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By Christian Hoffmann &
Bernd S. Kamps
19 June
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Epidemiology
Emeruwa UN, Ona S, Shaman JL, et al. Associations Between Built Environment, Neighborhood Socioeconomic Status, and SARS-CoV-2 Infection Among Pregnant Women in New York City. JAMA 2020, June 18, 2020. Full-text: https://doi.org/10.1001/jama.2020.11370
This cross-sectional study of 396 pregnant New York City residents delivering at New York hospitals showed that the likelihood of SARS-CoV-2 varied substantially across measures of built environment and neighborhood socioeconomic status. Large household membership, household crowding, and low socioeconomic status were associated with a 2-3 fold higher risk of infection.
Devi S. COVID-19 resurgence in Iran. Lancet 2020, June 20, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31407-0
Brief overview. Iran was one of the first countries to experience a COVID-19 epidemic, and began relaxing restrictions in April. Cases dropped, with fewer than 1000 new cases per day by the start of May, but daily cases have since increased, with the Iranian Health Ministry reporting 2,410 new cases on June 13.
Clapham H, Hay J, Routledge I, et al. Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity. Emerg Infect Dis. 2020 Jun 16;26(9). PubMed: https://pubmed.gov/32544053 . Full-text: https://doi.org/10.3201/eid2609.201840
Numerous challenges exist in terms of sample collection, what the presence of antibodies actually means, and appropriate analysis and interpretation to account for test accuracy and sampling biases. The authors review strengths and limitations of different assay types and study designs, and discuss methods for rapid sharing and analysis of serologic data.
Transmission
Xu XK, Liu XF, Wu Y, et al. Reconstruction of Transmission Pairs for novel Coronavirus Disease 2019 (COVID-19) in mainland China: Estimation of Super-spreading Events, Serial Interval, and Hazard of Infection. Clinical Infectious Diseases 2020. Full-text: https://doi.org/10.1093/cid/ciaa790
The virus is so fast: This database with detailed demographic characteristics, travel history, social relationships, and epidemiological timelines for 1,407 transmission pairs that formed 643 transmission clusters in mainland China used statistical model fittings to identify the super-spreaders and estimate serial interval distributions. There were 34 primary cases identified as super-spreaders, with 5 super-spreading events occurring within households. Serial intervals were short and were estimated as 5.0 (95% CI: 4.4-5.5) and 5.2 (95% CI: 4.9- 5.7) days for household transmissions and 5.2 (95% CI: 4.6-5.8) and 5.3 (95% CrI: 4.9-5.7) days for non-household transmissions, respectively.
Mani NS, Budak JZ, Lan KF, et al. Prevalence of COVID-19 Infection and Outcomes Among Symptomatic Healthcare Workers in Seattle, Washington. Clin Infect Dis. 2020 Jun 16:ciaa761. PubMed: https://pubmed.gov/32548613 . Full-text: https://doi.org/10.1093/cid/ciaa761
The authors have stablished two high-throughput employee testing centers in Seattle, Washington with drive-through and walk-through options for symptomatic employees at the University of Washington Medicine system and its affiliated organizations. Between March 12 and April 23, a total of 3,477 symptomatic employees were tested; 185 (5.3%) employees tested positive for COVID-19. The prevalence of SARS-CoV-2 was similar when comparing frontline HCWs (5.2%) to non-frontline staff (5.5%).
Diagnostics
Long Q, Tang X, Shi Q et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med 2020. Full-text: https://doi.org/10.1038/s41591-020-0965-6
“COVID-19 passes” will last a few weeks, at least in patients with mild symptoms: Compared to symptomatic patients, 37 asymptomatic patients had a significantly longer duration of viral shedding. The virus-specific IgG levels were significantly lower in the acute phase. IgG levels and neutralizing antibodies started to decrease within 2–3 months after infection. Of note, 40% became seronegative (13% of the symptomatic group) for IgG in the early convalescent phase.
Clinical
Tan T, Khoo B, Mills EG, et al. Association between high serum total cortisol concentrations and mortality from COVID-19. Lancet Diabetes and Endocrinology 2020, June 18. Full-text: https://doi.org/10.1016/S2213-8587(20)30216-3
In 535 patients, multivariable analysis showed that a doubling of cortisol concentration was associated with a significant 42% increase in the hazard of mortality, after adjustment for age, the presence of comorbidities, and laboratory tests. Cortisol seemed to be a better independent predictor than other laboratory markers associated with COVID-19, such as CRP, D-dimer, and neutrophil to leukocyte ratio.
Hubiche T, Le Duff F, Chiverini C, et al. Negative SARS-CoV-2 PCR in patients with chilblain-like lesions. Lancet Inf Dis 2020, Published:June 18, 2020. Full-text: https://doi.org/10.1016/S1473-3099(20)30518-1
Among 40 young patients with chilblain lesions and with suspected SARS-CoV-2 infection, COVID-19 serology was positive in 12 (30%) patients. All had negative PCR results at the time of presentation, suggesting that in young patients SARS-CoV-2 is completely suppressed before a humoral immune response is induced.
Comorbidities
Arlet JB, de Luna G, Khimoud D, et al. Prognosis of patients with sickle cell disease and COVID-19: a French experience. Lancet Hematology 2020, June 18. Full-text: https://doi.org/10.1016/S2352-3026(20)30204-0
Results of this French cohort of 83 patients suggest that COVID-19, even if potentially severe, does not seem to carry an increased risk of morbidity or mortality in patients with sickle cell disease, as most patients worldwide have the SS/Sβ0 genotype and are younger than 45 years.
Zeidan AM, Poddu P, Patniak MM, et al. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. Lancet Hematology 2020, June 18. Full-text: https://doi.org/10.1016/S2352-3026(20)30205-2
This article summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. It also offers a consensus on clinical practice guidance for optimal care in both the university and community health-care settings.
Treatment
Dao W, Zhang W, Zhang B. Structure-based design of antiviral drug candidates targeting the SARS-CoV-2 main protease. Science 19 Jun 2020. Vol. 368, Issue 6497, pp. 1331-1335. Full-text: https://doi.org/10.1126/science.abb4489
HIV protease inhibitors (PIs) such as darunavir or lopinavir probably don’t work. These authors have developed better ones, based on analyzing the structure of the Mpro active site. Both PIs strongly inhibited the activity of Mpro and showed good antiviral activity in cell culture. Compound 11a had good pharmacokinetic properties and low toxicity when tested in mice and beagle dogs, suggesting that it is a promising drug candidate.