Drug that calms ‘cytokine storm’ may reduce Covid-19 mortality


AN observational study finds that patients on ventilators who received a drug that dampens excessive immune responses had a 45% lower risk of dying compared with controls.
Despite being twice as likely to develop secondary infections, patients who received a single dose of the immune suppressing drug appeared to have a better chance of survival. Doctors usually prescribe the drug, called tocilizumab, for rheumatoid arthritis, a painful condition in which a person’s immune system attacks their joints.
The immune system of people with Covid-19, the illness that the coronavirus SARS-CoV-2 causes, can also go into overdrive, producing excessive quantities of immune signaling molecules called cytokines. However, the drug is known to increase the likelihood of secondary infections, which are a risk factor for death in those with Covid-19.
Early in the pandemic, split on whether the limited evidence of benefits and known risk of secondary infections justified using the drug to treat their patients. This lack of consensus had the fortuitous effect of creating a natural experiment, with some doctors at the center prescribing it while others did not. The researchers included in their analysis 154 patients who needed mechanical ventilation, out of who 78 received a single injection of tocilizumab, and 76 did not.
The two groups were broadly similar, but those who received tocilizumab were slightly younger and less likely to have chronic pulmonary disease or chronic kidney disease. The patients were admitted during the first 6 weeks after the start of the outbreak. At 28 days’ follow-up, 14 (18%) of the patients in the tocilizumab group had died, compared with 27 (36%) of those who did not receive the drug.
WHAT EXPERTS THINK ABOUT REOPENING SCHOOLS: The group’s recent recommendations include social distancing protocol based on different grades, for example, it’s more feasible to keep preschoolers in small groups (known as “cohorting”) with the same teacher throughout the day. Older children should have desks 3 to 6 feet apart and wear masks.
They also say schools should limit unnecessary visitors to the buildings and utilize outdoor spaces for learning. The guidelines recommend safer bussing, hallway traffic monitoring, cafeteria use, cleaning, and screening protocols among other recommendations.
Remote learning protocols must stay in place, especially as some schools stagger home and in-building learning.