Copy-editor: Rob Camp
Treatment
Paper of the Day
Murai IH, Fernandes AL, Sales LP, et al. Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial. JAMA. 2021 Feb 17. PubMed: https://pubmed.gov/33595634. Full-text: https://doi.org/10.1001/jama.2020.26848
The end of all speculations and hopes on immunomodulatory and anti-inflammatory properties of 25-hydroxyvitamin D? In this multicenter placebo-controlled trial from Brazil including 240 hospitalized patients with COVID-19 who were moderately to severely ill, vitamin D had no effect. A single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay.
Leaf DE, Ginde AA. Vitamin D3 to Treat COVID-19: Different Disease, Same Answer. JAMA. 2021 Feb 17. PubMed: https://pubmed.gov/33595641. Full-text: https://doi.org/10.1001/jama.2020.26850
Comment: according to Adit Ginde and David Leaf, several limitations should be considered. The main issue: the study was underpowered. And as always, further studies should determine whether vitamin D3 supplementation could be useful in other settings, dosages and patient populations. It is important to remain open-minded.
Epidemiology
Mwananyanda L, Gill CJ, MacLeod W, et al. Covid-19 deaths in Africa: prospective systematic postmortem surveillance study. BMJ. 2021 Feb 17;372:n334. PubMed: https://pubmed.gov/33597166. Full-text: https://doi.org/10.1136/bmj.n334
Do we vastly underestimate the impact of COVID-19 in Africa? Maybe. In this study of all deceased people of all ages at a University Hospital in Lusaka, Zambia, 70/364 (19,2%) were PCR positive. Most deaths in people with COVID-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death.
Variants
Liu Y, Liu J, Xia H, et al. Neutralizing Activity of BNT162b2-Elicited Serum – Preliminary Report. N Engl J Med. 2021 Feb 17. PubMed: https://pubmed.gov/33596352. Full-text: https://doi.org/10.1056/NEJMc2102017
Some more in vitro data on vaccine efficacy in SARS-CoV-2 variants. The authors produced different recombinant viruses, among them one with all the mutations found in the S gene in the B.1.351 lineage. After a single shot of BNT162b2 from Pfizer/BioNTech, neutralization of the B.1.351-spike virus was weaker by approximately two thirds. However, according to Yang Liu and colleagues, it remains unclear what this reduction means in terms of protection.
Wu K, Werner AP, Koch M, et al. Serum Neutralizing Activity Elicited by mRNA-1273 Vaccine – Preliminary Report. N Engl J Med. 2021 Feb 17. PubMed: https://pubmed.gov/33596346. Full-text: https://doi.org/10.1056/NEJMc2102179
Same with Moderna’s vaccine. In vitro reductions by a factor of 2,7-6,4 in titers of neutralizing antibodies against the partial or full panel of mutations. Again, protection against B.1.351 remains to be determined.
Twitter: Some more in vitro data on vaccine efficacy in SARS-CoV-2 variants (in particular B.1.351), after BNT162b2 from Pfizer/BioNTech https://doi.org/10.1056/NEJMc2102017 and Moderna https://doi.org/10.1056/NEJMc2102179
Vaccines
Amit S, Regev-Yochay G, Afek A, et al. Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients. Lancet February 18, 2021. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00448-7/fulltext
Good news from Israel, showing substantial early reductions in SARS-CoV-2 infection and symptomatic COVID-19 rates following first mRNA vaccine dose administration. Using a retrospective cohort of 9109 vaccine-eligible HCWs, Sharon Amit and colleagues estimate adjusted rate reductions of SARS-CoV-2 infections of 30% and 75% for days 1–14 and days 15–28 after the first dose, respectively.
Olliaro P. What does 95% COVID-19 vaccine efficacy really mean? Lancet Inf Dis February 17, 2021. Full-text: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00075-X/fulltext
Important note of caution: using simple mathematics, Piero Olliaro explains that 94–95% efficacy does not mean that 95% of people are protected from disease with the vaccine. This distinction is all the more important as we do not know whether and how it could vary if the vaccines were deployed on populations with different exposures, transmission levels, and attack rates.
Clinical
Pifarré i Arolas H, Acosta E, López-Casasnovas G. et al. Years of life lost to COVID-19 in 81 countries. Sci Rep February 18, 2021. Full-text: https://www.nature.com/articles/s41598-021-83040-3
Some numbers: The total years life lost (YLL) as of January 06, 2021 is 20.507.518. In heavily affected countries this is between 2 and 9 times the median YLL of seasonal influenza or between a quarter and a half of heart disease. Three quarters of the YLL are borne by people dying before age 75. Men have lost 45% more years of life than women.
Lee JT, Hesse EM, Paulin HN, et al. Clinical and Laboratory Findings in Patients with Potential SARS-CoV-2 Reinfection, May-July 2020. Clin Infect Dis. 2021 Feb 18:ciab148. PubMed: https://pubmed.gov/33598716. Full-text: https://doi.org/10.1093/cid/ciab148
Reinfection within 90 days of the initial infection seems to be unlikely. Investigating 73 patients with potential SARS-CoV-2 reinfection in the US in May-July 2020, the authors ruled out reinfection in almost all cases.
Reuken PA, Stallmach A, Pletz MW et al. Severe clinical relapse in an immunocompromised host with persistent SARS-CoV-2 infection. Leukemia February 19, 2021. https://www.nature.com/articles/s41375-021-01175-8
Another case of a female patient with a rituximab-treated B cell lymphoma with severe relapse 4 months after moderate COVID-19. These days, hematologic therapies should be selected with caution, particularly those containing anti-CD20 antibodies.