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Top 10: April 28

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By Christian Hoffmann &
Bernd S. Kamps

28 April

Epidemiology

Oliver N, Lepri B, Sterely H. Mobile phone data for informing public health actions across the COVID-19 pandemic life cycle. Science Advances  27 Apr 2020. Full-Text: https://doi.org/10.1126/sciadv.abc0764

This brief review outlines the ways in which different types of mobile phone data can help to better target and design measures to contain and slow the spread of the COVID-19 pandemic.

 

Bi Q, Wu Y, Mei S, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Inf Dis. April 27, 2020. Full-Text: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext

This important analysis of 391 early SARS-CoV-2 cases and their close contacts in Shenzhen, China, provides insight into the natural history and transmission. This work further supports a short incubation period (4–6 days). Notably, 5% took 14 days or more to develop symptoms. In multiple conditional logistic regression analysis of contact types, household contact (OR 6.3; 95% CI 1.5–26.3) and travelling together (OR 7.1; 1.4–34.9) were significantly associated with infection. The secondary attack rate was relatively low with 11·2% (95% CI 9·1–13·8) among household contacts and was similar across all age categories. However, this could be considered an underestimate, since transmission chains were cut short: index cases detected by symptom-based surveillance were rapidly isolated outside of the home.

 

Nie X, Fan L, Mu G, et al. Epidemiological characteristics and incubation period of 7,015 confirmed cases with Coronavirus Disease 2019 outside Hubei Province in China. J Inf Dis, 27 April 2020. Full-text: https://doi.org/10.1093/infdis/jiaa211

Huge study from China. Based on 2,907 confirmed cases, the median incubation period was 5 days, and more than 95% of cases had an incubation period of less than 13 days. From January 23, the incubation period among imported confirmed cases outside Hubei Province showed a gradual upward trend, but this trend was not obvious in nonimported cases.

 

Diagnostics

Altman DM, Douek DC, Boyton RJ. What policy makers need to know about COVID-19 protective immunity. Lancet April 27, 2020. Full-text: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext

Bottom line of this comment: We don’t know enough. There is no certainty as to the immunological correlates of antiviral protection or the proportion of the population who must attain them, making it impossible to identify a point when this level of immunity has been reached.

 

Lipsitch M, Kahn R, Mina MJ. Antibody testing will enhance the power and accuracy of COVID-19-prevention trials. Nature Medicine 27 April 2020. Full-text: https://doi.org/10.1038/s41591-020-0887-3.

Many groups have initiated trials of prophylactic drugs and have envisioned efficacy trials of vaccine candidates. Authors argue for serological testing of trial participants at the start and end of these trials (and at intermediate points), in order to enhance the value and interpretability of these studies.

 

Virology

Chu H, Chan JF, Yuen TT, et al. Comparative tropism, replication kinetics, and cell damage profiling of SARS-CoV-2 and SARS-CoV with implications for clinical manifestations, transmissibility, and laboratory studies of COVID-19: an observational study. Lancet Microbe  April 21, 2020. Full-text: https://doi.org/10.1016/S2666-5247(20)30004-5

Elegant study, explaining distinct clinical features of COVID-19 and SARS. Authors investigated cell susceptibility, species tropism, replication kinetics, and virus-induced cell damage from both SARS-CoVs, using live infectious virus particles. SARS-CoV-2 replicated more efficiently in human pulmonary cells, indicating that SARS-CoV-2 has most likely adapted better to humans. SARS-CoV-2 replicated significantly less in intestinal cells (might explain lower diarrhea frequency compared to SARS) but better in neuronal cells, highlighting the potential for neurological manifestations.

 

Huang H, Koyuncu OO, Enquist LW. Pseudorabies Virus Infection Accelerates Degradation of the Kinesin-3 Motor KIF1A. J Virol. 2020 Apr 16;94(9). pii: JVI.01934-19. PubMed: https://pubmed.gov/32075931. Full-text: https://doi.org/10.1128/JVI.01934-19

Pseudorabies virus (PRV), an alphaherpesvirus, is sorted and transported in axons in the anterograde direction by the kinesin-3 motor KIF1A. Why is this of interest? Because it’s currently (April 28, 2020, 7:15 a.m. CET) the headline article of the Journal of Virology, the Journal of the American Society of Microbiology (Impact Factor 4.3). No work, no link on COVID-19, nothing on their website. This journal aims „reporting important new discoveries and pointing to new directions in research“. Just saying.

 

Clinical

Gandhi RT, Lynch JB, del Rio C. Mild or Moderate Covid-19. NEJM April 24, 2020, Full-text: https://doi.org/10.1056/NEJMcp2009249.

Nice review on clinical manifestations, evaluation and management, but also on infection control and prevention efforts.

 

Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.3976.

Protecting health care workers is an important component of public health measure! This cross-sectional survey of 1257 health care workers in Chinese hospitals found considerable proportions of participants with symptoms of depression (50%), anxiety (47%), insomnia (34%), and distress (72%).Participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the care for patients with COVID-19.

 

Treatment

Strollo R, Pozzilli P. DPP4 inhibition: preventing SARS-CoV-2 infection and/or progression of COVID-19? Diabetes Metab Res Rev. 2020 Apr 26. PubMed: https://pubmed.gov/32336007. Full-text: https://doi.org/10.1002/dmrr.3330

The next new idea. Dipeptidyl peptidase 4 (DPP4) is a serine exopeptidase expressed ubiquitously in several tissues, including but not limited to lung, kidney, liver, gut, and immune cells. Some careful thoughts on whether DPP4 modulation or inhibition (by diabetes drugs such as gliptins) may prevent infection and/or progression of the COVID-19.