Top 10: July 9

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By Christian Hoffmann &
Bernd S. Kamps

9 July

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Saloner B, Parish K, Ward JA. COVID-19 Cases and Deaths in Federal and State Prisons. JAMA July 8, 2020. Full-text:

By June 6, 2020, there had been 42,107 cases of COVID-19 and 510 deaths among 1.3 million prisoners in the US. The case rate was initially lower in prisons but surpassed the US population on April 14, 2020. The mean daily case growth rate was 8.3% per day in prisons and 3.4% per day in the US population.


Maxmen A. California’s San Quentin prison declined free coronavirus tests and urgent advice — now it has a massive outbreak. Nature NEWS 07 July 2020. Full-text:

And this is a story behind the numbers. San Quentin Prison, which got through most of May without a single reported case among inmates, is now dealing with the third-largest coronavirus outbreak in the US. More than one-third of the inmates and staff (1,600 people) have tested positive. Six have died. Researchers fear that other institutions are at risk.



Chen J, He H, Cheng W, et al. Potential transmission of SARS-CoV-2 on a flight from Singapore to Hanghzou, China: An epidemiological investigation. J Trav Med 2020, Jul 6, 2020. Full-text:

Among 335 passengers on a flight from Singapore to Hangzhou in China (a Boeing 787, 5-hour flight, seat occupancy 89%), a total of 16 COVID-19 patients were diagnosed among all passengers, yielding an attack rate of 4.8%. However, after careful investigation, only one case was identified who appears to have become infected during the flight. He was seated near four infected passengers from Wuhan for approximately an hour (he had moved a seat) and did not wear his facemask correctly during the flight. The sources of infection in the other 15 passengers were complex and the passengers could have acquired their infections in Wuhan before the tour, or during the group tour before boarding.



Williamson EJ, Walker AJ, Bhaskaran K et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature 08 July 2020 (2020). Full-text:

Using a secure health analytics platform covering 40% of all patients in England, primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with being male (hazard ratio 1.59, 95% CI 1.53–1.65); older age and deprivation, ie marginalized, (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48 and 1.44, respectively).


Patterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain 08 July 2020. Full-text:

A broad spectrum of neurological complications: among 43 patients (29 with confirmed diagnosis) admitted to a London hospital, five major categories emerged: 1. Encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities 2. Inflammatory CNS syndromes (n = 12) including encephalitis 3. Ischemic strokes (n = 8) 4. Peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome. 5. Miscellaneous central disorders (n = 5) who did not fit these categories.


Liu YC, Ang M, Ong HS, et al. SARS-CoV-2 infection in conjunctival tissue. Lancet Resp Med July, 2020. Full-text:

Is the conjunctival epithelium a potential portal of infection? These authors doubt it. A brief review on current knowledge is given.


Severe COVID-19

Ackermann M, Verlden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. NEJM July 9, 2020; 383:120-128. Full-text:

This study examined the morphologic and molecular features of seven lungs obtained during autopsy from COVID-19 patients and found three distinctive angiocentric features: 1. Severe endothelial injury associated with intracellular virus and disrupted endothelial cell membranes. 2. Widespread vascular thrombosis with microangiopathy and occlusion of alveolar capillaries (9 times as prevalent as in patients with influenza). 3. significant new vessel growth through a mechanism of intussusceptive angiogenesis (2.7 x higher).



Panepinto JA, Brandow A, Mucalo L, et al. Coronavirus disease among persons with sickle cell disease, United States, March 20–May 21, 2020. Emerg Infect Dis. 2020 Oct. Full-text:

Sickle cell disease (SCD) disproportionately affects Black or African-American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the US who were reported to an SCD–coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died. According to the authors, this is alarming, given that the mean patient age was < 40 years. However, there may be bias toward more severe cases in this registry.



Wadman M. Can boosting interferons, the body’s frontline virus fighters, beat COVID-19? Science News Jul 8, 2020. Full-text:

Brief overview on current trials evaluating synthetic interferons given before or soon after infection, in order to tame the virus before it causes serious disease. Controlled clinical trials are eagerly awaited.



Parri N, Lenge M, Buonsenso D, et al. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med 2020; 383:187-190, July 9, 2020. Full-text:

Of 100 children (median age 3 years), 21% were asymptomatic, 58% had mild disease, 19% had moderate disease, 1% had severe disease, and 1% were in critical condition. The incidence of transmission through apparent exposure to a family cluster was lower than that in other cohorts, possibly because of the late lockdown in Italy.