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COVID-19 pneumonia and elevated IL-6 2 Ruan Q, Yang K, Wang W, Jiang L, Song J. The first question is why there was
Clinical predictors of mortality due to
in China (ChiCTR2000029765).9 Janus COVID-19 based on an analysis of data of
reluctance to call the COVID-19
kinase (JAK) inhibition could affect both 150 patients from Wuhan, China. outbreak a pandemic, and the second
inflammation and cellular viral entry in Intensive Care Med 2020; published online question is whether the terminology is
March 3. DOI:10.1007/s00134-020-05991-x.
COVID-19.10 3 Ramos-Casals M, Brito-Zeron P, of any practical importance.
All patients with severe COVID-19 Lopez-Guillermo A, Khamashta MA, Bosch X. In almost all good textbooks, an
Adult haemophagocytic syndrome. Lancet
should be screened for hyperinflam 2014; 383: 1503–16.
epidemic becomes a pandemic when
mation using laboratory trends (eg, 4 Karakike E, Giamarellos-Bourboulis EJ. there is widespread geographical
increasing ferritin, decreasing platelet Macrophage activation-like syndrome: distribution of the disease. For some
a distinct entity leading to early death in
counts, or erythrocyte sedimentation sepsis. Front Immunol 2019; 10: 55. weeks, the COVID-19 epidemic, which
rate) and the HScore11 (table) to identify 5 Seguin A, Galicier L, Boutboul D, Lemiale V, had spread to over 100 countries,
the subgroup of patients for whom Azoulay E. Pulmonary involvement in patients seemed to fit the classical definition of
with hemophagocytic lymphohistiocytosis.
immunosuppression could improve Chest 2016; 149: 1294–301. a pandemic. One could reasonably ask
mortality. Therapeutic options include 6 Huang C, Wang Y, Li X, et al. Clinical features of whether the use of the term pandemic
steroids, intravenous immunoglobulin, patients infected with 2019 novel coronavirus would change any of the actions
in Wuhan, China. Lancet 2020; 395: 497–506.
selective cytokine blockade (eg, anakinra 7 Russell CD, Millar JE, Baillie JK. Clinical evidence necessary to control the spread of the
or tocilizumab) and JAK inhibition. does not support corticosteroid treatment for virus.
2019-nCoV lung injury. Lancet 2020;
PM is a clinical training fellow within the 395: 473–75. There are several situations in
Experimental Medicine Initiative to Explore New 8 Shakoory B, Carcillo JA, Chatham WW, et al. which it could be helpful to use well
Therapies network and receives project funding
unrelated to this Correspondence. PM also receives
Interleukin-1 receptor blockade is associated defined terminology to control the
with reduced mortality in sepsis patients with
co-funding by the National Institute for Health features of macrophage activation syndrome: spread of an infectious disease. The
Research (NIHR) University College London reanalysis of a prior phase iii trial. Crit Care Med resources for controlling a pandemic
Hospitals Biomedical Research Centre. DFM chairs 2016; 44: 275–81.
9 Chinese Clinical Trial Registry. A multicenter,
are both different, substantially
the NIHR and Medical Research Council funding
committee for COVID-19 for therapeutics and randomized controlled trial for the efficacy larger, and generally much more
vaccines. DFM reports personal fees from and safety of tocilizumab in the treatment of far-reaching than for a localised
consultancy for ARDS for GlaxoSmithKline, new coronavirus pneumonia (COVID-19).
Feb 13, 2020. http://www.chictr.org.cn/ outbreak or epidemic. Thus the terms
Boehringer Ingelheim, and Bayer; in addition,
his institution has received funds from grants from
showprojen.aspx?proj=49409 (accessed used for the different situations
March 6, 2020).
the UK NIHR, Wellcome Trust, Innovate UK,
10 Richardson P, Griffin I, Tucker C, et al. Baricitinib
could be restricted according to the
and others, all unrelated to this Correspondence. control measures that are necessary.
as potential treatment for 2019-nCoV acute
DFM also has a patent issued to his institution for
a treatment for ARDS. DFM is a Director of Research
respiratory disease. Lancet 2020; 395: e30–31. Perhaps unique to pandemics, these
11 Fardet L, Galicier L, Lambotte O, et al.
for the Intensive Care Society and NIHR Efficacy and Development and validation of the HScore,
include considerable international
Mechanism Evaluation Programme Director. a score for the diagnosis of reactive coordination and collaboration in
All other authors declare no competing interests. hemophagocytic syndrome. Arthritis Rheumatol
2014; 66: 2613–20.
providing aid to affected countries,
Puja Mehta, Daniel F McAuley, recruiting the necessary resources for
Michael Brown, Emilie Sanchez, promoting research on medications
Rachel S Tattersall, *Jessica J Manson, Did the hesitancy in and vaccines, and developing complex
on behalf of the HLH Across Speciality risk communication. In particular,
Published Online Collaboration, UK declaring COVID-19 a travel restrictions become a major
March 12, 2020 jessica.manson@nhs.net pandemic reflect a need issue and, although these are guided by
https://doi.org/10.1016/
S0140-6736(20)30630-9
Centre for Inflammation and Tissue Repair, UCL
Respiratory, Division of Medicine, University to redefine the term? the International Health Regulations,
For the International Health College London, London, UK (PM); Department of
countries have the option to adopt
Regulations see https://www. Rheumatology (JJM), Hospital for Tropical Diseases WHO’s declaration that the global unilaterally their own barriers to
who.int/ihr/en/ (MB), and Department of Clinical Virology (ES), spread of coronavirus disease 2019 international travel. This was clearly
University College London Hospital,
London NW1 2PG, UK; Wellcome-Wolfson Institute
(COVID-19) is a pandemic 1 has the case for COVID-19. If the term
for Experimental Medicine, Queen’s University contributed greatly to clearing up pandemic is clearly defined, it can
Belfast, Belfast, UK (DFM); Regional Intensive Care confusion in the terminology in the communicate much more clearly the
Unit, Royal Victoria Hospital, Belfast, UK (DFM);
professional literature and the media. seriousness of the situation and
Department of Rheumatology, Sheffield Teaching
Hospitals NHS Foundation Trust, Sheffield, UK Discussions on when wide geographical help justify the extreme measures
(RST); and Sheffield Children’s Hospital NHS spread of a disease becomes a instituted. It can also provide the
Foundation Trust, Sheffield, UK (RST) pandemic tend to recur when the international health community with a
1 WHO. Coronavirus disease 2019 (COVID-19) world is confronted with an emerging common term to enlist the cooperation
situation report – 52. March 12, 2020.
https://www.who.int/docs/default-source/ infectious disease.2,3 The debate around of the general public and convey the
coronaviruse/20200312-sitrep-52-covid-19. the terminology used for COVID-19 necessary sense of urgency to decision
pdf?sfvrsn=e2bfc9c0_2 (accessed
March 13, 2020). raises two important questions. makers. This should stimulate rapid