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By Christian Hoffmann &
Bernd S. Kamps
17 June
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Epidemiology
Davies NG, Klepac P, Liu Y et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med 2020, June 16. https://doi.org/10.1038/s41591-020-0962-9
Do children have a lower susceptibility to infection? Probably yes. The authors used epidemic data from Canada, China, Italy, Japan, Singapore, and South Korea to determine the level of susceptibility and clinical symptoms in various age groups. Susceptibility to infection in individuals under 20 years of age was approximately half that of adults aged over 20 years, and clinical symptoms manifest in 21% (95% confidence interval: 12–31%) of infections in 10- to-19-year-olds, rising to 69% (57–82%) of infections in people aged over 70 years. These estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings.
Kucharski AJ, Klepac P, Conlan AJ, et al. Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study. The Lancet Infectious Diseases 2020 Published: June 16, 2020. Full-text: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30457-6/fulltext
Another mathematical modelling study, using pandemic data from 40,162 UK participants and simulating the effect of a range of different testing, isolation, tracing, and physical distancing scenarios. If combined with moderate physical distancing measures, self-isolation and contact tracing would be more likely to achieve control of SARS-CoV- 2 transmission.
Prevention
Cai C, Floyd EL. Effects of Sterilization With Hydrogen Peroxide and Chlorine Dioxide on the Filtration Efficiency of N95, KN95, and Surgical Face Masks. JAMA Netw Open. 2020 Jun 1;3(6):e2012099. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.12099
This quality improvement study found that the sterilization process had different effects on the filtration efficiencies of different masks. Sterilization with H2O2 had fewer negative effects than ClO2.
Diagnostics
Patel MR, Carroll D, Ussery E, et al. Performance of oropharyngeal swab testing compared to nasopharyngeal swab testing for diagnosis of COVID-19 -United States, January-February 2020. Clin Infect Dis. 2020 Jun 16:ciaa759. PubMed: https://pubmed.gov/32548635 . Full-text: https://doi.org/10.1093/cid/ciaa759
Among persons with specimens collected early in the course of illness, SARS-CoV-2 RNA diagnostic results were highly concordant between OP and NP swabs (95.2%). However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect SARS-CoV-2.
Transmission
Steensels D, Oris E, Coninx L, et al. Hospital-Wide SARS-CoV-2 Antibody Screening in 3056 Staff in a Tertiary Center in Belgium. JAMA. 2020 Jun 15. PubMed: https://pubmed.gov/32539107 . Full-text: https://doi.org/10.1001/jama.2020.11160
In this large, hospital-wide screening study for SARS-CoV-2 antibodies among hospital staff in a Belgian tertiary care center, neither direct involvement in clinical care nor working in a COVID-19 unit increased the odds of being seropositive, while having a suspected COVID-19 household contact did. Overall, 197 staff (6.4%, 95% CI, 5.5%-7.3%) had IgG antibodies for SARS-CoV-2.
Clinical
Suleyman G, Fadel RA, Malette KM, et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020 Jun 1;3(6):e2012270. PubMed: https://pubmed.gov/32543702 . Full-text: https://doi.org/10.1001/jamanetworkopen.2020.12270-
Case series of 463 consecutive patients with COVID-19 (72.1% African American), evaluated at Henry Ford Health System in metropolitan Detroit, Michigan. Most patients (94%) had at least 1 comorbidity, including hypertension (64%), chronic kidney disease (39.3%), and diabetes (38%). 355 patients (77%) were hospitalized; 141 (40%) required intensive care unit management and 114 (81%) of those patients required invasive mechanical ventilation. Male sex (OR, 1.8) and age older than 60 years (OR 5.3) were significantly associated with mortality, whereas African American race was not.
Patel MC, Chaisson LH, Borgetti S, et al. Asymptomatic SARS-CoV-2 infection and COVID-19 mortality during an outbreak investigation in a skilled nursing facility. Clin Infect Dis. 2020 Jun 16:ciaa763. PubMed: https://pubmed.gov/32548628 . Full-text: https://doi.org/10.1093/cid/ciaa763
Of 126 residents tested at a skilled nursing facility in Illinois, 33 had confirmed SARS-CoV-2. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on March 15 developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%.
Comorbidities
Piccolo R, Bruzzese D, Mauro C, et al. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak. Circulation. 2020 Jun 16; 141(24): 2035–2037. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.047457
This study investigated the association between the outbreak of COVID-19 and PCI rates for ACS (Acute Coronary Syndromes) in the Campania region, which, with 5.8 million residents, represents ≈10% of the Italian population. The outbreak was associated with a decline in the number of PCIs for ACS by 32%. In the last 2 weeks of the observational period, PCIs for ACS were reduced by 50%. In comparison with PCI volumes for the same time in 2019, the decline in PCI rates was of a similar magnitude (between 36% and 38%).
Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020 Jun 12:S1470-2045(20)30314-4. PubMed: https://pubmed.gov/32539942 . Full-text: https://doi.org/10.1016/S1470-2045(20)30314-4
Of 200 patients with COVID-19 and thoracic cancers (76% NSCLC) from eight countries were identified and included in the TERAVOLT registry, 152 (76%) were hospitalised and 66 (33%) died. Of note, in a multivariable analysis, only smoking history (OR 3.18, 95% CI 1.11-9.06) was associated with increased risk of death.
Treatment
Luo W, Li YX, Jiang LJ. Targeting JAK-STAT Signaling to Control Cytokine Release Syndrome in COVID-19. Trends Pharmacol Science June 17, 2020. Full-text: https://doi.org/10.1016/j.tips.2020.06.007
Several inflammatory cytokines that correlate with adverse clinical outcomes in COVID-19 employ a distinct intracellular signalling pathway mediated by Janus kinases (JAKs). JAK-STAT signalling may be an excellent therapeutic target. This article reviews the possibilities and challenges of targeting this pathway in COVID-19.