COVID Reference

The COVID Textbook

Top 10: August 11

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By Christian Hoffmann &
Bernd S. Kamps

11 August

Prevention

Lazzari S. Prevention. In: COVID Reference 2020.04, 4th updated edition, published 11 August. Full-text: https://covidreference.com/prevention

Stefano Lazzari, specialist in Public Health and Preventive Medicine, gives a 5000-word overview of this most important topic in a world without a COVID-19 vaccine. See also the PDF (320 pages) of the updated Fourth CR Edition.

 

Ramírez-Cervantes KL, Romero-Pardo V, Pérez-TovarC, et al. A medicalized hotel as a public health resource for the containment of Covid-19: more than a place for quarantining. J Public Health 2020, published 10 August. Full-text: https://doi.org/10.1093/pubmed/fdaa129

Karen Lizzette Ramírez-Cervantes and colleagues describe the implementation of a medicalized hotel in Madrid for the containment of COVID-19. Between March and 9 May 2020, 399 patients were admitted; 59% (235) were migrants; the main reason for referral (58%) was a lack of housing conditions for quarantining, including overcrowding. The hotel provided medical care and housing to a subgroup of a vulnerable population who could not afford a safe quarantine.

 

Vaccine

Dagotto G, Yu J, Barouch DH. Approaches and Challenges in SARS-CoV-2 Vaccine Development.  Cell Host Microbe 2020, published 10 August. Full-text: https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(20)30455-8

Progress in SARS-CoV-2 vaccine development to date has been faster than for any other pathogen in history. In this perspective, Dan Barouch, Gabriel Dagotto and Jingyou Yu discuss three topics that are critical for SARS-CoV-2 vaccine development:

  1. Antigen selection and engineering
  2. Pre-clinical challenge studies in non-human primate models
  3. Immune correlates of protection

 

Diagnostics

Kilic T, Weissleder R, Lee H. Molecular and Immunological Diagnostic Tests of COVID-19: Current Status and Challenges. iScience. 2020 Jul 25;23(8):101406. PubMed: https://pubmed.gov/32771976. Full-text: https://doi.org/10.1016/j.isci.2020.101406

We are presenting this article more than two weeks after publication – an almost inexcusable delay. Allocate at least half an hour to read the review by Tugba Kilic, Ralph Weissleder and Hakho Lee – it’s 16 pages. The authors describe currently available tests to detect either the virus (SARS-CoV-2) or virus-induced immune responses, explaining how the tests work and comparing their performance (see the graphical abstract). Discover also the shortcomings of certain tests and future needs.

 

Clinical

Crosby SS. My COVID-19. Ann Intern Med 2020, published 11 August. Full-text: https://www.acpjournals.org/doi/10.7326/M20-5126

In this On Being a Doctor report, Sondra Crosby, working at the center of the Boston coronavirus storm in March 2020, remembers a myriad of symptoms after coming down with COVID-19 herself. Read about her shortness of breath, confusion, not eating for 5 days, keeping in the prone position and a nauseating and horrid odor. With the exception of a handful of mediocre and uninspired politicians, this is not something you would wish on your worst enemy.

 

Treatment

Cain DW, Cidlowski JA. After 62 years of regulating immunity, dexamethasone meets COVID-19. Nat Rev Immunol 2020, published 10 August. Full-text: https://doi.org/10.1038/s41577-020-00421-x

The RECOVERY trial showed that treatment with dexamethasone, a synthetic glucocorticoid, enhanced the survival of critically ill patients with COVID-19. Not only was dexamethasone more effective than remdesivir (dexamethasone reduced COVID-19-related mortality while remdesivir didn’t), but it is also cheap, widely available and comes with 60 years of safety profiling. In this two-page comment, Derek Cain and John Cidlowski discuss the immunological impacts of glucocorticoid therapy for COVID-19.

 

Comorbidities

Restivo DA, Centonze D, Alesina A, Marchese-Ragona R. Myasthenia Gravis Associated With SARS-CoV-2 Infection. Ann Intern Med 2020, published 10 August. Full-text: https://www.acpjournals.org/doi/10.7326/L20-0845

Myasthenia gravis is an autoimmune disease in which antibodies bind to acetylcholine receptors (AChRs) or to functionally related molecules in the post-synaptic membrane at the neuromuscular junction. Now Domenico Restivo and colleagues describe 3 patients without previous neurologic or autoimmune disorders who were diagnosed with myasthenia gravis within 5 to 7 days after fever onset related to COVID-19. The authors speculate that antibodies directed against SARS-CoV-2 proteins might cross-react with AChR subunits.

 

Newborns

Patil UP, Maru S, Krishnan P et al. Newborns of COVID-19 mothers: short-term outcomes of colocating and breastfeeding from the pandemic’s epicenter. J Perinatol 2020, published 10 August. Full-text: https://doi.org/10.1038/s41372-020-0765-3

The authors report on 45 newborns born to SARS-CoV-2 positive mothers. The majority of positive mothers, 27 (60%), were asymptomatic. Mothers were encouraged to provide skin-to-skin care and breastfeeding. All the newborns were tested for SARS-CoV-2; only 3 (6.6%) tested positive (see Figure 1). Those three newborns were monitored until two consecutive tests obtained at least 24 h apart were negative and they remained asymptomatic, thus suggesting transient colonization.

 

Digital

Murray CJL, Alamro NMS, Hwang H, Lee U. Digital public health and COVID-19. Lancet Public Health 2020, published 10 August. Full-text: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30187-0/fulltext

Data have been central to public health ever since John Snow used maps and case reports to identify the Broad Street pump as the source of cholera in London in 1854. Today, in a way that was unimaginable just 15 years ago, digital technology collects data through administrative interfaces, sensors and social media. Now Christopher Murray and colleagues summarize how the new data webs can transform the public health response. A preview:

  1. Timely tracking of the COVID-19 pandemic
  2. Forecasting the next hotspot
  3. Speeding up the data collection for a large fraction of the population
  4. Contact tracing via tracing apps
  5. Interactive data visualization for communication to the media, the public, decision influencers, and decision makers
  6. Targeted control strategies at the city or neighborhood level

 

Beyond your tectonic plate borders

Abbott A. Inside the mind of an animal. Nature 2020, published 11 August. Full-text: https://www.nature.com/articles/d41586-020-02337-x

In this Nature feature, Alison Abbott explores how brains create emotions and other internal states such as aggression and desire.

 

German

Drosten C. Ein Plan für den Herbst. Die Zeit 2020, published 5 August. Full-text: https://www.zeit.de/2020/33/corona-zweite-welle-eindaemmung-massnahmen-christian-drosten

If you read German, read this article by Germany’s top virologist Christian Drosten. The subtitle: “Die Treiber der Epidemie aufspüren, die Quarantäne verkürzen, die Tests genauer auswerten – mit dieser Strategie können wir in einer zweiten Welle verhindern, dass es zu einem erneuten Lockdown kommt.”