Top 10: February 22

Copy-editor: Rob Camp


Paper of the Day

Nelson EJ, McKune SL, Ryan KA, et al. SARS-CoV-2 Positivity on or After 9 Days Among Quarantined Student Contacts of Confirmed Cases. JAMA February 19, 2021. doi:10.1001/jama.2021.2392

Testing at day 9 instead of 14 days of strict quarantine in students: this study found no evidence that an earlier return to school with a negative test result was linked with subsequent symptomatic illness. Among 799 student contacts of confirmed COVID-19 cases with a negative test result on days 9 to 14, only 1 student became symptomatic after returning to school and had a positive SARS-CoV-2 test result on day 14 after an initial negative test result on day 9. The virus from this student was genetically distinct from the virus isolated from the confirmed COVID-19 case to which the student had been exposed.


Brecht I, Peckeu L, Laga M, et al. Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium, August to November 2020. Euro Surveill February 17,. 2021;26(7):pii=2100065.

This study shows how stringent physical distancing measures (a limit to three close contacts per person, a curfew, closure of bars and recommended teleworking) that were introduced 1 month after a persistent increase in Rt, sufficiently controlled transmission in Belgium, even with high case numbers and without closing schools or full lockdown (remember, this was prior to the occurrence of B.1.1.7).



Cao W, Dong C, Kim S, et al. Biomechanical Characterization of SARS-CoV-2 Spike RBD and Human ACE2 Protein-Protein Interaction. Cell February 17, 2021. Full-text:

Using spectroscopy, the authors studied the interaction between the receptor-binding domain (RBD) at viral surface spike (S) protein of different coronaviruses and the angiotensin-converting enzyme 2 (ACE2) receptor expressed on many human cell types. The dissociate rate for RBD-CoV2−ACE2 and RBD-CoV1−ACE2 bonds or interactions were significantly different, possibly explaining the greater infectivity of SARS-CoV-2 vs SARS-CoV-1.



Gee J, Marquez P, Su J, et al. First Month of COVID-19 Vaccine Safety Monitoring — United States, December 14, 2020–January 13, 2021. MMWR Morb Mortal Wkly Rep. ePub: 19 February 2021. DOI:

From December 14, 2020 to January 13, 2021, a total of 13,794,904 COVID-19 vaccine doses were administered in the US. Anaphylaxis rates were comparable with those reported after receipt of other vaccines. No unexpected patterns of reactions or other safety concerns have been identified during early monitoring.



Kristiansen MF, Heimustovu BH, á Borg S, Mohr TH, Gislason H, Møller LF, et al. Epidemiology and clinical course of first wave coronavirus disease cases, Faroe Islands. Emerg Infect Dis. 2021 Mar [date cited].

The Faroe Islands are a unique place to investigate the effects of COVID-19. Because of large scale testing in the country, few unrecorded cases are expected. Mapping the transmission chains of COVID-19 on the islands reveals that most cases infected few or no secondary contacts, whereas 3 superspreading cases set off long, aggressive chains that led to most of the identified secondary locally transmitted cases.



Elezkurtaj S, Greuel S, Ihlow J, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep 11, February 19, 2021.

They die from COVID-19. In 26 decedents who had clinically presented with severe COVID-19, Sefer Elezkurtaj from the Charité in Berlin, Germany, found that septic shock and multi-organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. The majority of patients died of COVID-19 with only contributory implications of pre-existing health conditions.


Bajaj R, Sinclair HC, Patel K. Delayed-onset myocarditis following COVID-19. Lancet Resp Med February 19, 2021. DOI: Full text:

Nine patients with acute cardiac decompensation, negative RT-PCR for SARS-CoV-2, markedly increased serum troponin, and substantially raised inflammatory markers: Retesh Bajaj and colleagues from London suggest that this series describes cardiogenic shock due to a multisystem inflammatory syndrome in adults (MIS-A) after COVID-19.



Brix TH, Hegedüs L, Hallas J, et al. Risk and course of SARS-CoV-2 infection in patients treated for hypothyroidism and hyperthyroidism. Lancet Diabetes and Endocrinology February 19, 2021.

This large case-control study from Denmark indicates that patients treated for hypothyroidism or hyperthyroidism do not have an increased risk of contracting SARS-CoV-2 infection. The results also suggest that treatment for thyroid dysfunction, when controlling for relevant confounding, does not influence the prognosis of SARS-CoV-2 infection.


Mitchel KM, Dimitrov D, Silhol R, et al. The potential effect of COVID-19-related disruptions on HIV incidence and HIV-related mortality among men who have sex with men in the USA: a modelling study. Lancet HIV February 19, 2021.

What is the impact of COVID-19 on the HIV pandemic? This deterministic, compartmental HIV transmission model for MSM in Baltimore, US, used available data on COVID-19-related disruptions to HIV services to predict effects of reductions in sexual partners, condom use, HIV testing, viral suppression, PrEP and ART use. Results: it depends. A 25% reduction in sexual partnerships is estimated to offset the effect of the combined service disruptions on new HIV infections.



Mathews KS, Soh H, Shaefi S, et al. Prone Positioning and Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019-Related Respiratory Failure. Crit Care Med. 2021 Feb 17. PubMed: . Full-text:

Pro-proning: among 2338 eligible patients in this multicenter cohort study, 702 (30.0%) were proned within the first 2 days of ICU admission. After inverse probability weighting, baseline and severity of illness characteristics were “well-balanced” between proned and non-proned patients. Patients proned within the first 2 days of ICU admission had a lower adjusted risk of death compared with non-proned patients (HR: 0.84; 95% CI: 0.73–0.97).


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