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Top 10: July 22

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By Christian Hoffmann &
Bernd S. Kamps

22 July

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Google Translate has an excellent reputation for accuracy, but it isn’t perfect and does make mistakes. So use it with caution. In particular, be careful in relying on Google Translate for any important matter (health, treatment, etc.). In case of doubt, ask your friends.

Epidemiology

Ali ST, Wang L, Lau EHY, et al. Serial interval of SARS-CoV-2 was shortened over time by nonpharmaceutical interventions. Science  21 Jul 2020. Full-text: https://doi.org/10.1126/science.abc9004

The serial interval is the time between illness onset in successive cases in a transmission chain. The authors show that during the early epidemic in China, the mean serial intervals of SARS-CoV-2 infection shortened from 7.8 days to 2.6 days between January 9 and February 13. This reduction was driven by intensive non-pharmaceutical interventions, particularly, reduction of the isolation delay period. Isolation of an infector one day earlier is expected to reduce the mean serial interval by 0.7 days.

 

Virology

Cai Y, Zhang J, Xiao T, et al. Distinct conformational states of SARS-CoV-2 spike protein.  Science  21 Jul 2020. Full-text: https://doi.org/10.1126/science.abd4251

The authors report two cryo-EM structures, derived from a preparation of the full-length S protein, representing its pre-fusion (2.9Å resolution) and post-fusion (3.0Å resolution) conformations, respectively, and identify a structure near the fusion peptide – the fusion peptide proximal region (FPPR), which may play a critical role in the fusogenic structural rearrangements of S protein. Discover why the study raises potential concerns about current vaccine strategies.

 

Prevention

Sehgal AR, Himmelstein DU, Woolhandler S. Feasibility of Separate Rooms for Home Isolation and Quarantine for COVID-19 in the United States. Ann Intern Med. 2020 Jul 21. PubMed: https://pubmed.gov/32692931. Full-text: https://doi.org/10.7326/M20-4331

SARS-CoV-2-infected and -exposed persons are instructed to separate themselves from others to limit further spread through droplets and aerosol produced by coughs, sneezes, singing or even talking. But what if separate bedrooms and bathrooms are unavailable? The sober finding of the authors: more than 80 million persons in the US (about 1 in 5) live in places that are not suitable for isolation or quarantine.

 

Clinical

Walker A, Potting G, Scott A, Hopkins C. Anosmia and loss of smell in the era of covid-19. BMJ 2020;370:m2808. Full-text: https://doi.org/10.1136/bmj.m2808 (Published 21 July 2020)

The BMJ 10-Minute Consultation summarizes in four points what you need to do:

  1. Half of patients with COVID-19 may lose their sense of smell; guidance states that a new change or loss in sense of smell should prompt a period of self-isolation
  2. Nine in 10 patients can expect substantial improvement in their sense of smell within four weeks
  3. Most patients with loss of smell do not require further investigations or referral, although their COVID-19 status should be established if possible
  4. Treatment involves reassurance, olfactory training, safety advice, and topical corticosteroids—but oral prednisolone should be avoided where acute COVID-19 infection is suspected

 

Covid-19: What do we know about “long covid”? BMJ 2020;370:m2815. Full-text: https://doi.org/10.1136/bmj.m2815

A reminder of “long COVID-19”. In particular, re-read Paul Garner’s experience: For 7 weeks I have been through a roller coaster of ill health, extreme emotions, and utter exhaustion. The BMJ Opinion, 5 May 2020. Full-text: https://blogs.bmj.com/bmj/2020/05/05/paul-garner-people-who-have-a-more-protracted-illness-need-help-to-understand-and-cope-with-the-constantly-shifting-bizarre-symptoms/ (accessed 16 May 2020)

 

Hadjieconomou S, Hughes J. Covid-19 associated chilblain-like lesions in an asymptomatic doctor.  BMJ 2020;370:m2245. Full-text. https://doi.org/10.1136/bmj.m2245 (Published 22 July 2020)

A reminder of chilblain with two photos.

 

Treatment

Ramiro S, Mostard RLM, Magro-Checa C, et al. Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study. Ann Rheum Dis, 2020;0:1–9. Full-text: http://dx.doi.org/10.1136/annrheumdis-2020-218479

86 patients with COVID-19-associated cytokine storm syndrome received high-dose intravenous methylprednisolone for 5 consecutive days (250 mg on day 1 followed by 80 mg on days 2 – 5). If the respiratory condition did not improve sufficiently (in 43%), tocilizumab (8 mg/kg body weight, single infusion) was added on or after day 2. Compared to retrospectively matched patients (sex and age), treated patients had a 79% higher likelihood on reaching the primary outcome (defined as ≥ 2 stages of improvement on a 7-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital) (7 days earlier), 65% less mortality and 71% less invasive mechanical ventilation. Also, see the comment in BMJ.

 

Comorbidities

Yao Z, Chen J, Wang Q, et al. Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January-February 2020. Emerg Infect Dis. 2020 Jul 15;26(11). PubMed: https://pubmed.gov/32667282. Full-text: https://doi.org/10.3201/eid2611.201536

Tham SM, Lim WY, Lee CK, et al. Four Patients with COVID-19 and Tuberculosis, Singapore, April-May 2020. Emerg Infect Dis. 2020 Jul 15;26(11). PubMed: https://pubmed.gov/32667283. Full-text: https://doi.org/10.3201/eid2611.202752

Two papers about three patients with COVID-19 and tuberculosis in Wuhan and four patients in Singapore. Clinicians treating at-risk populations should be aware of possible co-infection with M. tuberculosis and SARS-CoV-2 in patients with atypical radiographic features of COVID-19.

 

Journal Feature

Dance A. Coronavirus vaccines get a biotech boost. Nature, published 21 July 2020. Full-text: https://www.nature.com/articles/d41586-020-02154-2

‘Platform technologies’, ‘plug-and-play’, ChAdOx1 – take a reconnaissance flight over the new Vaccine World. Read also Coronavirus vaccines leap through safety trials — but which will work is anybody’s guess, by Ewen Callayway, Nature.

 

Sweet Article!

Bohn AJ, Kenworthy MA, Ginski C, et al. Two Directly Imaged, Wide-orbit Giant Planets around the Young, Solar Analog TYC 8998-760-1. Astrophys J Lett, volume 898, Number 19. Published 2020 July 22. Article: https://iopscience.iop.org/article/10.3847/2041-8213/aba27e + comment in Science by Daniel Clery.

Just to remember that science is spinning fast in other research areas, too.