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By Christian Hoffmann &
Bernd S. Kamps

10 July

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Epidemiology

Houlihan CF, Vora N, Byrne T, et al. Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers. Lancet July 09, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31484-7

A total of 200 high-risk frontline HCWs were enrolled between March 26 and April 8 in a prospective cohort study in an acute National Health Service hospital trust in London. 25% of HCWs were already seropositive at enrolment and a further 20% became seropositive within the first month of follow-up. Most infections occurred between March 30 and April 5, the week with the highest number of new cases in London.

 

The Lancet. COVID-19: the worst may be yet to come. Lancet July 11, 2020. Full-text: https://doi.org/10.1016/S0140-6736(20)31517-8

What a depressing editorial. Don’t read this if you’re in a bad mood. Five months after WHO declared the SARS-CoV-2 outbreak a global health emergency, the virus continues to beat a concerning and complex path. For much of the globe, the worst may be yet to come.

 

Watsa M. Rigorous wildlife disease surveillance. Science 10 Jul 2020, 369: 145-147. Full-text: https://doi.org/10.1126/science.abc0017

There are no international or national conventions on pathogen screening associated with animals, animal products or their movements. Capacity for emerging infectious disease (EID) diagnostics is limited along much of the human-wildlife interface. EID risks associated with the wildlife trade remain the largest unmet challenge of current disease surveillance efforts. According to this comment, an internationally recognized standard for managing wildlife trade on the basis of known disease risks should be established.

 

Immunology

Zost SJ, Gilchuk P, Chen RE et al. Rapid isolation and profiling of a diverse panel of human monoclonal antibodies targeting the SARS-CoV-2 spike protein. Nat Med Jul 10, 2020. Full-text:  https://doi.org/10.1038/s41591-020-0998-x

Using a rapid antibody discovery platform, the authors isolated hundreds of human monoclonal antibodies (mAbs) against the SARS-CoV-2 spike protein. Antibodies could be grouped into five binding patterns on the basis of domain recognition and cross-reactivity. There were 178 mAbs that recognized the RBD domain and 43 that recognized the NTD domain. Most of the neutralizing antibodies (67/70) mapped to the RBD, revealing the RBD to be the principal site of vulnerability for SARS-CoV-2 neutralization.

 

Transmission

Rockett RJ, Arnott A, Lam C, et al. Revealing COVID-19 transmission in Australia by SARS-CoV-2 genome sequencing and agent-based modeling. Nat Med 2020 Jul 9. PubMed: https://pubmed.gov/32647358. Full-text: https://doi.org/10.1038/s41591-020-1000-7

These researchers examined the added value of near real-time genome sequencing of SARS-CoV-2 in a subpopulation of infected patients during the first 10 weeks of COVID-19 containment in Australia. Genomic evidence was used to cluster 38.7% (81 out of 209) of cases for which the available epidemiological data could not identify direct links. This included clustering 12.4% (26 out of 209) of cases with a history of recent arrival from overseas with other cases without a travel history and 5.3% (11/209) of locally acquired cases with unknown epidemiological links. Twenty-two (10.5%) of the 209 cases were epidemiologically classified as ‘locally acquired—contact not identified’.

 

Mueller AV, Eden MJ, Oakes JM, et al. Quantitative Method for Comparative Assessment of Particle Removal Efficiency of Fabric Masks as Alternatives to Standard Surgical Masks for PPE. Matter July 09, 2020. Full-text: https://doi.org/10.1016/j.matt.2020.07.006

The effectiveness of masks to protect wearers from airborne particles is known to be a function of both materials and fit. The authors present a rapid testing protocol for evaluation of loose-fitting type masks to provide quantitative, intercomparable data for particle removal efficacy of masks made with different types of fabrics and with different designs/fits, independently providing an assessment of the quality of the mask fit and the material used. Commercial surgical masks marketed for medical use had mean particle removal efficiencies from 50-75% when worn as designed but up to 90% when close fitting to the face under a nylon layer. Cloth masks tested had widely varying mean particle removal efficiencies (< 30% to near 90%), with some cloth masks achieving similar particle removal efficiencies as commercial surgical masks.

 

Diagnostics

Mathers AJ. The practical challenges of making clinical use of the quantitative value for SARS-CoV-2 viral load across several dynamics. Clin Infect Dis. 2020 Jul 10:ciaa958. Full-text: https://doi.org/10.1093/cid/ciaa958

Review of several hurdles and nuances which need to be addressed to deploy Ct value as a meaningful clinical metric. Facing the variability of specimen collection and different diagnostic platforms with varying sensitivity, laboratory professionals will need to develop a standard equivalency across their own diagnostic platforms and specimen types.

 

Clinical

Gupta A, Madhavan MV, Sehgal K. et al. Extrapulmonary manifestations of COVID-19. Nat Med Jul 10, 2020. https://doi.org/10.1038/s41591-020-0968-3

This article reviews the extrapulmonary organ-specific pathophysiology, presentations and management considerations for patients with COVID-19 (248 references!). These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications.

 

Faghy MA, Ashton RE, Maden-Wilkinson  TM, et al. Integrated sports and respiratory medicine in the aftermath of COVID-19. Lancet Resp Med July 09, 2020. Full-text: https://doi.org/10.1016/S2213-2600(20)30307-6

The long-term effects on recovering patients remains unknown. According to this commentary, we must marshal our resources and develop strong collaborative approaches that combine clinical and sports medicine disciplines.

 

Pediatrics

Davies P, Evans C, Kanthimathinathan  HK. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health July 09, 2020. Full-text: https://doi.org/10.1016/S2352-4642(20)30215-7

In 78 cases of PIMS-TS reported by 21 of 23 centres in the UK, male patients (67%) and those from ethnic minority backgrounds (78%) were over-represented. In total, 36 (46%) were invasively ventilated and 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed ECMO and two children died.