Mon, 04/13/2020 - 22:18
Dear colleagues,
- On the match: I read this study on the role of abnormal coagulation as a predictor of mortality by Tangh et al. It is, unfortunately again, a retrospective study and the results in Table 1 are plus-minus: yes there is significantly increased prothrombin time (PT), fibrinogen-degradation (FDP)and D-dimer, but there are other predictors, such as older age and male sex. So what? However, Table 2 is more interesting: if you calculate the “disseminated intravascular coagulation” (DIC) index, which combines thrombocytopenia, PT, D-dimer and FDP, the test becomes quite sensitive: 71 % of the non-survivors and only 0.6 of the survivors were recognized.
In the comment, it is postulated that a meta-analysis of 1779 patients with COVID-19 found that a low platelet count was associated with over fivefold increased risk of severe disease. Potential mechanisms are explained and I added at the end some illustrative figures to remind you how these systems interact.
- A colleague sent me a very nice must-read review on the present status of vaccines, much better than the short paper from Nature Briefings I sent you last week. Thanks, Martine.
- Finally some news from Gangelt, the “German Wuhan”. See the short note in the Guardian first: https://www.theguardian.com/world/2020/mar/31/virologists-to-turn-germany-worst-hit-district-into-coronavirus-laboratory and then the added preliminary report from the University Hospital of Bonn. So, while according to the Guardian “only” 1281 COVID infections had been found in the Heinsberg district of 250,000 people (or 0.5%), the Bonn team found in 1000 Gangelt inhabitants 2% PCR positives, but 14% IgG positives! Therefore the calculated case-fatality ratio is just 0.37%. So, apparently the proportion of asymptomatic and mild cases is massive! (Thanks again to Martine)
Be reminded that Gangelt is just at the Dutch and Belgian border, next to both “Limburgs”. The hardest-hit areas in Belgium and the Netherlands are very close and all have this very lively Karneval tradition.
Karneval and “après ski” have really “put the wig on the powder keg”!
Guido