Sections From The International Virtual Meeting titled Global Struggle with COVID 19

Information compiled by Prof. Dr. Kenan Hızel regarding the topics discussed in a webcast with international participation (China, Italy, France, Spain, Germany) organized by Astrazeneca:

1. Immunologists stated that Anakinra (IL-1 inhibitor) will be more logical than IL-6 inhibitor.

2. All participants recommended steroid therapy at a low dose and only during CPAP therapy, not before or after.

3. The Chinese participant recommended azithromycin for its immune-modulating effect; the German participant objected.

4. For hydroxychloroquine, there was also consensus that it be used for its immune modulatory effect, not as an antiviral.

5. It was concluded that hydroxychloroquine is not meaningful as prophylaxis.

6. Indication for azithromycin and hydroxychloroquine is valid starting at the onset of relevant pulmonary findings, not earlier.

7. It was stated that the protease inhibitor Kaletra, used in HIV, is not effective. Oseltamivir was not mentioned.

8. In the discussion session, the general ineffectiveness of antiviral agents other than favipiravir and remdesivir was discussed.

9. Immunoglobulin therapy was said to be a promising development.

10.  Stem cells were not discussed.

11.  It was emphasized that early diagnosis/treatment and preparedness are essential; the participant from Spain reported having problems with diagnosis and treatment, just as we fear.

12.  It was stated that we should not wait for any guidelines or evidence to take action.

13.  It was emphasized that everyone can treat their patients as they consider appropriate.

14.  The Chinese participants reported using hydrogen/oxygen mixture in severe cases in intensive care units and stated that their patients benefited from prone positioning.

15.  The participant from France stated that PCR sensitivity is low and detection should not be expected or trusted for initiation of treatment.

16.  The importance of viral load was discussed, especially for health workers and prognosis.

17.  It was noted that many patients could not be diagnosed because they did not present to hospitals.

18.  The participant from Italy attributed high mortality to low testing. He hopes the number of cases in Italy decreases after the second week of April.

19.  Half of all deceased patients have one of three comorbid factors, with hypertension being the most common (70%). In Italy, 40% of patients are followed up at home; however, patients with comorbidities who live at home present late to hospitals.

20.  Germany has a well-established system and is currently the most secure country.

21.  It was recommended that patients with asthma not discontinue their inhaler or oral steroid therapy.

22.  Fever and prolonged cough are the most common symptoms.

23.  Most COVID-positives are around 50 years of age.

24.  In intensive care, antibiotics are usually not required and not given.

25.  Immunologists did not recommend steroids because the mechanism is unknown, instead they cited the need for more targeted drugs, namely biological agents.

26.  All participants agreed that ibuprofen should be avoided.

27.  All participants recommended low-dose anticoagulants with D-dimer monitoring for severe cases.

28.  It was recommended to continue hypertension medications as prescribed.

29.  Regarding why males are more affected, there was discussion of the hypothesis related to the ACE-2 receptor being located on the X chromosome.

Prepared by Hakan Özdemir MD.