Top 10: July 21

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By Christian Hoffmann &
Bernd S. Kamps

21 July

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4th Turkish Edition

Today, Zekeriya Temircan, Füsun Ferda Erdoğan, Türev Demirtaş and Dilara Güngör have published the 4th Turkish edition of COVID Reference (PDF, 362 pages).


Transmission and Prevention

Stewart CL, Thornblade LW, Diamond DJ, Fong Y, Melstrom LG. Personal Protective Equipment and COVID-19: A Review for Surgeons. Ann Surg. 2020 Aug;272(2):e132-e138. PubMed: Full-text:

Are you a surgeon? Then your particular medical association has been using personal protective equipment (PPE) for more than a century. This review addresses both the mechanism of SARS-CoV-2 transmission and the capabilities of PPE in the perioperative COVID-19 setting.


Plautz J. Is it safe to strike up the band in a time of coronavirus? Science, 17 July 2020. Full-text:

Is keeping 2 meters away enough to stay safe from a trumpet at full blast? Try it, find out! Introduce five student musicians – a soprano singer and clarinet, flute, French horn, and trumpet players — in a clean room one at a time and let them perform a short solo piece.



Mato AR, Roeker LE, Lamanna N, et al. Outcomes of COVID-19 in Patients with CLL: A Multicenter, International Experience. Blood. 2020 Jul 20:blood.2020006965. PubMed: Full-text:

CLL patients have impaired humoral and cellular immune function. The authors describe the first large, disease-specific series in a defined cohort of hematologic cancer patients from 43 international centers. Of 198 CLL patients diagnosed with symptomatic COVID-19, 39% were treatment-naïve (“watch and wait”) while 61% received at least one CLL therapy. At a median follow-up of 16 days, the overall case fatality rate was 33%, while another 25% were still in hospital. Discover differences between “Watch and wait” and treated cohorts with regard to ICU admission, intubation, and mortality. CLL patients are at high risk of death.


Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. Published online July 20, 2020. Full-text:

The authors assessed the incidence of, and risk factors for, venous and arterial thrombotic events in patients with COVID-19 in 4 hospitals in New York City. Among 3334 consecutive patients, a thrombotic event occurred in 16.0%. 207 (6.2%) were venous (3.2% PE and 3.9% DVT) and 365 (11.1%) were arterial (1.6% ischemic stroke, 8.9% MI, and 1.0% systemic thromboembolism). All-cause mortality was 24.5% and was higher in those with thrombotic events (43.2% vs 21.0%). D-dimer level at presentation was independently associated with thrombotic events, consistent with early coagulopathy.


Collateral Effects

Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncology,  published: July 20, 2020. Full-text:

During the UK COVID lockdown, cancer screening was suspended, routine diagnostic work deferred, and only urgent symptomatic cases were prioritized for diagnostic intervention. The authors estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. They expect an increase in the number of avoidable cancer as a result of the COVID-19 pandemic:

Breast cancer: 281–344 additional deaths (increase: 7.9–9.6%)

Colorectal cancer: 1445–1563 additional deaths (15.3–16.6%)

Lung cancer: 1235–1372 additional deaths (4.8–5.3%)

Esophageal cancer: 330–342 additional deaths (5.8–6.0%)

See also the comment by Hamilton W: Cancer diagnostic delay in the COVID-19 era: what happens next? Lancet Oncology,  published: July 20, 2020. Full-text:


Kamrath C, Mönkemöller K, Biester T, et al. Ketoacidosis in Children and Adolescents With Newly Diagnosed Type 1 Diabetes During the COVID-19 Pandemic in Germany. JAMA. Published online July 20, 2020. Full-text:

The COVID pandemic has caused people to delay medical care, even for life-threatening conditions. The authors analyzed data of 532 children and adolescents with newly diagnosed type 1 diabetes from 216 German diabetes centers (median age: 9.9 years). Diabetic ketoacidosis was present in 238 patients (44.7%) and severe ketoacidosis in 103 patients (19.4%). During the same periods in 2019 and 2018, the frequency of diabetic ketoacidosis was significantly lower (2019: 24.5%; 2018: 24.1%). The incidence of severe diabetic ketoacidosis was also significantly lower (2019: 13.9%; 2018: 12.3% in 2018). Children younger than 6 years had the highest risk.



Abbas K, Procter SR, van Zandvoort K, et al. Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Global Health, published 17 July. Web: Full-text:

National immunization programs are at risk of suspension during the COVID-19 pandemic. This benefit–risk analysis estimates that routine childhood immunization in Africa outweighs the excess risk of COVID-19 deaths which might be associated with clinic visits for vaccinations.


Journal Feature

Guglielmi G. The explosion of new coronavirus tests that could help to end the pandemic. Nature. 2020 Jul;583(7817):506-509. PubMed: Full-text:

Mass testing for SARS-CoV-2 — millions of tests per country per week — is one of the ways out of the COVID-19 crisis. It allows you to isolate those who test positive, limit the spread of disease and help to determine when it is safe to relax restrictions. Faster, simpler and cheaper methods of testing — Giorgia Guglielmi  shows the way.