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By Christian Hoffmann &
Bernd S. Kamps
15 August
Virology
Sun Z, Cai X, Gu C et al. Survival of SARS-COV-2 under liquid medium, dry filter paper and acidic conditions. Cell Discov 6, 57 (2020). Full-text: https://doi.org/10.1038/s41421-020-00191-9
Zhenghong Yuan, Youhua Xie, Di Qu and colleagues show that SARS-COV-2 can survive for 3 days in liquid medium or on dry filter paper. At high titers, the virus might also be able to survive under acidic conditions that mimic the gastric environment.
Immunology
Zhang F, Gan R, Zhen Z, et al. Adaptive immune responses to SARS-CoV-2 infection in severe versus mild individuals. Sig Transduct Target Ther 5, 156 (2020). Full-text: https://doi.org/10.1038/s41392-020-00263-y
Zhiwei Huang and colleagues profiled adaptive immune cells of PBMCs from recovered COVID-19 patients with varying disease severity using single-cell RNA and TCR/BCR V(D)J sequencing. They observed multiple differences between severe patients (SPs) and mild/moderate patients (MPs) including TCR and BCR clonal expansion and diversity, isotype distribution of antibody sequences, V(D)J gene segments usage preference, and dysregulation of peripheral blood lymphocyte subsets. Higher levels of BCR clonal expansion and B-cell activation are present in the SP group, indicating that a more robust humoral immune response happens in severe infection. The authors conclude that SPs and MPs may experience different cellular and humoral immune responses, likely related to different degrees of disease severity.
Vaccine
Xia S, Duan K, Zhang Y, et al. Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes: Interim Analysis of 2 Randomized Clinical Trials. JAMA 2020, published 13 August. Full-text: https://doi.org/10.1001/jama.2020.15543
An Pan, Xiaoming Yang and colleagues provide the first interim safety, tolerability, and immune response results for a β-propiolactone–inactivated whole-virus vaccine adjuvanted in 0.5 mg of aluminum hydroxide. The incidence rate of adverse reactions in the current study (15.0% among all participants) was not significantly different between the vaccine groups and the active control (alum) groups; it was also lower compared with results of other SARS-CoV-2 candidate vaccines. The neutralizing antibody response suggested that the inactivated vaccine may effectively induce antibody production, but the optimal interval between injections and times of booster injections of the inactivated vaccine remains unclear. In the discussion, find more about ADE and VAERD. See also the comment by Mark Mulligan: An Inactivated Virus Candidate Vaccine to Prevent COVID-19. JAMA 2020, published 13 August 13. Full-text: https://doi.org/10.1001/jama.2020.15539
Clinical
Alwan NA. A negative COVID-19 test does not mean recovery. Nature 2020, published 11 August. Full-text: https://www.nature.com/articles/d41586-020-02335-z
Data from a UK smartphone app for tracking symptoms suggests that at least one in ten of those reporting are ill for more than three weeks. Clinicians have an idea of who is at increased risk of dying from COVID, but they don’t know who is more likely to experience prolonged ill health following symptomatic, or even asymptomatic, SARS-CoV-2 infection. Nisreen Alwan insists that we need a new ‘recovery’ definition. That definition must include duration, severity and fluctuation of symptoms, as well as functionality and quality of life. The narrow narrative of death as the only bad outcome from COVID needs broadening to include people becoming less healthy, less capable, less productive and living with more pain.
Treatment
Biran N, Ip A, Ahn J, et al. Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study. Lancet Rheumatol 2020, published 14 August. Full-text: https://doi.org/10.1016/S2665-9913(20)30277-0
Noa Biran, Andrew Ip and colleagues did a retrospective observational cohort study with 764 COVID-19 patients who required support in the ICU. In the final analysis, they included 210 patients who received tocilizumab (400 mg in a one-time scheme, with a second dose permitted at the point of worsening oxygenation) and 420 who did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (hazard ratio 0.64, 95% CI 0.47–0.87; p = 0.0040). Results of ongoing randomized controlled trials are awaited. See also the comment: Campochiaro C, Dagna L. The conundrum of interleukin-6 blockade in COVID-19. Lancet Rheumatol 2020, published 14 August. Full-text: https://doi.org/10.1016/S2665-9913(20)30287-3, where Corrado Campochiaro and Lorenzo Dagna superbly summarize the questions for the future: “Have we correctly identified the right COVID-19 population for treatment with anti-inflammatory drugs? Are systemic inflammatory markers reliable enough for selecting patients with hyperinflammation? Do increased concentrations of a specific cytokine imply that its neutralization will be effective in COVID-19? What is the degree of immunosuppression we are aiming for in SARS-CoV-2 infection?”
Co-morbidities
Solomon DA, Sherman AC, Kanjilal S. Influenza in the COVID-19 Era. Jama 2020, published 14 August. Full-text: https://doi.org/10.1001/jama.2020.14661
In some years and in some countries, the annual influenza epidemic can result in tens of thousands in deaths. Now clinicians face a second respiratory virus associated with morbidity and mortality several-fold higher than that of influenza. In this short Insight article, Daniel Solomon and colleagues stress the importance of widespread implementation of seasonal influenza vaccination and preservation of non-pharmacologic interventions (such as mandatory face coverings in public, closure of schools and retail spaces, and restrictions on movement) until community immunity is achieved through an effective SARS-CoV-2 vaccine and/or natural infection.
Society
Kroshus E, Hawrilenko M, Tandon PS, Christakis DA. Plans of US Parents Regarding School Attendance for Their Children in the Fall of 2020: A National Survey. JAMA Pediatr 2020, published 14 August. Full-text: https://doi.org/10.1001/jamapediatrics.2020.3864
What do parents plan to do about school attendance in the coming fall, and what factors are influencing these plans? These are the questions Emily Kroshus and colleagues addressed in their cross-sectional survey study in June 2020. 31% of a sample of 730 parents indicated they would probably or definitely keep their child home this fall, and 49% indicated that they would probably or definitely send their child to school this fall. The authors conclude that schools should act soon to address parental concerns and provide options for parents who decide to keep their child home. See also the Editorial by Nathaniel Beers and colleagues: Dooley DG, Simpson JN, Beers NS. Returning to School in the Era of COVID-19. JAMA Pediatr 2020, published 14 August. Full-text: https://doi.org/10.1001/jamapediatrics.2020.3874
French
Carpentier A, Pommier F. Covid-19 : comment certains malades deviennent des supercontaminateurs. Le Monde 2020, published 15 August. Audio link: https://www.lemonde.fr/videos/video/2020/08/15/covid-19-comment-certains-malades-deviennent-des-supercontaminateurs_6049016_1669088.html
If you understand French, listen to this short audio (7:28) about super-spreaders, R0 (R naught) and the dispersion coefficient K. By Arthur Carpentier and Félix Pommier.