Top 10: January 11

Copy-editor: Rob Camp


Charron N, Lapuente V, Rodriguez-Pose A. Uncooperative Society, Uncooperative Politics or Both? How Trust, Polarization and Populism Explain Excess Mortality for COVID-19 across European regions. The Quality of Government (QoG) Institute 2020 (December). Full-text:

Why have some places performed better than others in the fight against COVID-19? The authors found that societal polarization played a significant role. When the divide in political trust between supporters and opponents of incumbent governments within societies is high, the authors observe consistently higher COVID-19-related excess mortality deaths during the first wave of the pandemic. They also find that regions with a political elite less supportive of European integration are regions where excess deaths have been significantly higher. Vive l’Europe!



Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodies. bioRxiv 2021, posted 4 January. Full-text:

Jesse Bloom, Allison Greaney and colleagues comprehensively mapped how mutations to the SARS-CoV-2 RBD affected binding by the antibodies in convalescent human serum. One major finding is that serum antibody binding is predominantly affected by mutations at just a few dominant epitopes in the RBD. The most important site is E484, where neutralization by some sera is reduced > 10-fold by several mutations, including one in emerging viral lineages in South Africa and Brazil. Don’t miss this pre-print paper.


Andreano E, Piccini G, Licastro D, et al. SARS-CoV-2 escape in vitro from a highly neutralizing COVID-19 convalescent plasma. bioRxiv. 2020 Dec 28:2020.12.28.424451. PubMed: Full-text:

If constantly pressured, SARS-CoV-2 virus has the ability to escape even a potent polyclonal serum targeting multiple neutralizing epitopes. By Rino Rappuoli, Emanuele Andreano and colleagues.



Swadi T, Geoghegan JL, Devine T, et al. Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerg Infect Dis. 2021 Jan 5;27(3). PubMed: Full-text:

SARS-CoV-2 transmission may occur on aircraft and the risk may be increased during long-distance flights. Joep de Ligt, Tara Swadi and colleagues from New Zealand describe an air travel cluster where among the 7 eventually-infected passengers, 2 were probably index case-patients infected before the flight, 4 were probably infected during the flight, and the remaining passenger was probably infected while in New Zealand under “managed isolation and quarantine”. All 7 passengers were seated in aisle seats within 2 rows of where the presumed index case-patient(s) were seated.



Xie X, Zou J, Fonte-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited sera. bioRxiv 2021, posted 7 January. Full-text:

Recent SARS-CoV-2 variants in the United Kingdom and South Africa have multiple mutations in their S glycoproteins, which are key targets of viral neutralizing antibodies. These rapidly spreading variants share the spike N501Y substitution. Pei-Yong Shi, Philip R. Dormitzer and Xuping Xie generated isogenic N501 and Y501 SARS-CoV-2. Sera of participants in a previously reported trial of the mRNA-based COVID-19 vaccine BNT162b2 had equivalent neutralizing titers to the N501 and Y501 viruses.



Nehme M, Braillard O, Alcoba G, et al. COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings. Ann Intern Med. 2020 Dec 8:M20-5926. PubMed: Full-text:

In this cohort of 669 persons (mean age 43, 60% women, 24,6% health care workers, 68,8% with no underlying risk factors), symptoms persisted in one third of ambulatory patients 30 to 45 days after diagnosis. Fatigue, dyspnea, and loss of taste or smell were the main persistent symptoms.


Salmon-Ceron D, Slama D, De Broucker T, et al. Clinical, virological and imaging profile in patients with prolonged forms of COVID-19: A cross-sectional study. J Infect. 2020 Dec 4:S0163-4453(20)30762-3. PubMed: Full-text:

Cross-sectional mono-center survey on 70 consecutive patients presenting with an initial symptomatic COVID-19 infection who developed prolonged COVID symptoms defined as persistent symptoms (> 2 months after the first day of the initial episode) or resurgent symptoms (at least 3 weeks after the 1st episode). Median age was 45 (range 23–75), 78,6% were female. The authors classify the characteristics of late symptoms in 7 main categories:­

  • Major fatigue or exhaustion for 51 patients (72,9%)
  • ­Neurological symptoms, in 54 (77,1%), divided into neuro-cognitive disorders (such as memory, mood or attention disorders), headaches, sensory disturbances (such as balance disorders, tingling, burning sensations and neurogenic pains), or others (swallowing or speech disorders, thermoregulation disorders).
  • ­Cardiothoracic symptoms in 50 patients (71,4%): chest pain and tightness, palpitations, cough, dyspnea.
  • ­Muscular or/and articular pains for 20 (25,7%).
  • ­ENT symptoms: persistent or recurrent anosmia, hyposmia and/or dysgeusia for 21 (30%).
  • ­Gastro-intestinal symptoms for 17 (24,3%): diarrhea, nausea/vomiting, epigastric or abdominal pain.
  • ­Skin and vascular symptoms in 10 (14,4%).


Pun BT, Badenes R, La Calle GH, et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Health 2021, published 8 January. Full-text:

Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Now, Brenda Pun, Rafael Badenes and colleagues publish the results of a cohort study on 2088 patients treated in 69 adult intensive care units (ICUs) across 14 countries. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium. The authors conclude that their data present an opportunity to reduce acute brain dysfunction in patients with COVID-19.



Marjot T, Moon AM, Cook JA, et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol. 2020 Oct 6:S0168-8278(20)33667-9. PubMed: Full-text:

No comment needed. The key messages presented at the beginning of the paper:

  • Patients with cirrhosis experience high rates of hepatic decompensation and death following SARS-CoV-2 infection.
  • Mortality increased in stepwise fashion according to Child-Pugh class.
  • Other risk factors for death included advancing age and alcohol-related liver disease.
  • Mortality risk was higher in patients with advanced cirrhosis than propensity-score-matched controls without liver disease.
  • The majority of deaths in patients with cirrhosis were from COVID-19-related lung disease.



If you read Spanish, read Ansede M. Un caldo de cultivo para variantes del virus que escapen de las vacunas. El País 2021, published 10 January. Full-text:

La expansión fuera de control del coronavirus y el retraso de la segunda dosis vacunal pueden favorecer la aparición de mutantes resistentes.


Alessi G. Brasil, una trinchera especialmente letal para los enfermeros que luchan contra la covid-19. El País 2021, published 9 January. Full-text:

Un tercio de los 1.500 sanitarios fallecidos en todo el mundo trabajaba en el gigante sudamericano. A la falta inicial de equipos de protección se suma el agotamiento y la llegada de personal inexperto.

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