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By Christian Hoffmann &
Bernd S. Kamps
14 August
Epidemiology
Ward H, Atchison C, Whitaker M, et al. Antibody prevalence for SARS-CoV-2 following the peak of the pandemic in England: REACT2 study in 100,000 adults. Imperial College London 2020. Pre-print: https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/Ward-et-al-120820.pdf
By the end of June, an estimated 3.4 million people, or slightly under 6% of the UK population, had antibodies to the virus and had likely had COVID-19. London had the highest numbers (13%), while the South West had the lowest (3%). This is the result of the REACT (REal Time Assessment of Community Transmission) study, by Helen Ward, Paul Elliott and colleagues from the Imperial College London, using antibody finger-prick self-testing at home to track past infections. Black, Asian and minority ethnic (BAME) individuals were between two and three times as likely to have had SARS-CoV-2 infection compared to white people. An interesting trend: young people aged 18-24 had the highest rates (8%), while older adults aged 65 to 74 were least likely to have been infected (3%).
Transmission
Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020 Aug 13. PubMed: https://pubmed.gov/32790510. Full-text: https://doi.org/10.7326/M20-2671
Chen Mao and colleagues traced 3410 close contacts of 391 SARS-CoV-2 infected index cases between 13 January and 6 March 2020. 127 contacts (3.7%) were secondarily infected. Compared with the household setting (10.3%), the secondary attack rate was lower for exposures in healthcare settings (1.0%) and on public transportation (0.1%). Interestingly, although not unexpectedly, the secondary attack rate increased with the severity of index cases, from 0.3% for asymptomatic to 3.3% for mild, 5.6% for moderate, and 6.2% for severe or critical cases. Index cases with expectoration were associated with higher risk for secondary infection (13.6% vs. 3.0% for index cases without expectoration).
Immunology
Sekine T, Perez-Potti A, Rivera-Ballesteros O, et al. Robust T cell immunity in convalescent individuals with asymptomatic or mild COVID-19. Cell 2020, published 14 August. Full-text: https://www.cell.com/cell/fulltext/S0092-8674(20)31008-4
SARS-CoV-2-specific memory T cells will probably be critical for long-term immune protection. In this Cell paper, Marcus Buggert and colleagues mapped the functional and phenotypic landscape of SARS-CoV-2-specific T cell responses in unexposed individuals, exposed family members, and individuals with acute or convalescent COVID-19. They found that 1) acute phase SARS-CoV-2-specific T cells display an activated cytotoxic phenotype; 2) vs broad and polyfunctional SARS-CoV-2-specific T cell responses in convalescent phase; and 3) SARS-CoV-2-specific T cell responses are detectable even in seronegative individuals. The fact that many individuals with asymptomatic or mild COVID-19, after SARS-CoV-2 exposure or infection, generated highly durable and functionally replete memory T cell responses, not uncommonly even in the absence of detectable humoral responses, suggests that natural exposure or infection could prevent recurrent episodes of severe COVID-19.
Treatment
Ledford H. Antibody therapies could be a bridge to a coronavirus vaccine — but will the world benefit? Nature 2020, published 11 August. Full-text: https://www.nature.com/articles/d41586-020-02360-y
Are monoclonal antibodies a bridging solution before the general availability of a vaccine? Heidi Lenford reminds us that monoclonals are complex and expensive to produce, leaving people from poor countries locked out.
Comorbidities
Passamonti F, Cattaneo C, Arcaini L, et al. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol 2020, published 13 August. Full-text: DOI:https://doi.org/10.1016/S2352-3026(20)30251-9
In this 74-author study from Italy, Francesco Passamonti and colleagues report a retrospective study which included patients with a diagnosis of a hematological malignancy between 25 February and 18 May, 2020, with laboratory-confirmed and symptomatic COVID-19. 198 (37%) of 536 patients died. Progressive disease status, diagnosis of acute myeloid leukemia, indolent non-Hodgkin lymphoma, aggressive non-Hodgkin lymphoma or plasma cell neoplasms were associated with worse overall survival. See also the comment by Samuel Rubinstein and Jeremy Warner: COVID-19 and haematological malignancy: navigating a narrow strait. Lancet Haematol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2352-3026(20)30252-0
Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2213-8587(20)30271-0
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Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol 2020, published 13 August. Full-text: https://doi.org/10.1016/S2213-8587(20)30272-2
A double hit by Jonathan Valabhji and colleagues! In the first paper (Holman et al.), the authors did a population-based cohort study of people with diabetes in the UK. Between 16 February and 11 May 2020, 1,604 people with type 1 diabetes and 36,291 people with type 2 diabetes died from all causes. Of these deaths, 464 in people with type 1 diabetes and 10,525 in people with type 2 diabetes were defined as COVID-19 related, of which 289 (62.3%) and 5,833 (55.4%), respectively, occurred in people with a history of cardiovascular disease or with renal impairment (eGFR < 60 mL/min per 1.73 m2). Increased COVID-19-related mortality also corresponded with glycemic control and body mass index.
In the second paper (Barron et al.), the authors did a whole-population study assessing risks of in-hospital death with COVID-19 between 1 March and 11 May 2020. Among the 23,698 in-hospital COVID-19-related deaths, a third occurred in people with diabetes: 7,434 (31.4%) in people with type 2 diabetes, 364 (1.5%) in those with type 1 diabetes, and 69 (0.3%) in people with other types of diabetes.
Tartof SY, Qian L, Hong V, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med. 2020 Aug 12. PubMed: https://pubmed.gov/32783686. Full-text: https://doi.org/10.7326/M20-3742
In this retrospective cohort study, Sara Tartof and colleagues determined the adjusted effect of body mass index (BMI), associated comorbidities, sociodemographic factors, and other factors on risk for death due to COVID-19. Compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 and 4.18, respectively. This risk was most striking among those aged 60 years or younger and men. The authors found no increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics. See also the comment by David Kass: COVID-19 and Severe Obesity: A Big Problem? Ann Intern Med. 2020 Aug 12. PubMed: https://pubmed.gov/32783685. Full-text: https://doi.org/10.7326/M20-5677
Collateral Effects
McGuckin B. Dental Triaging: past, present and future. BDJ In Pract 2020;33: 22–23. Full-text: https://doi.org/10.1038/s41404-020-0472-y
Does a ‘lost’ upper anterior crown constitute a dental emergency and require an urgent non-scheduled appointment? It used to be, but in COVID times, it isn’t anymore, despite the emotional distress for the patient. Read these and other considerations in a short overview of dental triage yesterday, today and tomorrow. The next time you go to the dentist, you’ll remember Bronagh McGuckin.
Poisoning
Yip L, Bixler D, Brooks DE, et al. Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol – Arizona and New Mexico, May-June 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1070-1073. PubMed: https://pubmed.gov/32790662. Full-text: https://doi.org/10.15585/mmwr.mm6932e1
Don’t ingest alcohol-based hand sanitizer products, remind Luke Yip and colleagues after 15 cases of poisoning and four deaths. We would add: And don’t inject disinfectants – they don’t “knock it out in a minute”.
Education
Rubin EJ, Baden LR, Morrissey S. Building a Successful Public Health Response to Covid-19. Audio interview (25:18). N Engl J Med 2020; 383:e67. Access: https://www.nejm.org/doi/full/10.1056/NEJMe2027574
The editors discuss the varied use of public health measures to control SARS-CoV-2 transmission in countries around the world, as well as recent vaccine developments.
Beyond your plate borders
Hall S. Pluto’s dark side spills its secrets – including hints of a hidden ocean. Nature. 2020 Jul;583(7818):674-678. PubMed: https://pubmed.gov/32728264. Full-text: https://doi.org/10.1038/d41586-020-02082-1
Award-winning science journalist Shannon Hall introduces you to the dark side of Pluto. Listen also to the audio long-read (18:10): https://media.nature.com/original/magazine-assets/d41586-020-02327-z/d41586-020-02327-z_18253418.mpga
Spanish
If you read Spanish, read Cómo mejorar la ventilación en interiores y otros cinco retos prioritarios frente a la segunda ola. El País 2020, published 14 August. Full-text: https://elpais.com/ciencia/2020-08-14/como-mejorar-la-ventilacion-en-interiores-y-otros-cinco-retos-prioritarios-frente-a-la-segunda-ola.html
Javier Salas explica que la ciencia todavía tiene que dar respuestas a cuestiones como el papel de los niños y cómo se producen la mayoría de los contagios.