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By Christian Hoffmann &
Bernd S. Kamps

7 May

Epidemiology

Persad G, Emanuel EJ. The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”).  JAMA. Published online May 6, 2020. Full-text: https://jamanetwork.com/journals/jama/fullarticle/2765836

Chile, Germany and the UK, among others, have indicated they will implement certifications that a person has contracted and recovered from COVID-19. According to the authors, immunity-based licenses require careful implementation to be ethical in practice. These “licenses” may allow immune people to engage in economic activity and safer care for vulnerable populations. However, major concerns remain as community licensing could stigmatize people, undermining the value of equal treatment. Businesses may use unregulated evidence of immunity, such as test results, or use assumptions about immunity or vulnerability that are likely to be arbitrary and biased.

 

Virology

Watanabe Y, Allen JD, Wrapp D, McLellan JS, Crispin M. Site-specific glycan analysis of the SARS-CoV-2 spike. Science. 2020 May 4. PubMed: https://pubmed.gov/32366695. Full-text: https://doi.org/10.1126/science.abb9983

The surface of the envelope spike is dominated by host-derived glycans. These glycans facilitate immune evasion by shielding specific epitopes from antibody neutralization. The SARS-CoV-2 S gene encodes 22 N-linked glycan sequons per protomer. Using a site-specific mass spectrometric approach, authors reveal these glycan structures on a recombinant SARS-CoV-2 S immunogen.

 Transmission

Liao L, Xiao W, Zhao M, et al. Can N95 Respirators Be Reused after Disinfection? How Many Times? ACS Nano. 2020 May 5. PubMed: https://pubmed.gov/32368894. Full-text: https://doi.org/10.1021/acsnano.0c03597

How can we re-use N95 respirators? Heat is better than sun or vapors. At 85°C, 50 cycles of heat treatment did not significantly change filtration efficiency. At low humidity and temperatures up to 100 degrees, 20 cycles were possible. Ultraviolet irradiation was a secondary choice, which was able to withstand 10 cycles of treatment and showed small degradation by 20 cycles. However, UV can potentially impact the material strength. Treatments involving liquids and vapors require caution, as steam, alcohol, and household bleach all may lead to degradation of the filtration efficiency.

 

Diagnostics

Sethuraman N, Jeremiah SS, Akihide Ryo A, et al. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA May 6, 2020. Full-text: https://jamanetwork.com/journals/jama/fullarticle/2765837

Using available evidence, a clinically useful timeline of diagnostic markers for detection of COVID-19 is devised.

 

Clinical

Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020 May 5. PubMed: https://pubmed.gov/32369666. Full-text: https://doi.org/10.1111/jth.14888

The next study reporting on an incredibly high number of venous thromboembolism (VTE). In this single-center study from Amsterdam on 198 hospitalized cases, the cumulative incidence of VTE at 7, 14, and 21 days were 16%, 33% and 42%. In 74 ICU Patients, cumulative incidence was 59% at 21 days, despite thrombosis prophylaxis. The authors have changed their practice during the follow-up period by performing screening compression ultrasound in the ICU every 5 days.

 

Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 May 4. PubMed: https://pubmed.gov/32367170. Full-text: https://doi.org/10.1007/s00134-020-06062-x

Same idea: In this prospective study from France, 64/150 (43%) patients were diagnosed with clinically relevant thrombotic complications. Authors argue for higher anticoagulation targets in critically ill patients.

 

Ahmed MZ, Khakwani M, Venkatadasari I, et al. Thrombocytopenia as an initial manifestation of Covid-19; Case Series and Literature review. Br J Haematol. 2020 May 5. PubMed: https://pubmed.gov/32369609. Full-text: https://doi.org/10.1111/bjh.16769

Three patients, two of them with hemorrhagic manifestation and severe thrombocytopenia responded to IVIG fairly quickly with a sustained response over weeks.

 

Martin Carreras-Presas C, Amaro Sanchez J, Lopez-Sanchez AF, Jane-Salas E, Somacarrera Perez ML. Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Dis. 2020 May 5. PubMed: https://pubmed.gov/32369674. Full-text: https://doi.org/10.1111/odi.13382

Three cases of COVID-19-associated ulcers in the oral cavity, with pain, desquamative gingivitis, and blisters.

 

Treatment

Wang C, Li W, Drabek D, et al. A human monoclonal antibody blocking SARS-CoV-2 infection. Nat Commun. 2020 May 4;11(1):2251. PubMed: https://pubmed.gov/32366817. Full-text: https://doi.org/10.1038/s41467-020-16256-y

The first report of a human monoclonal antibody that neutralizes SARS-CoV-2. 47D11 binds a conserved epitope on the spike RBD explaining its ability to cross-neutralize SARS-CoV and SARS-CoV-2, using a mechanism that is independent of receptor-binding inhibition. This antibody could be useful for development of antigen detection tests and serological assays targeting SARS-CoV-2.

 

Cao B, Zhang D, Wang C. A Trial of Lopinavir-Ritonavir in Covid-19. Reply. N Engl J Med. 2020 May 5;382(21). PubMed: https://pubmed.gov/32369286. Full-text: https://doi.org/10.1056/NEJMc2008043#sa6

Interesting discussion about the results of the large open-label randomized trial which was published in March. In this trial, administration of lopinavir/r did not result in a shorter time until clinical improvement compared to placebo. Bottom line of most comments: “absence of evidence is not evidence of absence”. Lopinavir/r may still be a potential therapeutic agent against COVID-19, especially when given earlier.