COVID-19: Reinfections / New Name for "Long COVID" / IL-6 Inhibitor / NYC & Calif. Variants

By Amy Orciari Herman

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

Check out some of the latest developments in COVID-19:

Reinfections: Five residents of a Kentucky skilled nursing facility who tested positive for SARS-CoV-2 during an outbreak in July 2020 tested positive again during a second outbreak more than 3 months later. All five had at least four negative PCR tests between their first and second positive tests. That — plus the lengthy interval between the positive tests — suggests that the second positive tests represented reinfections, researchers write in MMWR. All five patients had more than three underlying health conditions, although none were immunocompromised. During the first outbreak, three of the five cases were asymptomatic and the other two had mild symptoms. During the second outbreak, all five experienced worse illness, and one patient died. The researchers write, "These findings highlight the importance of maintaining public health practices that reduce transmission risk, even among persons who have previously received a positive SARS-CoV-2 test result."

New name for "long COVID": "Long COVID" — in which patients experience persistent COVID-19 symptoms for months or develop new symptoms after the period of acute infection has passed — will now be referred to as post-acute sequelae of COVID-19, or PASC, Dr. Anthony Fauci announced at a White House briefing on Wednesday. He emphasized that PASC can occur even among those who initially experience moderate COVID-19.

IL-6 inhibitor results: Two industry-supported studies add to evidence on the potential role for interleukin-6 (IL-6) inhibitors in treating COVID-19. Both were previously posted on a preprint server and have now been published in the New England Journal of Medicine. In the REMAP-CAP trial, some 800 adults with COVID-19 who had started respiratory or cardiovascular organ support in the ICU in the prior 24 hours were randomized to receive tocilizumab, sarilumab, or standard care. At day 21, the median number of organ-support-free days was roughly 10 with the IL-6 inhibitors versus 0 with standard care alone. In addition, in-hospital mortality was 27% with IL-6 inhibition versus 36% with standard care. In the COVACTA trial, over 400 patients hospitalized with severe COVID-19 pneumonia were randomized to receive tocilizumab or placebo. At day 28, clinical status and mortality did not differ between the groups. Editorialists discuss how to interpret these seemingly disparate results, noting that the timing of IL-6 inhibition and concomitant use of glucocorticoids could affect treatment outcomes. They conclude, "For now, we are left with evidence of benefit from interleukin-6 inhibitors, at least under some circumstances, but how to best use them remains unclear."

NYC & Calif. variants: A variant of SARS-CoV-2 first detected in New York City in November accounted for roughly 25% of SARS-CoV-2 viruses sequenced in the city by mid-February, the New York Times reports. The variant has at least one mutation believed to make the current vaccines less effective. Separately, the Washington Post reports on another variant that's become dominant in California, now accounting for over half of SARS-CoV-2 infections in 44 counties. Evidence suggests that this variant is more transmissible than older versions of SARS-CoV-2.