Top 10: December 12


Amendola A, Bianchi S, Gori M, Colzani D, Canuti M, Borghi E, et al. Evidence of SARS-CoV-2 RNA in an oropharyngeal swab specimen, Milan, Italy, early December 2019. Emerg Infect Dis 2020, published 8 December. Full-text:

Elisabetta Tanzi, Antonella Amendola and colleagues from the University of Milan identified SARS-CoV-2 RNA in an oropharyngeal swab specimen collected from a child with suspected measles in early December 2019, more than two months before the first identified SARS-CoV-2 case in Italy. The authors cautiously conclude that “long-term, unrecognized spread of SARS-CoV-2 in northern Italy would help explain, at least in part, the devastating impact and rapid course of the first wave of COVID-19 in Lombardy.”


Picture: Lombardy (


Pouwels KB, House T, Pritchard E, et al. Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey. Lancet Public Health 2020, published 10 December. Full-text:

Seroprevalence for SARS-CoV-2 continues to be low in England. After randomly collecting samples from individuals aged 2 years and older living in private households in England, the percentage of people testing positive for SARS-CoV-2 initially decreased between April 26 and June 28, 2020, from 0·40% to 0·06%, followed by low levels during July and August, 2020, before substantially increasing at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Age (young adults, particularly those aged 17–24 years) was an important initial driver in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. More than half of infections were in asymptomatic individuals.



Siva N. Experts call to include prisons in COVID-19 vaccine plans. Lancet 2020, published 12 December. Full-text:

In any given week more than 200.000 people are booked into jails across the USA, and the same number leave each week. US prisons are SARS-CoV-2 hubs, says the author, “people go to court, go back to their prison, and often people get moved to another prison once they have been sentenced.” Consider prisoners an important group in vaccine prioritization.



Rubin EJ, Longo DL. SARS-CoV-2 Vaccination — An Ounce (Actually, Much Less) of Prevention (Editorial). N Engl J Med 2020, published 10 December. Full-text:

Before December 2020, no existing vaccines had been shown to be effective against infection with any beta-coronavirus; strategies to increase the speed of vaccine development had never been tested; and no vaccines based on mRNA technologies had yet been approved. Now, with the paper by Polack et al. that we presented yesterday, all this has been done and the NEJM editors qualify it as a triumph that holds the promise of saving uncounted lives. Rightly, they continue questioning: “Will unexpected safety issues arise when the number grows to millions and possibly billions of people? Will side effects emerge with longer follow-up? Implementing a vaccine that requires two doses is challenging. What happens to the inevitable large number of recipients who miss their second dose? How long will the vaccine remain effective? Does the vaccine prevent asymptomatic disease and limit transmission? And what about the groups of people who were not represented in this trial, such as children, pregnant women, and immunocompromised patients of various sorts?” The story will continue…


Singh JA, Upshur EG. The granting of emergency use designation to COVID-19 candidate vaccines: implications for COVID-19 vaccine trials. Lancet Infect Dis 2020, published 8 December. Full-text:


In the next weeks, SARS-CoV-2 candidate vaccines will be granted emergency use authorizations after only months of clinical experience. The authors caution that emergency use designations could inadvertently threaten ongoing vaccine research that is yet to define immunological correlates of protection against COVID-19, which could vary according to the vaccine platform, individual characteristics, age groups, and population subset.



Topol EJ. Is my cough COVID-19? Lancet 2020, published 12 December. Full-text:

Imagine that even if you have no symptoms of COVID-19, the sound of your forced cough transmitted to your smartphone or smart speaker then processed by an algorithm, could provide a 98·5% accurate diagnosis. Here, Eric Topol describes this science fiction scenario while commenting on a study by Laguarta et al. [Laguarta J, Hueto F, Subirana B. Covid-19 artifical intelligence diagnosis using only cough recordings. IEEE Open J Eng Med Biol 2020, published 29 September. Full-text:], who trained their MIT Open Voice model and built a data collection pipeline of COVID-19 cough recordings through their website ( between April and May 2020 and created the largest audio COVID-19 cough dataset reported to date with 5320 subjects. Result: COVID-19 sensitivity of 98,5% with a specificity of 94,2% (AUC: 0.97). For asymptomatic subjects it achieves sensitivity of 100% with a specificity of 83,2%.



Young TK, Shaw KS, Shah JK, et al. Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic. JAMA Dermatol 2020, published 9 December. Full-text:

In this case series of 25 hospitalized children (11 girls [44%]; median age, 3 years [range, 0,7-17 years]) with suspected MIS-C during the COVID-19 pandemic, Vikash Oza, Trevor Young and colleagues identify a wide spectrum of mucocutaneous findings. Although protean and transient in nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.


Ronchi A, Pietrasanta C, Zavattoni M, et al. Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy. JAMA Pediatr 2020, published 7 December. Full-text:

See also the comment by Kaufman DA, Puopolo M. Infants Born to Mothers With COVID-19—Making Room for Rooming-in. JAMA Pediatr 2020, published 7 December. Full-text:


Collateral Effects

Kapur N, Clements C, Appleby L, et al. Impact of the Covid-19 pandemic on the frequency of primary care-recorded mental illness and self-harm episodes in the UK: population-based cohort study of 14 million individuals. Lancet Psychiatry 2020, published 10 December. Full-text:

Self-harm often precedes suicide and can be used as a proxy outcome to identify how the pandemic has affected population mental health. As yet, there is no indication that the pandemic has caused self-harm rates to increase in the UK. The authors cite a study of 1500 general practices in the UK which found that the recorded incidence of self-harm was 38% lower in April, 2020, than the rate expected on the basis of previous years (Carr MJ, Steeg S, Webb RT, et al). Primary care contact for mental illness and self-harm before, during and after the peak of the COVID-19 pandemic in the UK: cohort study of 13 million individuals. Lancet Public Health (in press)). This decrease was particularly marked in women, people younger than 45 years, and those from the most deprived quintile of practices.



Nogrady B. How kids’ immune systems can evade COVID. Nature 2020, published 10 December. Full-text:

Young children account for only a small percentage of COVID-19 infections. Kids’ immune systems might simply be better equipped to eliminate SARS-CoV-2 than those of adults.



If you read Spanish, read Guimón P. Estados Unidos, a un paso de empezar la vacunación masiva contra la covid. El País 2020, published 11 December. Full-text:

El panel de expertos de la FDA recomienda la autorización del uso de emergencia de la vacuna de Pfizer-BioNTech, que se espera se realice en las próximas horas o días.



If you read French, read Covid-19 : le vaccin de Sanofi et GSK ne sera prêt qu’à la fin de 2021. Le Monde, published 11 December. Full-text :

Ce retard est dû à une réponse immunitaire insuffisante chez l’adulte. La disponibilité du vaccin est désormais attendue au quatrième trimestre 2021 si le plan de développement est terminé avec succès.



If you read German, read Schumann F, Simmank J. “Es gibt keinen Druck für das Virus, tödlicher zu werden” – Die Zeit 2020, published 10 December. Full-text:

Emma Hodcroft und Richard Neher verfolgen, wie Sars-CoV-2 mutiert. Im Virus-Erbgut lesen sie, wie gefährlich es wird, wo es herkam und warum es kaum verschwinden wird.


Copy-editor: Rob Camp


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