Top 10: July 27

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By Christian Hoffmann &
Bernd S. Kamps

 

This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give it early visibility.

27 July

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<<< 001 | Summer Picture 002. Since 19 July, we have been preparing the Top 10 from a European beach location. While the friends enjoy the beach, we draft the daily summaries.

Epidemiology

Jingwen Li, Chengbi Wu, Xing Zhang, Lan Chen, Xinyi Wang, Xiuli Guan, Jinghong Li, Zhicheng Lin, Nian Xiong. Post-pandemic testing of SARS-CoV-2 in Huanan Seafood Market area in Wuhan, China. Clinical Infectious Diseases 2020, published 25 July 2020. Full-text: https://doi.org/10.1093/cid/ciaa1043

The Wuhan lockdown lasted 76 days, from 23 January to 8 April, 2020. Two and a half weeks later, the number of both hospitalized COVID-19 patients and daily new cases in Wuhan decreased to zero. When sporadic cases were reported after May 11th, the Chinese authorities started a citywide mass nucleic acid testing of SARS-CoV-2 for all citizens in Wuhan city (14 May to 1 June 2020). Now Nian Xiong and colleagues report the results from 107,662 residents around the Huanan Seafood Market. Six (6) persons tested positive for SARS-CoV-2, accounting for 0.006%, the equivalent of 60 cases per million.

 

Transmission

Patterson EI, Elia G, Grassi A, et al. Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy. bioRxiv 23 July 2020. Full-text: https://doi.org/10.1101/2020.07.21.214346

Nicola Decaro and colleagues assess SARS-CoV-2 infection in 817 companion animals in northern Italy at the height of the spring 2020 epidemic. Although no animals tested PCR positive, 3.4% of dogs and 3.9% of cats had measurable SARS-CoV-2 neutralizing antibody titers, with dogs from COVID-19 positive households being significantly more likely to test positive than those from COVID-19 negative households. From their experience, the authors conclude that it is unlikely that infected pets play an active role in SARS-CoV-2 transmission to humans. Only under special circumstances, such as the high animal population densities encountered on infected mink farms, animal-to-human transmission might be more likely.

 

Prevention

Gallagher J, Johnson I, Verbeek J et al. Relevance and paucity of evidence: a dental perspective on personal protective equipment during the COVID-19 pandemic. Br Dent J 229, 121–124 (2020). Full-text: https://doi.org/10.1038/s41415-020-1843-9

Dentists and their staff are among the most exposed health care professionals to SARS-CoV-2 infection. The authors apply a recently updated Cochrane review (see below, Verbeek et al.) of personal protective equipment (PPE) and examine evidence on which type of full body PPE and which method of donning (putting on) or doffing (removing) are most effective.

Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020 May 15;5:CD011621. PubMed: https://pubmed.gov/32412096. Full-text: https://doi.org/10.1002/14651858.CD011621.pub5

 

Parker S, Mahomed O. Hypoxia and Thrombosis in COVID-19: New Considerations for Air Passengers.  Journal of Travel Medicine 2020, published 25 July. Full-text: https://doi.org/10.1093/jtm/taaa122

The authors recommend pre-boarding as well as on-board pulse oximetry screening for early detection of silent hypoxia, especially in unwell passengers boarding long haul commercial aircrafts.

 

Immunology

Simon, D., Tascilar, K., Krönke, G. et al. Patients with immune-mediated inflammatory diseases receiving cytokine inhibitors have low prevalence of SARS-CoV-2 seroconversion. Nat Commun 11, 3774 (2020). Full-text: https://doi.org/10.1038/s41467-020-17703-6

Might cytokine inhibitors be partially protective against the effects of SARS-CoV-2 infection? That’s what Georg Schett and colleagues from the University of Erlangen, Germany, are suggesting. They analyzed 534 patients who received continuous cytokine blockade for immune-mediated inflammatory diseases (IMIDs) of the joints, gut and skin (i.e., rheumatoid arthritis, spondyloarthritis, inflammatory bowel disease, psoriasis); 259 patients with IMIDs receiving no cytokine inhibition (N = 259); 285 health care professionals involved in the treatment of these patients; and 971 healthy controls from the same region. The authors conclude that patients with IMIDs receiving cytokine inhibitors may have a lower risk for SARS-CoV-2 infection than IMID patients not receiving such drugs or the general community.

 

n SARS-CoV-2 IgG+ (n) SARS-CoV-2
IgG+
[95% CI]
Control group 971 22 2.27%
[1.42–3.43]
Healthcare professionals 285 12 4.21%
[2.18–7.35]
IMID*, no cytokine blockade 259 8 3.09%
[1.33–6.09]
IMID*, continuous cytokine blockade 534 4 0.75%
[0.20–1.92]

* Immune-mediated inflammatory diseases of the joints, gut and skin (i.e., rheumatoid arthritis, spondyloarthritis, inflammatory bowel disease, psoriasis)

 

Vaccine

Zhang NN, Li XF, Deng YQ. A thermostable mRNA vaccine against COVID-19.  Cell 2020, ublished: July 23. Abstract: https://www.cell.com/cell/fulltext/S0092-8674(20)30932-6. Full-text:  https://doi.org/10.1016/j.cell.2020.07.024

The authors describe the development of a LNP-encapsulated mRNA vaccine (termed “ARCoV”) which targets the RBD of SARS-CoV-2. The vaccine induces neutralizing antibodies and T-cell immunity in mice and non-human primates. Two doses of ARCoV immunization in mice conferred complete protection against the challenge of a SARS-CoV-2 mouse adapted strain. Phase 1.

 

Clinical

Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep. ePub: 24 July 2020. Full-text: http://dx.doi.org/10.15585/mmwr.mm6930e1

What is the clinical course of COVID-19 and how long does it persons with milder illness to return to baseline health? Mark W. Tenforde and colleagues provide us with a treasure of data. They conducted telephone interviews with a random sample of adults aged ≥18 years who were tested SARS-CoV-2 positive at an outpatient visit at one of 14 U.S. academic health care systems. Interviews were conducted 14–21 days after the test date. 274 persons reported one or more symptoms at testing and were included in this data analysis. The median age of symptomatic respondents was 42.5 years Overall, 141 of 264 (53%) with available data reported one or more chronic medical conditions. Among the 270 of 274 interviewees with available data on return to usual health, 175 (65%) reported that they had returned to their usual state of health a median of 7 days (IQR = 5–12 days) from the date of testing. Ninety-five (35%) reported that they had not returned to their usual state of health at the time of interview. The proportion who had not returned to their usual state of health differed across age groups: 26% of interviewees aged 18–34 years, 32% aged 35–49 years, and 47% aged ≥50 years reported not having returned to their usual state of health (p = 0.010) within 14–21 days after receiving a positive test result.

 

Comorbidities

Karim QA, Karim SSA. COVID-19 affects HIV and tuberculosis care. Science  24 Jul 2020:Vol. 369, Issue 6502, pp. 366-368. Full-text: https://science.sciencemag.org/content/369/6502/366

Key resources that had been extensively built up over decades for the control of HIV and TB are now being redirected to control COVID-19 in various countries in Africa, particularly South Africa. Find out how HIV and TB prevention and treatment have been affected by the SARS-CoV-2 pandemic.

 

Léger D, Beck F, Fressard L, Verger P, Peretti-Watel P, COCONEL Group. Poor sleep associated with overuse of media during the COVID-19 lockdown. Sleep 2020, published 25 July. Full-text: https://doi.org/10.1093/sleep/zsaa125

This COCONEL survey was based on a permanent panel of 750,000 French individuals, authorized by the French National Agency for Data Protection (CNIL). Here, 1,005 panelists answered the survey out of the 25,800 invitations mailed out in mid-April of 2020. Damien Leger and colleagues report that the prevalence of sleep problems during the lockdown was notably higher (73%) than that reported among the general population in France in 2017 (49%). Their comment: “Physicians usually recommend coping with sleep disorders by exercising, going outside, avoiding screen time, and having a regular schedule—all recommendations difficult to apply during lockdown.” A concise two-page read.

 

Society

Khoury P, Azar E, Hitti E. COVID-19 Response in Lebanon: Current Experience and Challenges in a Low-Resource Setting. JAMA. Published online July 23, 2020. Full-text: https://doi.org/10.1001/jama.2020.12695

COVID-19 is a challenge in a densely populated country like Lebanon, with 6.9 million residents—87.2% of whom live in urban areas—including 2 million displaced persons and 500 000 migrant workers, all within 10 452 km2 (approximately the size of the state of Connecticut or Kosovo). It is even more of a challenge in a country that has been suffering, since autumn 2019, an unprecedented economic crisis (see Le Monde, 26 Juin 2020). Petra Khoury, Eid Azar, and Eveline Hitti report their experiences.