Background Anti-inflammatory therapies such as IL-6 inhibition have been proposed for COVID-19 in a vacuum of evidence-based treatment. However, abrogating the inflammatory response in infectious diseases MESHD
may impair a desired host response and predispose to secondary infections. Methods We retrospectively reviewed the medical record of critically ill COVID-19 patients during an 8-week span and compared the prevalence SERO
of secondary infection MESHD
and outcomes in patients who did and did not receive tocilizumab. Additionally, we included representative histopathologic post-mortem findings from several COVID-19 cases that underwent autopsy at our institution. Results 111 patients were identified, of which 48 had received tocilizumab while 63 had not. Receiving tocilizumab was associated with a higher risk of secondary bacterial (50% vs. 28.6%, p=0.021 and fungal (8.3% vs. 0%, p=0.078) infections. Consistent with higher number of infections, patients who received tocilizumab had higher mortality (39.6 vs. 17.4%, p=0.016). Seven cases underwent autopsy. In 3 cases who received tocilizumab, there was evidence of pneumonia HP
on pathology. Of the 4 cases that had not been given tocilizumab, 2 showed evidence of aspiration pneumonia HP
and 2 exhibited diffuse alveolar damage. Conclusions Experimental therapies are currently being applied to COVID-19 outside of clinical trials. Anti-inflammatory therapies such as anti-IL-6 therapy have the potential to impair viral clearance, predispose to secondary infection, and cause harm. We seek to raise physician awareness of these issues and highlight the need to better understand the immune response in COVID-19.