COVID-19: ID Group Recommends Tocilizumab / Layperson Phone Calls / Pooled Testing Benefits

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Here are some of the latest developments in COVID-19:

IDSA recommends tocilizumab: The Infectious Diseases Society of America (IDSA) now suggests adding the interleukin-6 inhibitor tocilizumab to standard care (e.g., corticosteroids) for hospitalized patients with severe or critical COVID-19 and elevated inflammatory markers. The group previously recommended against using the drug. IDSA characterizes the new recommendation as "conditional," based on a low certainty of evidence. While findings on tocilizumab have been mixed, two randomized trials — RECOVERY and REMAP CAP — have suggested a mortality benefit. Tocilizumab may be more beneficial when offered to patients early after hospitalization or ICU admission. The IDSA guideline authors offer this caveat: "Patients, particularly those who respond to steroids alone, who put a high value on avoiding possible adverse events of tocilizumab and a low value on the uncertain mortality reduction, would reasonably decline tocilizumab." The National Institutes of Health currently recommends against using the drug outside the ICU, and says there are not enough data to recommend for or against its use in those who've been admitted to the ICU in the past 24 hours and require mechanical ventilation or high-flow oxygen.

Layperson phone calls: A 4-week intervention in which laypeople call homebound older adults several times a week just to talk can help improve loneliness, depression, and anxiety, suggests a JAMA Psychiatry study. Sixteen people aged 17 to 23 years were trained, via a brief videoconferencing session, to deliver empathetic phone calls to roughly 200 Meals on Wheels Central Texas clients over 4 weeks between July and September 2020 (2–5 calls per week). The callers focused on listening to the clients and starting conversations with them on topics of their choice. Measures of loneliness, depression, and anxiety improved significantly after the intervention, relative to baseline. A control group showed no such effects. The researchers call the intervention "easily deployable and scalable."

Pooled testing benefits: A new study, published in Science Translational Medicine, highlights the benefits of pooled PCR testing for SARS-CoV-2. Between March and September 2020, researchers in Israel tested nearly 134,000 nasopharyngeal samples using roughly 18,000 pools; pool sizes of 5 or 8 were used, depending on the prevalence of infection in samples tested in the prior week. Overall, 32,000 PCR tests were used to test the 134,000 samples, sparing over 100,000 PCR tests. The researchers report a "minor, clinically insignificant loss of sensitivity" with pooling. They conclude, "Our empirical evidence ... strongly projects on the feasibility and benefits of carefully conducted pooling for surveillance, control, and community re-openings."