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By Christian Hoffmann &
Bernd S. Kamps

29 April

Epidemiology

Baggett TP, Keyes H, Sporn N, Gaeta JM. Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston. JAMA. 2020 Apr 27. PubMed: https://pubmed.gov/32338732 . Full-text: https://doi.org/10.1001/jama.2020.6887

Between March 28, 2020, and April 1, 2020, authorities became aware of a few cases in a single large homeless shelter in Boston, prompting SARS-CoV-2 testing of all remaining shelter residents. In total, 147/408 (36%) were positive. Of note, 88% had no symptoms and no fever at the time of diagnosis.

 

Transmission

Liu Y, Ning Z, Chen Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020 Apr 27. PubMed: https://pubmed.gov/32340022 . Full-text: https://doi.org/10.1038/s41586-020-2271-3  

Toilets are the hot spots! Important study, sampling airborne SARS-CoV-2 and its aerosol deposition at 30 sites in two designated hospitals and public areas in Wuhan in February/March. The concentration in isolation wards and ventilated patient rooms was very low, but it was elevated in the patients´ toilet areas. Levels were undetectable in the majority of public areas outside the hospitals and was undetectable except in two areas prone to crowding. Room ventilation, open space, sanitization of protective apparel as well as proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols.

 

Ferrazzi E, Frigerio L, Savasi V, et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020 Apr 27. PubMed: https://pubmed.gov/32339382 . Full-text: https://doi.org/10.1111/1471-0528.16278

Vaginal delivery is associated with low risk of intrapartum infection. Of 42 women with COVID-19 (19 with pneumonia), 24 delivered vaginally. Only 1/24 new-born had a positive test. Two women transmitted the virus while breastfeeding without a mask.

 

Diagnostics

Long Q, Liu B, Deng H et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med (2020). Full-text: https://doi.org/10.1038/s41591-020-0897-1

One of the largest study to date, reporting on acute antibody responses (using magnetic chemiluminescence enzyme immunoassay) in 285 patients (mostly non-severe COVID-19, 39 treated at ICU). Within 19 days after symptom onset, 100% of patients tested positive for antiviral IgG. Seroconversion for IgG and IgM occurred simultaneously or sequentially. Both IgG and IgM titers plateaued within 6 days after seroconversion. The median day of seroconversion for both IgG and IgM was 13 days post symptom onset. No association between plateau IgG levels and the clinical characteristics of the patients was found.

 

Clinical

Oxley J, Mocco J, Majidi S, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med, April 28, 2020. Full-text: https://www.nejm.org/doi/full/10.1056/NEJMc2009787

Five cases of large-vessel stroke in younger patients (age 33-49, 2 without any risk factors) who presented in New York City. By comparison, every 2 weeks over the previous 12 months, on average 0.73 patients younger than 50 years of age with large-vessel stroke had been treated.

 

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Apr 27. PubMed: https://pubmed.gov/32339221 . Full-text: https://doi.org/10.1182/blood.2020006000

Excellent review of coagulation abnormalities that occur in association with COVID-19, and clinical management questions likely to arise. The initial coagulopathy of COVID-19 presents with prominent elevation of D-dimer and fibrin/fibrinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time, and platelet counts are relatively uncommon. Coagulation test screening, including the measurement of D-dimer and fibrinogen levels, is suggested. Current data do not suggest the use of full intensity anticoagulation doses unless otherwise clinically indicated.

 

Comorbidities

De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med, April 28, 2020. Full-text: https://doi.org/10.1056/NEJMc2009166

Authors report a significant decrease in acute coronary syndrome-related hospitalization rates across several cardiovascular centers in northern Italy during the early days of the outbreak.

 

Castiglion V, Chiriacò M, Emdin M, et al. Statin therapy in COVID-19 infection. European Heart Journal Cardiovascular Pharmacotherapy, 2020, 29 April. Full-text: https://doi.org/10.1093/ehjcvp/pvaa042

Brief review. Adjuvant treatment and continuation of pre-existing statin therapy could improve the clinical course of patients with COVID-19, either by their immunomodulatory action or by preventing cardiovascular damage.

 

Procedures

Feldman O, Meir M, Shavit D, Idelman R, Shavit I. Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment. JAMA. 2020 Apr 27. PubMed: https://pubmed.gov/32338711 . Full-text: https://doi.org/10.1001/jama.2020.6633

Interesting simulation experiment. Authors used adult and pediatric manikins and a fluorescent marker to visualize deposition of simulated exhaled respiratory secretions and material onto HCWs performing or assisting in endotracheal intubation procedures. HCWs wore N95 respirators, eye protection, isolation gowns, and gloves. Fluorescent markers were found on the uncovered facial skin (7/8), hair, and shoes of the HCWs, suggesting that the current recommendations may not fully prevent exposures. Clothing that covers all skin may further diminish exposure risk.

 

Weissman DN, de Perio MA, Radonovich LJ Jr. COVID-19 and Risks Posed to Personnel During Endotracheal Intubation. JAMA. 2020 Apr 27. PubMed: https://pubmed.gov/32338710 . Full-text: https://doi.org/10.1001/jama.2020.6627

Brief review on current knowledge on the risk during intubation, discussing the study above. Fundamental research is needed to better inform recommendations. A better understanding of the duration of infectivity and level of risk posed by airborne SARS-CoV-2 would help to guide recommendations for respiratory protection.