Top 10: January 21

Copy-editor: Rob Camp


* * * Paper of the Day * * *

Lopes RD, Macedo AV, Silva P, et al. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA January 19, 2021; 325(3):254-264. Full-text:

Paper of the day: does discontinuation compared with continuation of ACEIs or ARBs change anything? No. In this randomized open label clinical trial that included 659 patients from Brazil who were hospitalized with mild to moderate COVID-19 who were taking ACEIs or ARBs before hospital admission, the mean number of days alive and out-of-hospital for those assigned to discontinue versus continue these medications was 21,9 vs 22,9, respectively.



Gouvea-Reis FA, Oliveira PD, et al. COVID-19 outbreak in a large penitentiary complex, April–June 2020, Brazil. Emerg Infect Dis, March 2021. Full-text:

Faster viral spread in overcrowded settings: the mean serial interval during this large SARS-CoV-2 outbreak at a Brazilian prison was only 2,51 days. Between April 1 and June 12, there were 1057 reported cases: 859 (81,3%) in inmates, 180 (17,1%) in prison guards, 9 (0,8%) in contracted staff, and 9 (0,8%) in health professionals. Nine patients were hospitalized, and 3 deaths were reported: 1 prison guard and 2 inmates.



Goyal R, Hotchkiss J, Schooley RT, et al. Evaluation of SARS-CoV-2 transmission mitigation strategies on a university campus using an agent-based network model. Clinical Infectious Diseases January 19, 2021. Full-text:

Continue wearing your mask! Interesting modeling study, investigating the impact of risk mitigation interventions at the University of San Diego. The authors assessed four scenarios with varying housing, instructional, and behavioral characteristics. The main message: structural interventions for housing (singles only) and instructional changes (from in-person to hybrid with class size caps) can substantially reduce R0, but masking and social distancing are required to reduce this to 1 or below.


Rader B, White LF, Burns MR, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. The Lancet Digital Health January 19, 2021. Full-text:

Again, masks work. This large web platform randomly surveyed almost 400.000 US individuals aged 13 years and older, to ask about face mask wearing. A logistic model controlling for physical distancing, population demographics and other variables found that a 10% increase in self-reported mask wearing was associated with an increased odds of transmission control (odds ratio 3,53, 95% CI 2,03–6,43). Communities with high reported mask wearing and physical distancing had the highest predicted probability of transmission control.



Zhang Z, Bi Q, Fang S. Insight into the practical performance of RT-PCR testing for SARS-CoV-2 using serological data: a cohort study. Lancet Microbe January 19, 2021.ft

Even rigorous RT-PCR testing protocols (as used in Shenzhen, China) might miss some SARS-CoV-2 infections, perhaps in part due to difficulties in determining the timing of testing in asymptomatic individuals for optimal sensitivity. In this study, 40 (4,5%) of 880 RT-PCR-negative close contacts were later found to be positive on total antibody ELISA.



Bravata DM, Perkins AJ, Myers LJ, et al. Association of Intensive Care Unit Patient Load and Demand With Mortality Rates in US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic. JAMA Netw Open January 19, 2021; 4(1):e2034266. Full-text:

Again, flatten the curve! In this cohort study of 8516 patients with COVID-19 admitted to 88 US Veterans Affairs hospitals, strains on critical care capacity were associated with increased COVID-19 mortality. Among patients with COVID-19, those treated in the ICU during periods of peak COVID-19 ICU demand had a nearly 2-fold increased risk of mortality compared with those treated during periods of low demand.


Rubinson L. Intensive Care Unit Strain and Mortality Risk Among Critically Ill Patients With COVID-19—There Is No “Me” in COVID. JAMA Netw Open January 19, 2021;4(1):e2035041. Full-text:

Comment: Lewis Rubinson argues that, in light of the important policy implications, additional analyses are urgently needed to investigate whether this association of ICU strain and mortality is causal. If causality is supported, delineation of which care processes are suboptimally provided as ICU load and demand increase will be important to assist hospitals to support them in the hope of reducing the impact of ICU strain on mortality.


Tan CW, Tan JY, Wong WH, et al. Clinical and laboratory features of hypercoagulability in COVID-19 and other respiratory viral infections amongst predominantly younger adults with few comorbidities. Sci Rep 11, January 19, 2021, 1793. Full-text:

This retrospective cohort study included 182 consecutive COVID-19 and 165 non-CoV-2-respiratory virus patients (median age 37 and 35 years) admitted to Singapore General Hospital. Thrombotic rates were low and comparable in this young and otherwise healthy population. Coagulation parameters did not differ throughout the course of mild COVID-19.


Collateral Effects

Li W, Zhang Y, Wang J, et al. Association of Home Quarantine and Mental Health Among Teenagers in Wuhan, China, During the COVID-19 Pandemic. JAMA Pediatr January 19, 2021. Full-text:

During the COVID-19 quarantine period, more than 20% of adolescents had anxiety and depression. This is the result of an online questionnaire (using convenient sampling method) with 7890 teenagers from Wuhan. The prevalence was 21,7% (n = 1708) for anxiety and 24,6% (n = 1941) for depression (HADS subscale score > 7). Long-term home restrictions might have adverse effects on mental health of adolescents because of a sharp change of lifestyle and various other stressors like fear of infection, frustration, and boredom.


Tanaka T, Okamoto S. Increase in suicide following an initial decline during the COVID-19 pandemic in Japan. Nat Hum Behav (2021). Full-text:

In Japan, monthly suicide rates declined by 14% during the first 5 months of the pandemic (February to June 2020). This could be due to a number of complex reasons, including the government’s generous subsidies, reduced working hours and school closure. By contrast, monthly suicide rates increased by 16% during the second wave (July to October 2020), with a larger increase among females (37%) and children and adolescents (49%).



Roucaute D. Covid-19 : faut-il privilégier les masques de catégorie 1 face aux nouveaux variants du coronavirus ? Le Monde 2021, published 20 January. Full-text :

Le Haut Conseil de la santé publique recommande de porter des masques en tissu ou chirurgicaux ayant une capacité de filtration supérieure à 90 %. Mais certains experts jugent que ce message introduit de la confusion.


Ducourtieux C. Vaccination contre le Covid-19 : le Royaume-Uni meilleur élève européen mais loin d’être sorti d’affaire. Le Monde 2021, published 20 January. Full-text :

Le gouvernement britannique est très inquiet à l’idée que les efforts nationaux puissent être en partie ruinés par l’apparition d’autres variants du SARS-CoV-2 que celui observé pour la première fois sur son territoire.


If you read French, read Handweiler V. Covid-19 : la vitamine D en question comme traitement préventif. Le Monde 2021, published 20 January. Full-text :

Des experts et des sociétés savantes estiment qu’une supplémentation pour réduire le déficit de cette hormone pourrait aider à combattre la pandémie. Pour l’heure, aucune étude n’a apporté de preuve directe de son efficacité.


Cordier S. Devenir parents en temps de Covid : « A partir de ses deux mois, on n’a plus vu personne ». Le Monde 2021, published 19 January. Full-text :

L’année 2020 n’a eu qu’un impact limité sur l’évolution de la natalité française, qui a poursuivi sa baisse. Reste qu’au-delà des statistiques, l’expérience de la parentalité a été largement modifiée par la crise sanitaire.



If you read German, read Simmank J, Schöps C, Stockrahm S. Ohne das Virus leben ist das Ziel. Die Zeit 2021, published 20 January. Full-text:

Der Lockdown ist verlängert – ohne Perspektive. Wieder reagiert die Politik nur. Eine Expertengruppe setzt auf einen Null-Fälle-Plan. “No Covid” könnte ein Ausweg sein.


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