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By Christian Hoffmann &
Bernd S. Kamps

13 May

Voice: Google Cloud Text-to-Speech: US

Transmission

Hijnen D, Marzano AV, Eyerich K, et al. SARS-CoV-2 Transmission from Presymptomatic Meeting Attendee, Germany. Emerg Infect Dis. 2020 May 11;26(8). PubMed: https://pubmed.gov/32392125. Full-text: https://doi.org/10.3201/eid2608.201235

Wanna make sure that SARS-CoV-2 is transmitted with almost 100% efficacy? Then organize advisory boards or comparable settings: Eight dermatologists and 6 scientists from the same company attended a meeting at a hotel in Munich. The meeting was held in a room (≈70 m2) with conventional radiators; a U-shaped set-up of tables were separated by a central aisle >1 m wide. Refreshments were served buffet style in the same room 4 times during the day. After the 9.5 hours of discussions, participants had dinner in a nearby restaurant. Additional direct contacts were handshakes during welcome and farewells with a few short hugs without kisses and a 45 min. taxi ride with 3 participants. Results: The asymptomatic (!) index patient managed to infect at least 11/13 (!) participants. Note: The meeting was held on February 20; the country had <20 diagnosed cases at the time.

 

Wu J, Huang Y, Tu C, et al. Household Transmission of SARS-CoV-2, Zhuhai, China, 2020. Clin Infect Dis. 2020 May 11. PubMed: https://pubmed.gov/32392331. Full-text: https://doi.org/10.1093/cid/ciaa557

The next study on a relatively low transmission rate among household contacts. A total of 35 index cases from Zhuhai, China and their 148 household contacts were carefully analyzed, using questionnaires, active symptom monitoring and nasopharyngeal swabs. The second infection rate in the household context was 32% (95% CI 22-44%). Multivariate analysis showed that household contacts with underlying medical conditions, a history of direct exposure to Wuhan, and shared vehicle with an index patient were associated with higher susceptibility.  

 

Comorbidities

Alqahtani JS, Oyelade T, Aldhahir AM, et al. Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. PLoS One. 2020 May 11;15(5):e0233147. PubMed: https://pubmed.gov/32392262. Full-text: https://doi.org/10.1371/journal.pone.0233147

Time to quit smoking. Meta-analysis of 15 studies, including a total of 2,473 confirmed cases. COPD patients were at a higher risk of more severe disease (calculated RR 1.88). Current smokers were 1.45 times more likely to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 39%.

 

Paul S, Rausch CR, Jain N, et al. Treating Leukemia in the Time of COVID-19. Acta Haematol. 2020 May 11:1-13. PubMed: https://pubmed.gov/32392559. Full-text: https://doi.org/10.1159/000508199

This paper offers some recommendations on the optimization of leukemia management during high-risk COVID-19 periods. Instead of reducing patient access to specialized cancer centers and modifying therapies to ones with unproven curative benefit, there is more rationale for less intensive yet effective therapies that may require fewer visits to the clinic or hospitalizations.

 

Diagnostics

Kirkcaldy RD, King BA, Brooks JT. COVID-19 and Postinfection Immunity: Limited Evidence, Many Remaining Questions. JAMA. 2020 May 11. PubMed: https://pubmed.gov/32391855. Full-text: https://doi.org/10.1001/jama.2020.7869

After reading this viewpoint on the knowledge gaps on post-infection immunity, you will realize that any “COVID pass” would be about as accurate as issuing a certificate that she or he is “a kind person”. J

 

Fraser B. Chile plans controversial COVID-19 certificates. Lancet. 2020 May 9;395(10235):1473. PubMed: https://pubmed.gov/32386581. Full-text: https://doi.org/10.1016/S0140-6736(20)31096-5

However, Chile is poised to become the first country to provide COVID passes to people who have recovered from the infection. We’ll see how this works.

 

Treatment

Rodel F, Arenas M, Ott OJ, et al. Low-dose radiation therapy for COVID-19 pneumopathy: what is the evidence? Strahlenther Onkol. 2020 May 9. PubMed: https://pubmed.gov/32388805. Full-text: https://doi.org/10.1007/s00066-020-01635-7

Given the lack of effective pharmacological concepts, this review (re)considers historical reports on low-dose radiation therapy for pneumonia. Although these reports are of low-level evidence, they indicate effectiveness in the dose range between 0.3 and 1Gy, similar to more recent dose concepts in the treatment of inflammatory/degenerative benign diseases with, e.g., a single dose per fraction of 0.5Gy. The authors (known experts in the field) critically review the evidence for low-dose radiation treatment of COVID-19 pneumopathy and discuss whether it is worth investigating (answer: yes).

 

Rosenberg ES, Dufort EM, Udo T, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020 May 11. PubMed: https://pubmed.gov/32392282. Full-text: https://doi.org/10.1001/jama.2020.8630

The next large retrospective cohort study of 1,438 patients from a random sample of all admitted patients with COVID-19 in 25 hospitals in the New York metropolitan region between March 15 and 28. In adjusted Cox models, compared with patients receiving neither drug, there were no significant differences in mortality for patients receiving hydroxychloroquine (HCQ) + azithromycin, HCQ alone, or azithromycin alone. In logistic models, cardiac arrest was significantly more likely in patients receiving HCQ + azithromycin (adjusted OR 2.13). The main limitation was the observational design. HCQ patients were more sick and had more comorbidities – the key (and unresolved) question is whether adjustment was sufficient.

 

Pediatrics

Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020 May 11. PubMed: https://pubmed.gov/32392288. Full-text: https://doi.org/10.1001/jamapediatrics.2020.1948

Cross-sectional study including 48 children with COVID-19 (median age 13 years) admitted to 46 North American pediatric ICUs between March 14 and April 3, 2020. Forty patients (83%) had significant preexisting comorbidities and 18 (38%) required invasive ventilation. Targeted therapies were used in 28 patients (61%, mainly HCQ). Two patients (4%) died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation.

 

Andina D, Noguera-Morel L, Bascuas-Arribas M, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020 May 9. PubMed: https://pubmed.gov/32386460. Full-text: https://doi.org/10.1111/pde.14215

Retrospective review (from Spain) of 22 children and adolescents with acute chilblain-like lesions [chilblain: Frostbeule (de), engelure (fr), sabañón (es), gelone (it), frieira (pt), 冻疮 (cn)]. All patients had lesions clinically consistent with chilblains of the toes or feet, with 3 also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited. All cases showed spontaneous marked improvement or complete healing.