Coronastream: neuropsychiatric features, Hydroxychloroquine and the predicted impact on African nations

Posted on May 26, 2020   by Dr Tim Inglis

In this special blog series, medical microbiologists led by Dr Tim Inglis summarise some of the research that will be essential to inform COVID-19 countermeasures. Find out more about the project in Dr Inglis' Editorial 'Logic in the time of coronavirus', published in the Journal of Medical Microbiology.

There are enough data at this stage in the COVID-19 epidemic to start populating a cohesive cause and effect narrative: congruence (convergence of molecular biology, clinical features and epidemiology), consistency (reproducible features of this nexus, and its temporal–spatial clustering), cumulative dissonance (upscaling through multiple levels of biological organisation) and curtailment (diagnosis, containment, control and preventive interventions).

Congruence: neuropsychiatric features of COVID-19 

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic

The neuropsychiatric features of COVID-19 have attracted attention recently. Rogers and colleagues examined the literature on the previous SARS and MERS epidemics and compared their findings, with what is known so far about neuropsychiatric presentations of COVID-19. During acute illness, common symptoms among hospital admitted SARS and MERS patients were confusion, depressed mood, anxiety, memory impairment and insomnia. After the acute illness; depressed mood, insomnia, anxiety, irritability, memory impairment, fatigue, traumatic memories and sleep disorder were reported. 

Consistency: predicted COVID-19 impact on African nations 

Projected Early Spread of COVID-19 in Africa Through 1 June 2020

There has been speculation about what impact COVID-19 is having across Africa. In this projection of its spread through the continent, Pearson and colleagues have considered when each of the 45 African nations reported cases are likely to see their first 1,000 and 10,000 reported cases. They predict that without interventions, all 45 nations would have reached 1,000 cases by the end of April and 10,000 cases a few weeks later. The authors note that the projected timings are largely synchronised across the continent and call for increased healthcare preparation for the expected wave of infection. 

Cumulative dissonance: cytokine storm

Cytokine Release Syndrome in Severe COVID-19

The pathogenesis of COVID-19 progression to respiratory distress and other manifestations of severe disease, has been attributed to an acute inflammatory reaction due to a so-called cytokine storm. In this viewpoint article, Moore and June explain the biology of cytokine release syndrome and show how coronavirus infection activates monocytes, macrophages and dendritic cells, resulting in an IL-6 triggered amplification cascade, and that increased systemic cytokine production contribute to pathophysiology of severe COVID-19. These are the processes targeted by the IL-6 antagonists now in clinical trials. 

Curtailment: treatment of COVID-19

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

There has been much debate about the use of hydroxychloroquine for prevention and treatment of COVID-19. Mehra and colleagues address its therapeutic use in this multinational observational study of 96,032 patients with confirmed COVID-19, of whom 14,888 were treated with either hydroxychloroquine or chloroquine, with or without a macrolide. They were unable to find any evidence of benefit. All four regimens analysed were associated with reduced in-hospital survival, and an increase in de novo ventricular arrhythmias when used to treat COVID-19. Noting the absence of benefit and risk of harm, the authors remind us that these regimens should not be used outside clinical trials. 

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Nature, in the end, humbles all the works of human hands. 

  Poacher's Pilgrimage, McIntoch A. Birlinn, Edinburgh, 2016.