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By Christian Hoffmann &
Bernd S. Kamps

11 May

Epidemiology

Tian H, Liu Y, Li Y, et al. An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China. Science. 2020 May 8;368(6491):638-642. PubMed: https://pubmed.gov/32234804. Full-text: https://doi.org/10.1126/science.abb6105

Quantitative analysis of the impact of control measures between 31 December 2019 and 19 February 2020. Travel restrictions in and out of Wuhan were too late to prevent the spread of the virus. However, measures such as closing citywide public transport and entertainment venues and banning public gatherings combined to avert hundreds of thousands of cases of infection.

 

Virology

Yuan M, Wu NC, Zhu X, et al. A highly conserved cryptic epitope in the receptor binding domains of SARS-CoV-2 and SARS-CoV. Science. 2020 May 8;368(6491):630-633. PubMed: https://pubmed.gov/32245784. Full-text: https://doi.org/10.1126/science.abb7269

Molecular insights into how SARS-CoV-2 can be targeted by the humoral immune response. The authors determined the crystal structure of CR3022, a neutralizing antibody previously isolated from a convalescent SARS patient, in complex with the receptor binding domain of the SARS-CoV-2 spike protein.

 

Zhou H, Chen X, Hu T. A novel bat coronavirus closely related to SARS-CoV-2 contains natural insertions at the S1/S2 cleavage site of the spike protein. Current Biology 2020, May 10. Full-text: https://doi.org/10.1016/j.cub.2020.05.023

A novel bat-derived coronavirus was identified from a metagenomics analysis of samples from 227 bats collected from Yunnan Province between May and October 2019. Notably, RmYN02 shares 93.3% nucleotide identity with SARS-CoV-2 at the scale of the complete genome and 97.2% identity in the 1ab gene, in which it is the closest relative of SARS-CoV-2 reported to date. However, RmYN02 showed low sequence identity (61.3%) in the receptor binding domain and might not bind to ACE2.

 

Enserink M, Cohen J. Fact-checking Judy Mikovits, the controversial virologist attacking Anthony Fauci in a viral conspiracy video. Science 2020, May 8. Full-text: https://www.sciencemag.org/news/2020/05/fact-checking-judy-mikovits-controversial-virologist-attacking-anthony-fauci-viral

The pandemic has resulted in numerous conspiracy theories and misinformation, mainly spread through social media. WHO has declared an “infodemic” of incorrect information about the virus, which poses risks to global health. In a video that has exploded on social media in the past few days, virologist Judy Mikovits claims the virus is being wrongly blamed for many deaths. Fortunately, there are intelligent science journalists who take the time to refute this crap.

 

Diagnostics

Sama IE, Ravera A, Santema BT, et al. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin–angiotensin–aldosterone inhibitors. European Heart Journal 2020, May 10. Full-text: https://doi.org/10.1093/eurheartj/ehaa373

The first substantial study to examine the association between plasma ACE2 concentrations and the use of RAAS blockers in patients with cardiovascular disease. Authors measured ACE2 concentrations in 1485 men and 537 women with heart failure (index cohort, 11 European countries). Results were validated in 1123 men and 575 women (validation cohort from Scotland). In both cohorts, plasma concentrations of ACE2 were markedly higher in men than in women, but not the use of either an ACE inhibitor or an ARB. Data might explain the higher fatality rate of COVID-19 in men, but do not support the hypothesis that RAAS blockers increase the vulnerability for COVID-19.

 

Clinical

Parohan M, Yaghoubi S, Seraj A. Liver injury is associated with severe Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of retrospective studies. Hepatol Res. 2020 May 9. PubMed: https://pubmed.gov/32386449. Full-text: https://doi.org/10.1111/hepr.13510

Meta-analysis of 20 retrospective studies with 3,428 COVID-19 infected patients (1,455 severe cases and 1,973 mild cases). Higher serum levels of ALT, AST, bilirubin and lower serum levels of albumin were associated with a significant increase in the severity of COVID-19.

 

Draulans D. Scientist who fought Ebola and HIV reflects on facing death from COVID-19. Sciencemag 2020, May 8. Full-text: https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19

Peter Piot, 71, one of the discoverers of the Ebola virus in 1976, former UNAIDS director and coronavirus adviser to European Commission President Ursula von der Leyen, discusses a severe case of COVID-19 occurring in March: his own. Interesting reflections on the disease and on death.

 

Comorbidities

Härter G, Spinner CD, Roider J, at al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 2020, May 11. https://doi.org/10.1007/s15010-020-01438-z. Full-text https://link.springer.com/article/10.1007/s15010-020-01438-z.

The first larger case series in HIV-infected patients. No excess morbidity and mortality was found among symptomatic COVID-19 cases. As the majority (22/33) was treated with tenofovir, including those developing severe or critical disease, data indicate no or only minimal clinical effect of tenofovir against SARS-CoV-2. Four patients also were on darunavir when they developed COVID-19 symptoms.

 

Xiong F, Tang H, Liu L, et al. Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China. J Am Soc Nephrol. 2020 May 8. PubMed: https://pubmed.gov/32385130. Full-text: https://doi.org/10.1681/ASN.2020030354

First large (multicenter retrospective) study about epidemiologic and clinical characteristics of patients undergoing hemodialysis with COVID-19. There were 101 mild/moderate and 30 severe/critical cases. Of note, 28 (21%) were asymptomatic over the whole course of the disease and were diagnosed only by universal screening. Morbidity was around 2% and only 52% of patients experienced fever.

 

Treatment

Spinelli FR, Conti F, Gadina M. HiJAKing SARS-CoV-2? The potential role of JAK inhibitors in the management of COVID-19. Sci Immunol. 2020 May 8;5(47). PubMed: https://pubmed.gov/32385052. Full-text: https://doi.org/10.1126/sciimmunol.abc5367

Targeting IL-6 and other cytokines with JAK-dependent signaling is one way to restrain the excessive level of cytokine signaling. JAK kinase inhibitors are being investigated as a way of managing the cytokine storm in severe COVID-19 patients. However, this well-balanced review also discusses potential concerns on side effects, such as the reduction of NK cells or thromboembolic risks seen with baricitinib and tofacitinib treatment.

 

Mojoli F, Mongodi S, Orlando A, et al. Our recommendations for acute management of COVID-19. Crit Care. 2020 May 8;24(1):207. PubMed: https://pubmed.gov/32384909. Full-text: https://doi.org/10.1186/s13054-020-02930-6

Some helpful (and very practical) clinical management suggestions, derived from the direct experience of Italian physicians.