Copy-editor: Rob Camp
Epidemiology
Guerriero M, Bisoffi Z, Poli A, Micheletto C, Conti A, Pomari C. Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020. Emerg Infect Dis. 2021 Jan. Full-text: https://doi.org/10.3201/eid2701.202740
In Veneto, Italy, Verona was the province with the most cases and deaths caused by SARS-CoV-2. Massimo Guerriero and colleagues estimated the prevalence of active or past infection among randomly selected participants > 10 years of age from Verona. Of 1515 participants, 2,6% tested positive by a serologic assay and 0,7% by PCR. The total prevalence was 3,0%, suggesting 7051 cumulative cases (4,6 times higher than the official count).
Immunology
Agarwal V, Venkatakrishnan AJ, Puranik A et al. Long-term SARS-CoV-2 RNA shedding and its temporal association to IgG seropositivity. Cell Death Discov. 6, 138 December 2, 2020. Full-text: https://doi.org/10.1038/s41420-020-00375-y
A retrospective analysis of 851 SARS-CoV-2-positive patients with at least two positive PCR tests. The mean lower bound of viral RNA shedding was 17,3 days (SD: 7,8), and the mean upper bound of viral RNA shedding from 668 patients transitioning to confirmed PCR-negative status was 22,7 days (SD: 11,8). Some seropositive patients actively shed viral RNA (14 of 90 patients).
Vaccine
Behr MA, Divangahi M, Schurr E. Lessons from BCG for SARS-CoV-2 vaccine candidates. J Infect Dis 2020, published 30 November. Full-text: https://doi.org/10.1093/infdis/jiaa637
A note of caution: according to Marcel Behr and colleagues from Montréal, developers of SARS-CoV-2 vaccines should consider some of the lessons from a ‘new’ vaccine introduced in 1921, where BCG introduced to great fanfare had no measurable effect on the global epidemic, despite evidence of protection at the individual level.
Diagnostics
Klumpp-Thomas C, Kalish H, Hicks J, et al. D614G Spike Variant Does Not Alter IgG, IgM, or IgA Spike Seroassay Performance. J Infect Dis 2020, published 1 December. Full-text: https://doi.org/10.1093/infdis/jiaa743
Does an individual exposed to one variant of a virus have cross-reactive memory to the second? Probably yes. Carleen Klumpp-Thomas and colleagues from NIH analyzed the serologic ELISA reactivity of both variants and found that antibodies from 88 donors from a high-incidence population reacted toward both the original spike and the D614 spike variant. This suggests that use of the full spike protein construct should not impact seroassay performance or “miss” seropositive samples. However, the fact that D614 and G614 both elicited seropositivity is perhaps expected, given that the human immune response is polyclonal.
Myhre PL, Prebensen C, Strand H, et al. Growth Differentiation Factor 15 Provides Prognostic Information Superior to Established Cardiovascular and Inflammatory Biomarkers in Unselected Patients Hospitalized With COVID-19. Circulation 2020 Dec;142(22):2128-2137. PubMed: https://pubmed.gov/33058695. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.050360
Growth differentiation factor 15 (GDF-15) is a member of the transforming growth factor β superfamily. Expression in pathological states is highly regulated through several pathways including inflammation, oxidative stress, and hypoxia and elevated concentrations of circulating GDF-15 have been identified in multiple disease entities. Among 123 hospitalized COVID-19 patients from Oslo, Norway, GDF-15 was elevated in the majority of patients. Higher concentrations were associated with SARS-CoV-2 viremia, hypoxemia, and worse outcome. The prognostic value of GDF-15 was additional and superior to established cardiovascular and inflammatory biomarkers.
Rieser M, Wirth L, Pollmeier L, et al. Serum protein profiling reveals a specific upregulation of the immunomodulatory protein progranulin in COVID-19. J Inf Dis November 29, 2020. Full-text: https://doi.org/10.1093/infdis/jiaa741
Another biomarker. The immunomodulatory protein progranulin (GRN) is a pleiotrophic growth factor and immunoregulatory molecule expressed in a broad range of tissues and cell types such as epithelia, bone marrow and various immune cells including T cells, DCs, monocytes and macrophages. In a prospective single-center registry, Marina Rieser and colleagues from Freiburg, Germany included 24 SARS-CoV-2 positive patients and 61 patients with “similar symptoms and severity of disease but negative for SARS-CoV-2” (cancer, cardiac disease, and others) admitted to the emergency department and compared their serum protein expression profiles. Of note, no differences in IL-6 expression between SARS-CoV-2-positive and -negative patients were observed. In contrast, a specific upregulation of GRN was found which was associated with COVID-19 severity. Among the proteins showing the most significant positive correlation with GRN were GDF-15, urokinase-type plasminogen activator (uPA) and urokinase-type plasminogen activator receptor (uPAR).
Clinical
Cao A, Rohaut B, Guennec LL, et al. Severe COVID-19-related encephalitis can respond to immunotherapy. Brain December 2, 2020. Full-text: https://doi.org/10.1093/brain/awaa337
See title (“can” respond). The authors report a case series of five patients with severe COVID-19-related encephalitis (impaired consciousness/unresponsive and mechanically ventilated) treated by therapeutic plasma exchanges and corticosteroids. The dramatic improvement in three of five patients “reinforces the hypothesis of an immune-related mechanism”.
Collateral damage
Perez S, Innes GK, Walters MS, et al. Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 1 December 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6948e1
Carbapenem-resistant Acinetobacter baumannii (CRAB) causes health care–associated infections that are challenging to contain and often linked to infection prevention and control breaches. What a mess: colleagues from a New Jersey hospital report on a cluster of 34 CRAB cases (26 isolates harbored the gene encoding the OXA-23 carbapenemase) that peaked during a surge in COVID-19 hospitalizations. The authors conclude that strategies to preserve continuity of care led to deviations in IPC practices; CRAB cases decreased when normal operations resumed.
Armitaage R, Nellums B. Antibiotic prescribing in general practice during COVID-19. Lancet December 01, 2020. Full-text: https://doi.org/10.1016/S1473-3099(20)30917-8
Richard Armitage and Laura B Nellums comment on the number of antibiotic prescriptions made in UK general practice between April 1, and Aug 31, 2020. The number was 15% lower than in the corresponding period in 2019. However, given the decrease in absolute number of appointments over this time, this number of prescriptions was 7% higher than expected, supporting evidence that antibiotic prescribing rates are higher in remote consultations than during in-person appointments.
Pediatrics
Lee EH, Kepler KL, Geevarughese A, et al. Race/Ethnicity Among Children With COVID-19–Associated Multisystem Inflammatory Syndrome. JAMA Netw Open November 30, 2020;3(11):e2030280. Full-text: https://doi.org/10.1001/jamanetworkopen.2020.30280
Distribution of race/ethnicity among 223 MIS-C cases reported to the New York City (NYC) Department of Health and Mental Hygiene: compared with White children, the authors observed a higher incidence of MIS-C among Black (IRR, 3.2) and Hispanic (IRR, 1.7) children. Black (IRR, 1.7) and Hispanic (IRR, 2.1) children had higher COVID-19 hospitalization rates compared with White children. It remains unclear whether this finding represents a phenomenon distinct from the increased burden of COVID-19 in Black and Hispanic communities.
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By Christian Hoffmann &
Bernd Sebastian Kamps
Copy-editor: Rob Camp