COVID-19 Clinical Trials and Expanded Access

The understanding of haemostasis and inflammation cross-talk has gained considerableknowledge during the past decade in the field of arterial and venous thrombosis. Complexand delicately balanced interaction between coagulation and inflammation involve allcellular and humoral components.Elements of the coagulation system such as activated thrombin, fibrinogen or factor Xamay increase inflammation by promoting the production of proinflammatory cytokines,chemokines, growth factors and adhesion molecules that lead to a procoagulant stateamplifying the pathological process. Recent evidence supports inflammation as a commonpathogenic contributor to both arterial and venous thrombosis, giving rise to the conceptof inflammation induced thrombosis.Patients with infection of COVID-19 and severe pneumoniae seem to have higher risk ofthromboembolism. The purpose of this project is to analyze hemostasis and coagulation ofevery hospitalized patient with infection of COVID-19.Blood sample for coagulation and hemostasis analysis will be collected on every patienthospitalized in Amiens hospital for COVID-19 infection. Thrombin time, factors V and II,fibrin/fibrinogen degradation products, antithrombin will be assessed every week.Anticardiolipin, anti-beta2 glycoprotein I and anti-annexin A2 antibodies IgG and IgM atday of admission and at fourth week after admission will be assessed. SARS-CoV2 viralload and serodiagnosis will be performed at the same time. At the same time venousultrasound to diagnose thrombosis will be performed.

This is a prospective study, involving contacting potential plasma donors and the use oftheir plasma to help fight off infections of those suffering from COVID19 in accordanceto collection guidelines for plasma and FDA IND requirement. This study will include upto 240 participants potentially receiving convalescent plasma and up to 1000 potentialdonors.There are 3 basic arms to the study: mild, moderate and severe/critical severity. All 3severity groups are eligible for enrollment, but mild severity will not be given plasmaunless there is progression. Moderate severity will given up to 1 unit of plasma andsevere/critical severity up to 2 units. There is no placebo group, however given theexcepted issues of shortages of plasma, intention to treat will be used for analysis.

Patient are being asked to provide respiratory and blood samples for a clinical researchstudy because the patients have a virus called the novel coronavirus, or SARS-CoV-2, thatcauses the disease known as Covid-19.Investigators do not know a lot about this virus, including all the ways it travels fromperson to person. Investigators also do not know if a person will get sick or not fromthe virus after being in close contact with someone who has the virus. Because of this,investigators are performing research on the virus found in respiratory secretions to getmore information on how investigators can best detect and treat this new virus in thefuture.Primary Objective - To determine the clinical characteristics and outcomes of Covid-19 in children. - To characterize the clinical risk factors of Covid-19 in children..Secondary Objectives - To characterize the immunological risk factors and serologic response to SARS-CoV-2 infection in children.- To evaluate the duration of viral shedding in children. - To evaluate the duration of SARS-CoV-2 viral shedding in children. Exploratory Objective

SARS-CoV-2, has caused an international outbreak of respiratory illness termed Covid-19.The investigators used peptides derived from SARS-CoV-2 virus, to study viral-specificimmune responses. COV-CREM is a French prospective monocentric study that will evaluateviral-specific cell responses in positive patients for SARS-CoV-2 on the basis of(RT-PCR) assay performed in respiratory tract sample tested by our local Center forDisease Control.

The purpose of this data repository is to provide a secure and centralized storagelocation and resource for the collection of essential data and medical specimens, acrossCOVID-19 related protocols at Duke.

Some authors have proposed the use of the flu vaccine to reduce the severity of COVID-19cases, while some have proposed the use of ACE Inhibitors (ACEI) or Angiotensin Receptorblockers (ARB), since this virus shares hemagglutinin as a transmission mechanism andacts on the ACE2 enzyme during infection.Other authors described how none of the elderly patients receiving antihistamines andazythromycin in two nursing homes in Toledo -Spain- during the first wave died or neededhospital admission, even considering that 100% of residents had a positive serologicaltest after that wave. Other authors have described a positive evolution in patientsreceiving amantadine for their Parkinson's disease.The aim is to evaluate whether the admitted patients who are previously vaccinated orthose who were already receiving these treatments showed a better evolution.

The novel coronavirus (SARS-CoV-2) has spread all around the world and testing has poseda challenge globally. Health care providers are highly exposed and are an important groupto test. On top of these concerns, health care workers are also stressed by the needs onresponders in the COVID-19 crisis. The investigators will look at different ways tomeasure how common COVID-19 is among health care workers, how common is the presence ofantibodies by serological tests (also known as serostatus). The investigators willdescribe health worker mental and emotional well-being and their coping strategies intheir institutional settings. Lastly, the investigators will describe how knowingserostatus can affect individuals' mental and emotional well-being and how to cope in themidst of the COVID-19 response. This will help to how to better test and help healthcareworkers in the COVID-19 pandemic and prepare for possible future outbreaks.

The purpose of this pilot study is to measure the impact of non-invasive pneumaticmanipulation of transthoracic pressure on oxygenation in patients with Acute RespiratoryDistress Syndrome (ARDS) due to Coronavirus Disease 2019 (COVID 19) who are on mechanicalventilator support. This will be achieved by a pneumatic Vest placed around the chestwall of consenting patients who meet inclusion criteria. The Vest is essentially anon-invasive segmental device placed upon the anterior and posterior right and leftaspects of the chest wall. The researchers have the ability to inflate and deflate thechambers of the Vest to achieve preset pressures as determined by the protocol andobserve the patient's physiological response. Participants will have up to four hours ofintervention with the study intervention, followed by 1 hour of post-interventionobservation.

A team at the University of Manchester are developing a test that tcould be helpful indetecting immunity to the Coronavirus (which causes the COVID-19 disease) in participantswith inflammatory arthritis. It is based on a flu assay has already developed; the teamwill replace the flu antigen with a Coronavirus antigen to see if it is effective.This project aims to develop a test to see if people who have had the virus havedeveloped immunity to it. This could help to predict who might or might not get thedisease a second time, who should stay at home to be protected from potential infectionor who will not develop any symptoms, even if exposed to the virus.When vaccination trials against the Coronavirus will be launched, this test could alsohelp to see if the vaccine is effective.

The etiological agent of the current pandemic is a (+)ssRNA virus. SARS-CoV-2 isinfecting thousands of people in the world with a fatality rate that varies from 0.1 to5% in affected countries, thereby causing enormous economic losses. Few antibiotics haveshown any efficacy in their combat, but have not yet proven adequate to stop the spreadof the disease, nor are there any approved vaccines at the moment. From experiments inplants ongoing infections by RNA viruses, using thermotherapy, which is the applicationof heat at a temperature between 35-43 °C, the investigators know that raising thetemperature affects the transcription of viral proteins due to the formation of small RNAmolecules that interrupt the replication process by grouping in specific regions of theRNA molecule, preventing and inhibiting transcription. These small molecules are calledsmall interfering RNAs (siRNAs). This feature has been used through thermotherapy inhumans to combat the rapid replication of cells (i.e. cancer cells), attack cellsinfected by RNA viruses, and in the treatment of some parasitic infections.There arevarious commercially available devices for thermotherapy use in humans; they are mainlybeing used to ease muscle pain. They work by increasing the temperature in the rangerecommended for thermotherapy in humans 39-43 ° C. Therefore, the investigators considerthis treatment modality can be used to aid in the elimination of SARS-CoV-2 from thehuman body, decreasing viral load, which could allow the immune system time for itscontrol and elimination.