COVID-19: Virus in Semen / DVT Findings on Autopsy / Anakinra

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Have a look at some of the latest developments in novel coronavirus disease (COVID-19):

Virus detected in semen: SARS-CoV-2 has been detected in the semen of men with COVID-19, according to findings in JAMA Network Open. Thirty-eight men with confirmed illness in China provided a semen sample for testing. Samples from 6 of the men (16%) tested positive for the virus; four of the men were in the acute stage of infection and two were in the recovery phase. The authors note that it is not yet known whether the virus can be transmitted sexually.

Autopsy findings & DVT: In a case series of the first 12 COVID-19 deaths in Hamburg, Germany, 58% had deep venous thrombosis discovered on autopsy, according to research in the Annals of Internal Medicine. In four cases, cause of death was massive pulmonary embolism with the thrombi originating in the deep veins of the lower limbs. Three additional cases had fresh deep venous thrombosis in both legs and no pulmonary embolism. The authors conclude: "The high incidence of thromboembolic events suggests an important role of COVID-19-induced coagulopathy." Of note, many of these patients did not appear to have received chemoprophylaxis for thrombosis.

Anakinra: Anakinra, a recombinant interleukin-1 receptor antagonist approved to treat rheumatoid arthritis, is associated with improved survival among COVID-19 patients, according to a small, retrospective study in the Lancet Rheumatology. Researchers in Italy compared 29 COVID-19 patients with moderate-to-severe acute respiratory distress syndrome who were given high-dose intravenous anakinra with 16 similar patients who weren't given anakinra. All patients received noninvasive ventilation and standard care outside the ICU at baseline. Anakinra was associated with a higher survival rate at 21 days (90% vs. 56% with standard treatment), although rates of mechanical ventilation-free survival were similar between groups. Additionally, C-reactive protein levels improved faster with anakinra. Commentators call the results "promising" but "exploratory."

Hydroxychloroquine: Use of hydroxychloroquine is not associated with reduced risk for intubation or death among hospitalized COVID-19 patients, according to an observational study in the New England Journal of Medicine. Among nearly 1400 consecutive patients with COVID-19 in New York hospitals, researchers compared outcomes between those who received hydroxychloroquine and those who did not. After multivariable adjustment, the risk for the composite outcome of intubation or death was similar between the groups during a median follow-up of 23 days.