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By Christian Hoffmann &
Bernd S. Kamps
8 August
Prevention
Budd J, Miller BS, Manning EM, et al. Digital technologies in the public-health response to COVID-19. Nat Med 2020, published 7 August. Full-text: https://doi.org/10.1038/s41591-020-1011-4
Your review for the weekend – seven pages and 151 references will give you a glimpse of how the digital world might fight back to SARS-CoV-2. Rachel McKendry and colleagues critically review how billions of mobile phones, low-cost computing resources and advances in machine learning and natural language processing are being recruited into a gigantic antiviral network.
Firth, J.A., Hellewell, J., Klepac, P. et al. Using a real-world network to model localized COVID-19 control strategies. Nat Med 2020, published 7 August. Full-text: https://doi.org/10.1038/s41591-020-1036-8
Lewis Spurgin and colleagues simulate control strategies for SARS-CoV-2 transmission in a real-world social network generated from high-resolution GPS data that were gathered in the course of a citizen-science experiment. They find that tracing the contacts of contacts reduces the size of simulated outbreaks more than tracing of only contacts and suggest that contact tracing and quarantine might be most effective as ‘local lockdown’ strategies when contact rates are high.
Schilling K, Gentner DR, Wilen L, et al. An accessible method for screening aerosol filtration identifies poor-performing commercial masks and respirators. J Expo Sci Environ Epidemiol 2020, published 7 August. Full-text: https://doi.org/10.1038/s41370-020-0258-7
During the initial phases of the COVID-19 pandemic the shortage of regulation-tested masks contributed to the rapid spread of SARS-CoV-2 in healthcare settings. Here Lisa Lattanza and colleagues present experimental methods to evaluate mask filtration and breathability via cost-effective approaches that could be easily replicated in communities without extensive infrastructure.
Immunology
Cohen J. Designer antibodies could battle COVID-19 before vaccines arrive. Science 2020, published 4 August. Full-text: https://www.sciencemag.org/news/2020/08/designer-antibodies-could-battle-covid-19-vaccines-arrive
Science writer Jon Cohen describes how the competition is heating up to produce targeted monoclonal antibodies which could both prevent and treat COVID-19. Read about treatment and prevention trials, antibody cocktails and the role monoclonal antibodies might play even after the general availability of effective vaccines. Read also about the final problem of monoclonal antibodies: their cost, especially for the higher doses needed for treatment. Don’t expect monoclonals to be affordable globally. Rather, they might split the world into the haves and have-nots, like many previous drugs. That’s another reason why accessible vaccines are so important!
Hadjadj J, Yatim N, Barnabei L, et al. Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients. Science. 2020 Aug 7;369(6504):718-724. PubMed: https://pubmed.gov/32661059. Full-text: https://doi.org/10.1126/science.abc6027
Interferons (IFNs) play an important role in the inhibition of viral replication. After performing an integrated immune analysis on a cohort of 50 COVID-19 patients with various disease severity, Benjamin Terrier and colleagues observed a distinct phenotype in severe and critical patients. These patients had a highly impaired interferon (IFN) type I response (characterized by no IFN-β and low IFN-α production and activity), which was associated with a persistent blood viral load and an exacerbated inflammatory response. The authors propose that type I IFN deficiency is a hallmark of severe COVID-19 and infer that severe COVID-19 patients might be relieved from the IFN deficiency through IFN administration and from exacerbated inflammation through anti-inflammatory therapies that target IL-6 or TNF-α.
See also the comment by Gary Grajales-Reyes and Marco Colonna. Interferon responses in viral pneumonias. Science 2020; 369: 626-627. Full-text: https://science.sciencemag.org/content/369/6504/626
Clinical
Perez-Guzman PN, Daunt A, Mukherjee S, et al. Clinical characteristics and predictors of outcomes of hospitalized patients with COVID-19 in a multi-ethnic London NHS Trust: a retrospective cohort study. Clin Infect Dis 2020, published 7 August. Full-text: https://doi.org/10.1093/cid/ciaa1091
In the UK, ethnic minorities are disproportionately affected by COVID-19. Shevanthi Nayagam and colleagues evaluated the factors associated with mortality in patients admitted for COVID-19 in three large London hospitals. As of 1 May, 381 of 614 patients (62%) were discharged alive, 178 (29%) died and 55 (9%) remained hospitalized. The authors provide evidence that, beyond the widely reported factors associated with increased COVID-19 mortality (age, sex and severe hypoxemia on admission), thrombocytopenia, leukocytosis, hypoalbuminemia and reduced eGFR are also significantly associated with increased in-hospital death. They also find an association of increased odds of death among black (compared to white) patients, when adjusted for age, sex, burden of comorbidities and severity of disease on admission.
Wang K, Luo J, Tan F, et al. Acute pancreatitis as the initial manifestation in two cases of COVID-19 in Wuhan, China. Open Forum Infect Dis 2020, published 7 August. Full-text: https://doi.org/10.1093/ofid/ofaa324
Weimin Li and colleagues describe two cases of COVID-19 (two males, 42 and 35 years old) with acute pancreatitis as the initial manifestation.
Brener MI, Kaslow SR. Where Do the Children Play? N Engl J Med. 2020 Aug 6;383(6):e35. PubMed: https://pubmed.gov/32459914. Full-text: https://doi.org/10.1056/NEJMp2011100
A dual-physician couple — a cardiology fellow and a general surgery resident —narrate their experience of memorizing the ARDSNet ladder for ratios of positive end-expiratory pressure and fraction of inspired oxygen instead of learning the ins and outs of coronary angiography and laparoscopy. In the middle of their unexpected experience: their 3½ year-old son and the Zoom session decision to keep him safe.
Privacy
Gerke S, Shachar C, Chai PR, Cohen IG. Regulatory, safety, and privacy concerns of home monitoring technologies during COVID-19. Nat Med 2020, published 7 August. Full-text: https://doi.org/10.1038/s41591-020-0994-1
Sara Gerke and colleagues describe how healthcare is shifting from the clinic to the home where people are treated via telehealth services and are monitored for signs and symptoms with the help of smartwatches, apps, and other technologies, including artificial intelligence. Learn how these sometimes revolutionary technologies raise major concerns pertaining to safety and privacy. A peek at the healthcare world of tomorrow.