Top 10: January 13

Copy-editor: Rob Camp


Salman D, Vishnubala D, Le Feuvre P, et al. Returning to physical activity after covid-19. BMJ. 2021 Jan 8;372:m4721. PubMed: Full-text:

“Only return to exercise after at least seven days free of symptoms and begin with at least two weeks of minimal exertion. Use daily self-monitoring to track progress, including when to seek further help.” In this nice 6-page paper, David Salman and colleagues give an excellent guide to physical activity after COVID-19. Clearly, patients with ongoing symptoms or who had severe COVID-19 or a history suggestive of cardiac involvement need thorough clinical assessment.



Bagchi S, Mak J, Li Q, et al. Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 January 2021. DOI:

Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.



Volz E, Mishra W, Chand M, et al. Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data. medRxiv 2021, posted 4 January. Full-text:

The new SARS-CoV-2 lineage B117 (B.1.1.7, also named VOC 202012/01), originated in England in late Summer to early Autumn 2020. Available data indicate a larger share of under 20-year-olds among reported B117 than non-B117 cases. B117 seems to have a substantial transmission advantage, with the estimated difference in reproduction numbers between B117 and non-B117 ranging between 0.4 and 0.7. Neil Ferguson, Erik Volz and colleagues note that these estimates of transmission advantage apply to a period where high levels of social distancing were in place in England; extrapolation to other transmission contexts therefore requires caution.



Atherstone C, Peterson ML, Malone M, et al. Time from Start of Quarantine to SARS-CoV-2 Positive Test Among Quarantined College and University Athletes — 17 States, June–October 2020. MMWR Morb Mortal Wkly Rep 2021;70:7–11. DOI:

Quarantine after SARS-CoV-2 exposure is critical to preventing transmission. Among young, healthy athletes, the probability of receiving positive test results after day 10 of quarantine is low. A shorter quarantine after COVID-19 exposure could increase adherence but still pose a small residual risk for transmission.


Jones A, Fialkowski V, Prinzing L, Trites J, Kelso P, Levine M. Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020. MMWR Morb Mortal Wkly Rep 2021;70:12–13. DOI:

Among the persons in quarantine who tested negative at day 7 after exposure, none who were retested between days 8 and 14 were positive. Allowing asymptomatic persons to shorten quarantine with a negative test at day 7 or later has not been demonstrated to result in transmission of SARS-CoV-2.



Zuniga M, Gomes C, Carsons SE, et al. Autoimmunity to the Lung Protective Phospholipid-Binding Protein Annexin A2 Predicts Mortality Among Hospitalized COVID-19 Patients. medRxiv 2021, posted on 4 January. Full-text:

Anti-Annexin A2 antibodies were elevated among hospitalized COVID-19 patients and these levels predicted mortality. This is the message of a pre-print paper by Ana Rodriguez, Marisol Zuniga and colleagues. The authors explain that inhibition of Annexin A2 induces systemic thrombosis, cell death, and non-cardiogenic pulmonary edema and that autoimmunity to Annexin A2 might explain key clinical findings of severe COVID-19. (Annexin A2 is a phospholipid-binding protein involved in fibrinolysis, cell membrane stabilization and repair, that ensures the integrity of the pulmonary microvasculature.)



Marjot T, Webb GJ, Barritt AS. SARS-CoV-2 vaccination in patients with liver disease: responding to the next big question. Lancet Gastroenterol Hepatol 2021, published 11 January. Full-text:

Patients with advanced liver disease have well recognized deficiencies in innate and humoral immunity, termed cirrhosis-associated immune dysfunction (CAID). Nonetheless, given the high COVID-19-related mortality in patients with decompensated cirrhosis, it remains of utmost importance to prioritize vaccinations in this sub-group. Eleanor Barne, Thomas Marjot and colleagues express their belief that patients with advanced liver disease should be prioritized for vaccination, with the likely benefits far outweighing any potential risks. Until it is established whether patients with liver disease and transplantation achieve optimal protection after immunization, clinicians should remain vigilant for post-vaccination COVID-19 in these cohorts.



Chen W, Tian Y, Li Z, et al. Potential interaction between SARS-CoV-2 and thyroid: a review. Endocrinology 2021, published 11 January. Full-text:

Certain thyroid diseases may have a negative impact on the prevention and control of COVID-19; some anti-COVID-19 agents may cause thyroid injury; and COVID-19 and thyroid disease may mutually aggravate the disease burden.


Editorial. Vitamin D and COVID-19: why the controversy? Lancet Diabetes Endocrinol 2021, published 11 January. Full-text:

In December, NICE published an updated rapid review of recent studies on vitamin D and COVID-19. Their recommendations: everyone should take vitamin D supplements to maintain bone and muscle health during the autumn and winter months. Later, new guidance from the UK government allowed extremely clinically vulnerable people to opt in to receive a free 4-month supply of daily vitamin D supplements—similar to an initiative launched earlier in Scotland. Several clinical trials on vitamin D and COVID-19 outcomes are underway.


Severe COVID

Gupta RK, Harrison WM, Ho A, et al. Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study. Lancet Respir Med 2021, published 11 January. Full-text: DOI:

How would you predict the risk of clinical deterioration in acute COVID-19 cases? Mahdad Noursadeghi, Rishi K Gupta and colleagues developed and validated a prognostic model for in-hospital clinical deterioration which integrated 11 routinely available predictors: age, sex, nosocomial infection, Glasgow coma scale score, peripheral oxygen saturation (SpO2) at admission, breathing room air or oxygen therapy (contemporaneous with SpO2 measurement), respiratory rate, urea concentration, C-reactive protein concentration, lymphocyte count, and presence of radiographic chest infiltrates.

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