of an adult.

Children can also become infected with Sars-CoV-2, but the Covid-19 disease is easy for them in most cases. And the symptoms also differ from those of adults, as researchers have now found.

Children can also contract the Covid-19 disease caused by the novel Sars-CoV-2 coronavirus. The course is usually mild. But there are apparently other differences to the course in adults: Children are more likely to have different coronavirus symptoms than adults. Researchers have now been able to use a large-scale study to find out that a very specific symptom predominates in children: The virus mainly upsets the gastrointestinal tract in very young people.





Children vs. Adults: A coronavirus symptom predominates in young people


Researchers at Queen’s University Belfast are currently studying children from England, Scotland, Wales and Northern Ireland to determine the spread and symptoms of Sars-CoV-2 infection in children in the UK. The study has not yet been completed, but the first findings are clear: Children suffer from gastrointestinal complaints more often than adults who are infected with the coronavirus.

Gastrointestinal problems, such as diarrhea and abdominal pain, also occur in adult Covid-19 patients – but these symptoms seem to increase in children and other typical symptoms such as cough and fever predominate.


Seven percent of the children examined were infected


The research team has already tested over 1,000 children as part of the study. Blood samples were taken, which were then examined for antibodies. In addition, children and parents were asked about the symptoms.


Seven percent of the children already tested had antibodies against Sars-CoV-2 – a sign of an infection that had already gone through.


Half of them were asymptomatic – the others showed mainly gastrointestinal problems


So far, two aspects have been particularly noticeable: Around half of the children had not even noticed the coronavirus infection; in the survey they reported that they had not noticed any complaints. The other half, however, mainly reported gastrointestinal symptoms. This included diarrhea and vomiting. Cough as well as that noticeable in adults Symptom of loss of taste and smell performed less, the children said.


Head of Research Dr. Tom Waterfield sums up the interim results: “After the first wave of the pandemic in the UK we found that half of the children participating in the study were asymptomatically infected with Sars-CoV-2. Those with symptoms are less likely to have the typical cough or changes in smell – or sense of taste, with gastrointestinal symptoms being far more common. “


Infections in young children under ten years of age were also just as common as in older children. And even asymptomatic children, i.e. those who did not experience any symptoms, seem to have developed antibodies as often as children who were under Symptoms of your Covid 19 disease suffered.


More research needed: pay more attention to certain symptoms in children


Waterfield concludes in a press release from the university that it may now be necessary to refine the test criteria for children and include gastrointestinal symptoms. However, this must be checked in further investigations. Maybe it is also in children Long-term coronavirus consequences can give is not examined in the study.


The Coronavirus– The study has not yet been completed, the first results are currently still on a so-called preprint server. So they still have to be checked by independent scientists.


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Study:





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Coronavirus live ticker: +++ 00:53 number of deaths in Israel exceeds 1000 mark +++

The number of deaths in Israel related to corona infection has passed the 1,000 mark. As the Ministry of Health announced, 1010 people died. The Sars-CoV-2 pathogen has been detected in 129,349 people in Israel since the pandemic began. The country has around nine million inhabitants. In view of the increasing number of cases, the Israeli government wants to curb the further spread of the virus with lockdown measures in particularly affected areas. A government statement said there will be curfews at 40 “red” places with high numbers of infections from Monday evening until the early morning.

+++ 22:28 Chinese manufacturer already vaccinates entire workforce +++
According to its boss, the Chinese biotech company Sinovac has already vaccinated more than 90 percent of its own employees and their families with the corona vaccine it developed. The drug has not yet passed all clinical test phases, but with an exemption from the authorities, the vaccine is already being administered to health workers in China, among others.

+++ 21:48 More than 45,000 new infections in the USA +++
In the United States, 45,405 new infections were registered within 24 hours. A total of 6.226 million people were demonstrably infected with the corona virus, according to the CDC. The death toll rose by 892 to 188,051. The numbers from the US Centers for Disease Control and Prevention do not necessarily reflect the data that individual states report.

+++ 21:17 France shows seven new risk areas +++
France has identified seven new corona risk areas. According to the government, 28 of the 100 or so French administrative districts are now considered “red zones” where the virus “actively circulates”. The classification enables the authorities to tighten the corona measures. In addition to the four departments of Nord, Bas-Rhin, Seine-Maritime and Côte-d’Or with cities such as Lille, Rouen, Le Havre, Strasbourg and Dijon, the two administrative districts on the Mediterranean island of Corsica and the overseas department on the island are also affected Reunion Island in the Indian Ocean. First, in August, the greater Paris area and parts of the Mediterranean coast were declared risk areas. Germany has issued a travel warning for the Paris region as well as the Côte Azur and Provence.

+++ 20:54 642 new infections and no death in Germany +++
The health authorities of the federal states today reported 642 confirmed new infections with the coronavirus. That is the highest value for a Sunday since the beginning of August.

Due to the Sunday, five federal states, including Bavaria with the last highest numbers, have not reported any current data. The eleven federal states with current figures have not recorded a new death in connection with a corona infection since yesterday.

The total number of infected people in Germany rose to 250,230 people according to ntv.de counts. According to an estimate by the Robert Koch Institute, 223,330 people have recovered from a corona infection. 17,574 people are considered acutely infected.

+++ 19:55 work in the home office massively damages the economy +++According to a British study, the country is losing around one percent of its economic output because many employees work from home. The consulting firm PWC has calculated that although small cities and towns beyond the major economic centers could benefit from the trend towards home offices, the overall effect is clearly negative. The study, about which the British “Times” reports, names among other things losses for cleaning services, gastronomy and security services due to permanent lack of employees in offices.

The most important developments of the previous day regarding the current situation regarding the global coronavirus pandemic can she read here.

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New test unsuitable for diagnosis – naturopathy & naturopathic specialist portal

COVID-19: New test examined

Experts keep pointing out how important it is to test as many people as possible for the SARS-CoV-2 coronavirus in order to find out how many people may have already been infected with the new pathogen without knowing it. New tests are always coming onto the market for this. One of them has now been examined by researchers and assessed as unsuitable for the diagnosis of COVID-19.

At the Medical University (Med Uni) Graz (Austria), a new PCR test (Polymerase Chain Reaction) from a well-known manufacturer was carefully examined and examined for the sensitivity for the detection of SARS-CoV-2. According to Message the tests have shown that the test is not suitable for diagnosing COVID-19 disease.

Tests help contain the pandemic

More than 25 million infections with the novel coronavirus have now been confirmed worldwide. There is currently no effective vaccine or therapy against SARS-CoV-2. In addition, not every infected person also develops symptoms.

The most effective method of containing the spread of the pathogen at the moment are therefore tests: Anyone who has become infected is isolated and does not spread the virus. The most common way to test whether someone is infected with SARS-CoV-2 is so-called PCR tests, which use the genetic material of the new pathogen as a basis.

Scientists working with Lucie-Marie Matzkies and Ivo Steinmetz at the Diagnostic and Research Institute for Hygiene, Microbiology and Environmental Medicine at the Medical University of Graz have now examined a newly launched PCR test for the diagnosis of COVID-19 as part of a study, to determine whether it is sensitive enough to reliably detect an infection with SARS-CoV-2.

For this purpose, the researchers compared over 100 samples using an established procedure and the test that has just come onto the market. The experts found differences in the test results and were able to establish that the new PCR test no longer recognizes samples from COVID-19 patients with relatively small amounts of virus as positive.

The research results were recently published in the internationally renowned journal “Clinical Microbiology and Infection” released.

Positive samples incorrectly counted as negative
“Some of the SARS-CoV-2 positive samples were incorrectly rated negative by the new test. The test was unable to achieve a result with a smaller number of samples; such samples would have had to be repeated for regular testing, ”explains Ivo Steinmetz.

According to the information, the PCR test examined at Med Uni Graz has a so-called CE mark, with which the manufacturer declares that the test complies with the applicable EU regulations and that a corresponding conformity assessment procedure has been carried out.

More transparency needed

“Our results show that the quality criteria that must be met in order to bring COVID-19 diagnostics onto the market urgently need to be specified more precisely,” says Ivo Steinmetz.

According to the communication, the European Commission has already recognized the challenge and since April 2020 has recommended, among other things, the testing of new COVID-19 diagnostics in comparison to reference methods in scientific studies that are assessed and published and are therefore accessible to the public. “Unfortunately, such transparency is not yet legally binding,” says Ivo Steinmetz.

Virus levels decrease very quickly

It has now been scientifically proven that the amount of virus in the upper respiratory tract of COVID-19 patients decrease very quickly after the onset of the symptoms of the disease, although the symptoms persist.

In other words, throat swabs that are taken from SARS-CoV-2 infected people with a certain time delay can be false-negative if insufficiently sensitive PCR methods are used.

“Such inadequate tests are not only dangerous for the individual patient, for whom the diagnosis is not made correctly, but can of course have serious consequences for the containment of the pandemic,” explains Ivo Steinmetz in conclusion. (ad)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical professionals.

Swell:

  • Medical University of Graz: COVID-19: Test examined, (accessed: 01.09.2020), Medical University of Graz
  • L.-M. Matzkies, E. Leitner, E. Stelzl, K. Assig, M. Bozic, D. Siebenhofer, M.E. Mustafa, I.Steinmetz, H.H.Kessler: Lack of sensitivity of an IVD/CE-labelled kit targeting the S gene for detection of SARS-CoV-2; in: Clinical Microbiology and Infection, (veröffentlicht: 08.07.2020), Clinical Microbiology and Infection

Important NOTE:
This article is for general guidance only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.

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Management of severe forms of Covid-19: a meta-analysis including the CAPE-COVID * study argues in favor of corticosteroid therapy | Newsroom

Sorry, this entry is only available in French.

Coronavirus SARS-CoV-2 attached to the cilia of human respiratory epithelial cell. © Manuel Rosa-Calatrava, Inserm; Olivier Terrier, CNRS; Andrés Pizzorno, Signia Therapeutics; Elisabeth Errazuriz-Cerda UCBL1 CIQLE. VirPath (International Center for Infectious Disease Research U1111 Inserm – UMR 5308 CNRS – ENS Lyon – UCBL1). Colorized by Noa Rosa C.

Identifying a treatment for severe forms of Covid-19 and in particular for the acute respiratory failure associated with it, is a priority to improve patient care and prognosis. The drug repositioning of corticosteroids has recently appeared as a therapeutic avenue to be explored. Scientists from Inserm, the University Hospital of Tours and the AP-HP publish on September 2 the results of the CAPE-COVID study in the Journal of the American Medical Association, in parallel with the publication in this same review a meta-analysis coordinated by the WHO and the University of Bristol, grouping together 7 studies (including CAPE-COVID). Taken collectively, the results of this work show that treatment with corticosteroids would reduce the risk of death from severe forms of Covid-19 by 21%.

Severe forms of Covid-19 can bring patients to intensive care, most often due to acute respiratory failure. Since no repositioned drug has until recently shown significant efficacy, the treatment was based only on different techniques of oxygenation and artificial ventilation (this is called “symptomatic treatment” or “standard care”).

On July 17, 2020, a British team published the results of part of the RECOVERY randomized trial, showing that treatment with dexamethasone, a synthetic corticosteroid, reduced patients’ mortality by approximately 11% at 4 weeks. hospitalized for Covid-19, compared to usual treatment. This benefit seemed to be observed only in patients receiving oxygen, and was greater in patients on mechanical ventilation, whose relative mortality was reduced by nearly 30%. When the first results of this study began to circulate, several therapeutic trials evaluating corticosteroid therapy in severe forms of Covid-19 were underway around the world. Following the positive results of RECOVERY with regard to the effectiveness of corticosteroid therapy, these various trials were stopped. At the initiative of the World Health Organization, the results of the seven most advanced randomized trials (including those of RECOVERY patients on mechanical ventilation) were the subject of a meta-analysis, a statistical method which, in bringing together patients from different studies, increases the statistical power of these studies. Such an analysis was justified in the present case to compensate for the premature termination of 6 of these studies.

Among the 7 trials included in this work, 3 are the subject of a simultaneous publication in the Journal of the American Medical Association, including the CAPE-COVID trial, a French multicenter trial promoted by the Tours CHRU and directed by Professor Pierre-François DEQUIN, head of the intensive medicine – resuscitation department of the Tours CHU, within the Center for the Study of respiratory pathologies (Inserm / University of Tours), with Prof. Djillali Annane, head of the intensive medicine and intensive care unit at Raymond-Poincaré hospital, AP-HP, Université Paris-Saclay and in collaboration with the CRICS-TriGGERSep research network , coordinated by Inserm.

In this work, 149 patients included from March 7 to June 1 in 9 French centers received blind (the teams in charge of the patient did not know what treatment was being administered) either hydrocortisone, a natural corticosteroid, or a placebo.

The objective here was to evaluate the effectiveness of hydrocortisone at 3 weeks after the start of treatment by comparing in each group the number of patients for whom it was necessary to continue mechanical ventilation or any other specific oxygen therapy technique. resuscitation, as well as the number of deaths.

The differences that were observed between the two groups in this study are too small to conclude on the benefit of hydrocortisone based on this publication alone. In fact, if the relative mortality at 3 weeks appeared to be reduced by 46%, the number that was too small did not allow us to conclude that this difference was not due to chance. The study was in fact interrupted, before reaching the 290 patients initially expected. However, this study found that secondary nosocomial infections, a feared risk with corticosteroids during a viral infection, were not more frequent under hydrocortisone.

Prof. Djillali Annane’s team also participated in the international REMAP-CAP study, coordinated by the University of Pittsburgh, the results of which are also the subject of a publication in the Journal of the American Medical Association. [1]

Teams from Tours CHRU, Inserm and AP-HP also participated in the meta-analysis, coordinated by the WHO and carried out by researchers from the National Institute for Health Research (NIHR, Institut national pour la health research) at the University of Bristol, published in parallel in the Journal of the American Medical Association and whose results include CAPE-COVID, REMAP-CAP and RECOVERY. This study compiled data from 1,703 patients from 12 countries who received by lot, either standard care, or a placebo combined with standard care, or a corticosteroid (dexamethasone, hydrocortisone or methylprednisolone).

Between 3 and 4 weeks after the start of treatment, patients treated with a corticosteroid had a relative risk of mortality of less than 21% compared to patients receiving only symptomatic treatment or symptomatic treatment combined with placebo. In addition, no side effects specific to treatment with corticosteroids have been demonstrated.

« The publication of the meta-analysis today confirms the benefit of corticosteroids in severe forms of COVID-19 ”, specifies Pierre-François Dequin, “Benefit that had never been shown in respiratory and systemic infection due to a virus. This is an important therapeutic step that was taken this summer, he adds, it only applies to patients hospitalized for a severe form: the benefit and especially the safety of corticosteroids are not shown in other forms. ” For Djillali Annane, “This is a turning point in the fight against the pandemic. The dramatic increase in the chances of survival thanks to treatment with low doses of corticosteroids is confirmed by seven independent studies, the results of which are now published in 4 articles in the prestigious journal JAMA. In response, WHO recommends in an article published simultaneously in the British Medical Journal, corticosteroid treatment of COVID 19 patients requiring oxygen therapy with or without ventilatory support ».

Other data are expected in the coming months, especially those from longer-term patient monitoring. In addition, Inserm, through the Center for the Study of Respiratory Pathologies, is currently studying blood samples from some of these patients, to better understand the impact of corticosteroids on the immune defenses of patients with Covid-19. .

[1] Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe COVID-19
The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial
Journal of the American Medical Association, doi: 10.1001 / jama.2020.17022

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New test unsuitable for diagnosis – naturopathy & naturopathic specialist portal

COVID-19: New test examined

Experts keep pointing out how important it is to test as many people as possible for the SARS-CoV-2 coronavirus in order to find out how many people may have already been infected with the new pathogen without knowing it. New tests are always coming onto the market for this. One of them has now been examined by researchers and assessed as unsuitable for the diagnosis of COVID-19.

At the Medical University (Med Uni) Graz (Austria), a new PCR test (Polymerase Chain Reaction) from a well-known manufacturer was carefully examined and examined for the sensitivity for the detection of SARS-CoV-2. According to Message the tests have shown that the test is not suitable for diagnosing COVID-19 disease.

Tests help contain the pandemic

More than 25 million infections with the novel coronavirus have now been confirmed worldwide. There is currently no effective vaccine or therapy against SARS-CoV-2. In addition, not every infected person also develops symptoms.

The most effective method of containing the spread of the pathogen at the moment are therefore tests: Anyone who has become infected is isolated and does not spread the virus. The most common way to test whether someone is infected with SARS-CoV-2 is so-called PCR tests, which use the genetic material of the new pathogen as a basis.

Scientists working with Lucie-Marie Matzkies and Ivo Steinmetz at the Diagnostic and Research Institute for Hygiene, Microbiology and Environmental Medicine at the Medical University of Graz have now examined a newly launched PCR test for the diagnosis of COVID-19 as part of a study, to determine whether it is sensitive enough to reliably detect an infection with SARS-CoV-2.

For this purpose, the researchers compared over 100 samples using an established procedure and the test that has just come onto the market. The experts found differences in the test results and were able to establish that the new PCR test no longer recognizes samples from COVID-19 patients with relatively small amounts of virus as positive.

The research results were recently published in the internationally renowned journal “Clinical Microbiology and Infection” released.

Positive samples incorrectly counted as negative
“Some of the SARS-CoV-2 positive samples were incorrectly rated negative by the new test. The test was unable to achieve a result with a smaller number of samples; such samples would have had to be repeated for regular testing, ”explains Ivo Steinmetz.

According to the information, the PCR test examined at Med Uni Graz has a so-called CE mark, with which the manufacturer declares that the test complies with the applicable EU regulations and that a corresponding conformity assessment procedure has been carried out.

More transparency needed

“Our results show that the quality criteria that must be met in order to bring COVID-19 diagnostics onto the market urgently need to be specified more precisely,” says Ivo Steinmetz.

According to the communication, the European Commission has already recognized the challenge and since April 2020 has recommended, among other things, the testing of new COVID-19 diagnostics in comparison to reference methods in scientific studies that are assessed and published and are therefore accessible to the public. “Unfortunately, such transparency is not yet legally binding,” says Ivo Steinmetz.

Virus levels decrease very quickly

It has now been scientifically proven that the amount of virus in the upper respiratory tract of COVID-19 patients decrease very quickly after the onset of the symptoms of the disease, although the symptoms persist.

In other words, throat swabs that are taken from SARS-CoV-2 infected people with a certain time delay can be false-negative if insufficiently sensitive PCR methods are used.

“Such inadequate tests are not only dangerous for the individual patient, for whom the diagnosis is not made correctly, but can of course have serious consequences for the containment of the pandemic,” explains Ivo Steinmetz in conclusion. (ad)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical professionals.

Swell:

  • Medical University of Graz: COVID-19: Test examined, (accessed: 01.09.2020), Medical University of Graz
  • L.-M. Matzkies, E. Leitner, E. Stelzl, K. Assig, M. Bozic, D. Siebenhofer, M.E. Mustafa, I.Steinmetz, H.H.Kessler: Lack of sensitivity of an IVD/CE-labelled kit targeting the S gene for detection of SARS-CoV-2; in: Clinical Microbiology and Infection, (veröffentlicht: 08.07.2020), Clinical Microbiology and Infection

Important NOTE:
This article is for general guidance only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.

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