Copy-editor: Rob Camp
ECDC 20201223. COVID-19 in children and the role of school settings in transmission – first update. ECDC 2020, published 23 December. Full-text: https://www.ecdc.europa.eu/en/publications-data/children-and-school-settings-covid-19-transmission
An update on the role of children in the transmission of SARS-CoV-2 and the role of schools in the COVID-19 pandemic, based on experience in the EU from August through December 2020. The document also addresses transmission to and from staff in school settings, school-related mitigation measures including risk communication, testing, contact tracing and the efficacy of partial and full school closures.
Children’s Task and Finish Group. Update to 4th Nov 2020 paper on children, schools and transmission. UK Government 2020, published 17 December. Full-text: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf + https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/935102/sage-65-meeting-covid-19-s0863.pdf
This paper presents evidence for increased transmission occurring among school children when schools are open, particularly in children of secondary school age (high confidence). Multiple data sources show a reduction in transmission in children following schools closing for half-term, and transmission rates increasing again following the post-half-term return to school.
Henkel M, Weikert T, Marston K, et al. Lethal COVID-19: Radiological-Pathological Correlation of the Lungs. Radiol Cardiothorac Imaging 2020. Full-text: https://doi.org/10.1148/ryct.2020200406
A report of 14 patients who died from RT-PCR confirmed COVID-19. All patients underwent ante-mortem CT and autopsy. A significant proportion of ground glass opacities (GGO) correlates with the pathologic processes of diffuse alveolar damage, capillary dilatation and congestion and micro-thrombosis. Maurice Henkel, Thomas Weikert and colleagues conclude that these results underline the importance of vascular alterations as a key pathophysiological driver in lethal COVID-19.
Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2021 Jan;21(1):52-58. PubMed: https://pubmed.gov/33058797. Full-text: https://doi.org/10.1016/S1473-3099(20)30764-7
Re-infections with SARS-CoV-2 are possible, but don’t seem to be the rule within the first 9 months after the original infection. As a matter of fact, we don’t currently see an epidemic of re-infections in people who were infected during the spring of 2020. Here, Marc Pandori, Richard Tillett and colleagues present the case of a 25-year-old man who presented to health authorities on two occasions with symptoms of viral infection, once at a community testing event in April 2020, and a second time to primary care then hospital at the end of May and beginning of June 2020. The authors show that the patient was infected by SARS-CoV-2 on two separate occasions by a genetically distinct virus.
See also the comment by Iwasaki A. What reinfections mean for COVID-19. Lancet Infect Dis. 2021 Jan;21(1):3-5. PubMed: https://pubmed.gov/33058796. Full-text: https://doi.org/10.1016/S1473-3099(20)30783-0
McCullough PA, Alexander PE, Armstrong R, et al. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19). Rev Cardiovasc Med. 2020 Dec 30;21(4):517-530. PubMed: https://pubmed.gov/33387997. Full-text: https://doi.org/10.31083/j.rcm.2020.04.264
Prompt early initiation of sequenced multi-drug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. Here, Peter McCullough et al. present a multi-pronged therapeutic approach that includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine.
Le Breton C, Besset S, Freita-Ramos S, et al. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care. 2020 Dec;60:10-12. PubMed: https://pubmed.gov/32731100. Full-text: https://doi.org/10.1016/j.jcrc.2020.07.013
Extra-corporeal membrane oxygenation (ECMO) in patients with severe COVID-1 has been associated with high mortality rates. Here, Jean-Damien Ricard, D. Roux, C. Le Breton and colleagues report on 13 patients who required VV-ECMO (femoro-jugular cannulation). All 13 patients were weaned from ECMO after a median of 13 days (range 3 to 34). Two patients died while still on mechanical ventilation. As of June 28th, 2020 all surviving patients were weaned from the ventilator after a median duration of 29 days (range 20 to 51) and were discharged alive from the ICU after a mean stay of 34 days (range 23 to 55). The authors conclude that ECMO should be an integral part of intensive care for properly selected COVID-19 patients without life-threatening co-morbidities.