Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.05.28.20114835; this version posted June 2, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
1
Category : Original Article
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Title: Viral Dynamics Matter in COVID-19 Pneumonia: the success of early treatment with
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hydroxychloroquine and azithromycin in Lebanon.
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Authors:
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Amanda Chamieh1,2, Claude Afif2, Gerard El-Hajj3, Omar Zmerli2, Isabelle Djaffar-
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Jureidini4, Roy A. Raad3, Raja Ashou3, Georges Juvelekian5, Jean-Marc Rolain1 and Eid
8
Azar2*
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10
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Affiliations:
1- Aix-Marseille Université, AP-HM, Institut de Recherche pour le Développement
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(IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Institut Hospitalo-
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Universitaire Méditerranée-Infection, Marseille, France.
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15
16
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2- Division of Infectious Diseases, Saint George Hospital University Medical Center,
Beirut, Lebanon.
3- Department of Radiology, Saint George Hospital University Medical Center, Beirut,
Lebanon.
4- Department of Laboratory Medicine, Saint George Hospital University Medical
Center, Beirut, Lebanon.
5- Department of Pulmonary and Critical Care Medicine, Saint George Hospital
University Medical Center, Beirut, Lebanon.
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Running Title: Viral Dynamics Matter in COVID-19 Pneumonia
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Declarations of Interest and Funding/Support Statement:
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NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
medRxiv preprint doi: https://doi.org/10.1101/2020.05.28.20114835; this version posted June 2, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
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This research did not receive any specific grant from funding agencies in the public,
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commercial, or not-for-profit sectors.
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Acknowledgements:
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This work was supported by the Saint George Hospital University Medical Center
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Beirut, Lebanon.
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*Corresponding Author:
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Eid Azar, M.D.
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Infectious Disease, Chief of Staff
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Associate Chief Medical Officer for Safety, Risk Management, and Infection Prevention and
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Control
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Saint George Hospital University Medical Center, Youssef Sursock St. – Achrafieh, Beirut,
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Lebanon; eeazar@stgeorgehospital.org; +961 03 665358
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medRxiv preprint doi: https://doi.org/10.1101/2020.05.28.20114835; this version posted June 2, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
41
Category: Original Article
42
43
Title: Viral Dynamics Matter in COVID-19 Pneumonia: the success of early treatment with
44
hydroxychloroquine and azithromycin in Lebanon.
45
46
Running Title: Viral Dynamics Matter in COVID-19 Pneumonia
5
medRxiv preprint doi: https://doi.org/10.1101/2020.05.28.20114835; this version posted June 2, 2020. The copyright holder for this preprint
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to..
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'group-title': 'Infectious Diseases (except HIV/AIDS)',
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'abstract': '<jats:label>1.</jats:label><jats:title>Abstract</jats:title><jats:sec><jats:label>1.1.</jats:label><jats:title>Background/Purpose</jats:title><jats:p>We '
'share our experience in COVID-19 pneumonia management at Saint George Hospital University '
'Medical Center (SGHUMC) in Lebanon. In the absence of a standard of care, early diagnosis and '
'opt-in therapy with Hydroxychloroquine and Azithromycin were '
'offered.</jats:p></jats:sec><jats:sec><jats:label>1.2.</jats:label><jats:title>Methods</jats:title><jats:p>We '
'reviewed records of COVID-19 pneumonia patients from March 16-April 26 2020. Based on NEWS '
'score, we stratified patients as A: low B: medium, and C: high clinical severity and obtained '
'pharmacotherapy data. Chest-CT-severity-score (CTSS) was used. We defined clinical cure as '
'resolution of symptoms and biomarkers and virologic cure as a PCR above 35 '
'cycles(Ct).</jats:p></jats:sec><jats:sec><jats:label>1.3.</jats:label><jats:title>Results</jats:title><jats:p>We '
'recorded 21 COVID-19 pneumonia patients of whom 19 opted for treatment. Clinical symptoms and '
'laboratory markers at presentation did not significantly correlate with severity. Lower '
'initial viral load significantly correlated with lower levels of clinical and radiological '
'severity (p=0.038). Virologic cure, Ct>35, by day 10, was only 33% in high severity '
'significantly less than categories A and B. We observed 100% clinical cure at day 10 in '
'Category-A, 67% in B, and 33% in C(p<0.05). Patients with the lowest severity had the '
'fastest virologic cure in a mean of 5.8 days from diagnosis, shortest hospitalization and '
'earlier radiological improvement(p<0.005). Ultimately, 18 patients were discharged home in '
'good condition and one remains in the '
'ICU.</jats:p></jats:sec><jats:sec><jats:label>1.4.</jats:label><jats:title>Conclusion</jats:title><jats:p>Viral '
'dynamics matter in COVID-19 pneumonia. An early control of replication may be crucial in '
'averting complications. Early administration of Hydroxychloroquine and Azithromycin '
'potentially explains our 94.7% success rate in treating a fairly complex cohort of COVID-19 '
'pneumonia.</jats:p></jats:sec>',
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