Copy-editor: Rob Camp
Duysburgh E, Mortgar L, Barbezange C, et al. Persistence of IgG response to SARS-CoV-2. Lancet Infect Dis December 17, 2020. Full-text: https://doi.org/10.1016/S1473-3099(20)30943-9
A rapid decline of SARS-CoV-2 IgG seropositivity or neutralizing capacity is unlikely: Among 74 (91%) HCW from Belgium who remained seropositive, median duration of antibody persistence (defined as the time between the day IgGs were last detected and the day of presumed onset of infection) is currently 168,5 (range 62–199) days. In total, 61 (82%) had neutralizing antibodies in their most recent IgG-positive serum sample.
Andersin EJ, Rouphael NG, Widge AT, et al. Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults. N Engl J Med, December 17 2020; 383:2427-2438. Full-text: https://doi.org/10.1056/NEJMoa2028436
Moderna’s messenger RNA vaccine (mRNA-1273) seems to work in older people. In this Phase I, dose-escalation, open label trial in 40 older adults, serum neutralizing activity was detected in all the participants by multiple methods after the second immunization. Solicited adverse events were dose-dependent and predominantly mild or moderate in severity.
Jones JM, Kracalik I, Rana MM, Nguyen A, Keller BC, Mishkin A, et al. SARS-CoV-2 infections among recent organ recipients, March–May 2020, United States. Emerg Infect Dis 2021. Full-text: https://doi.org/10.3201/eid2702.204046
In March 2020, US transplant centers began to report potential donor-derived SARS-CoV-2 transmission to the Organ Procurement and Transplantation Network (OPTN). For 8 potential donor-derived SARS-CoV-2 transmissions reported to the OPTN during March–May 2020, the available evidence suggest that the most likely source of transmission was community or healthcare exposure, not the organ donor.
Piroth L, Cottenet J, Mariet AS, et al. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study. Lancet Resp Med December 17, 2020. Full-text: https://doi.org/10.1016/S2213-2600(20)30527-0
No, again, it’s not a flu. This nationwide retrospective cohort study from France included discharge summaries for all hospital admissions, comparing 89.530 patients with COVID-19 and 45.819 patients with influenza. In-hospital mortality was higher in patients with COVID-19 than in patients with influenza (16.9% vs 5.8%), with a relative risk of death of 2.9 (95% CI 2.8–3.0) and an age-standardized mortality ratio of 2.82.
François J, Collery AS, Hayek G, et al. Coronavirus Disease 2019–Associated Ocular Neuropathy With Panuveitis. JAMA Ophthalmol December 17, 2020. Full-text: https://doi.org/10.1001/jamaophthalmol.2020.5695
Case report of an inflammatory ocular neuritis that was associated with uveitis may have been induced by SARS-CoV-2, and resulted in permanent loss of visual acuity. It is notable that although initial disc edema was moderate to mild in this patient, it led to severe atrophy. Other viruses (eg, varicella-zoster virus) have also been reported to have this effect.
Kwak PE, Connors JR, Benedict PA. Early Outcomes From Early Tracheostomy for Patients With COVID-19. JAMA Otolaryngol Head Neck Surg December 17, 2020. Full-text: https://doi.org/10.1001/jamaoto.2020.4837
Retrospective medical record review of 148 patients requiring mechanical ventilation at a single tertiary-care medical center in New York City. Median length of stay was 40 days in those who underwent early tracheostomy (within 10 days of endotracheal intubation) and 49 days in those who underwent late tracheostomy. In a competing risks model with death as the competing risk, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation (hazard ratio, 0.84; 95% CI, 0.55 to 1.28). According to the authors, their data provide an opportunity to reconsider guidelines for tracheostomy for patients with COVID-19, demonstrating non-inferiority of early tracheostomy.
Baig AM. Deleterious Outcomes in Long-Hauler COVID-19: The Effects of SARS-CoV-2 on the CNS in Chronic COVID Syndrome. ACS Chem Neurosci. 2020 Dec 16;11(24):4017-4020. PubMed: https://pubmed.gov/33275404. Full-text: https://doi.org/10.1021/acschemneuro.0c00725
Complex clinical findings are currently addressed in COVID long-haulers, for which the more clinically related term chronic COVID syndrome (CCS) has recently been coined. This Viewpoint highlights this syndrome, the possible pathogenetic pathways involved, and the treatment approaches that can be taken to help manage COVID long-haulers in CCS.
Morales DR, Conover MM, You SC, et al. Renin–angiotensin system blockers and susceptibility to COVID-19: an international, open science, cohort analysis. Lancet Digital Health December 17, 2020. Full-text: https://doi.org/10.1016/S2589-7500(20)30289-2
In this multicenter cohort study following more than 1,3 million patients with hypertension from the USA and Spain, no clear association of increased risk of COVID-19 diagnosis, hospital admission, or subsequent complications was seen with the outpatient use of ACEI or ARB. These findings support recent recommendations that patients should not halt their ACEI or ARB therapy despite previously posited mechanisms of increased COVID-19 risk. Furthermore, the marginal difference between ACEIs and ARBs does not warrant class switching to reduce COVID-19 susceptibility.
Vijenthira A, Gong IY, Fox TA. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood December 17, 2020, 136 (25): 2881–2892. Full-text: https://doi.org/10.1182/blood.2020008824
Systemic review and meta-analysis of 34 adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America (14 of 34 adult studies included only hospitalized patients). Adult patients with hematologic malignancy and COVID-19 found a 34% risk of death, whereas pediatric patients had a 4% risk of death. Patients on systemic anticancer therapy had a similar risk of death to patients on no treatment.
Weinreich DM, Sivapalasingam S, Norton T, et al. REGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19. NEJM December 17, 2020, Full-text: https://doi.org/10.1056/NEJMoa2035002
Antibodies may work, but only in seronegative patients. Here, an interim analysis is presented for the two anti-spike antibodies casirivimab (REGN10933) and imdevimab (REGN10987). Both make up REGN-COV2 (and were given to Trump). This ongoing Phase I–III trial randomly assigned 275 non-hospitalized patients to receive placebo, 2,4 g or 8,0 g of REGN-COV2. The least-squares mean difference (REGN-COV2 dose groups vs. placebo group) in the time-weighted average change in viral load from day 1 through day 7 was minus 0,56 log10 copies/mL among patients who were serum antibody–negative at baseline and minus 0,41 log10 copies/mL in the overall trial population. But did this translate into a clinical benefit? Maybe. At least one medical attended visit was necessary in 3% vs. 6% (placebo) overall and in 6% vs. 15% (placebo) in serum antibody–negative at baseline.
Sheppard JP, Nicholson B, Lee J, et al. The association between blood pressure control and Coronavirus Disease 2019 outcomes in 45,418 symptomatic patients with hypertension: An observational cohort study. Hypertension. 2020 Dec 16. PubMed: https://pubmed.gov/33325240. Full-text: https://doi.org/10.1161/HYPERTENSIONAHA.120.16472
This study examined the association between pre-infection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were diagnosed with COVID-19. A total of 4277 patients (9,4%) were diagnosed with COVID-19 and 877 died within 28 days. There was no association between BP control and COVID-19 diagnosis or hospitalization. Of note, individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (OR 0.76, 95%CI 0.62-0.92) compared to patients with well-controlled BP. However, these patients were older, had more co-morbidities and had been diagnosed with hypertension for longer, suggesting more advanced atherosclerosis and target organ damage.