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By Christian Hoffmann &
Bernd S. Kamps
9 August
Epidemiology
Baker MG, Anglemyer A. Successful Elimination of Covid-19 Transmission in New Zealand. N Engl J Med 2020, published 7 August. Full-text: https://www.nejm.org/doi/full/10.1056/NEJMc2025203
In mid-March, informed by science-based advocacy, national New Zealand leaders switched from a mitigation strategy to an elimination strategy. The government implemented a stringent countrywide lockdown which lasted 7 weeks (26 March – mid-May). Now, New Zealand views itself in the post-elimination stage, and public life has returned to near normal. The only cases identified are among international travelers who are kept in government-managed quarantine or isolation for 14 days after arrival. Michael Baker and Andrew Anglemyer conclude that rapid, science-based risk assessment linked to early, decisive government action was critical. The geographical isolation of New Zealand was another trump card the country had up its sleeve.
Heywood AE, Macintyre CR. Elimination of COVID-19: what would it look like and is it possible? Lancet 2020, published 6 August. Full-text: https://doi.org/10.1016/S1473-3099(20)30633-2
Anita Haywood and Raina Macintyre remember that the elimination of any infectious disease is ambitious, requiring substantial resources. They suggest a zero-case scenario of not less than three months before declaring an area SARS-CoV-2-free. For obvious reasons, islands or island states have the best chances to achieve this goal.
Moscola J, Sembajwe G, Jarrett M, et al. Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area. JAMA 2020, published 6 August. https://doi.org/10.1001/jama.2020.14765
Health care personnel (HCP) working in New York City had a high exposure risk for SARS-CoV-2 infection. To address this concern, the Northwell Health System, the largest in New York State, offered voluntary antibody testing to all HCPs. Now Karina Davidson and colleagues report the prevalence of SARS-CoV-2 among HCPs and associations with demographics, primary work location and type, and suspicion of viral exposure. They found a 13.7% prevalence of SARS-CoV-2 antibodies (5523 of 40,329 HCWs tested) which was similar to that among adults randomly tested in New York State (14.0%).
Petersen MS, Strøm M, Christiansen DH, Fjallsbak JP, Eliasen EH, Johansen M, et al. Seroprevalence of SARS-CoV-2–specific antibodies, Faroe Islands. Emerg Infect Dis 2020 Nov. Published August 2020. Full-text: https://doi.org/10.3201/eid2611.202736
Maria Petersen and colleagues conducted a nationwide study of the prevalence of SARS-CoV-2 infection in the Faroe Islands, an autonomous territory within the Kingdom of Denmark with a population of around 50,000. Of 1,075 randomly selected participants, 6 (0.6%) tested seropositive for antibodies to the virus. At present, small islands tend to have low seropositivity rates.
Immunology
Guo C, Li B, Ma H, et al. Single-cell analysis of two severe COVID-19 patients reveals a monocyte-associated and tocilizumab-responding cytokine storm. Nat Commun. 2020 Aug 6;11(1):3924. PubMed: https://pubmed.gov/32764665. Full-text: https://doi.org/10.1038/s41467-020-17834-w
In this study, Kun Qu and colleagues profiled the single-cell transcriptomes of 13,239 peripheral blood mononuclear cells (PBMCs) isolated prior to and following tocilizumab-induced remission. They identified a severe stage-specific monocyte subpopulation that contributed to the inflammatory cytokine storm in patients. Although tocilizumab treatment attenuated the inflammation, immune cells, including plasma B cells and CD8+ T cells, still exhibited robust humoral and cellular antiviral immune responses.
Pathogenesis
Zhu N, Wang W, Liu Z, et al. Morphogenesis and cytopathic effect of SARS-CoV-2 infection in human airway epithelial cells. Nat Commun 11, 3910 (2020). https://doi.org/10.1038/s41467-020-17796-z
Totura A, Livingston V, Frick O, Dyer D, Nichols D, Nalca A. Small particle aerosol exposure of African green monkeys to MERS-CoV as a model for highly pathogenic coronavirus infection. Emerg Infect Dis 2020. Published August 2020. Full-text: https://doi.org/10.3201/eid2612.201664
For the initial development of a MERS-CoV primate model, Allison Totura and colleagues exposed 12 African green monkeys to 103, 104, or 105 PFU target doses of aerosolized MERS-CoV. Clinical disease signs that replicated human cases of MERS were observed in all groups but were most pronounced in the group that received the highest dose of MERS-CoV. It would be interesting to investigate if a dose-dependent increase of respiratory disease signs can be replicated in a SARS-CoV-2 animal model.
Genetics
Ortiz-Fernández L, Sawalha AH. Genetic variability in the expression of the SARS-CoV-2 host cell entry factors across populations. Genes Immun 2020, published 6 August. Full-text: https://doi.org/10.1038/s41435-020-0107-7
Clinical
Kaige Wang, Jianfei Luo, Fen Tan, Jiasheng Liu, Zhong Ni, Dan Liu, Panwen Tian, Weimin Li, Acute pancreatitis as the initial manifestation in two cases of COVID-19 in Wuhan, China, Open Forum Infectious Diseases, , ofaa324, https://doi.org/10.1093/ofid/ofaa324
Tingting Liao, Zhengrong Yin, Juanjuan Xu, Zhilei Lv, Sufei Wang, Limin Duan, Jinshuo Fan, Yang Jin, The correlation between clinical features and viral RNA shedding in outpatients with COVID-19, Open Forum Infectious Diseases, https://doi.org/10.1093/ofid/ofaa331
Severe COVID
Prescott HC, Girard TD. Recovery From Severe COVID-19: Leveraging the Lessons of Survival From Sepsis. JAMA 2020, published 5 August. Full-text: https://doi.org/10.1001/jama.2020.14103
Up to 20% of patients hospitalized with COVID-19 will develop viral sepsis and acute respiratory distress syndrome (ARDS). Of those who survive, how many patients are likely to experience long-lasting morbidity? Hallie Prescott and Timothy Girard review what is known about long-term outcomes after severe disease caused by other coronaviruses (SARS and MERS)***. Despite the limited data available for severe COVID-19, they suggest following the practices that are recommended for recovery from sepsis.
*** Ahmed H, Patel K, Greenwood DC, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis. J Rehabil Med. 2020 May 31;52(5):jrm00063. PubMed: https://pubmed.gov/32449782. Full-text: https://www.medicaljournals.se/jrm/content/abstract/10.2340/16501977-2694
Comorbidities
Williams RD II, Shah A, Tikkanen R, et al. Do Americans face greater mental health and economic consequences from covid-19? Comparing the US with other high-income countries. Commonwealth Fund 2020, published 6 August. Full-text: https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/americans-mental-health-and-economic-consequences-COVID19
One-third of U.S. adults reported experiencing stress, anxiety, and great sadness that was difficult to cope with by themselves, a significantly higher proportion than in other countries. Over 30 percent of Americans faced negative economic impacts due to the pandemic, significantly more than in the comparison high-income countries. Can the US do more regarding mental health, an existing concern before COVID-19? See also the comment by Janice Hopkins Tanne: Mental health and economic problems are worse in US than in other rich nations. BMJ 2020, Aug 6;370:m3110. PubMed: https://pubmed.gov/32764109. Full-text: https://doi.org/10.1136/bmj.m3110
Collateral Effects
Gluckman TJ, Wilson MA, Chiu S, et al. Case Rates, Treatment Approaches, and Outcomes in Acute Myocardial Infarction During the Coronavirus Disease 2019 Pandemic. JAMA Cardiol 2020, published 7 August. Full-text: https://doi.org/10.1001/jamacardio.2020.3629
Out of fear of contracting SARS-CoV-2, large numbers of patients avoided hospitalization during the COVID-19 pandemic. After analyzing 15,244 hospitalizations involving 14,724 patients with acute myocardial infarction, Tyler Gluckman and colleagues found that patients hospitalized for acute myocardial infarction during the early COVID-19 period had an increased observed/expected mortality ratio which was associated disproportionately with patients with ST-segment elevation myocardial infarction (STEMI).
Pediatrics
Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 7 August 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6932e2
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition that has been reported approximately 2–4 weeks after the onset of COVID-19 in children and adolescents. Now Shana Godfred-Cato and colleagues report 570 US MIS-C patients who met the CDC case definition as of July 29. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results (Class 1). The remaining 367 (64.4%) of MIS-C patients (Class 2 and 3) had manifestations that appeared to overlap with acute COVID-19 or had features of Kawasaki disease. 364 patients (63.9%) required care in an intensive care unit ICU. Ten patients (1.8%) died. The median patient age was 8 years (range = 2 weeks–20 years). Approximately two thirds of the children had no preexisting underlying medical conditions.